Inspection on 21/12/05 for Duckyls Farm Centre

This inspection was carried out on 21st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Duckyls Farm Centre 03/07/09

Duckyls Farm Centre 30/07/08

Duckyls Farm Centre 13/06/06

Duckyls Farm Centre 20/07/05

Duckyls Farm Centre 04/11/04

Duckyls Farm Centre 28/06/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Duckyls Farm Centre Selsfield Road West Hoathly West Sussex RH19 4QY Lead Inspector Ms V Khan Unannounced Inspection 21st December 2005 11:30 Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 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 Duckyls Farm Centre DS0000014490.V268935.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Duckyls Farm Centre Address Selsfield Road West Hoathly West Sussex RH19 4QY 01342 811111 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 Brian James Jack Mrs Karen Heidi O`Neill Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2005 Brief Description of the Service: Duckyls Farm Centre is a care home registered to provide accommodation and personal care for up to seven people between the ages of 18 and 65 years with learning disabilities. It is privately owned by Mr Brian Jack, with Mrs Karen O’Neill managing the service. Duckyls Farm Centre is in a rural area, located on the outskirts of the village of West Hoathly in West Sussex. The home has many of the characteristics and features of traditional farmhouse. Communal rooms are on the ground floor and seven single bedrooms are on the first floor. There are extensive grounds with an organic vegetable garden and livestock. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector started the unannounced inspection at 11.30 am. The inspection lasted a total of four hours. The inspector spent time talking with service users, the manager and staff on duty. Time was also spent walking around the home and looking at paperwork. Six service users are currently living at Duckyls Farm Centre and there is one vacancy. Five service users were present for most of the inspection. One service user had gone to stay with family for the Christmas period. The other five service users were looking forward to going to stay with their relatives for Christmas. What the service does well: What has improved since the last inspection? What they could do better: All pre-employment recruitment checks need to be undertaken, before staff commence work. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 6 Staff training needs to be further developed, to include induction and foundation training, behaviour management including restraint, and infection control. The manager needs to continue with the formal supervision of all staff and a system for annual appraisals should be developed. The arrangements for the administration and storage of medication, including the self-administration of medication by one resident, needs to be reviewed. Risk assessments need to be reviewed and further developed. The laundry must not be used for the preparation and storage of food. The practice of service users paying for their own seven-day summer holiday needs to be reviewed. The whole system relating to staff paying for service users purchases and service users repaying Duckyls Farm Centre at a much later date should be reviewed. Mr Jack needs to undertake monthly unannounced visits, compile reports and provide a copy to the registered manager and the Commission, in accordance with Regulation 26. Arrangements for the storage of some records needs to be reviewed and amended. Records need to be available for inspection by the Commission at all times. 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. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 It is not known whether service users have individual contracts. EVIDENCE: The inspector asked to see service users individual written contracts, but the manager said Mr Jack was holding them. Arrangements should be put in place for the manager to be able to access all records that may be required for inspection. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 Failure to produce care plans means that members of staff may not receive sufficient guidance to provide the right care and support to meet service users needs. Risk assessments need to be further developed, to ensure that the safety and well being of service users is not put at risk. EVIDENCE: Since the last inspection, the manager has started to write care plans for service users, with three out of six completed. The manager needs to press ahead with this. Some old risk assessments are held on service users and the environment. The manager said that she has written a new risk assessment for one service user, but it was not available for inspection, as Mr Jack was holding it. Arrangements should be put in place for the manager to be able to access all records that may be required for inspection. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 10 The individual risk assessments need to be comprehensive, agreed with service users and any other relevant professionals, recorded in care plans, and reviewed on a regular basis. Action must be taken to minimise any identified risks and hazards. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 15 Opportunities are provided for service users to take part in leisure activities. Service users are supported in their relationships with family and friends. EVIDENCE: Duckyls Farm Centre has a craft room, where service users can participate in activities such as painting and weaving. Individual hobbies and interests are pursued, e.g. one service user attends yoga and another service user participates in football. Group trips are organised and a choice of entertainment is brought into the home. Service users are encouraged to utilise the local community facilities for their leisure. During the inspection, service users were taken to a local tourist attraction and to look at Christmas lights. Service users have opportunities to mix with people from the local village by joining in community events and visits to the local pub. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 12 Five service users went on holiday to Weston Super Mare in July 2005. Whilst looking through financial records at this inspection, it was discovered that service users paid for their own holidays. Standard 14.4 was discussed with the manager, which states that, ‘Service users in long term placements have as part of the basic contract price the option of a minimum seven-day annual holiday outside the home, which they help choose and plan’. Staff support service users to maintain family links and friendships inside and outside the home. Family and friends are welcomed to the home. One service user recently celebrated a birthday with a party at the home to which family and friends were invited. Five service users were looking forward to going to stay with their families for Christmas and one service user had already gone away for the Christmas period. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Any necessary personal support needed by service users is provided and their healthcare needs are being met. Service users may be put at risk because of the gaps in the medication administration sheets, storage of the medication cupboard key and also due to one resident self medicating without appropriate assessment having first been completed. EVIDENCE: All service users have good mobility and do not need any lifting. Appropriate assistance is provided to two service users with their shaving. All service users are able to bathe and shower without requiring any assistance from staff. Service users tend to retire to their bedrooms at around 9pm, to watch television in their rooms and to start settling down for bed. One service user likes to play computer games at this time in his room, and a system has been implemented whereby the amount of time he spends on the games is restricted for health and safety reasons. Specialist support from healthcare professionals is accessed as required. For example, one service user is awaiting an appointment with a speech therapist Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 14 and one service user has an appointment for a CT scan. A nurse from the community team for people with learning disabilities regularly visits one service user at the home. Service users are supported to attend routine G.P., psychiatric, dental and optical appointments. As per the last inspection, the arrangements for the storage of the medication cupboard keys need to be reviewed. The medication administration sheets were seen to have a couple of gaps. Service users consent to medication needs to be obtained and recorded in their care plans. One service user is still self-medicating, by being allowed to keep medication with him throughout the day in his pocket. There is no procedure to facilitate self-administration of medicines by service users and no risk assessment has been undertaken regarding this matter. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Staff in the home listens to service users and there is a complaints procedure in place. Service users are supported by staff who have been trained in adult protection. However, the unorthodox way of dealing with service users money could put them at risk of financial abuse. EVIDENCE: Daily morning meetings are held with service users and staff when the plans for the day ahead are discussed. A complaints procedure is in place at the home. Service users are able to approach any member of staff to raise any concerns. The manager has the West Sussex Social Services policy with procedures in her office. Adult protection training in the home has consisted of watching a video and completing questionnaires. The manager said that physical restraint does not need to be used in the home. However at the last inspection, inspectors discovered that a restraint had been carried out in June 2005. In case of any restraints needing to be undertaken in the future, the manager should ensure that physical intervention only be used as a last resort by trained staff in accordance with Department of Health guidance, to protect the rights and best interests of the service users and is the minimum consistent with safety. At the last inspection, the personal allowances policy was read, which was also explained by Mr Jack. On this visit to the home, the inspector accessed service Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 16 users personal financial records and read the book, which is used to record when money is paid out on behalf of service users. These were seen to have accumulated over time, resulting in service users repaying large sums of money. The manager explained that when service users go out shopping with staff, staff pay for service users purchases, e.g. slippers, shoes, clothes. This is then entered into the record book and service users then have to pay for their purchases at a later date. The inspector found the system confusing, some entries had been entered wrongly and it was unclear of how the amounts paid to the home by service users were worked out, as the amounts did not tally with the amounts that were entered in the record book. This was discussed with the manager, with suggestions made about how to change the system. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25, 30 Service users bedrooms are furnished and decorated to a reasonable standard. The home is generally clean and tidy. EVIDENCE: The inspector learned that service users enjoyed becoming involved in decorating the home for Christmas. Service users bedrooms are all on the first floor of the home. The rooms are a reasonable size and service users have personalised their rooms. None of the bedrooms have ensuite facilities. Since the last inspection, three service users bedrooms have been redecorated with new carpets fitted. Two service users also have new beds. The home was seen to be clean and tidy. However, staff are continuing to use the laundry as an extension of the kitchen to prepare and store food. This practice needs to be reviewed due to the guidelines of control of infection. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, 36 The failure to follow the correct recruitment procedure could mean that service users are put at risk. Staff training and supervision needs to be further developed, to ensure service users are supported appropriately. EVIDENCE: The inspector noted that the recruitment procedure had not been followed out properly. One member of staff had been allowed to start working and living at the home before the second reference and the enhanced CRB/POVA checks were returned. This poor practice could put service users at risk. The manager is reminded of the need to be completely thorough before allowing staff to commence working at the home. Staff training mostly consists of internal instruction, which involves watching videos and completing questionnaires. A training needs assessment should be carried out for the staff team as a whole, to identify training needs and to inform the development of a training and development plan. The manager has started the supervision of staff and to date one member of staff has received formal supervision. This needs to be further developed for all care staff in accordance with Standard 36.4. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 19 No staff induction records are maintained. The manager needs to ensure that all staff receive structured induction training (within six weeks of appointment) and foundation training (within six months of appointment) to Sector Skills Council specification. Written records should be kept as evidence of such training having been completed. Monthly staff meetings have started to be held at the home. Minutes read by the inspector showed that meetings addressed such issues as activities, service users, the garden, Christmas and the farm animals. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 40, 41, 42 The manager needs to review the policies and procedures, record-keeping and risk assessments to ensure service users are protected and their needs are met. Staff need to be trained in safe working practice topics, to ensure that they understand the risks to service users and themselves. EVIDENCE: In August 2005, Mrs O’Neill was registered by the Commission as the manager of Duckyls Farm Centre. Prior to this, Mrs O’Neill was working at the home as the deputy manager. Mrs O’Neill has completed three modules of the NVQ 4 training and from January 2006, intends to attend college once a week, to enable speedy completion. Mrs O’Neill needs a contract of employment that reflects her role and responsibilities as the registered manager. Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 21 Supplementary procedures that were produced by Mr Jack for ease of use by staff, are still in need of revision to ensure that they contain the necessary up to date information. For example, recruitment does not mention CRB/POVA checks, the prevention of abuse does not list all categories of abuse and medication does not include information on self-medication. Staff at the home have been recording all visitors to the home in the visitors book. Staff need induction and foundation training and training in safe working practice topics, e.g. infection control, to ensure safe working practices at the home. The manager needs to ensure that risk assessments are carried out for all safe working practice topics and that significant findings of the risk assessments are recorded. Under Regulation 26, Mr Jack, as the registered provider of the home, should undertake monthly unannounced visits to the home and interview some service users, their representatives and staff, to form an opinion of the standard of care provided at the care home. He should also inspect the premises, its record of complaints and events and prepare a written report on the conduct of the care home. A copy of the report needs to be supplied to the Commission and the registered manager. Duckyls Farm Centre DS0000014490.V268935.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X 3 X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 1 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Duckyls Farm Centre Score 3 3 1 X Standard No 37 38 39 40 41 42 43 Score 3 X X 2 1 1 X DS0000014490.V268935.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 YA6 Regulation 15 Requirement Care plans need to be developed for each resident. (Previous timescale of 20th October 2005 not met) All unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (Previous timescale of 20th October 2005 not met) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Previous timescale of 20th October 2005 not met) Ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. (Previous timescale remains) The registered person shall make arrangements by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Timescale for action 01/03/06 2. YA9 13 (4) 01/03/06 3. YA20 13 (2) 01/03/06 4. YA35 18 (1) 20/01/06 5. YA23 13 (6) 01/03/06 Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 24 6. YA30 16 7. YA41 26 (1) (3) (4) (5) 8. YA41 17 (3) 9. YA34 19 (1) The home needs to change the practice of using the laundry as an area in which food is prepared and stored due to the possible spread of infection. (Previous timescale of 20th October 2005 not met) Where the registered provider is an individual, but not in day to day charge of the care home, he shall visit the care home in accordance with this regulation. The registered person shall ensure that the records referred to in paragraphs (1) and (2)(a) are kept up to date; and (b) are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. The registered person shall not employ a person to work at the care home unless(b) subject to paragraph (6), he has obtained in respect of that person the information and documents specified in(i) paragraphs 1 to 7 of Schedule 2. 01/03/06 01/03/06 01/03/06 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA40 YA42 YA36 Good Practice Recommendations All policies and procedures need to be reviewed and amended as appropriate. All staff to receive induction and foundation training and updates on all safe working practice topics. The manager needs to press ahead with the supervision of DS0000014490.V268935.R01.S.doc Version 5.0 Page 25 Duckyls Farm Centre staff at least six times per year and implement an appraisal system. 4. YA20 Residents consent to medication needs to be obtained and recorded in their care plans. The arrangements for the storage of the keys to the medication cupboard need to be reviewed. A procedure needs to be developed, to include risk assessments, to facilitate the self-administration of medicines by residents. Training should be provided for staff in the use of restraint. Service users in long-term placements have as part of the basic contract price the option of a minimum seven-day annual holiday outside the home. The registered manager should be provided with a contract that reflects her role and responsibilities. 5. 6. YA23 YA14 7. YA37 Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Duckyls Farm Centre DS0000014490.V268935.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!