Inspection on 30/12/05 for Downside House

This inspection was carried out on 30th December 2005.

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

Downside House 18/07/07

Downside House 04/12/06

Downside House 10/02/05

Downside House 09/07/04

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

CARE HOMES FOR OLDER PEOPLE Downside House 3 - 4 St Boniface Terrace Ventnor Isle Of Wight PO38 1PJ Lead Inspector Mark Sims Unannounced Inspection 30th December 2005 11.15 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 Downside House DS0000044123.V250504.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. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Downside House Address 3 - 4 St Boniface Terrace Ventnor Isle Of Wight PO38 1PJ 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) 01983854525 01983 853606 Downside House Limited Mrs Keeley Groundsell Care Home 11 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (6), Physical disability over 65 years of age (4) Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2005 Brief Description of the Service: Downside House is situated within St Boniface Terrace, Ventnor and has wide sweeping views across the English Channel and St Boniface Down. The home is a combination of two Victorian town houses conjoined to create one premises, which has recently been tastefully extended. Accommodation is split between three floors all serviced by a passenger lift, the fourth floor comprising office space, training room and staff accommodation. The amenities of the local town are not easily accessed on foot, given the local geography, although public transport is accessible at the end of the road and the manager and staff often provide transport to the town if required. The home is currently registered to provide care and accommodation for up to 21 older people including up to 5 people over 65 years with additional physical disabilities, 3 persons over 65 years with mental health problems and 1 person under the age of 65 with a learning disability (this condition is for a named person only). Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken unannounced and formed the second statutory inspection of the year for Downside House Residential Home. The inspection focused on those core standards not addressed at the 7th August 2005 inspection and various sources of evidence were considered in the formulation of judgements: records, observations and discussions with service users and staff/management. What the service does well: What has improved since the last inspection? As mentioned above, the development work is progressing, although it has yet to be completed. In discussion with one of the company directors, it was ascertained that the areas currently being worked on should be competed by the end of the month, leaving some areas that are non-essential to the service users to be addressed at a slightly later date. It should be pointed out that the Commission for Social Care Inspection would not expect these areas of work to extend beyond March 2006, as the service users have experienced significant disruption during the extension and this now needs to be brought to a close. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 6 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. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 5. People have an opportunity to visit the home prior to admission to ensure it will meet their needs. EVIDENCE: It had not been the inspector’s intention to cover any of the standards within this section, having addressed the core standards at the previous inspection visit of 7th August 2005. However, whilst talking to a service user’s relative the subject of the resident’s admission to the home was discussed, with the relative explaining that the service user knew the home following a short period of respite some 4 or 5 years previously and that she had not wished to go anywhere else when it was decided that she required additional care. The relative had contacted the home prior to the resident being admitted and had visited with the manager, touring the premises and checking the room to be occupied. The relative also explained how she had been pleased or happy for her relative to be admitted to the home as she had heard good things Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 9 about the home from various sources before even re-establishing contact with Downside House. Since being re-admitted to the home both the service user and her relative have been impressed by the care and attention people are provided with, the staff being described as ‘very caring’. The relative also commented on the quality of the environment and described the accommodation and service as being comparable to that of a ‘hotel’. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 8 & 10. The health care needs of the service users are appropriately monitored and addressed. The rights of the service users to be treated with respect and dignity are promoted by the home’s caring and supportive ethos. EVIDENCE: During the inspection the inspector had the opportunity to observe and contribute to an interaction between the home’s manager, members of the care staff and a visiting Community Nurse. The circumstances, which had arisen and thus spawned the discussion, concerned potential conflict between a service user’s family and the wishes or instructions of the resident’s general practitioner, the doctor adamant that a specific treatment plan needed to be followed if the condition of the resident was to improve, the family on the other hand considered likely to disagree with this plan, as the secondary affects of the treatment might potentially have longer-term care implications for the service user’s needs. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 11 Throughout the discussion it was evident that all parties involved had the best interest of the service user at heart and that the issue being considered was the potential for compromise between the two perspectives, the concern being the upset any disagreement between the parties might have on the service user. At the end of the deliberation it was decided that the doctor’s request and need for diagnostic procedure(s) to be carried out before any medication therapy could be described would have to take precedent over the potential concerns of the family, as this was in the best interest of the service user. The service user, who due to cognitive limitations and the effects of the ailment, was perhaps not fully appreciative of the implications of the decision, nonetheless they were kept informed of the need to act and was prepared to acquiesce to the nurse’s advice, as the consequence of taking no action might be physically detrimental. It was later established with visiting family member(s) that the treatment plan implemented was acceptable and that they were satisfied with the interventions, which were obviously intended to improve their relative’s condition. They were given further reassured by the manager and her staff that they would manage any unfavourable side effects of the treatment and that the resident would be well looked after and comfortable. Full notes of the discussion and decisions reached were made in the service user’s plan, with additional notes made by the visiting nurse in the Community Nursing Team’s own records, copies of which are retained at the home whilst treatment is required. Later during the tour of the premises the inspector met with a representative of the resident who was happy with the outcome of the decision-making process; and appreciated that the treatment planned was in her relative’s best interest. The touring the premises actually enabled the inspector to visit several service users within their bedrooms, as well as spend time with people sat within the communal areas of the home. Through these contacts the inspector was able to observe the staff at work and was pleased to note the polite and professional manner with which the staff interacted with the service user and their families/visitors. It was evident from these observations that the staff are very familiar with how the service users and their relatives like to be addressed, with people Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 12 either addressed by their given name or a name of their own choosing, these preferences documented within the service user’s plan. In conversation with residents it was ascertained that they feel the staff are dedicated and committed to the service users and described them as nice, kind and caring people who are always around to help or assist when required. This view was supported by the comments of visitors, who felt the staff were always cheerful, polite and welcoming; and that their approach to care was second to none. Service users also confirmed that staff never enter their bedrooms without knocking or being invited and that care is taken to respect their wishes around rising and retiring times, the type of activity they undertake, where they go around the home and what they do, although the latter issues are tempered by the home’s risk assessments, which can on occasions indicate that action to restrict a person’s choice of activity might be required, as the potential for harm, either to themselves or others is too great. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 13 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): Standards 12, 14 & 15 People enjoy participating in the social, religious and recreational opportunities afforded them at Downside House. The ethos of the home encourages people to exercise choice and control of their lives. Service users receive a choice of meals, which are wholesome, appetising and well presented, which can be consumed wherever the person chooses. EVIDENCE: During the tour of the premises the inspector had time to speak with both service users and their families/visitors about life within Downside House. Generally, as highlighted within the body of the report, people find living at Downside House a positive experience, despite the recent upheaval and disruption caused to daily life by the development. In fact when asked about this specific issue people were quick to praise the builders for the way they have gone about their jobs and for the contribution they have made to the home socially over the preceding months including an impromptu carol service performed by several of the builders for the service Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 14 users, which was greatly appreciated and described as one of the funniest carol concerts a service user had ever been to. However, whilst the efforts of the builders to limit any disruption to the home’s day-to-day running should be acknowledged, the impact of their continued presence in the home is significant, as it is an indicator that the work on the new lounge, etc. is not complete, an issue the inspector felt personally was disappointing given its potential use at Christmas. It should however be acknowledged that the management and staff of Downside House, appear to have handled the loss of the large lounge area well over the Christmas period, utilising a smaller lounge and dining room to good effect when creating a festive atmosphere that was appreciated by those people spoken to during the visit. The Christmas Day festivities were mentioned by several service users and their representatives during the visit and described as relaxed, fun and enjoyable. For some people the day was made all the more special by the opportunity to go home to their families for lunch, etc. and the staff were thanked for their support in helping people get ready and organised. For those residents that opted to remain at the home the Christmas Day lunch was a positive experience, most people choosing to come down to the dining room to eat with their fellow service users. The lunch provided during this period was a traditional Christmas Day meal consisting of turkey, the trimmings and seasonal vegetables, which apparently was very well cooked and presented. Generally the home has a good reputation for the meals they serve and this was again confirmed through contact with the service users and their families, who felt sufficient choice and variety were provided by the home. During the tour of the premises the opportunity to check the food stores of the home arose and revealed that adequate stocks of fresh, frozen and preserved foods were maintained by the home. Fresh fruit and snack items, cake, etc. were readily available to service users, although being so close to Christmas most people seemed well stocked with sweets and chocolates anyway, some people accepting these will probably last them well into the New Year. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 15 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): Standard 16. The complaints process established by the home is well set out and structured and provides clear information on the role of the home and the Commission in investigating and resolving people’s complaints/concerns. EVIDENCE: The complaints process operated by the home is uncomplicated and designed to comply with the recommended format of the national minimum standards. Details of complaints made to the home are recorded using the home’s complaints logging system, which also documents outcomes and resolutions to complaints addressed internally. In conversations with several of the residents it was clear that their understanding of the complaints process was rudimentary, people stating that they would speak to the manager, etc. if they had any issues to raise or complaints to make. In discussions with the staff and management it was clear that all parties understand their role within the complaints process, understood the role of the Commission in reviewing, unresolved complaints and appreciate the need for good record-keeping. The willingness of service users, etc. to approach staff, the senior on duty or the manager should ensure the right people are informed of any concerns or problems. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19. The environment is improving, however some areas of the property and development require attention. EVIDENCE: On the whole the tour of the premises was reassuring, as those areas of the home recently added, with the completion of the extension, etc. are new, clean and well furnished, as would be expected. However, within these areas of the home it was noted that considerable cracking has occurred within the plaster; and this will need addressing as soon as possible, as it is unsightly and any delay in attending to the damage will prolong the disruption for service users. Within the existing areas (the original building) of the home the work to redecorate and refurbish the property continues, with several bedrooms being reshaped and a link corridor to the new lounge decorated Whilst it is understood that most of the outstanding work to be completed is cosmetic, it is important that every effort to finish be made, as again the disruption to the Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 17 service users’ day-to-day lives has been extensive and should now be brought to an end. One particularly important issue identified during the tour of the premises was the decrease in natural light in a downstairs bedroom, the result of an existing door and window being covered up by an external wall added during the creation of the extension. Whilst the room still has one window, this is recessed and opens up onto a covered walkway, thus reducing the light admitted. During previous meetings and visits to the home it has always been understood that the new wall, built in conjunction with the extension, would have a window or alternative opening included, which would admit adequate light, this issue will now require appropriate attention. A plan will also need to be submitted to the Commission indicating how the directors intend to address the issue of the rear garden, which to date remains a building site and inaccessible to the service users. Whilst it is acknowledged that winter is perhaps not the best time of year for the garden to be repaired and developed, plans for how the garden is to be set out, etc. can be drafted and a date for the commencement of the remedial works necessary scheduled. It is also important to ensure that fire escapes, etc., like that leading from the home to the rear fire safety zone, must remain clear of rubbish and debris, thus maintaining a clear and safe means of exit from the property in the event of fire, it being evident during the tour of the premises that the builders had left the fire escape impassable. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 28 & 30. Staff training is sufficient to ensure appropriately skilled employees who are competent in their jobs care for service users. EVIDENCE: To date 8 of the home’s 15 staff possesses a National Vocational Qualification (NVQ) at level 2 or above with a further 3 care staff in the process of completing their NVQ qualification. Currently this means that 53 of the staff team hold an NVQ qualification, which should rise to 73 in 2006 when the additional staff complete their courses. In addition to the NVQ courses made available to the staff the company also offer staff the opportunity to attend core-training events: • • • • • Moving and Handling Health and Safety Fire Safety Infection Control Food Safety Staff are also afforded the opportunity to attend courses that are not considered core to the business but are essential for the care and protection of the service users: Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 19 • • • Parkinson study day Medication Courses Mental Health In discussions with the staff it was evident that they are pleased with the levels of training provided and the opportunities to develop new skills or increase existing knowledge. In discussion with the manager, her plan to develop the role of the home’s previous deputy manager, who now works voluntarily, to include an element of training and training development were discussed. It is hoped that this specific role will be more focused and help to ensure that any training programmes scheduled will be based on the needs of the staff both developmentally and/or educational. It was also evident from talking to the service users that they appreciate the caring qualities of the staff, which could be attributed to their training and skills development, although the service users had little insight into the training completed by staff. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33 & 35. The home is well run by a manager who is appropriately skilled and qualified. The interests of the service users are safeguarded by the home’s quality auditing process. The home’s approach to supporting service users manage their finances enables people to be self sufficient and/or able to purchase items as they wish. EVIDENCE: The manager is a skilled and competent leader who possesses both a managerial qualification ‘The Registered Manager’s Award’ and relevant care qualification ‘National Vocational Qualification level 4 in Care’. In addition to undertaking the role of registered manager, Mrs Groundsell is also a company director and therefore well placed to ensure the home performs in accordance to the standards expected by the company. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 21 In conversation with the service users and their families it was established that the manager, as with all of her staff, are considered approachable, supportive and caring people, who have the best interest of the service users at heart, views supported by a visiting health professional. Quality management issues are at present being handled by the home’s manager, with service user and relative satisfaction surveys, environmental audits, reviews of the records and record keeping practices and the updating and monitoring of policy and procedure for the company undertaken. In conversation with service users, it appeared that a large percentage of the company’s quality assurance process is unfamiliar to them, although the relatives of people are familiar with the questionnaires about the service, staff and facilities. The service users were also unfamiliar with the quality co-ordinator position, although they obviously appreciated who the manager was and confirmed that she often spends time in the home speaking to them with regards to their feelings of how the service is performing. As a company with several directors the home should receive regular visits from one of the directors, in accordance with Regulation 26 of the Care Homes Regulations. However, records held by the Commission indicate that these visits are either not taking place or copies of the reports to be produced are not being appropriately sent on to the Commission, an issue which requires attention. The company historically prefer not to become involved in the direct management of service users’ finances, offering instead to support people through the provision of a tick system, the home purchasing all items required by a service user and billing or invoicing them at the end of the month. Presently the home is supporting two service users to manage their monies, although in total this consists of securing the money on their behalf and returning it to the service users when they require, full accounts for this process were available. Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation Requirement Timescale for action 31/01/06 Regulation Issues affecting the ongoing 23 development were raised as concerns at the previous Inspection: 07/08/05. The areas of the home still undergoing redevelopment must be attended to as a matter of priority. The issue of natural light within the downstairs bedroom must be addressed via a plan to the Commission. The issue of the garden must be addressed via a plan to the Commission. The repairs within the new build areas of the home must be undertaken to reduce disruption within the home. Regulation Copies of all reports written in 26 accordance with Regulation 26 must be submitted to the Commission (monthly). 2 OP33 12/02/06 Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Downside House DS0000044123.V250504.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Downside House DS0000044123.V250504.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!