Inspection on 25/11/06 for Coopers Way Respite Service

This inspection was carried out on 25th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coopers Way Respite Service 24/11/07

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Parkside

Park Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Coopers Way Respite Service 1a Coopers Way Blackpool FY1 3RJ Lead Inspector Mrs Ruth Edgington Unannounced Inspection 25th November 2006 09:45 Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coopers Way Respite Service Address 1a Coopers Way Blackpool FY1 3RJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01253 393531 Blackpool Borough Council Mrs Barbara Mary Crouch Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is registered to accommodate a maximum of 4 service users to include up to 4 service users in the category LD (Learning Disability) up to 4 service users in the category PD (Physical Disability). First Inspection Date of last inspection Brief Description of the Service: Coopers Way is a purpose built home situated in a residential area and within reach of local amenities and shops. The home can provide accommodation for a maximum of 4 adults who have a learning disability and require respites care (short stay). The period of stay depends on the needs of the individual resident and their relatives. The accommodation consists of four single bedrooms, all of which have ensuite toilet and bathing facilities. There is also a large lounge, kitchen-dining room and a separate toilet on the ground floor. The home is fitted with a passenger lift and aids are provided throughout the home to assist service users as required. The information contained in the home’s Statement of Purpose/ Service User Guide is included in the information provided to prospective service users and their families. This written information explains the care service that is offered, the management and staff and what the service user can expect if he or she decides to stay at the home. Information received prior to the visit (25/11/06) showed that the fees for an over night stay were £9.03. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that started at 9.45am on a Saturday morning and took place over 5.30 hours. This included a visit to the home at Mansfield Road, which operates in conjunction with Coopers Way. Service users are able to stay in either home depending on their needs and availability of accommodation at that time. The homes are managed by the same manager, deputy and the staff group work between the two homes, depending on which service users are receiving care at any one time. On the day of the visit there were three service users being accommodated in this home, one of whom had just arrived after requesting to move over from Mansfield Road that morning. Prior to the visit the registered manager completed a pre-inspection questionnaire, which provided information about the service users, staff and other information, which assisted in assessing how the home was meeting the National Minimum Standards. Comment cards had been sent out prior to the visit and in total four relatives and four service users completed and returned these to express their views about the service. As part of the visit the records of one of the service users in the home that day were looked at in detail, staff records and a sample of other relevant records were also looked at. Discussions took place with the manager and staff on duty and a tour of the home was undertaken. The service users interacted very positively with the staff and spoke freely and openly, which contributed greatly to the visit. From observations made, comments received and written documentation examined, the information has been put together to produce this report. The Pharmacy Inspector undertook a Random Visit on the 6th November 2006 to Mansfield Road and because the homes operate together the findings were also looked at as part of this visit, in order to assess what steps the manager had taken to comply with the requirement and recommendations made. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This was the first visit to the home and therefore there are no comments to make. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures are clear to ensure the care needs of the service users are met. EVIDENCE: The case file of one of the three service users in the home was looked at and was found to contain very comprehensive assessment information, which had been obtained before admission had taken place. The admission procedure included introductory visits over a period of time and assessments made during that this time helped the service user, relatives and staff to decide if the service can meet the service user’s needs. The written assessments seen confirmed that the involvement of the individual service user’s carer at home. Evidence was seen that service user and their relative had been informed in writing that the home could meet the assessed needs. Staff spoken to were able to demonstrate their understanding of the individual needs of the service users accommodated. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent care planning system in place, which ensures that the service users’ needs, aspirations and goals are met. EVIDENCE: On examination of the service user’s file it was found that it contained detailed information in the Guest Profile document, which included information about their personal, social, emotional and health needs. The information also included a skin map on which any bruises, marks etc seen on admission, were recorded. A care plan had been complied from this information with the involvement of the service user and their family. Service users are very much involved in all decisions that affect them and they are consulted at all times. Care plans show the level of support and assistance being provided to service users with their decision- making. The records also included risk assessments, which enable the staff to give support in encouraging service users to maintain their independence. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 11 Following each stay the staff complete an ‘Information Sharing Booklet’, which gives the family feedback on what sort of a stay the service user had. The document also gives the family the opportunity to make any comments that they have about the service provided. The home operates a system of ‘Link Worker’ who as part of their responsibility for the care of individual service users are also responsible for liaising with individual service users and their families once a month to update service users file to identify any changes and ensure that their needs continue to be met. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were looked at. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Opportunities for development and community participation are addressed in the care plans, ensuring that people have a lifestyle that meets their individual needs and expectations. EVIDENCE: From discussions with the manager and staff on duty it was clear that they understood their role in encouraging independence and promoting the residents’ personal development. Staff recognised the importance of working very closely with the relatives in order that the needs and wishes of the residents are met appropriately. The service users had arrange of activities available to them, which included television, music, videos and board games. One of the staff had commenced an “Out and About” booklet, which identified facilities available within a three-mile radius of the home, which service users could visit and become involved in if they wished to. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 13 The homes had their own transport, which enabled the service users to get to the different venues much easier. The manager stated that a working group was looking into the policies relating to equality and diversity, however from discussions during the visit evidence was gained that staff had an understanding of equality and diversity needs in relation to the service users. Activities are arranged to meet individual wishes and abilities. One of the service users was sitting at the dining table writing information about their favourite television programmes. They explained what they were doing and said that they were very happy in the home. Another service user who had been spoken to at length during the previous visit to Mansfield Road was waiting to go out but unfortunately the support worker did not arrive. The manager confirmed that she would get someone to take the service user to where they wanted to go. The two homes in the service operate together and service users can choose which to use depending on availability of rooms. Their choice often is dependent on who is in the home at that time, as they develop friendships with other service users. One service user who had gone into Mansfield Road for the weekend asked to move over to Coopers Way due to a conflict with another service user. This was arranged and the situation was improved for all concerned. Sample menus were looked at and these confirmed that service users were provided with a varied and healthy diet and a degree of choice. A working group had been formed which included, service users and staff, to look at devising new menu’s. Details of individual preferences and dietary needs were recorded on the service users care plan. Information seen in regard to one service user indicated that they had a Nut Allergy and all staff were made aware of this. Meals times are flexible to met individual needs and what activities the individual is involved in. Weekends the service users usually have Brunch as this enables them to have a lie in if they wish. The manager and deputy have attended a series of training on diets etc, which staff are to attend later and which will ensure that through the knowledge gained the dietary needs of the individual service users are met appropriately. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Shortfalls in the medication procedures have been addressed in order to ensure the health and wellbeing of the service users. EVIDENCE: Throughout the visit observation were made of the support that was given to the service users to maximize their privacy, dignity and independence. The record of the service user looked at in detail contained very comprehensive information in regard to their physical and emotional needs and the amount of support that they required. Comments received from service users spoken to confirmed that they always enjoyed their stay and the staff were “very good.” One relative confirmed that the service user only used this home because it met their needs more appropriately. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 15 From the documentation seen, discussions with staff, comments received and observations made during the visit, evidence was gained that the service users were receiving the personal support that they needed. The findings of the random inspection carried out by the Pharmacy Inspector at Mansfield Road were discussed and the manager was able to demonstrate that the requirements and recommendation made had been addressed and appropriate action was being taken to ensure that the practices in the homes protected the service users at all time. Evidence was seen of the actions taken. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The arrangements in place for handling complaints ensure that people feel confident that their complaints will be listened to and taken seriously. Safeguarding Adult Procedures for dealing with and reporting incidents were satisfactory ensuring the people are adequately protected. EVIDENCE: Evidence was seen that the complaints policy and procedure was clear, accessible and met the requirements of the standards. It is very unlikely that the majority of service users would be able to make a formal complaint, but from comments made by the relatives it was clear that they were aware of the procedure and would do so on their behalf. Staff were able to demonstrate that they were aware of individual behaviour changes and gestures that may indicate if a person was not happy and not able to communicate verbally. Staff are given guidance around “ Awareness of Abuse” through the NVQ (National Vocational Qualification) in care and the Learning Disabilities Award Framework (LDAF). There had been no complaints received by CSCI (Commission for Social Care Inspection) or referrals to POVA (Protection of Vulnerable Adults) in the time that the home has been open. Comments received from relatives were very positive and confirmed that the staff acted upon any concerns that they brought to their attention. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were looked at. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The service users live in a comfortable, homely and safe environment. EVIDENCE: This home was purpose built and opened in August 2006 and met all the requirements of the National Minimum Standards and other relevant agencies. A great deal of time and effort has been put into ensuring that the needs of those using the service can be met by the facilities in the home. The service users spoken to confirmed that they liked the home very much. All bedrooms are for single occupation and have their own bathing and toilet facilities. Aids are provided throughout the home especially in relation to meeting the needs of service users with more complex physical needs. A passenger lift enables easy access between the ground and first floor. The home was found to be warm, clean and free from any obvious hazards. The home was decorated and furnished to provide a homely environment. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 18 Additional chairs had been purchased recently for bedrooms and the manager confirmed that she is to request the purchase of a number of additional armchairs that could be placed in the bedrooms to enable service users who wished to relax in their room to do so. During the visit undertaken by the Pharmacy Inspector to Mansfield Road, it was recommended that a lockable facilities should be provided for service users who keep their own medication. The manager confirmed that they were in the process of making arrangements to ensure that one piece of furniture in each bedroom was lockable in both homes. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. There was little evidence available to confirm that the robust recruitment procedures of the local authority had been complied with to ensure that people using the service were protected. Staff in the home are trained, skilled and in sufficient numbers to support the people who use. EVIDENCE: The staff files kept in the home included a check list of the documentation received as part of the recruitment process, however it was not clear when the CRB (Criminal Records Bureau) and PoVA (Protection of Vulnerable Adults) declarations had been requested and received and who gave permission for staff to commence working with a PoVA declaration whilst awaiting their CRB declaration to be received. Whilst the organisation has a very robust recruitment procedure in place there was very little evidence of this at the home. All new staff are inducted through LDAF and evidence was seen of the training undertaken and training which was planned for the future. The training programme ensures that the staff employed by the home are competent and well trained to meet the needs of the residents. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 20 One staff member had undertaken a course in sign language to enable them to communicate more effectively with service users if needed. The staff work in both homes in the scheme and staff records are kept at Coopers Way. Of the eighteen staff employed, nine had achieved a minimum of level 2 NVQ (National Vocational Qualification). Evidence was seen of staff undertaking regular supervision and appraisal but not in line with the requirements. The manager confirmed that they had identified this has an issue for improvement and it was being addressed. Documentation was seen to confirm this. Comments received from staff spoken to confirmed that they felt supported and included in all aspects of the service users care. A relative commented that they are always made very welcome, the staff are friendly and caring and don’t mind them contacting the home at any time. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 &42 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the service users. EVIDENCE: The leadership from the manager was very good and staff confirmed that they felt valued in their role. The manager confirmed that she had a very committed team, which ensured that the needs of all individual service users could be met. This home is managed in conjunction with Mansfield Road. The opening of Coopers Way has been time consuming, however the manager was confident that with the assistance of the deputy manager who took up post in July of this year, any short fall identified during the visit could be rectified, in order that the management team and staff continued to provide an excellent service. The manager has achieved the required qualifications to ensure that a competent and qualified person manages the home. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 22 Comments received from relatives confirmed that they were satisfied with how the home was managed and the support that they received. The health and safety of the service users was protected by the policies and procedures in place in the home. Evidence was seen that confirmed that staff received mandatory training in relation to these issues. The representative of the Responsible Individual, visits on a regular basis, however copies of their report, which should be completed on a monthly basis were not being sent to the CSCI. This is a requirement under Regulation 26 of the Care Homes Regulations and must be addressed. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 4 30 4 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 x 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 2 x x 3 x Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 24 First visit Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The registered person must ensure that an accurate record of medicines administration is made. The registered person must ensure that evidence is available in the home to confirm that a robust recruitment procedure has taken place before staff commence employment. The registered person must ensure that monthly visits are carried out to the home and a copy of the report sent to the Commission for Social Care Inspection. Timescale for action 31/01/07 2 YA34 17 31/01/07 3 YA43 26 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA20 Good Practice Recommendations The medicines handling policy should be reviewed and updated to include all key issues. Lockable facilities for storing medicines should be provided DS0000067774.V312884.R01.S.doc Version 5.2 Page 25 Coopers Way Respite Service 3 YA36 for all service users who self-medicate. All staff should receive formal supervision at least six times per year. Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Coopers Way Respite Service DS0000067774.V312884.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!