Inspection on 23/05/05 for Cottingham Road

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Cottingham Road 30/08/07

Cottingham Road 22/08/06

Cottingham Road 31/01/05

Cottingham Road 14/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 Cottingham Road 399 Cottingham Road Corby Northants NN18 0TW Lead Inspector Kathy Jones Unannounced 23 May 2005 14:00 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. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cottingham Road Address 399 Cottingham Road Corby Northants NN18 0TW 01536 401888 01536 406388 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) Royal Mencap Society Miss Susan Ball Care Home Only (PC) 4 Category(ies) of Learning Disability (LD) 4 registration, with number Physical Disability (PD) 4 of places Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 31 January 2005 Brief Description of the Service: Cottingham Road is a small MENCAP home that provides personal care and emotional support for four service users who have learning and physical disabilities. The home is a bungalow that has been tastefully decorated, with good quality furnishings, and is in keeping with a family home in style and design. There is a garden area to the side and rear of the building, which is easily accessed by the service users. All of the service users have single bedrooms, on the ground floor. The communal areas, have limited space, and there is insufficient space in the lounge for all of the service users to sit together, given that additional equipment, such as wheelchairs and adapted seating is required. The home has one communal bathroom and no en-suite bathrooms. The home has its own transport and service users are encouraged and enabled to enjoy the use of local facilities in the town Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the afternoon of a weekday. The inspection involved review of records relating to the assessment and planning of care needs, review of the statement of purpose, discussion with Staff and review of previous requirements. The Inspector also had a telephone conversation with the temporary Manager following the inspection. Residents are unable to communicate verbally however interactions and responses to Staff were observed. Feedback was received from three relatives/visitors in the form of comment cards and the Inspector had a telephone conversation with a relative. All relatives/visitors confirmed that they were satisfied with the overall care provided. The temporary Manager completed a pre-inspection questionnaire, which provided the Inspector with some information to inform the inspection. What the service does well: What has improved since the last inspection? Discussion with a small number of Staff indicated that they are working with the temporary Manager to review practices and implement change where necessary. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 6 The need to review, revise and update care plans has been acknowledged and work has now commenced on these. Staff training needs have been reviewed and seven staff were receiving medication training at the time of the inspection. Staff indicated that Mencap had carried out reviews of some areas of the premises following the inspection in January. A Thermostatic valve had been fitted to the kitchen sink to regulate the water temperature and reduce the risk to Residents and medication has been moved to a new temporary location. 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. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 7 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 Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 8 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) 1 The homes statement of purpose and service user guide does not provide sufficient information for Residents and prospective Residents to be clear about the services the home provides to meet their needs. EVIDENCE: There is a statement of purpose in place however it does not contain all the required information as detailed in the regulations. The missing information includes details of the organisational structure, staffing levels and staff qualifications, training and experience and details of the room sizes. There is also no date for implementation or review. The document needs to be reviewed alongside the standards and regulations with consideration being given to a more user friendly format. The residents who live at Cottingham Road have all lived there for some years however it is expected that an up to date statement of purpose setting out the aims and objectives, philosophy of the home, the services and facilities and terms and conditions is in place to inform them, their relatives or placing authorities and any potential new residents what the organisation aim to provide. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 9 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 The shortfalls in planning of care and instruction to staff have the potential to put Service Users at risk particularly in relation to meeting dietary needs and the management of seizures. EVIDENCE: A sample of care plans for three Residents were reviewed. This identified that care plans are not up to date, reviewed regularly or reflective of Residents needs. For example a Resident who Staff identified as having lost weight and was having liquidised food had no care plan in place to address their nutritional needs and the fact that they were having liquidised meals was not reflected in the care plan. Advice was given on the previous inspection to access advice from a dietician however Staff advised that they were having difficulty getting this advice. Inspectors suggested that the concerns regarding weight loss are discussed again with the General Practitioner and that care plans and menus are implemented based on the calorie needs and preferences of each individual. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 10 A care plan/risk assessment was in place for a Resident who has regular seizures however there was no detail regarding the type or usual length of the seizures. A Staff member was able to describe behaviours that may indicate the onset of a seizure which if included in the care plan would help guide Staff in managing safely. There was also no guidance regarding the most effective point to administer medication or at what point further assistance should be sought if the medication does not appear to be taking effect. Staff advised that since the temporary Manager had been in post care plans were in the process of being reviewed, revised and updated. Advice was given to consider the areas of risk for each individual and develop care plans for those areas first. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 11 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) 17 A good variety of meals is offered however the lack of individual assessment and planning leaves Residents at risk of their nutritional needs not being fully met. EVIDENCE: A two week menu was submitted with the pre-inspection information; this indicates a variety of different meals are offered. As indicated in the previous section there were concerns about the lack of care planning to meet individual nutritional needs. Two Residents were identified by Staff as having lost weight and one of these is having liquidised meals. Advice was given to ensure that the General Practitioner is aware that meals are being liquidised because this does lead to a loss of nutrients. Meals are being liquidised as a whole rather than individual parts of the meal being liquidised separately which would improve the appearance of food and ensure the flavours are retained. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 12 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) 19, 20 Without access to the necessary equipment to monitor weight, Residents who are susceptible to weight loss are put at further risk. EVIDENCE: Inspectors were told during discussion with Staff on the day of inspection and in a telephone conversation with the temporary Manager following the inspection, that reviews of residents needs including health care needs are currently being carried out. Records and discussion with Staff identified that the home does not have any suitable equipment to weigh Residents which given the concerns about weight loss means this cannot be effectively monitored. Staff advised that in the past equipment has been borrowed however recent attempts to borrow equipment have proved unsuccessful. Consideration should be given to purchasing suitable equipment given the identified needs and risks to Residents. As indicated in the previous sections the lack of care planning, up to date risk assessments and review has the potential to put Residents at risk of their needs including health care needs not being met. However there are indications from discussion with Staff and the temporary Manager that these areas are currently being addressed. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 13 The location of the medication has changed following a requirement made at the last inspection. The new temporary location is an improvement and means medication is now more safely stored. Inspectors were told that more suitable storage has been ordered. Medication systems were not reviewed during this inspection. However on arrival at the home seven members of Staff were found to be taking part in medication administration training delivered by a pharmacist. Staff advised that Residents medication is being reviewed and altered where necessary by the General Practitioner. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 14 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) 0 This section of the standards was not reviewed during this inspection. EVIDENCE: This section of the standards was not reviewed during this inspection. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 15 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, 27, 28, 29 The premises do not adequately meet the needs of the current Residents in terms of accessibility, space or equipment. EVIDENCE: The home is indistinguishable from any other family home. Inspectors saw two Residents bedrooms and the communal areas of the home during the inspection. The lack of adequate space to meet the needs of Residents has been the subject of various requirements and recommendations since the establishment of the National Care Standards Commission the predecessor to The Commission for Social Care Inspection in April 2002. The most recent requirements were for programmes for development to demonstrate how the Registered Providers intend to ensure that the physical design and layout of the premises to be used as the care home meet the needs of the Service Users to be submitted to The Commission for Social Care Inspection by 1 April 2005. To date no plan for development has been received. All four Residents have complex needs and three of them are wheelchair users. Discussion with Staff indicated that the limited space causes difficulties with equipment but also impacts on behaviours. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 16 Communal space consists of a small dining area of the kitchen and one very small sitting room. These spaces are insufficient to accommodate the four Residents currently living there and the Staff who are needed to support them. A comment card received from a relative includes the need for more living space to accommodate Residents and visitors. The toilet and bathroom facilities were seen to comprise one separate toilet, inaccessible to wheelchair users and a bathroom, which contained a toilet, shower and domestic bath and hoisting equipment. The decor and condition of the sanitary ware was very poor. A shelf was loose and likely to fall on someone (It was confirmed by the temporary Manager that a member of staff removed this on the night of the inspection) and there was a bolt on the inside of the bathroom door which if used by a Resident presents the risk of Staff being unable to gain access in an emergency. The actual bathing facilities do not meet the needs of Residents as confirmed by Staff. Residents can’t access the shower and even though some hoisting equipment has been installed because the bath can’t be accessed from both sides this creates risks of injury to Residents and Staff while transferring to and from the bath. Staff informed Inspectors that plans are in place to fully refurbish the bathroom while Residents are on holiday however there are no firm timescales for this. The planned refurbishment is also to include the provision of more suitable aids in the bathroom. The bathroom is required for all four Residents and is also used by Staff who carry out a sleep in shift. It was identified at the previous inspection that Residents were often late for attendance at day centres due to the demand on the one existing bathroom. Inspectors noted that one of the Residents has a bed with rails to reduce the risk of falls however there were no bumpers to prevent injury through limbs being trapped between the rails. There is a large garden at the rear of the home with a sitting area and some raised flowers beds providing a pleasant area to sit when the weather is good. There is space for car parking at the front of the home and Staff advised that new fencing has been ordered to secure the outdoor areas as currently this presents a risk to a Resident. The pathway to the front of the home is broken and uneven and the front door is not easily accessible to the three wheelchair users due to the raised lip at the bottom. At the time of the inspection the back door was broken and unable to be opened and had been in this condition for several days. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 17 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) 33 Staffing levels are insufficient to meet the needs of current Residents. EVIDENCE: There are two members of Staff on duty at all times. Discussion with Staff, observations and a brief review of some Residents files confirmed that all Residents require a high level of support, monitoring and assistance with three Residents requiring two Staff for movement and handling. If two Staff are bathing or changing a Resident the other three Residents are left unsupervised. Inspectors noted that a letter had been sent to Senior Managers in October 2004 highlighting the difficulties and risks in providing adequate care and supervision for Residents on the current Staffing levels. There is no evidence of any action being taken to increase staffing levels or review the staffing requirements in relation to Residents needs. Of the three comment cards received from relatives two said that in their opinion there were sufficient staff however one did not. Comment cards received from relatives all confirmed that Staff welcome them into the home, keep them informed about important matters and where the Resident id not able to make decisions consult them about the care provided. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 18 Discussion with Staff indicated that this has been a difficult period for them however they would appear to have accepted the need to make changes within the home and appeared committed to working with the temporary Manager to address the shortfalls. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 19 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) 39, 42 Failure to identify risks to Residents poses health and safety risks. EVIDENCE: An experienced temporary Manager is currently managing the home having recently moved there due to the Registered Manager leaving. Discussion with Staff indicated that the temporary Manager is working with them to improve standards within the home and address the identified shortfalls. An immediate requirement had been made at the previous inspection regarding the exceptionally hot water to the kitchen sink and the associated risks. It had been confirmed at a follow up visit that the problem had been addressed by fitting thermostatic valves to the sink. Given that this risk had been highlighted it was of particular concern that Inspectors found the water to the sinks in residents bedrooms was so hot they were unable to put their hand underneath it presenting a risk of scalding. An immediate requirement was made during this inspection to check all hot water outlets and take action to Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 20 reduce the risk. The risks related to the hot water pose serious health and safety risks to at least one Resident and indicate a failure to review, assess and monitor risk within the home. Although the quality assurance system was not discussed during this inspection the extent of the requirements raised in the previous inspection and the fact that issues are only just starting to be addressed indicates that either the quality assurance system is not effective or that the findings are not being acted on. Reliance on inspection alone to identify shortfalls and risks puts Residents health and safety at risk. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 21 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 2 x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x 1 1 1 x Standard No 11 12 13 14 15 16 17 x x x x x x 1 Standard No 31 32 33 34 35 36 Score x x 1 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cottingham Road Score x 1 2 x Standard No 37 38 39 40 41 42 43 Score x x 1 x x 1 x D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 22 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 7, 8 Regulation 12 (1) (a & b) Requirement Up to date care plans must be in place which contain specific information regarding the individual needs and the required actions of the carer. Care plans based on nutritional assessments must be implemented in all cases where weight loss is identified. Professional advice must be sought about the preparation of liquidised meals. A programme of development must be submitted to the Commission for Social Care Inspection to demonstrate how the Registered Providers intend to ensure that the physical design and layout of the premises to be used as the care home meet the needs of the Service Users & staff.(Previous timescale of 01.04.05 not met) A programme of development must be submitted to the Commission for Social Care Inspection to demonstrate how the Registered Providers intend to ensure sufficient numbers of lavatories, wash basins, baths and showers with regard to the Timescale for action 30.08.05 2. 7,8 12 (1) (a & b), 13 (4) (c ) 12 (1) (a & b), 13 (4) (c ) 23 (2) (a,g) 30.06.05 3. 4. 8 24, 28 30.06.05 30.07.05 5. 27 23 (2) (j) 30.07.05 Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 23 6. 28 23 (2) 7. 29 13 (4) 8. 9. 33 42 18 (1) 13 (4) number and needs of the Service Users .(Previous timescale of 01.04.05 not met) (i) A programme of development must be submitted to the Commission for Social Care Inspection to demonstrate how the Registered Providers intend to ensure suitable facilities for Service Users to meet their visitors in communal accommodation and in private accommodation which is separate form the Service Users own private rooms. (Previous timescale of 01.04.05 not met) (c ) A risk assessment must be carried out on the use of bed rails with consideration to the need for bumpers to prevent the risk of limbs becoming entrapped. (a) Sufficient Staff must be provided to meet Residents assessed needs at all times. (c ) Timescales for fitting thermostatic valves based on a risk assessment must be submitted to The Commission for Social Care Inspection. 30.07.05 30.06.05 30.06.05 30.05.05 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 7,8 8 Good Practice Recommendations In updating and improving care plans priority should be given to areas of higher risk. Consideration should be given to purchasing suitable equipment to monitor Residents weight unless a regular loan of equipment can be arranged. Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Northamptonshire Area Office Newland House, First Floor Campbell Square Northants, NN1 3EB 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 Cottingham Road D C51 C08 S12753 Cottingham Road V223606 230505 Stage 4.doc Version 1.30 Page 25 - 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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