Inspection on 06/09/06 for Darwin House

This inspection was carried out on 6th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Darwin House 09/09/09

Darwin House 22/07/08

Darwin House 04/09/07

Darwin House 18/01/06

Darwin House 30/06/05

Darwin House 12/02/05

Darwin House 16/08/04

Darwin House 17/06/04

Darwin House 11/05/04

Darwin House 24/02/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Darwin House Darwin Lane Sheffield South Yorkshire S10 5RG Lead Inspector Stuart Hannay Key Unannounced Inspection 09:00 6 September 2006 th 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 Darwin House DS0000002955.V304553.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. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Darwin House Address Darwin Lane Sheffield South Yorkshire S10 5RG 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) 0114 230 1414 0114 230 7039 None Darwin House Limited Mrs Christine Frudd Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Darwin house is a home providing personal care for 25 older people. It is situated in a residential area of Sheffield. The facilities are on three floors accessed by a lift. Seventeen single and five double rooms are available. Each of the bedrooms is provided with en-suite toilet facilities, five rooms have ensuite showers. A variety of communal lounge space, and communal library room and dining room are provided. A central laundry and kitchen serve the home. Sufficient bathing facilities are available. The home has pleasant landscaped gardens with seating for service users. The home has a car park. The fees are £515.00 per week and service users are expected to pay for toiletries, hairdressing and chiropody. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection lasted for 7.5 hours. Eight service users, two relatives and two members of the care staff were interviewed to obtain their views about the service. Discussions were held with the Manager and the Deputy Manager throughout the day A check was made of the environment and the following records were checked: staff training, fire safety, service users’ care plans, the service users’ guide and staff recruitment records. A check was made of the storage and recording of medication. Records relating to the maintenance of equipment in the home were also checked. What the service does well: Darwin House had a relaxed and pleasant atmosphere on the day of the inspection. The staff were welcoming to visitors and they interacted with service users in a friendly, patient and respectful way. The people living at the home said that staff were very responsive to their needs, that they were ‘lovely’ and ‘helpful and quick off the mark’. All the service users spoken with said that the staff looked after their health and personal care needs and tended to them in a respectful manner. Some service users were not able to verbally express themselves about how they felt about the service, but all looked wellcared for, staff had made the effort to ensure that people were well-dressed in clean clothing, that their glasses were clean and items such as hearing aids were working properly. Assessments had been made of the service users prior to them coming to the home and clear records had been kept of the care they needed and the care that had been provided. Records included contact with any other healthcare professionals. Staff and service users spoken with thought that there were sufficient staff at the home to meet the needs of the service users. There are dedicated staff hours for activities and all the service users spoken with felt that there was enough to do. Many preferred to spend time in their own rooms reading or watching television. Service users said that staff did have time to chat to them but sometimes it was ‘a bit too busy’. Checks had been made on the staff when they were recruited to reduce the risk of harm to service users. There were systems in place for recording and reporting any concerns or complaints about the care. The medication system was generally well-managed and service users could look after their own medication if they wanted to. The home was decorated to a high standard throughout. Service users’ rooms were spacious, well-decorated and highly personalised. One service user said, “This is my home – it feels like my home and I have all my things around me”. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 6 All the bedrooms seen had pictures, ornamentation or furniture belonging to the service users. There were no obvious hazards noted in the home. Checks had been made on the major systems in the home such as the gas, electricity, lifts and fire alarms to ensure they were in good working order. 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. Darwin House DS0000002955.V304553.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 Darwin House DS0000002955.V304553.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, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had made assessments of the service users’ needs prior to them coming into the home to ensure that they could meet their needs. The home employed suitably qualified and experienced staff to ensure that this care could be provided. There was written information for service users about the nature of the service to help them make a choice about the home. The home provides some respite care but does not provide intermediate care. EVIDENCE: The care plans contained evidence of assessments made by the home or provided by other professionals; these were used when deciding if the home could meet the potential service user’s needs. Six service users spoken with confirmed that they had had the opportunity to visit the home prior to making a decision about moving in. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 9 There was a Statement of Purpose, which explained in detail the nature of the service. Service users also had their own guide, explaining their rights and how to contact the Commission For Social Care Inspection if they wished to raise any concerns they felt the home had not addressed. Each service user had a contract detailing the fees, what was included in the fees and any extra costs. The service users interviewed said that their health and personal care needs were met and the care plans identified what help they needed. Those who could not verbally express themselves looked well cared for. The care staff interviewed were knowledgeable about the needs of the service users; both the staff and the service users interviewed said that they felt there was generally a sufficient number of staff on duty. Darwin House DS0000002955.V304553.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 good. This judgement has been made using available evidence including a visit to this service. Each service user had a plan, which identified the help that they needed and identified service users’ abilities. All the service users looked physically well cared for and they said that the staff treated them with friendliness and dignity. Service users, if they wished to, were able to look after their own medication, helping them to maintain their independence. The medication system was generally well managed but the home needs to ensure that handwritten entries on the medication sheet are signed and witnessed to ensure that the correct medication is being given out to service users. EVIDENCE: Three service users’ care plans were checked. They recorded the personal, social and healthcare needs of the service users. Action plans were in place to guide staff on what action needed to be taken to meet the identified needs of the service users. Any contact with visiting professionals, such as opticians, dentists and chiropodists had been recorded, including any recommendations for treatment. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 11 The care plans identified what personal care needs had been attended to and there were records to show that service users had regular baths or showers. The plans recorded their preference for a bath or shower and this confirmed what individuals said in interview. The care plans had been regularly reviewed by the key workers, although there was scope for the comments or opinions of the service users to be included in the monthly summary. Eight of the service users were interviewed. Those able to clearly say how they felt about the service said that the staff treated them with respect and in a friendly way. The inspector noted that staff were unfailingly patient and respectful towards the service users, knocking on doors and ensuring doors were closed when personal care was being provided. One service user spoke highly of one of the carers and said “She’s great. Her heart’s really in it”. All staff knocked on doors before entering service users’ bedrooms or the bathrooms. Two visitors spoken with said that they had always found the staff to treat service users and visitors in a warm and friendly way. One service user kept her own medication and the Deputy Manager said that all service users had a lockable space for the safe storage of money or medication. Service users had signed consent forms to say if they wished to control their medication. Medication was securely stored and there were systems in place for receiving the medication into the home. There were medication administration (MAR) sheets for each service user; these recorded the type of medication, the dosage and how it was to be administered. There were reasonable stock levels in the home. Two senior care staff interviewed said that they had been assessed as competent and safe to administer medication. Records had been kept of each time the medication was given or withheld for any reason. There were no controlled drugs in the home at the time of the inspection but the home had facilities for their storage. The medication system had not recently been checked by the home’s pharmacist. Most of the Medication Administration Record sheets had been pre-printed at the pharmacy, however for medications received into the home in-between regular deliveries, the prescription information had been copied by staff onto the Medication Administration Record sheets. This information had been recorded clearly and legibly on 2 MAR sheets checked, however not all the handwritten entries had been signed by the person making the entry. The entries also need to be checked and countersigned by a witness to reduce the risk of errors. Darwin House DS0000002955.V304553.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 good. This judgement has been made using available evidence including a visit to this service. There were activities provided at the home and the service users said that they enjoyed these. Visitors were welcomed into the home and service users were encouraged to spend time with people important to them. Service users said that routines were relaxed and that they had been asked how they wished to spend their day, thus ensuring their views were taken into account. They felt that the food was of a good standard. Care plans included information about their dietary needs to ensure they received the appropriate nutrition. EVIDENCE: Eight service users were interviewed. Most of the people were able to say that they felt well cared for and that staff looked after them well. All service users spoken with looked clean and were dressed smartly in clean clothing – service users said that this was important to them. The home employed an activities co-ordinator who worked for three afternoons per week; service users said that she did quizzes and played word games with them. They were happy with the activities provided. Three of the service users interviewed said that they preferred their own company and liked to stay in their rooms and read or Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 13 watch television. One service user said that she went to church every Sunday morning. Two of the service users said that they were encouraged to eat their meals in the dining rooms but had the choice of eating in their rooms. All those spoken with said that the food was of a good quality, except for one person who said “it’s alright, but I’m a bit finicky”. They confirmed that there was a choice everyday and plenty to eat. Risk assessments had been completed in the care plans for service users’ nutritional needs and special diets were provided if necessary. The care plans checked contained information about their personal preferences with regard to food. Two relatives and friends were interviewed. They said that the home made them feel very welcome and they could drop in at anytime they wanted. Both people interviewed said they were kept up-to-date with information or concerns about their friend or relation. The service users said that there were no strict routines in the home and that service users could negotiate what time they wanted to get up or go to bed, the care plans checked contained information about service users preferred daily routines and these coincided with what people said in interview. One service user said that she had wanted to be bathed by older care staff and had been able to get a new key worker to ensure that this happened as often as possible. Service users felt that they were consulted by the home about issues relating to their care but as noted above, there is little evidence of service users’ opinions being recorded in the care plan. Darwin House DS0000002955.V304553.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. The home had a clear complaints procedure and service users, or their relatives, have used it to raise concerns. The home responds to complaints and treats them seriously to ensure these are investigated properly. Staff were aware of the need to report concerns and there was ongoing training in adult protection. EVIDENCE: The home had a complaints procedure and kept a log of complaints received. There were details of investigations and the outcome was recorded. Two complaints were recorded since the last inspection; they had both been resolved to the complainants’ satisfaction. Two staff interviewed had both had training on adult protection and the recognition of abuse as part of their NVQ Level II qualification. They were aware that there were procedures in place and of their obligation to report any concerns to the relevant authorities. As required in the previous report, staff had received training in adult protection and the manager said that the remaining staff were to receive training within 4 weeks of the date of the current inspection. No recent adult protection issues had been raised at the home. In May 2006, the Commission For Social Care Inspection received an anonymous complaint from someone who said that they were a relative of a service user at the home. The complainant said there has been a large Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 15 turnover of staff due to poor working conditions, that staff were using their mobile phones whilst on duty and that staff used inappropriate language, which was ‘vulgar and crude’. They also said that the care records did not include information about health issues. The home was asked to investigate the complaints and responded in full. The complaints were not upheld by the Commission For Social Care Inspection and no further action was taken. As part of their response, the home created a policy on the use of mobile phones at work. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was clean, tidy and well maintained ensuring that the service users live in pleasant and comfortable surroundings. All the bedrooms and the communal areas were clean, decorated and furnished to a high standard and fresh smelling. EVIDENCE: The communal areas of the home were light and pleasant. Bedrooms (10) were checked on each of the three levels of the home. They were decorated to a high standard, highly personalised and clean. A range of furniture had been provided for the service users and all those interviewed said they were very happy with their rooms. All the rooms had en suite toilets and some had en suite bathrooms. There were no unpleasant odours noted in the communal areas or in any of the bedrooms checked. The service users had been able to Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 17 bring a range of their own furniture for their rooms and all the rooms had personal photographs, paintings and other ornamentation on display. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The staff team were qualified and experienced in working with this group of service users; they understood their needs and had received training to ensure they could care properly for them. The home had good recruitment records and had completed checks on staff to reduce the risk of harm to vulnerable service users. EVIDENCE: Two senior care staff at the home were formally interviewed. They had received a range of statutory training and training related to the specific needs of service users. However, they and other members of staff had not all had upto-date manual handling training. One person had completed NVQ II in care and the other was in the process of gaining this qualification. They were knowledgeable about the specific needs of the service users. The staff and service users spoken with felt that there were usually sufficient staff on duty, unless someone phoned in sick at the last minute. Eight weeks rotas were checked and these confirmed that staffing levels were being generally maintained at: 1 senior and three carers in the morning and 1 senior and 2 carers in the afternoon. The Manager and Deputy Manager were supernumerary and generally worked office hours from Monday to Friday. At Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 19 night there was 1 senior and 1 care assistant on duty. At the time of the inspection there were 21 service users. The recruitment records of two employees were checked and these contained all the required information: application forms, employment histories, written references, CRB and POVA checks. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 20 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care staff interviewed said that their line managers were supportive and approachable so that they felt able to report any concerns to them about service users. There was a system of professional supervision to ensure that staff were maintaining a good level of care to the service users. Staff felt that they worked well as a team. Service users said that their views were taken into account by the staff. There were effective health and safety systems in place to minimise the risk to service users and the building was safe with no obvious risks to service users. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home has an experienced manager who is registered with the Commission For Social Care Inspection. She has significant experience in working with older people at a senior level and she had a good understanding of their needs. The staff members interviewed felt that she was very approachable and there was a very supportive atmosphere in the team. The Manager and the Deputy worked well as a team with focused goals to improve the service. There was professional supervision of the care staff who said that they had a one-to-one meeting with their line manager every other month. The meetings covered training, care and staffing issues and written records were kept of the meetings. Staff were also observed performing care tasks and given guidance and advice. There was also an annual appraisal of their work. Service users said that their views and opinions about the care had been taken into consideration. Accredited professionals had checked the home’s major gas and fire systems within the previous 12 months. The fixed electrical circuits and the lift had been checked. The home’s fire training records were generally of a good standard and regular checks had been made of the fire alarms, emergency lighting and fire fighting equipment. However, according to the home’s fire testing records, there were some occasions since the last inspection when the alarms had not been tested every week. The fire training records did not make it easy to check when staff had last had fire training and when they were next due to have it updated, however a new format was shown to the inspector, which should make this clearer. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 22 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 4 X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 2 Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 23 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) Timescale for action Handwritten entries on MAR 30/10/06 sheets must be signed by the person making the entry. A witness must also sign to confirm the instructions are accurate. The home’s medication system 30/11/06 must be checked by the pharmacist who supplies the medication. All staff must have updated 30/11/06 training in moving and handling service users. Fire alarms must be tested every 30/10/06 week. Requirement 2. OP9 13 3. 4. OP30 OP38 13 (5) 23 (4) (c) (v) 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 Refer to Standard OP7 Good Practice Recommendations The views and opinions of the service users should be included in the written reviews of the care plans wherever DS0000002955.V304553.R01.S.doc Version 5.2 Page 24 Darwin House possible. Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Darwin House DS0000002955.V304553.R01.S.doc Version 5.2 Page 26 - 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!