Inspection on 19/05/05 for Cromer House

This inspection was carried out on 19th May 2005.

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

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

Other inspections for this house

Cromer House 17/06/09

Cromer House 04/05/07

Cromer House 17/05/06

Cromer House 12/09/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cromer House 15 Redan Street Ipswich Suffolk IP1 3PQ Lead Inspector Jan Davies Announced 19 May 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cromer House Address 15 Redan Street Ipswich Suffolk IP1 3PQ 01473 226399 01473 226396 cromer.house@achuk.com Aitch Care Homes Ltd, Fairways House, 2a St Barnabas Road, Woodford Green, Essex 1G8 7DA Application in process CRH Care Home 10 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Learning Disability (10) registration, with number of places Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The registered person must propose a new manager for registration should the current proposed manager be deemed unfit. this proposal must be within 3 months of the date of the refusal of the current proposed manager. Date of last inspection n/a Brief Description of the Service: Cromer House is owned and operated by ACH Ltd. and offers a service to residents with 24 hour support. Cromer House has ten bedrooms and all residents have their own bedrooms with individual facilities and en-suite toilet. The home is situated near to the centre of the Ipswich. It is served by local transport and near to local community facilities. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an announced visit and took place between the day-time hours of 10.15am and 16.30pm on a normal week day. This was the first inspection of the home since it had been registered and there were 4 residents living in the home at the time who contributed to the inspection process. The inspection took account of the need to involve residents and their representatives as fully as possible and to reflect their views. The Home’s Manager, Deputy Manager and Regional Operations Manager were all present in the home throughout the inspection. What the service does well: There was good evidence that a comprehensive assessment of need was undertaken prior to new residents being admitted. Also there was some evidence that risk assessments had been developed to support the independence of residents and that they cross-referenced to information in care plans that were developed from the initial assessment. The home provided a varied and interesting programme of activities and access to social events for residents. There was evidence that this was done in consultation with the residents who said that they were supported to try new opportunities as well as maintaining their regular routines. Residents were encouraged and helped to maintain and promote family contact and take appropriate responsibility toward personal development and independence. Personal support was being given and health care needs were promoted within the home and help given to access the community- based facilities for this. The registered person has policies and procedures in place to address protection for service users. The location and layout of the home were suitable for the service group being typically domestic, modern and comfortable but with personalised areas in line with residents assessed needs and preferences. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 6 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. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Prospective residents move into the home with the assurance that their needs are fully assessed and they are provided with a comprehensive contract setting out the terms and conditions between them and the Home. EVIDENCE: There was good, clear evidence in personal files, admission/placement plans and related documentation that new residents had a detailed assessment of need prior to their admission to Cromer House. The information from this was used to develop a comprehensive care plan with risk assessments to support the placement. Tracking a recent admission the inspector was able to form the above judgement. Individual records were kept for all residents and inspection of the records for the most recent admission contained a full assessment including an appropriate risk assessment Contracts were available for all residents placed. Residents’ guides to the home’s services were appropriate for the service group and included an interactive video recording aimed at informing and involving residents. This had a personal element by incorporating residents favourite theme tunes and logos to attract and hold their attention. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 9 There were 4 residents in the home during the course of the inspection and the inspector was able to obtain the views of 2 of them about choice of home. In one case the resident told the inspector that they liked the home to be very quiet and that they liked to play his own choice of music and to help with household tasks such as cooking and checking fire safety arrangements in the home with staff. From care plans these preferences had been identified and supported and it was demonstrated that appropriate pre inspection visits had been arranged. Staff had assisted the prospective residents and their families at all levels in the admission process. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 Personal and social care needs of service users are set out in individual and comprehensive plans of care. Service users’ health care needs are being identified and fully met. EVIDENCE: Individual plans of care were available and appropriate arrangements had been recorded to demonstrate that relevant aspects of health, personal and social care needs had been identified and planned for. Plans were comprehensive, up to date and being reviewed within the timescale identified. Risk assessments had been conducted in relation to the environment, and in relation to particular activities that service users were involved in, that could present a degree of risk, and particular aspects of their health care. Significant events in the home had been clearly recorded and daily entries into case records made, giving indication of the actual care given. This was particularly evident for one service user with identified challenging behaviours. One resident’s risk assessment identified that specific and appropriate care was needed to address the potential areas of difficulty. A recent incident, recorded and reported to CSCI demonstrated the need for keeping risk assessments Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 11 updated with strategies on file of appropriate interventions for staff to provide a consistent response. There must be suitable arrangements,strategies and risk assessments in place to lessen risk of physical restraint for residents who exhibit challenging behaviour. One resident collects two-pound coins and likes to keep these in his bedroom and stack these into small piles. Although the resident’s room was kept locked and they had a key (and a lockable facility in the room) in view of the potential financial risk involved there must be a suitable risk assessment in place for this. The care plan recorded the arrangements to encourage the resident to save their money in a bank account and should also include the risk assessment. Residents spoken with were able to describe care needs that the inspector could see had been recorded in their care plans. Discussion with staff confirmed that residents’ needs were being addressed in line with their care plans. They were also very aware of the sorts of issues where confidentially might need to be over-ridden in the interests of the health safety and welfare of an individual, and where there would be a need to pass information on. According to their skills and abilities, residents were invited to be included in the tasks associated with the running of the house – shopping, hanging out laundry, light dusting, or helping to prepare an evening meal. Safe hot water temperatures were maintained via the installation of thermostatic controls, and the Manager also confirmed that some window restrictors had already been fitted as part of an earlier risk assessment process. The staff team have held meetings for residents, at regular intervals with minutes kept of decisions. These were being used to air views, to discuss future events, and to find out what residents feel about the home, their likes, preferences and choices. It also provided a forum for any group dynamic issues to be raised. There were written procedures for staff in the event that a resident may go missing from the home, and there were contemporary photographs of service users, on file. Records were being maintained confidentially, and on an individual basis. Staff were respectful of personal client information, and careful about what conversations they held in front of others, or in public. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,16,17 People using this service can be assured that social activities are wellmanaged, individualised and provided daily variation and interest for people living in the home. Records kept of meals taken should be complete and include all alternatives the home provides. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 13 EVIDENCE: Plans of care for each resident confirmed that they have access to a wide range of opportunities to maintain, develop, and pursue social and recreational interests, as well as further developing their educational, emotional, and independent living skills. The culture of the home was one where residents were actively being encouraged to achieve their goals, both great and small, and where residents were praised and encouraged for their achievements. Two residents attended school prior to transfer to college, others visited a local day centre and others had care plans that were tailored to provide opportunities for one to one support programme during the day. Family contact was actively encouraged and residents talked with the inspector about this. There was also information of this providing ‘cross-reference’ in care plans. Menus were inspected and the inspector spoke with residents and staff about the arrangements for the preparation and presentation of meals. Records of alternative meals offered including cultural, dietary and vegetarian options were not completed and did not demonstrate that the home was making arrangements to meet the needs of residents by providing choices in this area. One resident told the inspector that they wanted to try recipes for Caribbean food that they had had with their family. Staff said that choices had been offered to meet their cultural dietary needs but there were insufficient records held to demonstrate this. Records kept of meals taken should be complete and include all alternatives the home provides. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The home has appropriate arrangements in place for identifying the physical and emotional health needs of service users and was ensuring that they receive personal support in line with their assessed needs and preferences. The arrangements for the administration and recording of medicines must be more robust. EVIDENCE: Staff members respected the privacy and dignity of residents and staff conduct in this area was defined in the home’s information available to staff on how to perform their duties. This also included a policy for personal care giving. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 15 Through discussion with both staff and residents (and observation) it was evident that the healthcare needs of the service users were being identified in an appropriate and timely manner. All service users were registered with local general practitioners and have the choice of seeing a male or female GP. Discussion took place around the arrangements for the training provided to support workers for administration of medication and records were seen to show that the training was according to the home’s time-scale for this. There were protocols in place which provided guidance for staff on administration of ‘as required’ medication. At the time of the inspection medication systems were incomplete and inaccurate and did not demonstrate that medicine was being administered in accordance with the policy and procedure of the home. Medication administration records must be correctly completed to evidence that the home is fully meeting residents’ health needs. The advice of the local pharmacist should be sought about recording medicines. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents are cared for, respected and listened to in that their views are being listened to and acted on and can be assured that there are appropriate systems in place to protect them from abuse. EVIDENCE: Discussion with residents and their key-workers confirmed that they would talk to staff if they had a complaint. One resident named their key-worker when asked who would they talk to for help if they were worried about anything or if they were hurt. Another resident said that (named) staff ‘are my friends’. There have been no complaints since the home opened. The complaint procedure was available in different formats including computer interactive, to make it accessible to the service users. The home’s complaint’s policy correctly identified the role of the CSCI and the timescale of response. Not all residents were able to identify the procedure set out for complaints that the home would follow should they need to do this (because of their level of dependency). The home had provided external, independent advocacy for residents with an appropriate person to act in the role of advocate in this event. Those service users spoken with expressed to the inspector their contentment with the service being provided and arrangements for them to be kept safe. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 People using this service can be assured that it is modern, clean, bright, airy and well decorated with personalised areas for residents. It is suitable for the needs of the residents who live there and meets their individual and collective needs. (One health and safety issue apparent at the time of the inspection was highlighted and immediately attended to and is referred to in the requirements below.) EVIDENCE: It was evident from visiting different residents’ rooms that these had been decorated and furnished to a high specification in a style which had been chosen for and which reflected the individuality of the resident; for example one room had musical instruments and was decorated with pictures of the occupant’s interests; another room showed that the resident enjoyed collecting CDs. and other items. Residents told the inspector that they were happy with their rooms. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 18 Bathrooms and toilets were well decorated, spacious, and comfortable. Doors had suitable working locks, and health and safety was well observed in these areas. All bedrooms had en-suites and risk assessments were on file to reflect that accessing and using the premises were part of individual residents initial assessment on admission to the home. On the day of the inspection the home was well maintained, hygienic, and smelt pleasant. This was to the credit of staff members who, in addition to their support worker duties, helped with domestic routines including cleaning. Residents were involved with keeping their own rooms clean and tidy (in line with their care plans and independence tasks). The outside of the property contains parking for staff and visitors and otherwise grounds are laid to lawn and easily maintainable gardens. A large panel of glass covering an area leading to the basement posed a health and safety issue and must be removed at the earliest opportunity. Until this is done premises/risk assessments for all residents must take account of this potential hazard. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35,36 People using this service can be assured that the procedures for the recruitment of staff are robust and provided the safeguards to offer protection to people living in the home. EVIDENCE: The staff team were clearly committed to training and viewed it as an essential component to developing their practice. Of the present staff team the majority had completed their NVQ level 2 training and were working to completing NVQ level 3 training. When completed the percentage of staff trained to the recommended level will be well over the minimum of 50 . The manager assistant manager and senior staff had either completed or were completing their L4 NVQ award in Care and Management. The staff recruitment procedure was examined in relating to new members of staff appointed since the home opened. There was evidence that references were requested and received. All seen had a satisfactory Criminal Record Bureau (CRB) check. The dates indicated that CRB s had been received prior to staff commencing their duties. There was also good evidence of new staff undertaking a detailed induction and foundation programme. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 20 Staff expressed the view that supervision was a useful way of discussing work and/ or other issues which may impact on work and that it provided support to enable them to carry out their work effectively. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,40,42,43 There was good leadership, direction and guidance to staff to ensure residents receive consistent quality care. Care practices indicated that the health, welfare and safety of the people using the service were being promoted. EVIDENCE: Staff expressed the view that the manager was approachable and supportive. From discussion and observation the inspector was satisfied that this was the case and that the manager had an appropriate support system within the organisation for himself. A number of staff said that they had moved with the manager because of this and had worked with her, by choice for several years. The home had a health and safety policy with designated staff with responsibility for this area including staff training in fire safety. There was evidence that fire safety training was updated on a regular basis. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 22 There were regular house meetings held which residents and staff both attend and separate staff meetings with minutes taken. The inspector was satisfied that the views of residents and staff were actively sought and acted upon. Policies, procedures, and codes of practice records were signed by the manager, dated, monitored, reviewed and ammended as appropriate and demonstrated that these were current/up to date. The manager and staff demonstrated that the organisation has looked at ways of making essential information contained in policies relevant to residents available in a format that was more appropriate to their levels of learning disability and understanding. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 4 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 4 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 4 4 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 x 3 2 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cromer House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 x 3 3 I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 24 no 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 20 Regulation 13(2) Requirement Medication administration records must be correctly completed to evidence that the home is fully meeting residents’ health needs. A large panel of glass covering an area leading to the basement posed a health and safety issue and must be removed at the earliest opportunity. Risk assessments for all residents must take account of this potential hazard. There must be suitable arrangements, strategies and risk assessments in place to lessen risk of physical restraint for residents who exhibit challenging behaviour. Records kept of meals taken should be complete and include all alternatives the home provides. Timescale for action 30/6/05 2. 24 23,(3)(n) immediate 3. 9 13(6) 30/6/05 4. 17 17(a)(b) 30/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 25 No. 1. Refer to Standard 9 Good Practice Recommendations The care plan recording the arrangements to encourage residents to save their money in a bank account should include the risk assessment about safekeeping of their money. The advice of the local pharmacist should be sought about recording the administration of medicines. none none 2. 3. 4. 20 none none Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 26 Commission for Social Care Inspection 5th Floor St Vincent House Cutler Street Ipswich IP1 1UQ 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 Cromer House I54-I04 S62387 Cromer House V220267 050519 Stage4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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