Inspection on 26/02/07 for Dove`s Nest Nursing Home

This inspection was carried out on 26th February 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dove`s Nest Nursing Home 14/08/09

Dove`s Nest Nursing Home 14/08/07

Dove`s Nest Nursing Home 06/03/06

Dove`s Nest Nursing Home 21/09/05

Dove`s Nest Nursing Home 08/02/05

Dove`s Nest Nursing Home 13/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Dove`s Nest Nursing Home 17/19 Windsor Road Clayton Bridge Manchester M40 1QQ Lead Inspector Nick Allen Unannounced Inspection 26th Febuary 2007 10:30 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 Dove`s Nest Nursing Home DS0000021641.V326728.R02.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. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dove`s Nest Nursing Home Address 17/19 Windsor Road Clayton Bridge Manchester M40 1QQ 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) 0161 681 7410 0161 681 3612 Dove`s Nest Limited Ms Jane Rawsthorne Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (2) of places Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Nursing or personal care may be provided for a maximum of 31 service users of either sex aged 60 years or over. Two named service users are currently accommodated and receiving nursing care by reason of physical disability. Should these service users no longer require the accommodation offered by Dove`s Nest the service user category will revert to OP (old age). At any one time one younger adult aged 18 - 60 years can in addition be accommodated for nursing care / personal care, by reason of physical disability for respite care for a period of no longer than 3 weeks. Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice previously served in accordance with Section 13 of the Care Standards Act 2000 and dated 11th March 2005. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing for the service users assessed as requiring personal care only must comply at all times with the minimum levels set out in the Residential Forum guidelines ` Care Staffing in Care Homes for Older People`. 6th March 2006 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Dove’s Nest is a nursing home providing 24-hour accommodation for up to 31 older persons. The home is owned by Doves Nest Limited. The Responsible Individual, is Ms Helen Claffey The home is situated in the North of the City of Manchester. Local facilities and bus routes are within easy walking distance. Parking to the side of the property is available. The building is an extended and converted detached house set in its own grounds. Accommodation is provided on two floors, served by a passenger lift and the home is accessible to wheelchair users. Bedroom accommodation is on the ground and first floor. The third floor provides office space. There are 21 single and 5 double rooms. All rooms, Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 5 with the exception of one single room, are provided with a wash hand basin. There are no en-suite facilities available. The double rooms have strategies in place for the maintenance of privacy. There are 3 lounges, a hair dressing room and conservatory/dining room, which is designated as a smoking area. The conservatory has patio doors leading out on to a small patio area, overlooking a wooded garden area, which enables service users to sit outside in warm weather. A separate house situated within the grounds of the home is currently being converted into an administration and training centre. The work is nearing completion and part of the building is in use. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over three days in February 2007. Before visiting the home information was gathered from a number of sources including the Pre Inspection Questionnaire completed by the home and both statutory and non statutory notifications together with any other information sent to the commission about the service since the last inspection. During the site visit the inspector spoke to a number of the residents, four members of staff, the manager and the Responsible Individual, carried out a partial inspection of the premises, and examined records. Some residents, who were able to give their views at the last inspection, had moved from the home. Of those people spoken to most of the comments were positive. What the service does well: What has improved since the last inspection? Some redecoration has taken place in five of the bedrooms. There has been some replacement of old bedroom furniture. There had been an increase in the number of training courses available to staff. The home has achieved Investors in People. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 8 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 Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2, 3 & 6 Quality in this outcome area is good. The home provides information to enable potential residents to make an informed choice about moving into the home. The home ensures that residents have their health needs met through completion of a needs assessments prior to becoming resident in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Service User Guide was examined This document contained information about staff qualifications and experience, the philosophy of care provision, a brief description of the home and a copy of the home’s complaints procedure. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 10 The files of two residents were examined, both were chosen at random. They did not contain copies of signed contracts detailing the terms and conditions. Nor did they identify the fees payable. Following the inspection, the Responsible Individual advised that all financial details, including contracts for each resident, are kept separately to the care plans. On admission each resident and their relatives are given a service users guide and a copy is kept in each person’s room. Detailed assessments completed by the home were seen in all care files and these included information about the psychological well-being, food preferences, health and social needs and expectations of the residents. During discussions the manager stated that residents and their representatives were encouraged to visit the home prior to admission. The Registered Provider stated that the home does not have designated respite care beds but can offer respite care if required. The Statement of Purpose and Service User’s guide reflect this. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 Quality in this outcome area is good. The health care needs of residents are well-documented and known to staff, which ensures that such needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were examined and instructions about meeting health needs were clearly identified. Nursing staff said that they reviewed these as necessary. Records and daily reports for residents confirmed that all routine and specialist health care including pressure area care is provided. There were details of out patient appointments, nursing care and other specialist input as appropriate. Evidence was found of residents weight and blood pressure being monitored. However the information was not recorded appropriately on the relevant form. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 12 This gave the impression that details of weight gain and loss were not up to date with one person not having been weighed for three months. . There were details of the monthly reviews of care plans but these in the main were limited to a one-line entry. It was recommended on the day of the site visit that these should be more detailed. The manger said that the process had started to change and senior care staff now completed the monthly reviews of those residents who were “residential”. Three residents were interviewed as part of the inspection process. They were satisfied with the standard of health care provided in the home. The staff interaction with residents was also observed and monitored, it was noted that the interaction was very good. Staff supported the residents in line with the written care plans. There was evidence during this inspection that there had been updated training on the storing and administration of medication. However details of medication that had been identified for disposal were not recorded. The manager said that they were waiting for a book to be provided by the waste disposal service. However the Registered Provider said that an appropriate record had been provided following the last inspection. There was no evidence of this on either day one or day two of the site visit. This meant that there was no record of medication leaving the home. Staff were observed appropriately administering medication. There were no locks provided to any of the bedrooms. This meant that it was possible for the residents to enter each other’s bedrooms whenever they wished. This issue was discussed with the provider who was reviewing the suitability of locks to be provided to bedrooms. The need for these to be able to be opened by staff by sue of one master key in an emergency was discussed. There were two bedrooms that had an adjoining door, there was no lock on this door. The Registered Provider explained that it was not possible to secure this door. These rooms were used as a passage way for residents who used the passenger lift to move from one side of the first floor to the other. There were no telephone facilities easily available to residents to make private calls from. This meant that the privacy and dignity of residents was not maintained. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 13 A number of residents were highly dependant and required high levels of support from staff. Staff were observed discreetly talking to residents about personal issues. The need for risk assessments on the use of Kirton chairs had been identified at the last inspection and the home was asked to produce these by July 06. This work had not been completed by day two of the site visit but had been completed by the third day of the site visit. Risk assessments for the use of these needs to include the length of time people use the chairs for and the time intervals for staff to monitor their use to ensure people’s comfort. Bed rails were seen to be used without the use of protective covers. The Responsible Individual informed the Commission that an audit of protective covers had been done and replacements provided to ensure that al rails have covers available. Staff had also been instructed to ensure that, if covers were being laundered, alternative protection should be used. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. Residents are supported to maintain some choices and preferences of lifestyle including choice of meals, the range of activities was varied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents told the inspector that they have choices in their routines and daily living activities; they were able to join in with the planned activities, but were able to have quiet time if they wished. There were a number of residents who were not able to join in a number of the activities. For these residents staff were aware of their likes and dislikes; such as music, and were provided with appropriate resources to assist them to meet these residents social needs. There were a number of more able residents who either sat in the conservatory or in a small lounge Residents confirmed that they could see their family and friends any time they wished. This was evidenced on the first day of the site visit. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 15 The inspector stayed at the home during the midday meal and this looked very appetising. The cook had prepared different choices for the residents and along with the carers, knew what each resident liked or disliked. A number of residents were on soft diets . Care staff were very attentive during the mealtime and helped any resident who need it in a relaxed and dignified way. Due to major building work being undertaken the dining room had been de commissioned and residents had to eat in their easy chairs. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. Management of dealing with complaints and the protection of residents from abuse was appropriate and offered residents protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is clearly written and staff and residents understand who they can go to and that they are entitled to voice any complaints and be listened to if they have any concerns. The complaints procedure was examined and assessed as offering residents and their relatives a procedure that enables people to be confident that complaints would be taken seriously and acted upon. Of those residents spoken to all confirmed that they were confident the staff would treat any concerns seriously. All staff confirmed that they were aware of the complaints process and all felt confident with using it. Training had been provided. The manager stated that staff training in respect of Adult Protection was a priority for all members of staff. Those staff currently employed had been provided with updated training on Adult Protection. The service had its own policy on Adult Protection. This policy is based on the No Secrets documentation. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and improvements were being made to improve the environment for residents. At the time of the site visit there was major construction work being undertaken. A fifteen-bed extension was being built to the rear of the home. Once completed there will be a new kitchen and upgraded laundry facility and a new passenger lift together with level access bedrooms and a hydrotherapy facility. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 18 Bedrooms within the existing home will also be upgraded. However as part of the process approximately half of the conservatory has been demolished. The remainder is accessible to residents. The dining room has been decommissioned and residents have to eat their meals at small over bed tables in the lounge. Some bedrooms were furnished and decorated to suit the individuals’ tastes and preferences Four bedrooms have been decommissioned. The Registered provider said that the decommissioning of the small lounge , the “quiet” room will be delayed to prevent the communal space available to residents being further reduced. Of those rooms that have been decommissioned on day one and day two of the site visit not all were locked. On the second day of the site visit the Registered Provider agreed to address this issue. No bed room had a lock fitted. No bedroom door had any means of identifying it to the resident other than a room number however as part of the refurbishment bedroom doors are to be renumbered. This may cause some problems for those residents who have memory problems and the home should research best practice in this area to minimise the risk of confusion for residents. Not all residents had access to lockable storage facilities in their bed rooms. The responsible individual has delegated some of the responsibilities of completing weekly checks on the fire system and other routine checks to a senior member of staff. The handy person continued to complete electrical testing of equipment and weekly water temperature checks. These were appropriately recorded. The builders have employed a consultant Health and Safety officer to complete a full Health and Safety and Fire Risk assessment on the building prior to building work commencing. The site foreman said that the consultant was due to re visit the site to review the issues during the building work. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 29 and 30 Quality in this outcome area is good. Effective recruitment and training processes competent staff members were employed. ensured that skilled and This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection the home was accommodating 20 residents. There were sufficient staff on duty to meet the assessed needs of those resident. The dependency needs of the residents was increasing. The registered manager stated that all new referrals were for more dependent residents. There were details of training programmes available to staff with allocated places, in the office. This included training on revised policies and NVQ training. Staff commented positively about training. Staff supervision records showed where training had been identified Files and records for four staff members were examined. Each file contained the necessary paperwork to show that the home operated good recruitment procedures. There was evidence of induction, supervision and training. However it was noted that on one file two references had been obtained for Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 20 one person from the manager and assistant manger at a previous home. It was recommended on the second day of the site visit that a third reference be sought from another employer. On another file it was noted that an address of one referee was identified as part of a Primary Care Trust (a local hospital) However on a third file the same address appeared as a private address of a member of staff. A recommendation relating to this has been made Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home was run in the best interests of the service users. Health and Safety arrangements were in place to ensure the environment was safe for the residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is suitably qualified and experienced and has managed the home for some years. There is evidence of good administrative systems, but some improvements were needed in the auditing of the use of the systems. Following the inspection the Responsible Individual confirmed that the requirements made at the previous inspection for the completion of risk Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 22 assessments for the use of Kirton chairs and for a record to be kept of disposal of medication have now been implemented. A development plan for the home has been written, this addresses all the requirements concerning the repair of the furniture, fixtures & fittings and provision of activities together with the development of the new unit. Appropriate records for fire, electrical installation, equipment and risk assessments were in place and up-to-date. There were detailed records of monies held on behalf of residents. Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 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 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 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 2 X X X X 2 x 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 24 yes 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 OP9 Regulation 13 Requirement A record must be kept of medication to be disposed. Previous time scales of1/4/05, 1/11/05 and 31/03/06 still apply and remain the date on which this requirement should have been met. Timescale for action 30/04/07 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 plan of care, where possible, must be drawn up with the involvement of the resident in a style accessible to the resident. Once agreed it must be signed for by the resident whenever possible and/or their representative. Within the proposed refurbishment the home should provide telephone facilities, which are suitable for the needs of service users and make arrangements to enable service users to use such facilities in private. 2 OP10 Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 25 3 OP24 Within the proposed refurbishment the responsible individual must ensure that: Locks are provided on residents’ bedrooms to respect privacy and dignity. The locks must be suited to their capabilities and accessible to staff in emergencies. The provision of keys must be the result of the risk management process. All residents should be provided with a lockable storage space. It is recommended that the Responsible Individual reviews existing and future references to ensure that any duplication of addresses or referees is identified and clarification sought 4 5 OP24 OP29 Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection CSCI, Local office 11th Floor Westpoint 501 Chester Road Old Trafford, Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Dove`s Nest Nursing Home DS0000021641.V326728.R02.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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