Inspection on 20/02/07 for Corona House

This inspection was carried out on 20th February 2007.

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 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

Corona House 23/01/06

Corona House 18/11/05

Corona House 21/03/05

Corona House 11/11/04

Corona House 09/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Corona House 1 Osmaston Road Prenton Birkenhead Wirral CH42 8PY Lead Inspector Les Hill Unannounced Inspection 09:30 20 February 2007 th X10015.doc Version 1.40 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 Corona House DS0000018879.V303820.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 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. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Corona House Address 1 Osmaston Road Prenton Birkenhead Wirral CH42 8PY 0151 608 3536 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) Mrs Deborah Elaine Jane Wallace Mr John Wallace Mrs Deborah Elaine Jane Wallace Care Home 15 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (14) Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Corona House was registered to the present owners in January 2000 and provides accommodation and care for fifteen residents. There are six shared and three single bedrooms, on the ground and first floors. Special facilities include a stair lift on the main staircase and bath-lifts in the two bathrooms. Communal accommodation comprises a lounge with attached conservatory, a dining room and a hairdressing/visitors’ room. The home is by the main shopping area in Prenton and has good local transport links to other areas in Wirral. Fees for the home are £338 per week. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced, “Key” inspection of Corona House was undertaken on Tuesday 20th February 2007 over a period of three hours. It involved the examination of some records, meeting with the senior carer, five residents and a tour of the building. The homeowner/manager was on holiday at the time of the visit. Overall residents in Corona House are pleased with the care and support that is provided. The Commission’s concerns are in regard to the establishment and maintenance of records that can confirm what is provided. The inspection was undertaken as part of the Commission’s responsibility to visit and report on all registered care establishments. What the service does well: What has improved since the last inspection? What they could do better: Requirements have been made to improve the home’s statement of purpose and service user guide. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 6 Requirements have also been made to improve all record keeping in the home and particular reference is made to the recording of medicines and the records of staff appointments and training. 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. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Corona House DS0000018879.V303820.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3, 4, 5 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. Prospective residents do not have the complete information they would need to make an informed choice about the home. EVIDENCE: The home has a statement of purpose that is kept by the front entrance. However the document has been constructed from a pro-forma template and parts of it have not been completed with information directly relating to Corona House. The Care Standards Act 2000 requires a statement of purpose to be provided by all care homes. Information regarding the content of these documents is contained in Schedule 1 of the National Minimum Standards, Care Homes for Older People. The home has a service user guide that also serves as a contract/terms and conditions of residence. The document should be developed to include the matters identified again in National Minimum Standards, principally a summary of the Statement of Purpose and a summary of the complaints procedure. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 9 There was evidence on the three care files seen during the visit that a new pre-admission assessment form was being used. The document provided the opportunity for comprehensive information to be obtained and for the home to be able to make more informed decisions about the home’s ability to provide appropriate care and support to prospective residents. Staff said that they are pleased with the new documents as it gives them better information about residents in the home. On the day of this inspection the home was supporting its full compliment of 15 residents. The senior carer said that prospective residents and their families are encouraged to visit the home and to spend some time there before taking the decision to move in. The home is not contracted to provide Intermediate Care. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Resident’s health and social care needs are recognised but records do not always confirm safe practices are in place. EVIDENCE: Care plans had been created from the new assessment documents and they identified areas of need and the ways in which support should be provided. However, evidence did not confirm that the care plans were being reviewed on a very regular basis. Review reports were located on two of the files seen but the timing was irregular. In one case a resident’s file contained a Consultants letter to confirm a particular medicine was to be used, but from discussions with staff it became clear that a later decision had been made to withdraw the medicine. Confirmation of the later decision was not clear in the file or care plan. It was evident throughout the visit that staff work well as a team and know the residents day-to-needs. However, it is essential to ensure that all decisions about the care and support provided to individual residents are clearly Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 11 recorded and that there is a clear line of accountability for any actions taken by the home. Staff reported that they receive good support from most of the GP’s who attend the home and that resident’s who need the involvement of district nurses are provided with a good service. A dentist and an optician who have their Practices in the shops adjacent to the home will make domiciliary visits if necessary. The care plan for one resident included regular treatment that is provided by a visiting chiropodist. One of the home’s residents is able to self medicate but a risk assessment to confirm the arrangements is not in place. A local pharmacist supplies medicines to the home using the NOMAD system. Weekly cassettes of tablets are delivered and staff make a record on the Medicine Administration Record (MAR) sheets to confirm that they have given the prescribed medicines at the times directed. However, the monthly quantity of medicines provided for individual residents is listed on the MAR sheets but the home cannot sign to confirm receipt of all of the medicines until the fourth weekly supply is delivered. Additionally the member of staff said that the home has a book in which medicines returned to the pharmacist are recorded but it could not be located during the visit. The CSCI inspection report of 23rd January 2006 identified that the manager and a member of the care staff had completed a distance-learning course in the administration of medicines. Some other staff have a certificate to confirm their training in medicines management. However, training has not been provided as a matter of course for all staff that administer medicines in Corona House. Staff have been asked by relatives to give non-prescribed, alternative medicines to one of the residents. Before any non-prescribed medicines are given the homeowner must confirm with the resident’s GP that it is safe for the particular medicine to be administered and must then complete a medicine record sheet to confirm when it has been has been given. The Royal Pharmaceutical Society sets out the standards for managing medicines in care homes that must be followed to ensure safe practice. It would be helpful for the homeowner to discuss with the supplying pharmacist mutually appropriate systems for ensuring that the Royal Pharmaceutical Society’s standards can be followed at the home. All of the residents spoken to during the visit were complimentary about the care and support they receive from staff at Corona House. They said the staff are respectful and that personal care is provided in private to maintain their personal dignity. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 12 Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. Residents find the lifestyle experienced in the home satisfies their expectations and preferences, and meets their social, cultural and recreational needs. EVIDENCE: Residents were complimentary about the home and said it is a comfortable, clean and friendly place to live. They are free to make decisions about their own life but are secure in the knowledge that there are staff around who will provide the care and support they need and other residents who provide companionship. Visitors are welcomed at any time and residents who are able to go out alone are encouraged and supported to do so. Staff said that residents choose what time they get up and what time they go to bed and are able to request an alternative meal if they do not like (or wish to take) the one being prepared. The home has TV and radio systems in place and some of the residents have their own. They can choose to spend time in the communal lounge and conservatory or to spend time in their own room. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 14 On Thursdays a visiting activity organiser offers simple exercises and games and on Fridays another visiting occupational therapist offers opportunities for art and craft therapies and quizzes. Entertainers are invited to the home and staff said this usually happens on two occasions each month except at Christmastime when more entertainment is provided. Residents meetings are held from time to time at which matters affecting the day-to-day life in the home are discussed. The home’s menus showed that a balanced and nutritious diet is offered. Residents have a choice of breakfasts and the main meal is served at lunchtime. Cold and hot foods are offered at teatime and staff again said that a choice of snacks is provided at suppertime. The cook and the senior carer said that the cottage pie meal being served on the day of this visit was different to the one on the menu because residents had expressed a wish for an alternative to the sausage that was originally planned. Residents said that the food provided at the home is of a good quality and is served in adequate portions. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Residents are confident that any complaints will be addressed and adult protection procedures are in place to protect residents from abuse. EVIDENCE: The home has a complaints procedure that details the process for making and investigating any complaints received. Previous CSCI inspection reports have referred to a user-friendly version that encourages residents and their visitors to raise any matters of concern so that perceived problems can be dealt with as soon as possible. No formal complaints have been made to the home or to CSCI in the past twelve months. Al of the residents are listed on the Electoral Register and are eligible to vote in local and national elections. Adult protection policies and procedures are in place and the home has a copy of Wirral’s adult protection procedures. Since the CSCI inspection in January 2006 all of the staff have attended a Protection of Vulnerable Adults (POVA) training course that they found both interesting and helpful. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a safe and well-maintained environment. EVIDENCE: Corona House is a large detached property situated in a residential area but close to local shops and supermarkets. The home has been adapted to provide accommodation for 15 older people. It is well decorated and furnished in a homely style. On the ground floor there is a large lounge leading to a conservatory and a separate dining room. A bathroom is fitted with a hydraulic bath seat and a separate WC has adaptations to assist individual residents. Some bedroom accommodation is provided on the ground floor. The homes kitchen and laundry are located at one end of the building. Upstairs are the rest of the bedrooms an adapted bathroom and WC’s. One bathroom has a shower that residents can choose to use. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 17 WC’s should be provided with liquid soap dispensers rather than block soap and have disposable paper towels, to avoid the potential for cross infections. Most of the accommodation is provided in shared bedrooms with curtain screening to maintain a level of privacy. Bedrooms are well decorated and have been personalised by the residents. When tested some of the wardrobes could be pulled forward with little effort making them a potential hazard for residents who are unsteady when walking. A risk assessment should be carried out and any wardrobes able to be pulled forward should be fastened to the wall with an appropriate bracket. Wall mounted, electric convector heaters are installed as the main providers of heating around the home. Those in corridors and communal rooms have been provided with a safety guard to prevent residents from direct contact with a very hot surface. However, the same heaters in resident’s bedrooms are not guarded. A risk assessment should be undertaken to confirm whether or not radiators in individual bedrooms constitute a safety hazard for residents who occupy individual rooms. Where a risk is identified the radiator should be guarded to protect the residents. On the day of this visit the home was clean and well kept and there were no obvious unpleasant odours. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are supported by competent staff. Written confirmation of appointment and ongoing staff support would give greater confidence in the procedures. EVIDENCE: As the home manager was not available during the visit access to full information about staffing matters was limited. Any shortfall in information will be explored at the next CSCI visit. Staff rotas showed that four care staff are available each morning, two each afternoon and two wakeful staff are on duty throughout the night. Staff said that additional care staff are brought in if residents are unwell. The home has been able to maintain a stable staff team that can provide continuity of care and support to residents. Staff on duty during the course of this visit got on with their work without constant reference to the senior carer and the residents appreciated their input. 11 of the 22 care staff have an award at NVQ level 2 or above in care. Additional training has been provided in the protection of vulnerable adults and updating training is planned in first aid. Staff who have undertaken NVQ training have received instruction in moving and handling but this is not routinely offered to ensure the continued safe handling of residents and the safety and welfare of staff. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 19 Staff said that fire awareness is discussed form time to time but there were no records to confirm that training is provided and updated every six months. As the homeowner was not available it was not possible to confirm whether a training plan is in place to ensure staff are kept up to date with the most recent guidance and legislation in areas that affect their day-to-day work. The Commission would expect to see that basic training is provided in the above skills and in food hygiene, health and safety and medicine management and that it is routinely updated. Staff records were seen, but is not clear whether this is all of the information held about staff. The records consisted of an application form and two references and confirmation that Criminal Records Bureau (CRB) and POVA clearances had been obtained. Some of the records seen also had a contract of employment, but not all. However, there was no evidence to confirm the identity of staff that would have been seen when the authorised person applied for CRB clearance and should be maintained through Schedule 4 (6) of the National Minimum Standards, Care Homes for Older People. Staff said that annual appraisals are undertaken but that formal supervision on a one-to-one basis is not carried out. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 37. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Whilst from the perspective of direct care provision the home is run in the best interests of residents, the service is let down by the standards of record keeping. EVIDENCE: The homeowner/manager has been in post for seven years and has the registered Managers Award. Staff and residents spoke highly of the manager and the ways in which the home is run. It was clear from the comments made by both residents and staff and from the ways in which the home is presented, that Corona House is run in the best interests of residents. However, it is of concern that written records kept in the home do not adequately support practice. In the event of any inquiry into care Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 21 practices at the home the homeowner would have some difficulty in providing evidence of what and what has not been done for individual residents. Confirmation of the accounting and financial procedures in the home was not carried out as the homeowner was on holiday. Staff said that they keep small amounts of money for some residents to pay for day-to-day expenses but they were not aware of any large amounts being held. Staff said that they regularly communicate with the homeowner during their working time about their work and the needs of individual residents but that formal one-to-one supervision is not provided and recorded. Confirmation that safety checks are being carried out within the appropriate guidelines was not undertaken during this visit for reasons already explained. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 2 3 Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 4 Requirement The registered person must produce a statement of purpose for the home that contains all matters identified in Schedule 1 of the National Minimum Standards, Care Homes for Older People. The registered person must produce a service users guide that contains all maters identified in Regulation 5 of the National Minimum Standards, Care Homes for Older People. The registered person must ensure that the management of medicines in the home is conducted according to standards laid down by the Royal Pharmaceutical Society. From this report measure should be taken to: 1. Agree some method of confirming the medicines that are delivered to the home. 2. Undertake a risk assessment for residents who are self-administering their own medicines. Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 24 Timescale for action 31/03/07 2 OP2 5 31/03/07 3 OP9 13(2) 31/03/07 4 OP29 17 5 OP37 17 3. Ensure all staff that administer medicines are trained to do so. The registered person must ensure that all staff records listed in Schedule 4 paragraph 6 of the National Minimum Standards, Care Homes for Older People are kept in the home. The registered person must ensure that all records identified in Schedule 4 of the National Minimum Standards, Care Homes for Older People are kept in the home and maintained to a good standard. 31/03/07 31/03/07 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 OP7 OP25 Good Practice Recommendations The registered person should ensure that care plans for residents are maintained to a good standard and are reviewed on a regular basis (usually monthly). The registered person should carry out a risk assessment to confirm the safety of unguarded radiators in resident’s bedrooms. Where there is a risk of harm the radiator should be protected with an appropriate cover. The registered person should ensure that all staff receive one-to-one supervision six times each year and that a record of the matters discussed is kept for future reference. 3 OP36 Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Corona House DS0000018879.V303820.R01.S.doc Version 5.2 Page 26 - 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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