Inspection on 15/11/05 for Didsbury Court Rest Home

This inspection was carried out on 15th November 2005.

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 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

Didsbury Court Rest Home 04/05/07

Didsbury Court Rest Home 27/02/06

Didsbury Court Rest Home 01/02/05

Didsbury Court Rest Home 28/07/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Belma

Hunters Care Centre

Manor Lodge

The Garden House

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

CARE HOMES FOR OLDER PEOPLE Didsbury Court Rest Home 17-19 Park Road St Marychurch Torquay Devon TQ1 4QR Lead Inspector Judy Cooper Announced Inspection 15th November 2005 10:00 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 Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 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. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Didsbury Court Rest Home Address 17-19 Park Road St Marychurch Torquay Devon TQ1 4QR 01803 329735 01803 329735 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) Mr Stuart Watson Mrs Ann Watson Mrs Ann Watson Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 01/02/05 Brief Description of the Service: Didsbury Court is a large detached property. It is located in the St. Marychurch area of Torquay and is within walking distance of local shops and amenities. Torquay town centre is approximately 1 mile from the home and can be reached by public transport. Didsbury Court provides accommodation with personal care to older people (65 ) both male and female. It is currently registered to provide a service for up to 14 residents. The owners also offer a small day care service for up to three service users on a daily basis. The home is laid out over 3 levels, ground, mezzanine and first floor. It has a passenger lift, which facilitates full access to each level. Current accommodation is provided in 12 single bedrooms and 1 double (which is currently being used for single occupancy). All bedrooms have en suite facilities except one, which has its own bathroom and toilet next door. It is the owners’ intention to incorporate this into the bedroom to create a full en suite facility (toilet, washbasin and walk-in bath) whilst the extension, detailed below, is being undertaken. In terms of communal space, the home currently offers a lounge, conservatory and dining room, two communal assisted bathrooms as well as an attractive and accessible garden. An extension is now well underway to provide an additional three en-suite bedrooms. A new, large kitchen area is also to be created. This will allow the owners to utilise the old kitchen, sited off the dining room, to extend the dining room, thus making the dining room larger, and providing the potential to offer more facilities i.e. a small coffee lounge area etc. A new disabled toilet facility is to be provided, whilst the hallway leading into the dining room is to be widened to allow easy access for any wheelchair user etc. New storage areas, including a new medication storage room, are also to be provided as part of these works. On completion of the extension to the building, the owners intend to reregister the home to provide accommodation for up to 17 residents within the Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 5 same category the home is already registered for. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day (Tuesday). Prior to the inspection the owner had returned the home’s pre-inspection questionnaire and several standard written feedback forms were also received, prior to the inspection, from one resident and five residents’ relatives/friends. Opportunity was taken to tour the premises, observe the progress of the new extension, examine some of the home’s records and policies and talk with the owners, deputy manager, residents and staff on duty. All of the current twelve residents were spoken with/observed during the inspection. Three day care residents were also in the home on the day of inspection, and were able to give feedback as to how they felt the service was running. Staff on duty were also observed, whilst in the course of undertaking their daily duties. Therefore this report is based on the findings from these observations and conversations. What the service does well: Didsbury Court provides a comfortable, secure and caring environment, where residents’ individuality is encouraged and maintained. Basic residents rights, such as dignity, respect and privacy are also firmly upheld which the residents themselves confirmed. The residents receive excellent meals, with residents encouraged to have a say in what meals they wish to receive, visitors are always welcomed, various informal and formal activities are made available and the local community is invited to visit the home when appropriate/desired. The staff team are very well trained and so able to meet the current and changing needs of the residents aided by the constant provision of appropriate, work related, on-going training. The owners and deputy manager are continually monitoring the quality of care given within the home and undertake a variety of quality assurance measures to ensure that the home is meeting the residents’ needs and expectations. . Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection? What they could do better: This home continues to maintain very good standards with no requirements identified from the last inspection and the only recommendation issued at that inspection now complied with, whilst only two general recommendations were identified at this inspection. One being in relation to the owners continuing to ensure that the new, previously described extension, is completed to the environmental standards required by this Commission, and that these works comply with the requirements of the other agencies involved i.e. building regulations, fire department etc, before new accommodation is offered for resident occupancy. The second recommendation was for the owners to undertake risk assessments on the home’s window openings and provide window restrictors, if a risk is subsequently identified. Please contact the provider for advice of actions taken in response to this Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 9 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 Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 10 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): 3, (6 is not applicable). The admission process is thorough and well managed with prospective residents being made aware that their needs can be met by the staff at the home. EVIDENCE: The home continues to maintain its statement of purpose and service user’s guide appropriately. Since the last inspection the owners have admitted two new residents and it was noted, by observing both of these residents’ records, that a full and detailed admission procedure was undertaken in both instances, which ensured that Didsbury Court was the appropriate home for both of the residents. Both had quite specific, differing needs and it is to the credit of the owners and deputy manager that these needs were fully explored, and agreement reached that they could be met, before any final decision was taken from the home’s perspective as to whether admission would be appropriate. This ensured that the residents could be fully confident that their needs were known and would be met as required. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 11 Both the residents were able to confirm that they had received a warm welcome from staff, and that they themselves, had been aware of what the home could offer before they chose to live at the home permanently. (One resident had had a respite stay prior to taking up admission and the other resident had visited for day care before taking up permanent residency). The relatives of both residents were also available to speak with, and they confirmed that the admission process had been handled professionally, and in the best interests of their respective relative. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 12 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): 7,8,9,10,11 All residents are looked after well in respect of their health and personal care needs by a well trained, experienced staff team. EVIDENCE: Care plans seen were very comprehensive and contained all relevant details appertaining to providing for individual residents’ care. The care plans had been regularly reviewed with the resident. The owner and deputy manager work closely with the local G.P’s surgeries and recently had some input from the McMillan services. The home’s medication cupboard and medication records were inspected and found to be satisfactory with medication training provided by the local pharmacist. A new medication storage room is in the process of being created as part of the general upgrade/extension programme currently on-going at the home. Information is held by the home in respect of any medications administered, to allow staff to be fully aware of the effects of the medication. No resident currently self-medicates. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 13 The home has recently excelled in providing care for one terminally ill resident, whilst being supported by visiting professionals including G.P’s and the McMillan nurse service. Letters written, following the sad death of this resident, clearly showed that the late resident’s friends had valued the care given and that they felt the resident had been treated exactly as they would have wished to be during this sensitive time. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 14 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): 12,13,14,15 Residents enjoy a peaceful, pleasant yet varied life at the home, with visitors encouraged and links maintained with the local community as required/requested. Various activities are regularly made available and excellent, well thought out meals are provided. EVIDENCE: Staff regularly undertake activities with residents both individually and as a group. There were full details of all activities that had been/were made available. A special note must be made regarding the huge effort put in by all staff and management to provide a week of interesting, and entertaining, events to celebrate V.E day earlier in the year, which all the residents thoroughly enjoyed. The same level of enthusiasm has been put into the Christmas programme which residents were keen to share with me, having now received details of what they can expect!! External entertainment is also provided on a regular basis. Some of the current residents are still relatively independent and as such come and go as they so choose. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 15 Many residents and their visitors used the words “excellent and satisfied” to describe the staff and the overall standard of their daily life. The home operates an open visiting policy and during the day at least three visitors came and went, whilst the visitor’s book clearly showed that the residents had many visitors at varying times throughout the day. One resident stated the following “ I like absolutely everything about the home and am delighted to be living here”. The home’s visiting hairdresser was in the home during the inspection and several residents were using this facility. A junior carer at the home has some training in hairdressing and also offers hairdressing and manicure sessions within the home, which are very popular. Residents commented on the food and said how good it was. The meal on the day of inspection was chicken in a cream sauce with cheese potatoes and fresh vegetables, followed by “Queen of Puddings”. There was also a choice available if requested and it was noted that individual residents’ likes and dislikes were well known by the staff serving the meal. The meal was hot, well presented and enjoyed by all. The home’s menu planning and cooking are, primarily undertaken by Mr Watson (owner) and the home’s deputy manager (both of whom are very interested in cooking), supported by a part time cook during the week. Menus are both well balanced and interesting, and flexible enough to accommodate individual resident preferences, including providing for any specific dietary needs. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 16 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): 16,17. Arrangements for protecting residents are satisfactory. Residents have been made aware of how to complain should they need to. Staff are also made aware of adult abuse issues, and how to deal with any concerns they may have. EVIDENCE: Residents, visitors and staff comments confirmed that people feel comfortable discussing any concerns they may have with the owners, deputy manager or the staff. There have not been any complaints made within the past twelve months either to the CSCI or internally. However to facilitate residents and their visitors with the opportunity to complain anonymously if desired, the home does offer a complaints box, but, to date, no complaints have been received in this manner. The home continues to maintain appropriate, updated adult protection policies, which staff have easy access to and regular training is provided by the home’s owner who is an NVQ assessor and also holds the Advanced Care Management certificate. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 17 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): 19,26. Didsbury Court provides very comfortable, clean and well maintained accommodation for the residents. Some areas of the home are the process of being upgraded and extended, however the owners are ensuring that any works in progress does not compromise the health and safety of the residents. EVIDENCE: Inspection of the home, showed the home to be in the process of creating an extension to provide an additional three en-suite bedrooms. A new, large kitchen area will also to be created, (where the owners intend to create a part that residents can use, under supervision, to take part in some cooking if they wish to). The owners intend to utilise the old kitchen, sited off the existing dining room, to extend the dining room, thus making the dining room larger, with the potential then, to offer additional facilities i.e. a small coffee lounge area etc. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 18 A new disabled toilet facility is also to be provided, whilst the hallway leading into the dining room, is to be widened to allow easy access for any wheelchair user etc. New storage areas are also to be provided as part of these works. Consideration is being taken to ensure that the works are undertaken with the least disruption to the residents and residents confirmed that the works in progress had not really affected them. The existing home, most of which will not change, was seen to be clean, safe and very comfortable. All rooms were seen to have been personalised as desired and the majority of residents had several personal items in their rooms. The one resident who had not, had chosen not to have any personal possessions brought in for personal reasons. Again this evidenced the way that the owners and staff facilitate individual residents’ choices. Residents’ bedrooms are provided with a suitable lock to ensure privacy is maintained, which are then disabled if not desired. The owners and the deputy manager maintain the home’ fire precautions in line with the requirements of the local fire department. The home has an infection control policy, whilst staff receive regular training in this area, and all areas of the home were odour free. Staff also observe infection control policies in their day-to-day work with the residents, such as ensuring hand cleansing is a regular part of the care provided with hand cleansing materials easily available. The home has a weekly collection of clinical waste and any heavily soiled linen is washed in red laundry bags which then disintegrate within the washing machine to prevent as little handling as possible by the staff, and thus help prevent cross infection within the home. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 19 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): 27,28,29,30 Staff at the home are well trained, competent and supported by the management, which ensures residents receive a good quality of care. They are employed in sufficient numbers to meet the residents’ needs. Residents are protected by the staff recruitment policies. EVIDENCE: Staffing levels were seen to be in sufficient numbers to ensure that residents’ needs could be met at all times of the day and night. Residents said that they felt well looked after and that staff were always available if needed. Positive feedback was received from both the residents and their relatives as to the standard of care received, and the manner the care was delivered. Training continues to be very well planned and supports the staff in providing for the varied needs of the residents. Well over 50 of staff hold NVQ2/3 in care, ensuring that an experienced and aware staff group provide care for residents. Regular staff supervision is provided and each staff member has their own personal development plan. The staff file, in respect of the last member of staff to be appointed at the home, evidenced that a full staff recruitment programme operates within the home, ensuring that staff appointed are deemed suitable to work with the residents. It was pleasing to note that this particular staff member’s role was very clearly defined as the staff member was under eighteen and her job description clearly Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 20 evidenced that no personal care was expected to be given to the residents, in accordance with the standard that no one under the age of eighteen should provide personal care. Residents stated that they were happy living at Didsbury Court and were benefiting from the care they received. Staff feel supported in their caring role and it was evident, from watching the verbal communications that took place during the day, that the owners, deputy manager, staff and residents communicate well with each other each other in a friendly relaxed manner. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 21 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): 31,33,35,38 The home is managed efficiently and well, with both the owners and deputy manager being easily available and approachable. The home provides a safe, secure environment where residents’ safety and well being is maintained. EVIDENCE: Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 22 The owners have owned the home for many years and Mrs Watson is a qualified NVQ assessor, holding the D32/33 award as well as having obtained the Advanced Care Management qualification. The deputy manager has been in post for the past two and a half years, having worked as carer and senior carer in the home previously. She is therefore well acquainted with the day to day running of Didsbury Court and supports the owners in their role. She is respected and approachable, with residents and staff spoken to, saying how confident they were to approach her as well as the owners, feeling secure that any one of them would be able to help with any worry/ concern they may have. The deputy manager holds the NVQ level 3 qualification in care and is currently completing her NVQ level 4 in care as well as her Registered Manager’s Award. The home operates thorough internal quality monitoring systems with residents’ and relatives’ etc feedback invited as part of the overall process. The financial aspects of residents are, mostly, undertaken by either the individual resident or their families. The owners have involvement in dealing with two residents’ financial affairs, for which there is a fully accountable system. Health and safety issues are well managed within the home, with water regulation provided and hot surfaces protected. Required records were made available at this inspection, including a recent bacterial analysis in respect of the home’s water supply, to ensure the risks of Legioella within the home are minimised. All records inspected were seen to be up to date, which further confirms that residents are cared for in a safe and secure environment. Discussion took place at the inspection regarding the assessment of the homes’ windows. As the window openings are relatively high within the residents’ bedrooms, the owners have not considered them previously to be a risk. During this inspection a general discussion took place regarding this matter. Following the discussion the owners agreed to undertake risk assessments on the homes’ window openings to ensure that they feel they remain risk free, and if any risk is identified they will provide window restrictors accordingly. Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 23 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 x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP19 Good Practice Recommendations The extension and upgrading programme currently underway, at the home should comply with the required physical standards of the National Minimum Standards and meet the requirements of any other involved agency i.e. the fire department and building control department etc. The owners should undertake risk assessments in relation to the window openings within the home and subsequently provide suitable window restrictors if any risk is identified. 2 OP38 Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 Page 25 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 Didsbury Court Rest Home DS0000018347.V263118.R01.S.doc Version 5.0 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!