Inspection on 13/10/06 for Croft Avenue Residential Home

This inspection was carried out on 13th October 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

Croft Avenue Residential Home 10/01/08

Croft Avenue Residential Home 09/12/05

Croft Avenue Residential Home 02/09/05

Croft Avenue Residential Home 24/01/05

Croft Avenue Residential Home 10/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Croft Avenue Residential Home Wordsworth Street Penrith Cumbria CA11 7RJ Lead Inspector Jenny Donnelly Unannounced Inspection 13th October 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 Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croft Avenue Residential Home Address Wordsworth Street Penrith Cumbria CA11 7RJ 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) 01768 867155 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Ms Denise Shearer Care Home 40 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (40) of places Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: up to 40 service users in the category of OP (Older people) up to 4 service users in the category of DE(E) (Dementia over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 9th December 2005 2. Date of last inspection Brief Description of the Service: Croft Avenue is a care home registered to provide care for forty older adults. The home is owned and run by BUPA Care Homes. The home is located in a quiet residential area of Penrith and is approximately half a mile from the town centre and local facilities and amenities. Accommodation is offered on the ground and first floors, there are three sitting rooms, two dining rooms, a treatment room, general offices, kitchen and laundry on site. The home has a passenger lift and a stair lift for access to one area of the home. A call bell system is operational throughout the home. There are well-attended garden areas of the home and car parking is available to the front of the home. The weekly fees at the time of this visit ranged from £343.00 to £520.00. Copies of the latest inspection reports and information for prospective residents about Croft Avenue, was available in the home. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection comprised of gathering written information from the home, as well as sending out questionnaires for residents and relatives to complete. Two inspectors made an unannounced visit to the care home, on 13th October 2006. This visit lasted from 09.30 to 16.15 hours, and included talking with residents, visitors and staff, touring the building, and looking at care, medication and staff records. The daily routine of the home including lunch was observed. No written questionnaires were received from residents or relatives. What the service does well: What has improved since the last inspection? What they could do better: As a result of this inspection six requirements and 2 recommendations are made of the home. The requirements are, to improve the provision of care delivery in line with residents’ wishes while maintaining their privacy and dignity. To offer residents a regular programme of activities and enable residents to have a choice in this. To provide training for staff on the protection of vulnerable adult procedures. To ensure staffing levels are sufficient to meet residents’ needs. And, to tighten up staff recruitment practices. The recommendations are to produce a programme of works for those bedrooms and bathrooms in need of refurbishment. And, to improve the level of cleaning in known problem areas, to reduce smells. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 6 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. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. There is good information available to interested parties about living at Croft Avenue. Preadmission procedures are thorough and serve to ensure that only those people, whose needs can be managed by the home, are offered a place. EVIDENCE: The home had good written information for prospective residents about the services offered. Some residents and visitors told us, they had been able to come and look around the home, meet the staff and see the bedrooms available before deciding to move in. Some people had looked at several homes in the area before making a positive choice to come to Croft Avenue. Each resident had a contract detailing the terms, conditions and costs of their stay. These were either directly with the home, or arranged through the local authority. Some residents spoken to knew all about their terms and conditions and arranged their own fee payments. The home carried out good pre-admission assessments on prospective residents, before offering them a place. This assessment included information Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 9 from other professional bodies including the hospital, district nurse and social worker, as relevant. This process served to ensure that only residents whose needs could be adequately met, were offered a place in the home. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The delivery of personal care was rushed and therefore variable in quality, and reduced the ability to fully maintain residents’ privacy and dignity. The arrangements for healthcare and medicines were good. EVIDENCE: Each resident had an individual plan of care completed. Three of these were studied in detail whilst others were dipped into. Care plans were laid out in a set sequence making it easy for staff to find information. Assessments had been kept up dated, and care plans reflected changes in residents needs. The plans showed residents’ wishes and preferences and made reference to the importance of maintaining peoples’ privacy and dignity. Lifestyle choices and interests were also recorded. In discussion with residents however, some of the information in care plans was not carried out in practice. One lady had made a choice in her care plan to have personal care from female carers, but she had been cared for that day by a man. The resident said, “well you do get a bit embarrassed”, and went on to say “you have to fit in with the system”. There was also some confusion about bathing, one resident was very clear that she had a set-bathing day, and Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 11 could request extra. Other residents felt baths were offered rather more randomly and not so often. When asked if she could have a weekly bath one resident said, “oh no they couldn’t possibly manage that”. The bathing records did indicate that some residents were rarely offered a bath. Residents described their care as being “rushed” and talked about “often having to wait a long time”. This is commented on further in the “Staffing” section of this report. Although there were good intentions towards maintaining residents’ privacy and dignity, this was lacking in some areas. Two residents had a very obvious body/incontinence odour that advertised their problem, some wore stained clothing, and although residents’ personal preferences were asked and recorded, they were not always followed. The management of medicines in the home was good. The staff were knowledgeable about individual residents’ medicines, and understood about those medicines which were given in alternating doses, or in accordance with blood test results. There was information about what any “as required” medications were used for. The storage and record keeping for medicines was good, and staff that had dealings with the medicines had received appropriate training. Residents had good access to healthcare, including the doctor, district nurse, chiropody and eye care. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The provision of planned activities and daily occupation for residents is poor. Residents enjoyed good access to visitors and regular religious services were provided. Residents said the provision of meals was very good. EVIDENCE: The home has not had an activities organiser since June of this year despite advertising the vacancy. There was a notice in the entrance apologising for the lack of activities because of this. Several residents and visitors commented that this was a shame and it was “a long and lonely day”. Residents particularly missed the armchair exercise sessions that used to take place. The manager continued to arrange periodic visiting entertainers, such as singers. Care staff were said to organise the odd game of dominoes, but it was evident that care staff did not really have time for this. There was an advert for regular religious services of different faiths, and these were either weekly or monthly, depending on the faith. The lack of regular organised activities or one to one time, meant residents were not really able to exercise choice in how to spend their days. Lunch consisted of tomato soup or egg mayonnaise, followed by fish and chips or cheese pasties, with Eve’s pudding or jelly and ice cream to follow. Residents confirmed that the meals were “very good”, and that they had a Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 13 choice of menu, saying, “They ask you the day before and you choose what you want for lunch and evening meal”. There were alternatives to the main dishes on offer, and we saw people having egg and chips or plain poached fish as they requested. Lunch was seen to be a relaxed occasion, with the food being served promptly and staff assisting where necessary. Residents chose whether to eat in the dining rooms or in their bedroom. There were regular hot and cold drink rounds throughout the day, and biscuits and fresh fruit were offered with these. There were two suppers of toast, teacakes and crumpets during the evening for those residents who wanted it. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 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 and 18 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The home had a complaints procedure that was accessible and easy for residents’ to use. Staff lacked knowledge of the procedures for safeguarding residents. EVIDENCE: The home had copies of the BUPA complaints procedure in the entrance hall. This was in a leaflet format and included a complaints form for posting or handing in. Residents spoken to say, if they had any complaint they would raise it with the home manager, and felt confident she would rectify matters. Visitors were aware of the complaint leaflets and one lady said she had used this procedure in the past and received a response from head office. The manager had not directly received any complaints and none had been made to the commission for social care inspection since the last inspection. The system for residents and relatives to raise concerns was accessible and easy to use. No staff had received training in safeguarding vulnerable adults from abuse. The manager and one other staff member were planning to attend a training course on this in the New Year. It is important for all staff to have a good awareness and understanding of safeguarding residents, and to know when and how to make referrals to the appropriate bodies. A lack of knowledge in this area was highlighted through the commission not being notified of an adult protection referral, and in another case a referral was not made, when it should have been. This is subject to a requirement. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 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): 19, 20, 21, 23, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The home provides comfortable accommodation, with pleasant communal rooms, although some bedrooms and bathrooms are in need of upgrading. EVIDENCE: Croft Avenue is located in a quiet residential area of Penrith and is approximately half a mile from the town centre and local facilities and amenities. Accommodation is offered on the ground and first floors, there are three sitting rooms, two dining rooms, a treatment room, general offices, kitchen and laundry on site. The home has a passenger lift, and a stair lift for access to one area of the home. A call bell system is operational throughout the home. There are well-attended garden areas of the home and car parking is available to the front of the home. The communal rooms and outside space were nicely presented and comfortable for residents. Bedrooms varied in size and shape throughout the building; there were 24 single and 7 shared bedrooms, some with an ensuite toilet. Since the last inspection the manager said windows had been replaced Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 16 in eight bedrooms and new furniture had been provided in five. These bedrooms were very pleasant, and most residents told us they liked their bedroom very much. A number of other bedrooms were in need of refurbishment, as furniture had become shabby and basin units were damaged. The manager said refurbishment work was planned for next year, following the completion of current work to install new water pipes. A programme of works needs to be set out for this. The majority of bedrooms had been nicely personalised and made homely. Some bedrooms lacked a second armchair for visitors use, and these residents did receive visitors in their bedrooms. The home had five bathrooms, consisting of two assisted baths, two ordinary baths (which residents are not able to use) and a shower room. There are plans to upgrade one bathroom, which would improve residents’ access to regular bathing. The home appeared clean and tidy, although there were areas that smelt strongly, and a more frequent in depth cleaning of these known problem areas is recommended. The laundry arrangements were satisfactory and residents said their clothes were nicely laundered and returned promptly. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Staffing levels were sufficient only to provide basic care to residents. Recruitment procedures were not thorough enough to adequately protect residents, although the provision of staff training was good. EVIDENCE: Croft Avenue is generally staffed by four carers during the day, and two at night. The senior carer on duty is responsible for dealing with the medicines, and liaison with doctors and district nurses. Leaving three care staff to provide the bulk of the actual care delivery for residents. In addition were the manager, administrator, housekeeping, kitchen and maintenance staff. From discussions with residents and staff it was clear that the staffing structure allowed little time for staff to provide anything beyond a very basic level of care. Residents spoke of “having to wait your turn”, “you never know when they’ll come” and “the staff are always running round trying to help people”. Staff commented that it was very busy, saying “four staff is not enough for basic care of residents” and “we have no time for social activities”. All residents we spoke to praised the individual staff members, saying they were very kind, lovely and helpful. The atmosphere in the home was pleasant and staff did interact nicely with residents when assisting them. The home needs to review its staffing levels in relation to residents care needs, and the layout of the building. Staff training and supervision was running satisfactorily. Staff had regular supervision meetings with their manager and an annual appraisal. Staff said Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 18 there were good opportunities for training both within the home and externally. Mandatory training for fire and moving and handling was ongoing, and monitored by the manager by use of a training matrix. The home had submitted information to the inspector stating that 73 of care staff had a National Vocational Qualification (NVQ) in care, which is excellent. The home had sound recruitment procedures in place, but on examination of staff files, these had not been adhered to. We saw the files of three care staff who had started work in the home, despite having no references, no criminal records bureau disclosure, and no PoVA list check on file. (PoVA is a list of people named by the secretary of state as being unsuitable to work with vulnerable adults). These checks need to be in place before new people start work. The manager said new staff were fully supervised, but the staff rota, and discussion with staff, did not demonstrate this to be the case. The home must improve their recruitment practices to safeguard residents from having unsuitable persons working in the care home. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents benefit from having a stable management team, who operate sound accounting arrangements and have a good regard to health and safety needs. EVIDENCE: The registered manager, Denise Shearer, has been in post for two years, and has completed the Registered Managers Award. A local general manager and a regional operations manager support her in her role. Staff and residents knew the manager well, staff said she was very supportive, and residents found her easy to talk to and helpful. Residents meetings were held periodically, the last one being in September. There were quality surveys done throughout the year by the BUPA quality department. A survey on “happiness” had been carried out in February and yielded very positive results. Other questionnaires seen had collected residents’ views about activities. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 20 There were management audits in place to monitor the quality of care planning, medicines management and the kitchen. We saw the results of some of this audit work, by way of notes in care plans to alert staff to missing information that needed to be completed. Any residents spending money managed by the home, was safely handled, kept in personal banking accounts, and all spending (such as hairdressing and newspapers) invoiced monthly. The written information supplied by the home indicated that all service records were up to date for the building and the equipment. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 21 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 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 3 2 X 2 2 X 2 STAFFING Standard No Score 27 2 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must accurately reflect residents’ health, personal, social care needs and their personal choices and care preferences. Residents’ privacy and dignity must be maintained at all times. There must be provision for, and choice of, leisure and social activities for residents. Staff must be trained in and understand the adult protection procedures. Staffing numbers and skill mix must be appropriate to meet the assessed needs of residents at all times. Full pre-employment checks, as set out in the care homes regulations, must be completed before new staff start work in the care home. Timescale for action 31/12/06 2. 3. 4. 5. OP10 OP12 OP14 OP18 OP27 12(4) 16(2)n 13(6) 18(1) 31/12/06 31/12/06 31/03/07 31/12/06 6. OP29 19(1) schedule 2 31/12/06 Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 23 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 OP19 OP26 Good Practice Recommendations The home should produce a programme of works, setting out the upgrading of bedrooms and bathrooms. There should be more regular in depth cleaning of known problem areas, to reduce unpleasant smells in the home. Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Croft Avenue Residential Home DS0000022547.V308625.R01.S.doc Version 5.2 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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