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Inspection on 29/04/05 for Cornwallis Court Residential And Nursing Home

Also see our care home review for Cornwallis Court Residential And Nursing Home for more information

This inspection was carried out on 29th April 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is run in such a way that staff are clear that it is the residents home. Some residents have views on how the home should be run and these are encouraged through open discussion and use of residents meetings, with minutes published and displayed. Staff are well recruited and suitably trained to support the residents and understand the needs of the resident groups. The home is generally well looked after and most areas are nicely decorated and bright. Residents are able to move around the home freely and easily. Aids and adaptations for disabilities are appropriate. The variety and option on entertainment and activities suits the needs of the residents. One resident was very keen on the carpet bowls group that met regularly and two people particularly liked the transport each week into Bury St Edmunds town centre.

What has improved since the last inspection?

All of the requirements made from the last inspection have been actioned. All first floor windows are now fitted with a restrictor. Room 44 has been converted into a comfortable additional bedroom with an en-suite. Staff records show that staff are adequately recruited and the manager had knowledge of the change in regulation around these matters. Updated policy and new procedures were given to the residents or read to them by staff in order that residents were kept informed of changes within the home.

What the care home could do better:

It was clear from the outcomes of speaking to residents, relatives and staff that there were two issues that everyone thought could improve. Firstly, the catering. Just after the last inspection a new catering company had taken over and since that time the quality of food has not been the same. All parties spoken to had an example of unhappiness of the food being of poor quality, too salty, cold, not enough or did not meet the individual requirements such as a special diet. Secondly, was the high usage of agency staff at the weekend. Residents gave examples of inconsistent care and were not happy with the changing faces and having to explain their needs again. One example given was that water jugs were not changed over the weekend. These concerns were borne out by the last four weeks of roters. These showed that more agency than permanent staff were used. One other matter that needs improvement was expressed by the residents and observed by the inspector. This was the time taken to respond to a call bell. In two cases observed this was eleven and fourteen minutes. The manager agreed this was unacceptable and would address the matter.

CARE HOMES FOR OLDER PEOPLE Cornwallis Court Hospital Road Bury St Edmunds Suffolk IP33 3NH Lead Inspector Claire Hutton Unannounced 29 April 2005 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 Older People. 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. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cornwallis Court Address Hospital Road, Bury St Edmunds, Suffolk, IP33 3NH 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) 01284 768028 01284 700709 Royal Masonic Benevolent Institution Post Vacant Older People 63 Category(ies) of older people registration, with number of places Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No Date of last inspection 25th October 2004 Brief Description of the Service: Cornwallis Court is situated in very well maintained grounds and gardens and was originally part of the West Suffolk Hospital. Cornwallis Court opened in June 1981 and has provided care for freemasons since that time. The Home can care for up to 63 residents and up to 20 of those beds could have been used for nursing care. The accommodation offered residents single bed sitting rooms with en-suite facilities. There were two main lounges, one on the ground floor and one on the first floor, and a ground floor dining room. There were also other smaller areas for use by residents who may wish to sit on their own or in a small group. All rooms were comfortably furnished to a good standard, with a continuous program of decoration and upgrading. There is also a well-stocked library.There were bathrooms and WCs, which are well equipped to assist residents and staff. There are a number of kitchenettes for use by residents and their relatives to make hot drinks and snacks. There is also a small shop and hairdressing salon for use by residents. Ramps are provided and pathways maintained to enable residents to access the garden and to enable people wishing to walk around the grounds to do so safely. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Following this inspection a letter was received that confirmed the RMIB’s acceptance of a proposed revised certificate to be issued to Cornwallis. This certificate shows that Cornwallis and Geoffrey Dicker House have amalgamated under one registration with Mr Alan McMahon as the registered manager and that Cornwallis now caters for 74 older people, 10 of whom have dementia and live in Geoffrey Dicker and 12 of whom may receive nursing care and live in the west wing of Cornwallis. This was a unannounced inspection carried out over 5 hours on a Friday afternoon. The inspector met and spoke with six residents at the home, one nurse and one member of care staff, one relative and spent time with the manager at the beginning and at the end of the inspection. A tour of the ground floor accommodation was made. Records inspected included staffing roters, the complaint records, care records, menus and staff recruitment records. What the service does well: What has improved since the last inspection? All of the requirements made from the last inspection have been actioned. All first floor windows are now fitted with a restrictor. Room 44 has been converted into a comfortable additional bedroom with an en-suite. Staff records show that staff are adequately recruited and the manager had knowledge of the change in regulation around these matters. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 6 Updated policy and new procedures were given to the residents or read to them by staff in order that residents were kept informed of changes within the home. 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. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 People who use this service can be assured that their needs will be assessed and that the home then by offering a place can meet them. EVIDENCE: The care plans for two newer residents were examined and these showed an assessment of need had been completed before the person moved into the home and where an assessed need had been highlighted the necessary care plan and risk assessment had been put into place, thus demonstrating the home knows the needs and how they intend to address them. Residents and relatives spoken with all confirmed they had sufficient information about the home and that it was specifically chosen for it being a home from freemasons and their dependants. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 People who use this service will find that their health and personal care needs are well looked after. EVIDENCE: Care plans examined had health, personal and social care needs set out in an individual plan. Manual handling assessments were completed with evidence of review. Staff were seen to use equipment appropriately and hoist residents using a variety of equipment available to them. Nursing requirements such as pressure care was assessed, documented and reviews seen. The GP was visiting at the time of inspection and saw the individual in the privacy of their room. Residents said they just needed to ask and a GP appointment would be made with the one they were registered with. All health appointments were recorded. One relative said that the nursing care was satisfactory and met the needs of the resident. On the notice board was a list of appointments that residents could sign up to see the visiting chiropodist. This was another example of residents having control over their lives. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 10 All details such as next of kin, GP, funeral arrangements were all in place in the plans inspected. One plan examined showed that they were responsible for their own medication as were others in the home. Two residents said they just had a word with the nurse and let her know when they were running low and she always got them their pills within a couple of days. A lockable facility was provided in each room and well as a safe for valuables and money. There had been an incident with one persons medication at the home of an accidental overdose. This matter was being appropriately investigated to ensure no repeat could happen again. Respect and privacy were maintained. Some people preferred to have their own telephone installed, but there was a private one that residents could use. The post was delivered daily in pigeon holes for each resident at the home. Residents were referred to as Mr, Mrs or other title they had. Residents spoken with said the regular care staff were excellent and knew how to look after them, especially the older staff who had more empathy. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 People who use this home will find that their social and recreational needs are well met, but that a wholesome and pleasing diet cannot be assured. EVIDENCE: As the inspector arrived at Cornwallis a clothes company who had spent the morning at the home were packing up and leaving. In the afternoon, there was a tea party with piano playing. One of the strengths of Cornwallis is their offering of social and leisure activities. Residents spoken with were all very happy with the choice on offer. These were listed on the notice board for all to see and included gentle jerks, crafts, carpet bowls and hairdressers. There tended to be between two and four things on offer each day, with Sundays being free time. Holy communion was regularly available. A weekly minibus from the home went into Bury St Edmunds each week and dropped off residents. This was a favourite with four people spoken with, but recently this had not been available due to staff sickness and this was disappointing to them. The manager said an alternative transport was available to those who wished. Relatives were visiting at the time of inspection and were happy with the arrangements in place for visiting residents within the home. Residents could and did have visitors to stay for lunch at the home. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 12 Five residents, one nurse and a relative all spoke about the catering at the home. All were disappointed with the change to an outside catering company as the food quality had dropped. Examples were given of special diets such as a pureed diet and a gluten free diet not being adequately catered for. There was another example given of residents in the west wing being offered insufficient bacon and egg. They could have either bacon or egg, but on the one occasion there was not enough for each person to have both. It was later found that catering staff had bacon and egg for their brunch. There was concern expressed at the food being placed on cold plates and then transported to rooms whereupon the food was served just warm or cold. A recent steak pie was said to be too salty to eat. Previously catering and meals had been awarded a 4 rating that is commendable and exceeds the standard. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 People who use this service are assured that their complaint will be listened to and recorded, but they cannot be sure that a satisfactory outcome will follow. EVIDENCE: The home displays their complaints procedure in the entrance hall for all to see and access if needs be. The home keeps a record of all complaints made and their out come. The records of complaints showed that five complaints had been made since the last inspection in October 2004. One of these was about insufficient soup. And two of these were related to use of agency staff at a weekend. Both were still areas found at this inspection that needed to improve as dissatisfaction was still being expressed in both these respects. There were not any complaints recorded from residents or staff about catering and agency staff. This is surprising given the level of dissatisfaction expressed to the inspector during the time at the home. Postal voting had been arranged for some residents and other residents were looking forward to going down to vote on 5th May in the mini bus. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22, 23, 25 and 26 People who use this service will find that the environment is generally well maintained and a plan of maintenance in place. People can be assured that specialist equipment will be available to meet their care and access needs. EVIDENCE: The main communal areas in Cornwallis are well maintained and provide a welcoming and warm atmosphere. It was evident from observations that residents are able to use the home as they wish. A good example of this was the coffee and mints served after lunch in the main sitting room. There are two main lounges, one on the ground floor and one on the first floor, and a large ground floor dining room. There is also one lounge/dining room in the west wing used by people who are more dependant in their care needs. The west wing was showing signs of wear and tear and did not match the same high standard as the other communal areas. The manager explained the plans currently being actioned for the refurbishment of the west wing. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 15 There were also other smaller areas for use by service users, including two small conservatories, where service users may wish to sit on their own or in a small group. There were a number of kitchenettes for use by service users and their relatives to make hot drinks and snacks. There was also a small shop and hairdressing salon for use by service users. The home had a range of aids, adaptations and equipment designed to meet the needs of residents and assist them with mobility and personal care. There are sufficient bathrooms with adapted facilities. All bedrooms had an en-suite facility. Two bedrooms in the west wing were viewed and provided comfortable accommodation that met the needs of the residents. All areas of the home seen was clean and free from any odour. Residents spoken to all spoke highly of the environment both internal and external. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 People who use this service can be assured that staff are well recruited, but that the number of agency staff especially at a weekend will be high, therefore consistency of care cannot be assured. EVIDENCE: The staffing levels at the home always ensure a nurse is on duty at all times. In addition, there is one senior carer on shift and nine care staff on an early shift and six carers on a late shift. At night, there is one nurse and three care staff. The staffing levels are well within the Residential Staffing Forum Guidance that determines the level of need balanced against the minimum staff required. In speaking to residents and relatives there was a concern about the high usage of agency staff at a weekend. Care needs were said not to have been responded to in a consistent way and residents were needing to express their needs over and over to the new changing faces of agency staff. One example given of care not being maintained was the water jugs not being changed over the weekend. The roters were examined for the previous four weeks. This showed that at a weekend agency staff outweighed the use of permanent staff at the home. At a weekend agency usage is about ten out of fifteen shifts and a weekday is about five out of fifteen shifts needed. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 17 These findings were discussed with the manager who confirmed the roters as correct. The manager was aware of the high use of agency staff. The home had undertaken a recruitment drive and as a result eight new staff would be starting. This would put the home 10 over actual hours required and therefore permanent staff would be used to cover sickness, annual leave and training. At a recent pay review at the home weekend enhancements had been removed. Staff were therefore not willing to work additional at a weekend as was previously the case. The manager had been discussing the homes needs within the organisation and hoped to have the home designated as needing additional bonuses for staff. Current vacancies at the home were for two part time domestics, one RGN on nights and four care staff. In further discussions with residents one concern they did have was that call bells were not responded to quickly. The response to call bells was observed and in two cases the wait was too long. The inspector brought one case to the attention of the nurse on duty who dispatched a carer to investigate. The home had installed a system that measured the time taken to respond to calls. Therefore, the manager was able to know the exact time taken to respond to the nurse call. In one case it was eleven minutes and in the other it was fourteen minutes. Upon discussion with the manager it was agreed that call bell waiting time would be reviewed and a change brought about. The recruitment records of two new staff were examined and were found to meet the regulation perfectly. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32 and 37 People who use this service will find the manager is qualified, keen and responsive to concerns raised. EVIDENCE: The registered manager for this service is Mr Alan McMahon. He started managing the home on 7th January 2004 and has been subsequently been interviewed by the CSCI and found to be a fit person to manage both Cornwallis and Geoffrey Dicker. Alan McMahon has suitable qualifications such as the Managers Award and D32 and D33. Nurse within the home are line managed by an RGN level one in the Care Coordinators role. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 19 Residents spoken to feel the manager lacks a woman’s touch in some areas, but on the whole think he is doing an OK job apart for the concerns they have raised in relation to catering, agency staff and call bells. The Inspector found the manager helpful and very responsive to the inspection process and keen to resolve matters. All records inspected, staffing roters, the complaint records, care records, menus and staff recruitment records were all appropriately completed and up to date. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 x 3 3 STAFFING Standard No Score 27 1 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 x 3 3 x x x x 3 x Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 21 yes 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 15 Regulation 16 (2)(i) Requirement Residents must have a wholesome, varied, appealing and balanced diet to meet their needs therefore: - individual diets such as gluten free and pureed must be given more than one choice that is presented in a manner that is attractive and appealing in terms of texture, flavour and apprearance. - Sufficient choice of meal must be available to all residents. Residents and relatives must be confident that their complaints will be acted upon therfore the current areas of discontent that have been raised previously with the home such as catering and staffing must be promptly and demonstarbly resoved to ensure confidence in the complaints system remains. Residents needs must be met at all times therfore: - the skill mix of agency and permanent staff must be kept to a minimum. The use of agency staff should never outwiegh the Timescale for action immediate 2. 16 22 15th June 2005 3. 27 18 (1)(a)(b) immediate Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 22 use of permanent staff in any one shift. i.e no more that 50 agency staff. - Call bells must be responded to promptly. 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 15 27 Good Practice Recommendations Residents should be surveyed about their views on the whole catering experience to agree a strategy of improvements that meet the needs of the residents. The call bell system review should determine what length of time is too long to wait. Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 5th Floor, St Vincent House Cutler Street IPSWICH IP1 1UQ 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 Cornwallis Court I54-I04 S24366 Cornwallis Court V224866 050429 Stage 4.doc Version 1.30 Page 24 - 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. 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