Inspection on 07/06/05 for Cordwainers

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cordwainers 23/08/06

Cordwainers 02/12/05

Cordwainers 13/12/04

Cordwainers 08/07/04

Cordwainers 04/02/04

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

CARE HOME ADULTS 18-65 Cordwainers Chase Road Lindford Hampshire GU35 0RW Lead Inspector Marilyn Lewis Unannounced 07/06/05 & 24/06/05 10:00 a.m. 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 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 Stationary 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. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cordwainers Address Chase Road, Lindford, Hampshire GU35 0RW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01420 472459 Robinia Care Ltd Miss Karen Louise Wilmott CRH 8 Category(ies) of LD Learning Disability SI Sensory Impairment registration, with number of places Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users are not to be admitted under the age of 16 years. 2. A maximum of 3 service users may be accommodated under the age of 18 years. Date of last inspection 13/12/2004 Brief Description of the Service: Cordwainers is a home for eight young people with learning disabilities, three of whom may be sixteen or seventeen years of age. The home is a large extended bungalow, situated in a quiet residential area in the village of Lindford, Hampshire. The bungalow has been modified to provide accommodation for wheel chair users. All residents are accommodated in single rooms. There is a large enclosed garden and patio area to the rear of the property. The home is owned and operated by Robinia Care Ltd, an organisation that has provided care services, mainly in the learning disabilities sector, since 1995. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The initial unannounced inspection on the 7th June 2005 was not completed as residents and staff had arranged to go out for the day. The inspection was completed during an unannounced inspection on the 24th June 2005. During the visits the inspector met with four residents, three staff members and the area manager for Robinia Care Ltd. Care plans and finance records were sampled for three residents and records were seen for staff training, fire drills, fire safety training and medicines. Service users at the home wish to be known as residents and this has been respected in the report. What the service does well: No residents are admitted to the home without the completion of a full needs assessment and prospective residents are able to visit the home prior to admission, ensuring the home can meet their needs. Residents are supported to make their own decisions about all aspects of their lives, including the participation in daily living and leisure activities. Residents spoken to knew that all information about them is confidential and that they would be consulted before any information was passed to other staff members and people involved in their care such as health professionals or care managers. Staff support residents to participate in leisure activities and hobbies of their own choosing. Transport is provided for visits to local places of interest and for transfers to and from the local resource centre for education sessions. Residents are able to choose the staff members they would prefer to help them with personal care. Staff receive training in the administration of medicines and follow clear procedures for dealing with medicines ensuring the residents health and welfare are protected. The home has policies for handling illness and death that respect the cultural beliefs and wishes of the resident and their family. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 6 The home has procedures in place to be followed should abuse be suspected and two staff members spoken to were aware of the procedures and said that they would not hesitate to report any concerns to the manager or person in charge. Residents live in a safe, clean and comfortable home with personalised bedrooms and homely communal rooms. Sufficient bathroom and toilet facilities are provided. Specialist equipment is provided as required to allow residents maximum independence. Residents are supported by staff trained in all aspects of care, who receive regular formal supervision. What has improved since the last inspection? What they could do better: Care plans seen for three residents were very detailed but one plan did not indicate that advice from a physiotherapist was being followed. Records of food provided for residents indicated that improvements were required to give a nutritious, balanced diet. Finance records seen for three residents indicated that residents were not being subsidised by the home for meals taken when out at meal times. Fire records did not provide clear evidence that all staff had attended fire drill practice and fire safety training. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 7 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. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 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 standard(s) 2 and 4 All residents receive a comprehensive full needs assessment and are able to visit the home prior to admission to ensure the home can meet their needs. EVIDENCE: A full needs assessment is undertaken for each resident prior to admission. The assessment is undertaken at the prospective residents’ place of residence by a senior manager from Robinia Care Ltd and the manager of the home. Records seen for three residents contained very detailed assessments on all aspects of care needs including personal, social and emotional needs. The residents’ hobbies, interests and further education sessions were documented. Relevant information from care managers and health professionals was also included in the completed assessment report. Relatives and friends were encouraged to participate in the assessment process. The full needs assessment forms the basis for the individual care plans providing information on the residents care needs and the support required to meet those needs. The area manager said that prospective residents are able to visit the home during the transition period as often as is thought best for the individual. Visits usually start with a day visit where they can join permanent residents and staff for a meal. Weekend and overnight visits follow before the they move in for a three month trial period. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 10 If possible, staff meet with the prospective residents’ carers to discuss the most appropriate methods for providing care such as the best way to communicate. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 11 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 standard(s) 6, 7 and 10 Good care plans are in place for residents, however records did not provide evidence that instructions provided by health professionals were always acted upon which may put residents’ health at risk. Residents are encouraged and supported to make decisions regarding their daily lives and know that their confidences are kept. EVIDENCE: Care plans were seen for three of the residents. The care plans were good and were developed and reviewed with involvement of the resident or their relative. A parent who had signed to say she had agreed with the plan had congratulated the staff for a very good plan that indicated they knew the person well and understood her needs. However one care plan sampled had instructions from a physiotherapist for an exercise regime to be undertaken on a daily basis dated February 2004. There was no indication in the plan that this regime had been reviewed or that it was being carried out. The area manager was unable to confirm that the regime had been followed. Staff sign to say they have read and understood the plans and two staff members spoken to said that they discussed any areas of the documents they were unsure of with a senior member of staff. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 12 The care plans are reviewed during a one to one meeting between the resident and the key worker staff member. It was evident during the inspection visits that residents were able to make decisions about daily living activities including the time they wished to get up, clothes they wore and where in the home they wished to spend time. A charter of residents’ rights is included in the service user guide provided for all residents. The area manager said that the residents had recently started a forum for meetings where future activities were discussed. The meetings were minuted and the minutes provided in symbol format suitable for the residents. The home has a confidentiality policy in place. A resident spoken to indicated that she knew what was said was kept confidential unless she was told it was necessary to pass the information on to the member of staff in charge of the home. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 13 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 standard(s) 14, 16 and 17 Residents are able to choose from a variety of suitable leisure activities and are supported by staff to have control over their daily lives. The menus require improvement to provide more nutritious and well balanced meals. EVIDENCE: The area manager said that residents decided which activities they would like on a daily basis unless there was a planned outing such as a visit to the cinema. The residents have recently started a forum for meetings and have chosen to hold them every two months. Minutes of the meetings are produced in symbol format suitable for the residents. The home has its own transport and one of the carers is able to drive the vehicle. Outings have taken place to Southsea and other coast resorts, Aldershot for shopping and local pubs for lunch. Residents are charged for the use of transport. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 14 At home activities include jigsaws, television, music, drawing and board games. One resident spends time daily on an exercise bike and the residents enjoy using a specially adapted swing in the garden. It was evident during the inspection visit that residents are in control of their daily lives including who enters their own rooms with staff observed to knock on doors and wait before entering. The three residents at home were seen to make decisions about activities they wished to be involved in, with one resident doing jigsaw puzzles, one watching television and a third spending time alone in her room chatting on her mobile telephone to family and friends. The residents are called by their preferred name, which is documented in their care plans. Good interaction was seen between staff and residents and between the residents themselves. Residents are able to assist with household chores and this is documented in their care plan. Menus seen indicated that many meals taken were of a fast food type such as pizza and chicken nuggets with chips provided frequently. Records of the meals taken by residents did not offer a clear picture as residents documents were not completed for meals taken at the resource centre, therefore foods such as chips may have been eaten at lunchtime and at supper. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 15 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 standard(s) 18, 20 and 21 Good support from staff allows residents to receive personal support in the manner they prefer and they are protected by staff who adhere to safe procedures for dealing with medicines. Procedures are in place to give appropriate care and respect during illness or death. EVIDENCE: Residents are able to choose which staff member attends to them for personal care needs. During the inspection a resident commented on her wish to change her key worker and the area manager immediately discussed this with her. Care plans inform staff of the residents’ preferences for daily living activities such as the time of day they like to take a bath or shower and indicate which toiletries they like to use. Residents choose their own clothes and decide on their make up and hairstyles. Specialist equipment such as wheelchairs and hoists, is provided for residents as required, enabling them to be as independent as possible. The home has procedures in place for handling medicines and staff receive training in the administration of medication. Records seen were up to date and had been completed appropriately. At the time of the inspection there were no residents who were self administering their own medication. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 16 Residents’ awareness of dying and death were recorded in their care plans. The records indicated that relatives or care managers would be kept closely informed and would be involved in any decisions should a residents’ health give cause for concern. The records also indicated that cultural beliefs would be respected. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 17 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 standard(s) 23 Staff knowledge of the procedures to be followed should abuse be suspected and their willingness to act, protects residents from abuse. EVIDENCE: The home has procedures in place to be followed should abuse be suspected. Staff receive training in abuse awareness and two staff members spoken to were aware of the procedures in place and said that they would have no hesitation in reporting any concerns to the person in charge of the home. Records seen for the personal finances of three residents indicated that residents paid the full price for meals taken at lunchtime when out at pubs and restaurants. There was no evidence that they received reimbursement for the amount of £1.50, as stated in the homes’ policies, from the homes’ house keeping funds as lunch was included in their fees for residency at the home. This was discussed with the area manager who agreed to investigate. The area manager contacted the inspector following the inspection and stated that all residents had been reimbursed for meals taken when away from the home and procedures had been put in place to ensure this was the case in the future. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 18 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 standard(s) 24, 25, 26, 27, 28, 29 and 30 Residents live in a clean, safe and homely environment, with bedrooms, bathroom and toilet facilities and communal areas that are suitable for their needs and the provision of specialist equipment as required, maximises their independence. EVIDENCE: At the time of both inspection visits, Cordwainers looked clean and welcoming. The home is a large extended bungalow that has been adapted for the residents, who are all wheelchair users. A keypad entry system is fitted to allow control over persons entering and exiting the home and all visitors are required to complete the record book. Robinia Care Ltd employ a maintenance team who are responsible for the repair and redecoration of the home. The home has a large enclosed flat rear garden that has a lawn and patio area. At the time of the last two inspections problems were arising from the septic tank situated in the garden, which was prone to overflowing and causing foul smells. The area manager said that until building work on neighbouring properties has been completed the septic tank cannot be renewed and until then the tank is being emptied on a weekly basis. This has addressed the Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 19 overflow problems and the residents and staff said that there were no foul smells from the area. The shift leader on the first inspection day said that arrangements were in place for ramps to be fitted outside the patio doors to provide easier entry and exit for residents using wheelchairs. All the residents are accommodated in single rooms that are suitable for their needs. All have large windows and are light and airy. Each room looks individual with colour schemes, furniture, curtains and bed linen chosen by the resident. Rooms contained many personal items such as posters, pictures and ornaments and some had their own television and music systems. Two residents in their rooms at the time of the visits said that they really liked their rooms. The home has sufficient bathroom and toilet facilities, with two bathrooms and a shower room that are equipped to suit the needs of the residents. The home also has four toilets. All the bathroom and toilet facilities seen during the visits, looked clean and in good order. Residents are able to choose to spend time in their own room or one of the two lounges. One lounge has a television and is situated close to a conservatory that is used as the office and the other lounge is used as a quiet area or music room. The second lounge also has a conservatory that a resident uses while exercising on her exercise bike. Both lounges have dining areas. The kitchen and laundry are domestic in style and looked clean and tidy. The home is adapted to suit the needs of the residents with wide doorways and specialist equipment such as overhead hoists has been fitted where required. All areas of the home looked clean. Staff receive training in the control of infection and disposable gloves and aprons were readily available. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35 and 36 Residents are supported by staff who receive training and regular supervision but the lack of clarity in staff roles could put residents safety at risk. EVIDENCE: The homes’ manager is currently on leave and the area manager for Robinia Care Ltd is providing support for the staff employed at the home. Two of the senior carers have been given the responsibility of shift leaders. At the time of the first inspection visit both senior carers were away from the home and the three carers on duty were not clear about who was in charge for the shift. However one of the carers took control of the situation very well and assisted the inspector with the inspection until the arrival of the area manager. This was discussed with the area manager who said that she would ensure the rota indicated who was responsible for each shift. Staff are provided with a clear job description when they commence employment with the home. New staff complete a five day induction course and shadow a senior carer for the first few weeks at the home. Staff employed from overseas are required to attend a two week induction course at the Robina Care Ltd area headquarters. The organisation provides a training programme that includes all aspects of Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 21 care, communication, health and safety and sessions on specific areas relevant to the service group such as epilepsy. At the time of the inspection the home employed eleven carers. All had received training in moving and handling and fire safety. Eight had received training in abuse awareness, food hygiene and care of medicines and nine had attended sessions on infection control. All bar one had training in epilepsy. The area manager said that staff received formal supervision on a monthly basis. In the absence of the manager, supervision sessions are undertaken by the area manager and a shift leader who has received training in providing supervision for care staff. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Safe working practices promote the health, and welfare of the residents, however their safety could be compromised by the lack of clear documentation for staff fire drills and training. EVIDENCE: Staff receive training on safe working practices including moving and handling, infection control, food hygiene and first aid during induction and on refresher courses. During the inspection it was noted that hazardous substances such as detergents were stored safely in locked cupboards and not within reach of the residents. The home had information sheets for the substances used in the establishment and these were readily available to staff. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 23 At the time of the inspections the kitchen looked clean and in good order. Food was stored appropriately and the temperatures of the fridge and freezer were being monitored and recorded daily. The home has good fire risk assessments in place for the home and each individual resident. However fire records seen did not clearly indicate which staff members had attended fire drills and fire safety training and it was therefore not possible to confirm all staff had attended the drills and training sessions. Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x x x 3 x 3 2 Standard No 31 32 33 34 35 36 Score 3 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cordwainers Score 3 x 3 3 Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 25 No 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 6.1 Regulation 15 Timescale for action Individual care plans must reflect 31/07/05 the current needs of the resident and the support required to meet those needs. Menus must be reviewed to 31/07/05 provide a varied, suitable, wholesome and nutritious diet. An investigation is to be 31/07/05 undertaken with regard to residents payment for meals taken when out of the home and if necessary residents are to be reimbursed for any overspend. All staff must attend fire drill 31/07/05 practice and fire safety training and records of attendance must be kept up to date. Requirement 2. 3. 17 23.6 16(2)(i) 4. 42.2 4(d)(e) 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. Refer to Standard Good Practice Recommendations Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 Page 26 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Cordwainers H54 S11561 Cordwainers v224056 070605.doc Version 1.30 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. 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