CARE HOMES FOR OLDER PEOPLE
Cumberland Court Cumberland Court 6 Cumberland Gardens St Leonards On Sea East Sussex TN38 0QL Lead Inspector
Jason Denny Unannounced Inspection 18th January 2006 09:40 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 Cumberland Court DS0000042898.V274644.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. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cumberland Court Address Cumberland Court 6 Cumberland Gardens St Leonards On Sea East Sussex TN38 0QL 01424 432949 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) PJP Care Ltd Mrs Julie Piercy Mary Elhefnawy Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty (20) Service users must be older people aged sixty-five [65] years or over on admission 24th May 2005 Date of last inspection Brief Description of the Service: Cumberland Court is situated in a residential area of St Leonards-on-Sea in East Sussex. The premises which are of the Victorian era are situated a short walk from a pleasant park, local shops, a mainline railway station and approximately 1km from the promenade and beach of St Leonards and the English Channel. The home is situated on a quiet road. Cumberland Court benefits from a homely feel throughout and is well decorated. The home benefits from a long, well maintained, and decorative garden. This garden is generally inaccessible to Residents with mobility needs. The home is exploring several plans, such as a decking area. The home is registered to provide services for up to 20 persons. A number of bedrooms, along with communal space, is below the National Minimum Standard. The home is except from these standards due to being a preexisting home before their implementation in April 2002. The owners of Cumberland Court, PJP Care Ltd also own a care home in Eastbourne with an experienced Manager who conducts monthly inspections of Cumberland court. The home benefits from an established and settled staff team who have worked in the home for a number of years. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April1st 2006], which took place between 09.40am and 3pm. The Inspection found that of the 20 National Minimum Standards inspected, that 16 of these standards had been met, with all others nearly met. This report should be read in conjunction with the last inspection report of May 24, 2005, which covered some standards not looked at on this visit such as activities, adult protection, and complaints management. The overall focus of the visit was on following up on the requirements made at the last inspection, and looking at how the home is being managed, some new areas such as medication and, food, and seeing how new residents were settling in including how their health needs are being met. The inspector started the inspection by talking with residents [7] and staff followed by a meeting with the acting Manager. A tour of communal areas and some bedrooms was undertaken along with looking at a range of records such as staffing, resident’s contracts, and health and safety. Comment cards were sent to the home prior to the inspection for circulation to residents, relatives, and other representatives such as visiting professionals. Comments received back were found to be positive with comments followed up during the inspection. What the service does well: What has improved since the last inspection?
All requirements from the last inspection have been met along with all but one recommendation. A highly experienced and skilled manager carries out monthly inspections of the home on behalf of the managing organisation resulting in continuous improvements to the service. The home now ensures
Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 6 that the person in charge of the home at any time is at least 21 years old. The home has introduced a job description for a sleep-in person with this used on occasions. The home was found to be comfortably meeting the needs of all 18 residents with no concerns during this inspection period in relation to staffing ratios. The home has increased staffing levels during the evening period leading to improvements to the amount of care on offer enabling two staff to be available to care for residents whilst one other prepares the supper and washes up. The rota of the home is clear. There is at least one member of staff on duty with first aid training at all times. All staff is now receiving written supervisory support. The home confirms in writing that it can meet the needs of prospective new residents before they move in. Contracts between the resident and the home are clear with variations from the standard fee explained. The home has updated its Residents guide to ensure it is offering up to date information to visitors. Regular surveys of Resident’s views are taking place through questionnaires along with the recent commencement of quarterly residents meeting forums along with daily consultation about activities and meal choices. 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. Cumberland Court DS0000042898.V274644.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 Cumberland Court DS0000042898.V274644.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): 1,2 & 3 The home now provides both prospective and existing residents, with a good level of information, which is accurate and up to date. Contracts are transparent and are signed shortly after admittance The way in which the home currently assesses prospective or existing residents ensures that it can currently meet need. EVIDENCE: A copy of the home’s resident’s [service user] guide including a complaints procedure is on display in the reception areas with this containing the most recent Inspection report. The guide has a recent report on a survey of resident’s views November 2005 with the overall guide updated during the month of the inspection [January 2006]. Residents and visitors were found to be knowledgeable about their rights. The Inspector found that the home’s assessment information was full on all 4 admitted Residents since the last inspection including a respite user. With this information tallied up with his observations and discussions with individual residents. A medical condition noted in one social services [care] assessment but not in the care-plan was discussed with the manager for investigation although this was not affecting outcomes.
Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 9 There was evidence in the case of more recently admitted residents that the home had written to the resident and social services to confirm that they could meet assessed needs prior to admittance. Staff were observed to be particularly mindful of the mobility needs of residents with no residents requiring two staff at any time. Contracts were found to meet the standard detailing full terms and conditions including the right to increase fees, and were signed by all parties. All contracts looked at showed the same fee, showed the room number along with who is responsible for paying what proportion of the recommended fee of £310. This fee is more for the larger rooms, which are available for those willing to pay extra. Contracts are signed by all Residents within around two weeks after they move in based on those examined. It was recommended to the home that where possible that they are signed at least on admittance, as this is when the terms and conditions are effective from. Newer residents confirmed that the home sends them all relevant information before they move in, such as the home’s guide, which contains a sample copy of a contract. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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 & 10 The home was found to be meeting resident’s health and general Care needs. The quality of monthly care-plans reviews has improved and clearly shows how all needs are being met and responded too. Medication arrangements are sound with the exception of secure storage, which needs review. The rights of resident’s are strongly upheld with the overall quality of care assessed as exceptional. EVIDENCE: Four Individual plans of care were inspected relating to the newest residents and were found to be sufficiently detailed, up to date, and contained clear information to support staff to meet the needs of residents. The plans were found to be user-friendly and covered the full range of health needs, which the inspector observed during the inspection. The plans also showed in detail how changing health needs such as stomach related issues are responded too. Not all care-plans are being reviewed monthly although they are all reviewed regularly. The quality and detail of these reviews has also improved with the deputy and other staff taking a greater role. The home is advised to put the original assessment information in the care-plan folder to assist accessibility of
Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 11 information. This will also be helped once all care-plans have the resident’s photograph on their file. Other information relating to the resident is stored elsewhere with the home asked to consider storing this in one folder. One assessment [Social Care] mentioned a epilepsy condition which was not covered in the care-plan which the home agreed to investigate although this was not affecting outcomes which the resident confirmed were good. Neither the resident nor the home was aware of such a condition existing. The home was found to be mindful of how to prevent the risk of falls. Most missing person profiles had been filled in with photographs to follow especially for those who go out independently. Care-plans, observations, and discussions with Residents and staff showed how Resident’s personal care needs are sensitively met with full regard given to their rights, dignity, and respect. Comment cards filled in by relatives all indicated satisfaction with the care being provided to residents. The inspector looked at medication stocks, record keeping, training records and observed trained staff dispensing medication all of which was found to be in order with one exception. The new acting Manager discussed the range of checks carried out in relation to medication arrangements. Medication is stored in a dedicated medication cabinet along with some filing cabinets, which are locked. The concern relates to the absence of double security with the medication cabinet visible from the homes Main reception hallway area due to this office area being open plan. The home was advised to seek advice from the relevant medication custody guidelines and liaise with the supplying pharmacy about the best way to improve security. None of these observations were found to be affecting outcomes at present. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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): 13,14 & 15 The home maintains good arrangements in relation to visitors. Residents are encouraged to be involved in the running of the home. Food is good, varied, and popular with residents. St 12 Activities and routines were found to be fully meeting the standard at the last inspection. EVIDENCE: Visitors to the home confirmed the flexibility afforded to them in relation to their visits. A number positively completed comment cards and met with the Inspector at the last Inspection. Residents confirmed satisfaction with these arrangements. The home was found to have a written visitors policy, which is due for updating as it was last reviewed in 2003[see standard 33]. Minutes, the new acting Manager, and residents confirmed that they have their own meetings, which recently started with the aim of these occurring quarterly. Minutes showed that the last meeting 17/10/05 was well attended with the resident suggestion of an art club acted upon along with some changes to the menu. Decisions such as the choice of a bedroom key are carefully recorded in careplans along with activities and dietary preferences.
Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 13 A meal was sampled and found to be tasty, well cooked, and healthy. Menus contain two clear choices along with individualised diets for some residents based on their choices and needs. All residents spoken with along with comment cards given to the Inspector indicated a good level of satisfaction with the meals provided by the home. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. Standards 16 & 18, were assessed to be fully met at the last inspection May 24, 2005. EVIDENCE: Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 24 The home was found to be clean, warm, and homely. The home is well-maintained including bedrooms and will fully meet the standard when all communal areas such as the Garden are fully accessible. EVIDENCE: A tour of all communal areas took place along with some bedrooms [where residents were spoken with] and bathrooms where all areas were found to be clean and met residents needs. One resident confirmed that she is on a waiting list for a larger room although she had declined one on a higher floor. The location of the home is suitable for its stated purpose. The premises were found to be well maintained, comfortable and in general met Resident’s individual and collective needs. The home was found to be bright and free from hazards. The large garden at the rear of the house does not have disabled access. The Garden is good to view and well maintained but because of a steep drop from the house level the main garden is inaccessible to all but the very agile. Access to the outside patio area, which borders the garden, is through the kitchen or via the front of the house, both routes are unsafe for anyone with
Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 16 mobility needs. A few of the residents confirmed that they do use the garden in the Summer with staff indicating that this amounts to 2-3 residents. The current owner has over recent inspections discussed a future plan to extend the street level patio with an area of decking to be reached via patio doors from the dining room. During this inspection some other plans were discussed with no agreement yet reached. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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): 27,29 & 30 There are sufficient numbers of suitable staff on duty at all times to meet current needs in accordance to a clear rota. Staff are experienced and have worked in the home for a long time. Staff training has improved in relation to inductions for new staff and National recognised qualifications. All residents and visitors praised the quality and stability of the staff team. Tight recruitment procedures are followed although the storage of documentation can improve. Induction arrangements for new staff are good. EVIDENCE: Staffing levels included 2 per day shift plus the hands on manager and 2 additional staff, cleaner and cook, for the 18 residents at the time of the inspection. An additional person now works a 4-8 pm shift to ensure that there are at least 2 staff on the care-side when the evening supper is being prepared and when the kitchen is being cleaned. Staff described this improvement as extremely useful. The home has 1 waking night person and uses an additional sleep-in when required. No current residents were found through discussion, observation, or care-plans, to need more than 1 person day or night to assist them. The sleep-in role was found to now have a job description. The rota/roster now shows the capacity and role that each person works in the home.
Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 18 A new member of staff confirmed at the last inspection that she had completed the National Approved Induction TOPSS in 6 weeks and that another new person was starting this. Staff interviewed explained the benefits of this induction. A person employed since the last inspection confirmed that she had already competed this induction along with a National Vocational Qualification level 2, prior to her employment by the home. She confirmed in discussion how helpful she found the home’s in- house induction, which includes 2 weeks of shadowing senior staff. Written records showed how the in-house induction had been carried out with the deputy manager. Three examples of employment records relating to newer staff were inspected and showed that all necessary checks had been carried out prior to those people starting work in the home such as two written references being received, POVA checks carried out, and full Police CRB checks applied for. In one case, written references could not initially be located although the homes management confirmed that these had been seen. The organisation of another staffing file was potentially confusing. The new acting Manager confirmed that she is currently working through to improve the organisation of all staffing files as well as destroying files relating to people either not employed by the home or who have ceased to worked there in recent years. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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): 31,33,35,36 & 38 The new acting Manager has contributed to improvements to the service. Quality assurance practices, with one exception, have significantly improved since the last Inspection supported by regular inspections from the managing organisation. The only shortfall relates to the need to update the home’s Policies and Procedures. Where necessary Residents finances are soundly managed by the home All staff are regularly and appropriately supervised. Residents are further protected from harm by improvements to health and safety training. EVIDENCE: The new acting manager has managed the home since June 2005 and has submitted an application to be registered, which is currently being processed. She has previous relevant experience in a deputy manager role. Comments from residents and staff indicated that the manager was making a helpful contribution. The manager is currently making improvements to the
Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 20 homes administration along with studying for the relevant management qualification National Vocational Qualification level 4 in management and care along with the Register Managers Award. An experienced manager now visits the home and carries out detailed unannounced monthly inspections of the home with full reports sent to the Commission which identify areas for improvement and gives the new acting manager key support. The most recent report sent of a [28/12/05] visit was thorough and identified a small number of areas for improvement such as the monthly review of all care-plans. Residents views were surveyed in November 2005 with a full report published in the homes guide [see standard 1]. This review shows excellent satisfaction ratings by those residents taking part. The homes policies and procedures file was examined which showed that no review had taken place since 2003. The home was found to have started a review with this due to be completed within the next 6 months. The homes abuse reporting policy was found to need urgent review given major changes in the law and practice since 2002, such as the need to report suspicions to social services in the first instance. Similarly, the recruitments of staff policy needs to reflect changes such as the POVA list effective form July 2004. None of these shortfalls was found to affect outcomes with the home following good recruitment practices despite its outdated policy. Once complete the home intends for all staff to sign the new updated policies and procedures. The management of resident’s monies was found to be sound in relation to the sample inspected which showed an accurate running total and itemised records of expenditure, complemented with receipts. A number of residents manage their own finances with some preferring the home to maintain safe storage which only the management have access too. Staff supervision records showed that all staff are now being regularly supervised. Staff spoken with confirmed how helpful this formalised system is, with it occurring at least every two months. Staff confirmed that they are provided with a copy of their written supervision. Health and Safety training has improved with most staff now first aid trained with a first aider on every shift. Further first aid courses along with Moving and Handling training were found to be booked within the month following the inspection. The home has also obtained a hoist since the last inspection with all staff shortly due to receive training [January 25, 2006] before its use. A particular resident indicated the safe way she is supported to use the toilet with this recorded and confirmed in staff discussion. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X 3 X X STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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 OP9 Regulation 13[2] Requirement Timescale for action 18/06/06 2. OP33 10[1] 12[1] 6[a] That the Registered Person must take appropriate advice on the current way that Medicines are secured in the home. That this review takes into account guidance from the Royal Pharmaceutical society and requirements from the Medicines act. That the supplying pharmacist is involved in this review. That the outcome of this review is sent to the Commission by the date shown. That the Registered Person must 18/07/06 ensure that the home’s Policies and Procedures are regularly reviewed and rewritten in light of changing legislation. That the homes recruitment policy and protocol for reporting allegations of abuse are prioritised in this rewrite. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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 3 4 5. 6 Refer to Standard OP2 OP7 OP7 OP7 OP19 OP29 Good Practice Recommendations That Contracts are signed before, or on admittance to the home. That all Care-plans show evidence of a monthly review. That Care-plans contain supporting information such as pre-assessments, and are appropriately organised. That a photograph of each resident is maintained by the home and displayed on the care-plan. That the Garden is made accessible to Residents with the provision of disabled access. That Staff recruitment files are appropriately organised. Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Cumberland Court DS0000042898.V274644.R01.S.doc Version 5.1 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. 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!
