Inspection on 06/01/06 for Credenhill Court

This inspection was carried out on 6th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Credenhill Court 22/02/07

Credenhill Court 14/06/05

Credenhill Court 25/11/04

Credenhill Court 10/06/04

Credenhill Court 10/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Credenhill Court Credenhill Hereford Herefordshire HR4 7DL Lead Inspector Sarah das Neves Pedro Unannounced Inspection 6th January 2006 05:30 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 Credenhill Court DS0000024702.V276766.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. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Credenhill Court Address Credenhill Hereford Herefordshire HR4 7DL 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) 01432 760349 01432 761466 Mr Narendra Nauth Mrs Sheila May Nauth Mrs Susan Patricia Davies Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (35) Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The Home can continue to accommodate the named current service users who are under 65 years of age as long as their social care needs can continue to be met within a service primarily for older people. 14th June 2005 Date of last inspection Brief Description of the Service: Credenhill Court is registered primarily to provide accommodation and personal care for thirty five people over the age of 65 who need care due to their age or because they have care needs due to the effects of dementia related illnesses. There are also some people who have lived at the home for a while who are under 65 and have learning disabilities or mental health related needs. The home is no longer offering places to people under 65 or to people with learning disabilities. Credenhill Court is a large country house set in large grounds and has lovely rural views, especially from the rooms at the front of the house. Credenhill village church is reached from the same driveway and is just a few minutes walk from the Home. The village of Credenhill (with a post office and general stores) is about a mile away. Hereford city centre is 4 miles. The accommodation is on 3 floors with the majority of bedrooms being single. There are bathroom and toilet facilities on each floor and 2 sitting rooms and 2 dining rooms on the ground floor. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Credenhill Court was carried out during a Friday evening from 18.45 until 21.10. There were 31 residents in the home with five carers. Comment cards were not used as part of this inspection as they were provided for health and social care professionals and relatives, residents and staff for the previous inspection. During the inspection residents were spoken to in groups in the day areas and two staff (including the senior on duty) were spoken to individually. Other staff members were spoken to and observed whilst carrying out their duties. Samples of care records were looked at. Time was spent looking around the building and observing interactions between staff and residents. Because the majority of residents have dementia or mental health needs the extent to which their views could be sought directly was limited and some reliance had to be placed on observation to get an impression of what life at the home is like from their point of view. Although criticisms will be made regarding the records seen and some of the practices underpinning the service at Credenhill, the staff were observed being kind, caring and respectful to the residents. They were open and forthcoming with their responses and co-operated fully with the inspection. The home was warm and welcoming; the seasonal decorations were still in place showing that the home had been very bright and cheerful over the festive season. The residents were well presented and care had obviously been taken with their appearance. Because of the timing of the inspection, some aspects of the service, particularly documentation, could not be seen and have been identified as not assessed. What the service does well: As referred to in the previous inspection, there is a friendly, welcoming atmosphere at the Home. The staff group is hardworking and conscientious and have a caring, respectful approach to residents. They were professionally dressed and went about their work in a calm and unhurried manner. The members of staff spoken to were very caring and stated their dedication to the residents at the home. The inspector was told that they loved their work. The home is clean and tidy with good quality, comfortable furnishings. The decorative standard is good and traditional in nature, commensurate with the age and style of the house. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 6 Overall, this was a satisfactory inspection which confirmed that Credenhill Court continues to provide a caring and professional service to those living there. What has improved since the last inspection? 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. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 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 Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 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): 2. Standard 6 does not apply to this home Resident’s accommodation in the home is confirmed in a contract which is understood by all parties. Standard three was met at the previous inspection EVIDENCE: The contract seen was specific to the room occupied by the resident it was comprehensive and easy to understand. The home continues to insist on receiving a copy of the social services assessment before considering the placement. The manager or deputy manager completes their own assessment of a person’s needs whether they are funded by a placing authority or in a position to fund their care themselves. A letter is sent to the person and/or their representative and to the social worker if there is one confirming a place is being offered and that the person’s care needs can be met by the Home. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9(aspects of), 10, and 11 People living at the home are treated with care and respect. Staff are aware of the care needs of the residents and manage them conscientiously but the content of the care plans is insufficient: • to record the hard work carried out by the staff and • to record changes in care when care needs change. Further work is needed to complete the care records. Medicines storage requirements are not being complied with. The absence of screening in the shared rooms severely compromises the privacy and dignity of the occupants. EVIDENCE: Care Plans There is a care plan for each person. In addition to this there is a ‘baths book’ which records residents bathing needs; the inspector was pleased to note that those who have been assessed as self-caring in this regard are recorded as such. Two care plans were selected, one by the senior and one by the inspector. The care plan format provides space for describing all the expected aspects of a person’s care with full assessments to form the basis of the care given. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 10 In the first plan, the resident had suffered a fractured hip but the initial full assessment and plan had not been changed to take this into account and was thus inappropriate and incomplete. The second plan contained unsigned and undated assessments and main document entries. Where entries had been made, action had not been taken in regard to them. Correction fluid had been used on entries. Parts of the documentation were misleading and ambiguous. However, evaluations had been carried out and been signed and dated (but not all monthly) and staff had tried to make the care plan comprehensive. The spiritual needs of the resident had been completed which included full instructions on the residents wishes following death and the resident had signed the plan indicating that they had been involved with it’s development. The low mark given to this section is an indication of the importance of accurate documentation when managing the care of people with dementia related needs who would be unable to alert staff to changes in their care. Medicines A full medicines inspection was carried out on 26th October 2005 and readers are advised to obtain a copy of this report to see the pharmacists’ comments. The requirements from this inspection have been added to those outstanding from the announced inspection. Some of the requirements from this inspection were reviewed and the following observed: • The care records contained out of date information regarding the self medication status of a resident • The key was again in the medicines fridge door and it was unlocked • Chocolate had been stored in the fridge along with (correctly stored) antibiotics and Daktacort cream. It is noted that the temperature of the room in which medicines were stored was 23º and the senior carried the medicine keys on her person. Privacy and Dignity During the inspection, the inspector observed many affectionate, kind and respectful interactions between residents and staff; it was evident that the staff were keen to preserve the residents dignity. However it was noted that there were no screens between the beds in two of the shared rooms seen and it was confirmed that screens were not available if residents wished to use the commode in these rooms. In addition to privacy and dignity being compromised the following points have infection control implications. Residents’ toothbrushes were stored in the same tooth mug and they were apparently sharing the same toothpaste. Residents’ combs were unnamed and apparently shared as were deodorants, talcum powder and body spray. None of the above is acceptable and must be remedied as a matter of urgency. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed but were satisfactory at the previous inspection. EVIDENCE: Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 12 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): These standards were not assessed but were satisfactory at the previous inspection. EVIDENCE: Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 13 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, 23, 24, 25 and 25 The house is generally well maintained and comfortable. Resident’s bedrooms and the day rooms and public areas are well furnished, but the absence of any screening in shared rooms denies privacy to the occupants. The home is well lit and warm but it is not possible to adjust the heating from individual radiators Infection control is compromised by the absence of a sluice and the subsequent practices adopted by staff and in shared rooms as described above. EVIDENCE: The second floor bathroom has been completed to a satisfactory standard, but on examination it was observed that the underside of the hoist was dirty. This had been commented on in the previous report. In the first floor bathroom a commode liner was observed in the shower. The inspector was told that residents rarely use the shower and that the shower or Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 14 a basin was used to rinse commode liners after the contents had been disposed of via the lavatory. This practice is unacceptable as it severely compromises infection control measures in the home. If commodes are used, sluicing facilities must be provided to clean them. Six bedrooms were inspected including three shared rooms. Two of the shared rooms had two occupants. All of the rooms seen were clean, tidy, comfortable, homely and well personalised; they were very nicely presented. The day rooms and public areas are furnished and decorated in a way that makes them look welcoming and comfortable. Staff were seen wearing gloves and aprons but not always appropriately, for example, a carer wore gloves for the duration of the inspection for all procedures; however, liquid soap, paper towels and alcohol hand gel is readily available throughout the building. As it was dark it was not possible to assess compliance with the requirements from the previous inspection regarding the outside of the home but the inspector was informed that a fence had been erected to guard the drop from the edge of the front lawn to the field beyond. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 15 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 These standards were not fully inspected but there appeared to be sufficient staff on duty to care for the residents. Training was discussed with staff but records were not seen to confirm responses. EVIDENCE: There were five carers on duty with a senior. The staff were unhurried, carrying out their work quietly and competently. Residents were being prepared for bed as they wished, some staying up to watch television and others going to their rooms. The inspector was informed that staff had undertaken an external manual handling training course and had attended training specific to the care of residents with a dementia illness. This standard was not scored as training records were not seen to obtain corroboration. For this reason the Requirements from the previous inspection have not been removed as details of compliance could not be checked. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 16 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): These standards are not scored as they were not fully assessed during this inspection. EVIDENCE: This inspection was carried out during the evening and most of the information required under this standard was not immediately available. The bathing procedure document was considered and the following points are made: • It does not contain sufficient information regarding cleaning procedures and the prevention of cross infection • The temperature control information is ambiguous. The following health and safety points were observed during the inspection of the premises and were satisfactory: • A hoist was available but no resident had been assessed as requiring one at present • The fire extinguishers had been checked on March 2005. Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 17 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 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 2 2 3 1 2 1 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13 Requirement Timescale for action 30/09/05 2. OP19 13 3. OP19 13 and 23 4. OP19 13 and 23 The manager, deputy or a senior member of staff must do moving and handling training at a level that develops their knowledge and skills for carrying out moving and handling assessments and for monitoring moving and handling practice at the home. UNABLE TO ASSESS AT THIS INSPECTION, CARRIED FORWARD Timescales for work cited in the 31/07/05 report by the Environmental Health Officer must be met and written confirmation sent to CSCI when the work has been completed. NOT ASSESSED AT THIS INSPECTION Professional fire safety guidance 30/07/05 must be sought regarding an acceptable method of holding back the fire door by the ground floor toilets. NOT ASSESSED AT THIS INSPECTION Temporary measures for holding 14/06/05 the above door open must be subject to risk assessment and clear instructions given to staff regarding closing it at night. NOT DS0000024702.V276766.R01.S.doc Version 5.1 Credenhill Court Page 19 5. OP27 18 6. OP30 18 ASSESSED AT THIS INSPECTION A review of staffing levels in relation to the care needs of residents must be carried out (it is suggested that the Residential Forum guidance would provide a useful framework for this work). The results of the review must be forwarded to CSCI. NOT ASSESSED AT THIS INSPECTION Training in Dementia Care must be established as a core element of management and staff training drawing on expert sources such as the Alzheimers Society, Bradford Dementia Group, Stirling University and Dementia Care Matters in addition to local trainers. NOT ASSESSED AT THIS INSPECTION All keys to medicine storage areas must be securely held at all times. The security of the doors of the medicine cupboard must be improved. MET IN PART ONLY Medicine containers must be dated on opening and medicines replaced with new stock after the self-life stipulated by the manufacturer or as described in accepted good practice. NOT ASSESSED AT 30/09/05 31/12/05 7 OP9 13(2) 19/11/05 8 OP9 13(2) 19/11/05 THIS INSPECTION 9 OP9 13(2) All medicines must be kept with the full label as supplied by the pharmacy. NOT ASSESSED AT 19/11/05 THIS INSPECTION 10 OP9 13(2) 17(1) 13(2) MAR charts must be kept completely and accurately at all times. NOT ASSESSED AT THIS 30/11/05 INSPECTION 11 OP9 Full records must be kept of all medicines received in the home. 19/11/05 NOT ASSESSED AT THIS INSPECTION 12 OP9 13(2) 17(1) Written information must be recorded for each resident describing the use of any medicine prescribed ‘as required’. NOT 15/12/05 ASSESSED AT THIS INSPECTION Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 20 13 OP9 13(2) Medicines must be administered as prescribed by the doctor and effective Arrangements must be in place to ensure prescriptions contain the correct directions for administration. NOT ASSESSED 30/11/05 AT THIS INSPECTION 14 OP7 15 The content of care plans must be accurate and provide specific details about how care needs are to be met. They must be updated monthly. CARRIED FORWARD FROM RECOMMENDATIONS OF THE PREVIOUS INSPECTION 28/02/06 15 OP10 12(4), 16(4) 16 OP26 23 The arrangements for health 31/01/06 and personal care ensure that service users’ privacy and dignity are respected at all times, and with particular regard to: personal care giving, including, bathing, washing, using the toilet or commode, entering bedrooms, toilets and bathrooms. • Screens must be provided in shared bedrooms to ensure the privacy and dignity of residents. • Individual storage must be provided for personal equipment such as toothbrushes • Residents must have their own supplies of personal items such as deodorant, toothpaste etc. The home must provide 03/03/06 sluicing facilities to allow equipment to be cleaned appropriately. Plans should be presented by the date stipulated Credenhill Court DS0000024702.V276766.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP18 Good Practice Recommendations It is strongly recommended that discussion about adult protection is regularly included on the agendas of staff meetings and individual supervision as well as in staff training to make sure that all staff are fully aware of the correct action to take if an adult protection issue arises. NOT REVIEWED DURING THIS INSPECTION CARRIED FORWARD. Review car-parking arrangements to ensure emergency vehicles have good access to the premises. NOT REVIEWED DURING THIS INSPECTION CARRIED FORWARD. Access to the two new pagodas in the garden would be improved by laying paths with handrails. NOT REVIEWED DURING THIS INSPECTION CARRIED FORWARD. The radiator covers should be altered to allow residents and staff access to the temperature controls. NO CHANGE NOTED DURING THIS INSPECTION CARRIED FORWARD. It is recommended that a dishwasher be provided in the kitchen. NOT REVIEWED DURING THIS INSPECTION CARRIED FORWARD. It is recommended that a small group of suitably experienced staff are identified to provide staff supervision to the wider team and that these staff are given the necessary training to equip them for this role. NOT REVIEWED DURING THIS INSPECTION CARRIED FORWARD. It is recommended that more robust recording of staff attendance at training and tracking of gaps in staff training is set up to assist in the prioritising and planning of staff training. NOT REVIEWED DURING THIS INSPECTION CARRIED FORWARD. It is recommended that more robust risk assessment, and reporting systems are established in respect of general health and safety in the Home. NOT REVIEWED DURING THIS INSPECTION CARRIED FORWARD. The use of protective equipment should be reviewed to ensure it’s effectiveness in the protection against infection The written bathing procedure should be produced. DS0000024702.V276766.R01.S.doc Version 5.1 Page 22 3. OP19 4. 5. 6. 7. OP19 OP19 OP19 OP36 8. OP38 9. OP38 10. 11 OP26 OP38 Credenhill Court Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Credenhill Court DS0000024702.V276766.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!