Inspection on 09/05/06 for Deanbrook

This inspection was carried out on 9th May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Deanbrook 20/05/08

Deanbrook 02/02/06

Deanbrook 23/06/05

Deanbrook 22/10/04

Deanbrook 13/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Deanbrook Totnes Road South Brent Devon TQ10 9BY Lead Inspector Wendy Baines Unannounced Inspection 9th May 2006 10:00 Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 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 Deanbrook DS0000003684.V291803.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 Adults 18-65. 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. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Deanbrook Address Totnes Road South Brent Devon TQ10 9BY 01364 72446 01364 72446 deanbrook@havencare.plus.com 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) Havencare (Plymouth) Mrs Elizabeth Frances Bannister Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 6 service users who have a learning disability and are aged over 18 years may be accommodated at any one time Adults with a learning disability who may also have a physical disability may be accommodated 2nd February 2006 Date of last inspection Brief Description of the Service: Deanbrook is a large converted bungalow close to the centre of the village of South Brent. The home is owned by Havencare, (Plymouth) a voluntary organisation specialising in caring for adults with a Learning Disability. Deanbrook is registered to provide care for six people with a learning disability who may also have a physical disability, including those aged over 65 years. The home caters for people with a high level of needs. The accommodation comprises of five single, and one double bedroom. There is a large communal lounge, separate dining room and large conservatory, which open onto extensive gardens. The property is all on one level with specialist bathing and toilet facilities for service users with a physical disability. Deanbrook has its own transport, which is used extensively and has access to the shops and facilities within the village. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place between the 9th and 10th of May 2006. The Registered Manager Mrs Elizabeth Bannister was available throughout the day. All service users have very limited verbal communication and are unable to verbally comment on the quality of the care provided. However, the inspector was able to spend time, sampling records, meeting with individual keyworkers and observing the interaction between staff and service users. In addition questionnaires were sent to outside agencies, including Care Managers and the Learning Disability Service to request their views on the quality of the care provided. The Inspector also met with a Specialist Speech and Language Therapist who provided positive feedback regarding the home and their relationship with external support services. A sample of care plans, Person Centred Plans, Risk assessments, and daily records were inspected as were the homes Health and Safety records including the Fire log and accident/injury charts. The inspector completed a full tour of the inside and outside of the building and all service users bedrooms were seen. On the second day the inspector joined service users and staff for lunch and was able to observe the care of service users during this time. The Provider had completed and returned a Pre- inspection questionnaire prior to the visit, and six service user questionnaires had been returned to CSCI. What the service does well: Deanbrook provides good, individualised care and support for the people who live there. Sufficient information is provided to current and prospective service users to enable them to make an informed choice about where they live and the support they receive. A thorough and detailed assessment is undertaken regarding every aspect of care and clear guidelines are set out for staff detailing how the care should be delivered. There is a small and consistent staff team who have a good understanding of the needs of service users and are able to use their knowledge and skills to encourage choice and independence. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 6 The home regularly liaises with the Primary Health care and Specialist Learning Disability services to ensure that needs continue to be met as individuals become older and health needs change. Positive feedback was received from external agencies as part of the inspection process. The accommodation is comfortable and attractive and the provider continues to consider ways of improving the facilities to meet changing needs. The management approach is open and inclusive. Staff moral is high resulting in an enthusiastic workforce that work positively with service users to improve their whole quality of life. What has improved since the last inspection? What they could do better: The Registered Manager must install adequate hand-washing facilities in the laundry area to ensure the control of infection in the home. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 7 The Provider should ensure that all staff are aware of local multi-agency adult protection procedures and ensure that the homes Adult Protection procedures includes this information for staff. 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. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users can be confident that the home will provide sufficient information to enable them and their representatives to make an informed choice about where they live and the care they receive. EVIDENCE: A written Statement of Purpose and Service user guide is available for current and prospective service users. This includes information about the home and services provided. Each service user has a booklet with a collection of photos, signs and symbols relating to the home, staff and local community. The staff continue to develop this information with support and advice from the Specialist Speech and Language services. The home has a written admissions procedure, which includes a pre-admission assessment and visits, however there have been no new service users since the home opened approximately 17 years ago. All service users have a local Authority contract and a written statement of terms and conditions between the home and the individual. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 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 the following standard(s): 6,7,8,9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The home has a clear and consistent care planning process, which provides staff with the information they need to satisfactorily meet service users needs and enable them to make choices about their lifestyle and the care they receive. EVIDENCE: A sample of care- plans and Person centred plans were made available for inspection. The inspector randomly selected two service users and case tracked their information by reading records, meeting with the service user and key staff and requesting feedback from outside agencies. The home undertakes a thorough assessment of every aspect of an individuals care needs. This information is translated into a detailed care plan for the home, which includes short and long term goals, strengths and support needs, risk assessments and specific guidelines for staff. The format and content of this information confirmed that much consideration is given to service users Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 11 choice, rights and personal preference. Details are included about an individuals preferred choice of support from when they wake up in the morning and throughout the day. All service users have a Person Centred Plan (Essential Life Plan) and staff had received appropriate training to support this approach. There is a PCP team for each service user, which may include staff, family and other people involved in their care. Staff demonstrated a good understanding of service users needs and communication methods. During the inspection they were observed using this knowledge and skills to encourage choice making and independence. Discussion with the speech and language therapist visiting the home on the day of the inspection confirmed that the home regularly liaises with external agencies and follows the advice and guidance given. The speech and language therapist said that she had received ‘ excellent feedback’ from the home regarding the communication methods of each individual. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Much consideration is given by the home to ensure that service users can partake in a range of opportunities inside and outside the home. The meals in the home are good, offering both choice and variety and catering for special dietary needs. EVIDENCE: Service user care-plans, Person Centred Plans and other daily records included a range of information about opportunities for personal development, social and leisure opportunities. Strengths and needs assessments provide details of service user skills and the support required and Person Centred Plans include the individual’s preferences about their lifestyle and care they receive. Records confirmed that this information is regularly reviewed and updated. Due to a recent Local Authority review of services several service users have now stopped attending LA day centres. The manager said that as part of this Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 13 change the home has been working with the day centre and care manager to review the individuals care plan, consider alternative day opportunities and to make the transition as smooth as possible. Referrals have also been made to the speech and language services that have been supporting staff to develop communication systems and enhance choice making within the home environment. Each service user has a daily/weekly activity planner, which includes photos, symbols and signs. The home has recently purchased a large shed/activity room, which has heating, lighting and level access for day activities including arts and crafts. The manager said that staff had been very positive regarding the changes to day care arrangements and were applying a more Person Centred approach to planning activities. One care manager provided feedback from three service users who had recently withdrawn from Plymouth Day Services, which said that ‘their lives had improved through Deanbrook devising a plan of activities that fit around their needs’ Case tracking confirmed that service users are supported to maintain positive relationships with family and friends and these arrangements are documented and reviewed as part of the care planning process. Service user records contained information regarding dietary needs, likes and dislikes. This information is used to plan a weekly menu. On the second day the inspector was able to join staff and service users for lunch. A choice of food was available and was presented attractively. The mealtime was sociable, pleasant and unrushed. Staff were aware of service users who needed additional support and this was provided sensitively and respectfully at all times. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 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 the following standard(s): 18,19,20,21. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The health needs of service users are well met with evidence of good multidisciplinary working taking place on a regular basis. EVIDENCE: Records were inspected, which evidenced good assessments and information regarding individual’s personal and healthcare needs. Guidelines were available for staff detailing individual’s routines for the day and preferences about how care is delivered. Person Centred Plans confirmed that individuals are involved in planning their day and making decisions about their care routines. All service users living in the home require a high level of support in all areas of personal care, and staff were observed responding sensitively and respectfully to all care needs throughout the inspection. Discussion and records confirmed that service users healthcare needs are addressed via services from the Primary Care Team and specialist learning disability services. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 15 Case tracking confirmed that staff had a good understanding of changing needs due to illness and/or the ageing process. The specialist Learning Disability services have been involved with the home to undertake health screening for Dementia and staff had attended training in this area of care. Clear guidelines were available for staff about procedures to follow if an individual’s health significantly deteriorates. These guidelines had been agreed with the home, specialist consultant and family. Files contained a range of charts used to monitor service users health care needs and any changes that may occur, these include; a falls register, weight, food/fluid intake and behaviour charts. The home had clear and safe systems for recording, storing and administering medication. Each service user had a medication profile and this information is reviewed and updated as required. A senior staff member was able to advise the inspector of the homes medication procedures and confirmed that all staff receive regular training, which includes 6 monthly checks by a Boots Pharmacist. All records were found to be in good order and up to date. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 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 the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff awareness of individual’s needs and the homes complaints procedure ensures that any concerns are identified and dealt with promptly. EVIDENCE: There have been no complaints made to the home or CSCI since the last inspection. The home has a written complaints procedure, which has been effectively simplified and converted into pictures and symbols. This is displayed in the communal dining area. The home has a small, consistent staff team who have a good awareness of the service users needs, and how each individual communicates. This knowledge and understanding ensures that any concerns are dealt with promptly. The key worker system, daily recording and health charts are used to monitor the well being of each individual. The manager advised that the home regularly liaises with the specialist speech and language services to improve the communication systems for each individual and to encourage choice and inclusion. Staff were able to verbalise issues regarding Adult protection and abuse, and were clear about ‘ Whistle-blowing’ procedures. However, the Registered manager had not attended local multi-agency Adult Protection training and was not clear about locally agreed protocols. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 17 All service users require support to manage their finances and details of the support required was documented. Clear records were available for all incoming and outgoing expenditure and these were found to be well maintained and up to date. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 24,25,26,27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are provided with accommodation, which is comfortable, safe and clean. EVIDENCE: A full tour of the premises was undertaken during the inspection. All parts of the home were found to be well maintained and clean. Service user bedrooms were attractively decorated with lots of personal items and décor to suit individual tastes and needs. Since the last inspection a large outdoor shed has been erected in the rear garden to be used as a craft/activity room. This has lighting, heating and a level access path with rail so that all service users can use this new day care facility. The large gardens are well maintained and the home has recently purchased a ‘gazebo’ for summer entertaining. On the day of the inspection service users were enjoying lunch on the patio area, which was shaded by large garden umbrellas. The Registered Manager advised that a wash hand basin is due to be fitted in the laundry area as required in the last inspection. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 19 Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Deanbrook has an experienced staff team who provide continuity of care for service users. Staff receive the support they require to fulfil their role. EVIDENCE: The home has a small and well- experienced staff team. Some have worked in the home for many years and have a very good understanding of service users needs. All staff spoken to during the inspection were able to give a clear account of procedures in the home, their own role and the role of others. Each staff member has a designated additional responsibility and those spoken to said that this made them feel valued and part of a team. All staff on duty were spoken to during the inspection. A sample of staff records were seen, which confirmed that the home has a robust recruitment process, and structured induction programme. One new member of staff said that although she had previously worked in the home before she had to complete the full induction programme, and fully familiarise herself with records and procedures. Records confirmed that all staff are registered to undertake relevant NVQ training as well as completing a range of in-house and external training Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 21 courses. Recent training had included; Total communication, Dementia Care and Nutrition. The manager confirmed that additional funding had been agreed by Social Services as part of the day care changes. These arrangements were reflected within the staff rota and individual activity charts. In addition to daily support and hand-over meetings staff receive formal 1:1 supervision every six weeks. There is an agreed format for these meetings and all details are documented. All staff have an annual appraisal to review their progress. Staff spoken to said that they felt well supported by their colleagues, management and senior staff within the organisation. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users and staff benefit from an open, positive and inclusive style of management. Staff moral is high resulting in an enthusiastic workforce that work positively with service users to improve their whole quality of life. EVIDENCE: Mrs Elizabeth Bannister is the Registered Manager for the home and was available throughout the inspection. Mrs Bannister has worked in the home for just over 2 years and previously worked within senior management posts in other homes owned by the organisation. She is currently undertaking the Registered Managers award and has NVQ3 in Mental Health and NVQ4 in management and care. Mrs Bannister also has an NVQ Assessor qualification Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 23 and undertakes regular training as part of the homes on-going training programme. Throughout the inspection there was a feeling of staff being open and supportive, and working closely as a team to ensure that service users needs are met. The home has a quality assurance system, which includes questionnaires for service users, relatives and other agencies. Examples of these were available and comments including; ‘ My relative is always dressed well, Deanbrook is an excellent home’ Monthly provider reports are also completed and sent to the Commission. Throughout the inspection a range of records were inspected including; care plans, Health and safety risk assessments, accident books, fire logs, and policies/procedures. All records were found to be in good order and up to date. Staff spoken to said that they were able to find important information and felt that they had the information they needed to adequately meet service users needs on a daily basis. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 4 3 4 3 3 3 3 X Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 25 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 YA30 Regulation 23 Requirement In addition to hand gel the home must provide sufficient hand washing facilities in the laundry area. Timescale for action 10/10/06 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. OP22 Refer to Standard Good Practice Recommendations The Registered Provider should ensure that the homes Adult Protection procedures include guidelines for staff regarding locally agreed protocols. The Registered Manager should attend the local multiagency adult protection training. Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Deanbrook DS0000003684.V291803.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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