Inspection on 27/02/06 for Coxwell Hall and Mews Nursing Home

This inspection was carried out on 27th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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Coxwell Hall and Mews Nursing... 08/02/05

Coxwell Hall and Mews Nursing... 30/06/04

Coxwell Hall and Mews Nursing... 19/02/04

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

CARE HOMES FOR OLDER PEOPLE Coxwell Hall and Mews Nursing Home Fernham Road Faringdon Oxfordshire SN7 7LB Lead Inspector Lilian Mackay 2nd Inspector Kate Harrison Unannounced Inspection 27th February 2006 09:30 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 Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 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. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Coxwell Hall and Mews Nursing Home Address Fernham Road Faringdon Oxfordshire SN7 7LB 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) 01367 242985 01367 241594 coxwellcare@yahoo.co.uk Sovereign (Coxwell Hall) Limited Mrs Carol Burnett Care Home 68 Category(ies) of Dementia - over 65 years of age (37), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (37), Old age, not falling within any other category (31) Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Condition 1. On admission persons should be aged 60 years and over. Condition 2. The total number of persons that may be accommodated at any one time must not exceed 68, of which 37 may be in either the DE (E) or MD (E) category. 16th May 2005 Date of last inspection Brief Description of the Service: Coxwell Hall and Mews is registered to provide care for up to 68 people from the age of 60. The company voluntarily limits occupancy to 27 in Coxwell Hall and 36 in Coxwell Mews to reduce the number of double rooms to one on each unit. The home has two separate units, linked by a covered walkway. Coxwell Hall provides care for people with general care needs and Coxwell Mews specialises in people with dementia. Registered nurses are on duty 24 hours a day to provide nursing care and to supervise care assistants. En-suite facilities of toilet and washbasin are provided in Coxwell Mews in addition to two baths and two showers. Three bedrooms there have full en-suite facilities. In the Hall all rooms have en suite facilities of toilet/washbasins except for one room on the first floor, and there are two baths and two showers. There are communal lounges and dining rooms in each unit. Coxwell Hall is an early 19th century Grade 2 listed building, whilst the Mews was purpose-built. It is set in its own grounds on the outskirts of the market town of Faringdon in Oxfordshire. The Hall has a pleasant private patio and the Mews also has its own private secure garden. Both are equipped with attractive garden furniture. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place between 09.30 and 15.30 on a weekday. The purpose of the visit was to see how the home is meeting the National Minimum Standards for care homes for older people. This inspection included a sampling of the home’s records for residents and other documentation, talking to nine residents, four relatives and several members of staff on duty. Additional feedback was obtained by means of questionnaires completed by health and social care professionals, GPs, relatives and visitors in contact with the home. The home has a qualified and experienced registered manager who has been registered since July 2004. Two new staff have been employed since the last inspection. Feedback from health and social care professionals in contact with the service was mixed. Their feedback indicated that whilst there is always a senior member of staff on duty to confer with, they did not all feel they are able to see residents in private or that specialist advice is incorporated into care plans. Their comments included - “Staff are helpful and cooperative”. “I do sometimes wonder about the staffing levels on the floor for the very confused.” “Communication issues need to be improved, both internally and between the home and external teams. The staff in the home are working in collaboration with the Oaks Team looking at behavioural and psychological interventions with residents with severely challenging behaviours. This will improve standards of care for this client group.” Feedback from residents indicated that they like living at the home, feel well cared for, feel staff treat them well, have their privacy respected, have suitable activities provided for them, feel safe and know who to communicate with if they are unhappy with the care they are receiving. Residents’ comments included, ”Staff are very caring”. “I love it. The people are nice. I take my visitors to the conservatory.” “The food could be a little better. The staff are very pleasant. I’ve been asked if I want to go out but I don’t want to go.” “No place to roam”. “I quite like it [the home]”. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 6 GPs’ feedback confirmed that there is always a senior member of staff to confer with, that they are able to see their patients in private, that medication is appropriately managed and that management staff take appropriate decisions when they can no longer manage residents’ care needs. GPs’ feedback indicated that the home needs to communicate more clearly and work more in partnership with them, that staff need to demonstrate a clearer understanding of residents’ care needs and that how to obtain a copy of the CSCI inspection report needs highlighting to them. GPs’ comments included “No improvement apparent from last time.” “Relatives have commented that they don’t get clearly communicated histories/problems/issues because of a language barrier. Staff helpful and pleasant always. Misunderstandings re. care are mostly language-based or not handed over to staff correctly. X [name supplied] is excellent and things have improved since she has been in post.” Feedback from relatives or visitors confirmed that they are welcome in the home at any time, that they can visit their relative or friend in private, are kept informed of important matters affecting their relative or friend, are consulted about their care when their relative or friend is unable to make decisions and are satisfied with the overall care provided. Feedback from relatives or visitors indicated that the home’s complaints procedure needs highlighting for some of them. Their comments included “On the whole my mother is very happy at Coxwell Hall. Any complaints I have made have been put right very quickly. You can always see the house manager any time”. “A very well–managed home. Pity about the horrendous state of the car park. In wet weather it is a serious problem to get ambulant residents to and from vehicles without getting their feet wet and keep them from falling over.” “The home sends me bulletins of events and activities”. “Sometimes limited staff cover during breaks. I will look into the complaints procedure. It would be good to be advised of future inspections [Is there a log of interested parties and contact details?]”. “My sister has been a resident at the home since [date supplied]. Her friends and myself have been very impressed with the care and attention she continues to receive. The manager and her staff have been so kind and attentive towards her and their efforts cannot be criticised in any way”. The inspectors would like to thank the manager, staff, visitors and residents for their hospitality, courtesy and co-operation during this inspection. What the service does well: Staff are friendly, warm, helpful and caring. Staff manage residents who have dementia with patience. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 7 The home provides a service tailored to individual needs through the key worker system where the care of each person is the responsibility of a named member of staff. Care plans contain appropriate nursing instructions, are generally clear and accurate and good use is made of wound assessment charts, photographs and body charts. When a critical incident occurs a structured analysis is undertaken of this. Staff receive clear direction. Residents’ hobbies and interests are reflected in the activities programme, and activities are seen as an important part of daily life. Life histories are recorded on all residents as a matter of course. What has improved since the last inspection? What they could do better: Indicate clearly in the Statement of Purpose the range of needs the home is intended to meet. Document in care plans when staff perform toileting tasks. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 8 Provide more appropriate telephone facilities for residents’ use. Keep residents’ private information according to the Data Protection Act so that privacy and confidentiality are maintained. Evidence in care plans how recording food preferences on admission is used for the benefit of individual residents. Either provide individual lockable facilities for residents’ rooms or record in the care plan the reasons for not doing so. Implement the 2005-06-refurbishment plan to provide the recommended furniture and lockable doors. Meet the recommended ratio of 50 of staff trained to NVQ level 2 as soon as possible. Draw up a policy on sexuality and relationships. 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. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 9 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 Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 10 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. The home’s Statement of Purpose needs amending. Standard 6 is not applicable, as intermediate care is not provided. EVIDENCE: The home’s Statement of Purpose does not currently indicate clearly the range of needs it can or cannot meet. Whilst respite care is provided, intermediate care is not. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 11 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): 8,9,10. Additional recording is required in care plans to evidence that residents’ health care needs are fully met. The home’s medication policies and procedures protect residents. Additional arrangements are needed to ensure residents’ right to privacy is respected. EVIDENCE: The care plan of one resident requiring assistance with toileting was checked. Although it was documented in the care plan that the resident needed to be toileted 2 hourly, no record was made of the toileting tasks performed by the staff. The inspector was told that there were no residents with fluid intake problems so fluid charts were not required at this time. The inspector tracked the care of residents to see how health care needs are met. Records seen show that residents see a GP when the need arises, and are referred as necessary to other health care professionals in the community setting or at a hospital. Individuals are supported to maintain their personal care, and help is given when needed. Outcomes of risk assessments are acted on, for instance regarding pressure wounds or moving and handling residents. Where Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 12 appropriate, equipment is provided. Life histories are recorded with the help of families, and daily activities for residents are developed with this in mind. Activities are seen as an important part of the daily routine, and a member of staff is allocated daily to work with the activities coordinator. Relatives told the inspector that they were satisfied with the care at the home. Residents have their health care needs met by the community health services. Staff do not automatically refer new residents with dementia to the community psychiatric nurse. Referrals are only made when a problem is identified. The inspector saw care plans which included appropriate risk assessments and detailed instructions for staff to enable them to carry out the care needed by the individual. Care plans are reviewed regularly, are up to date and are drawn up with the involvement of the resident and/or relatives. It was reported that when a resident becomes distressed that a staff member is assigned to spend time with this resident. The importance of recording all disabilities in care plans has been highlighted to staff since the last inspection. Assessments are made and records kept of the mobility status of all new admissions and manual handling assessments are completed. Care plans contain appropriate nursing instructions, are generally clear and accurate and good use is made of wound assessment charts, photographs and body charts. When a critical incident occurs a structured analysis is undertaken of this. The home has a medication policy, which includes guidance for staff on how to manage medication coming into the home with individuals admitted for respite care. No residents self medicate and only registered nurses administer medication. The inspector saw medication records and was satisfied that recording is appropriate. An audit of signatures is carried out for recording on the MAR sheets. Residents appeared well dressed and groomed, and though meaningful conversation with residents on The Mews was difficult, the inspector noted that staff addressed residents respectfully. Visitors also told the inspector that staff treated residents respectfully. Residents can use a mobile phone free of charge. As some residents may find this arrangement deters them from using the phone it is recommended that more appropriate telephone facilities are provided. The inspector noted that six residents’ files are still kept together, so that when using one file an individual has access to the private information of the other five residents. Information on residents should be kept so that privacy and confidentiality are maintained. The registered manager should check that residents’ confidential information is kept according to the Data Protection Act. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 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): 15. Staff have received training in assessing and meeting residents’ nutritional and dietary needs. EVIDENCE: The food preferences of new residents are recorded on admission. Care plans do not currently evidence how this information is used for the benefit of individual residents. The Body Mass Index of residents is checked monthly. Staff have received recent training in the use of a tool for assessing residents’ nutritional and dietary needs on admission. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 14 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): 16,18. The complaints procedure meets the requirements of the Regulations and is prominently displayed. Senior staff need additional training to ensure they respond promptly and appropriately to allegations of abuse. EVIDENCE: The complaints procedure was amended at the last inspection and now indicates that complaints can be referred to the CSCI at any stage. A recent complaint highlighted a need for senior staff to have additional training in the protection of vulnerable adults from abuse. It was reported that arrangements are being made to ensure senior staff attend such training at level 2. The home’s policy on the protection of vulnerable adults from abuse has been rewritten recently. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 15 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): 23 For the most part residents’ bedrooms appeared to be adequately furnished. EVIDENCE: The inspector heard a very loud banging noise from the plumbing in one room and the residents’ visitors said that it had been present for some time. This needs to be addressed. The carpet in the same room was stained and needed cleaning. Not all residents were seen to have a lockable item in their bedrooms. The manager should either provide individual lockable facilities for all residents in their rooms or document in their care plans the reasons for not doing so. The 2005-06 refurbishment plan will address any shortfalls on recommended minimum furniture and lockable bedroom doors. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 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 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): 28,30. Residents are in safe hands at all times. Staff are trained and competent to do their jobs. EVIDENCE: Criminal Records Bureau checks are routinely conducted of staff prior to employment. In exceptional circumstances, where the staff member has to start before receipt of their Criminal Records Bureau check, a check of the Protection of Vulnerable Adults [POVA] list is undertaken, appropriate supervision arrangements are put in place and the position explained to residents. The inspector understood that the home’s induction process is being reviewed to include the recent changes made by the Skills for Care organisation. After induction new staff are encouraged to enrol on the NVQ programme. Out of a care staff team of 39 there are 12 first level nurses and five care staff with NVQ level 2 training or above. The home just failed to meet the recommended ratio of 50 of staff trained to NVQ level 2 by 2005. The manager has identified two staff members who will become NVQ assessors. The inspector saw evidence that staff received recent training in diabetes, dementia and challenging behaviour. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 17 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): 33,35,38. Leadership, guidance and direction are given to staff to ensure residents receive consistent care. Residents’ financial interests are safeguarded. The home promotes and protects residents’ health and safety. EVIDENCE: The manager is registered with the CSCI and is accountable for the service along with the responsible individual of Sovereign [Coxwell Hall] Ltd. Staff are well supervised. Monthly unannounced reports on the management of the home are undertaken diligently and copies of these sent to CSCI for information. Visitors to Coxwell Hall/Mews are encouraged to complete a Quality Scale Survey. Questionnaires were sent out as part of the Review of the Quality of Service Provision in 2005. All of those who responded were either satisfied or very satisfied with the care provided. The home may find Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 18 that by putting a date for return on these that a better response is obtained. This will also assist in formulating an action plan to develop the service. CSCI inspection reports are left beside the Visitors Book for information. Care managers or relatives usually manage the financial affairs of individuals resident in The Mews. Personal allowances are kept securely. These were inspected at this time and found to be well maintained and accurate. A property list is completed for individuals on admission and secure storage can be provided centrally for personal property, if necessary. With the exception of a policy on sexuality and relationships, all of the recommended policies and procedures were available. These were all reviewed in 2005. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 19 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X 2 X X X STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 4[1][c] Sch 1 Requirement Indicate clearly in the Statement of Purpose the range of needs the home is intended to meet. Timescale for action 31/05/06 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 3 4 5 6 7 Refer to Standard OP8 OP10 OP10 OP15 OP23 OP23 OP23 Good Practice Recommendations Document in care plans when staff perform toileting tasks. Provide more appropriate telephone facilities for residents’ use. Keep residents’ private information so that privacy and confidentiality are maintained and according to the Data Protection Act. Evidence in care plans how recording food preferences on admission is used for the benefit of individual residents. Remedy the loud banging noise from the plumbing identified. Clean the carpet in the same room. Either provide individual lockable facilities for all residents in their rooms or document in the care plan the reasons for not doing so. Implement the 2005-06 refurbishment plan to provide the DS0000027145.V284053.R01.S.doc Version 5.1 Page 21 Coxwell Hall and Mews Nursing Home 8 9 OP30 OP38 recommended furniture and lockable doors. Meet the recommended ratio of 50 of care staff trained to NVQ level 2 as soon as possible. Draw up a policy on sexuality and relationships. Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU 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 Coxwell Hall and Mews Nursing Home DS0000027145.V284053.R01.S.doc Version 5.1 Page 23 - 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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