Inspection on 30/05/08 for Eastwood House

This inspection was carried out on 30th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Eastwood House 06/12/07

Eastwood House 19/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Eastwood House 7 Eastwood Avenue Grimsby North East Lincs DN34 5BE Lead Inspector Rob Padwick Key Unannounced Inspection 30th May 2008 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eastwood House Address 7 Eastwood Avenue Grimsby North East Lincs DN34 5BE 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) 01472 278073 Mrs Christine Lyte Manager post vacant Care Home 16 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (8) of places Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2007 Brief Description of the Service: The home is situated in a residential area of Grimsby. It is a converted domestic house and has been extended; there is large conservatory to the rear of the house and a small garden. The home is easily accessible and is on a bus route. The home provides care for 16 elderly people, some with dementia. Bedrooms are provided on both the ground and first floors; there is a lounge and the conservatory is used as a dining room. Fees for living in the home vary from £329 to £400 a week with additional charges for toiletries. This information was on display within the home. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home which took place on 6th December 2007 and a subsequent Random Pharmacy inspection that was carried out on 3rd March 2008, together with information gained during a site visit to the home. As part of the inspection process we send out an Annual Quality Assurance Assessment (AQAA), which is a self-assessment document, which the registered person completed and returned to the Commission. The site visit took place on 30th May 2008 and lasted for 8 hours. For part of this time the Inspector was joined by a fellow Pharmacist Inspector and some of his findings are included in this report. As well as talking with the acting manager we talked to two staff members and to some of the people living in the home. We looked round the home including their rooms and the shared areas of the home, and inspected the records of people’s care, some staff files, the health and safety documents and other records maintained in the home. What the service does well: What has improved since the last inspection? Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 6 Good progress had been made to develop the home and to implement the requirements and recommendations made at the last time we visited the home. A lot of work had been carried out to develop the care plans in the home, so that staff had better information about how they should support the people using the service. A member of staff had been appointed to develop the range of activities so people using the service had more opportunities for their social stimulation. Medication administration practices were observed to have improved since the last time we visited and the provider taken advice from a local pharmacist about the storage of these. Improvements had been made to the building with locks and fire safety devises fitted to most of the bedroom doors and the bathing facilities had been upgraded. Work was in the process of being carried out to improve the hot water supply throughout the home. The staff training and development programme had been improved so that they were equipped with the skills needed to meet the needs of people living in the home and maintenance procedures and records keeping about aspects of safety had been developed to ensure the health and welfare of people using the service was promoted and protected. 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. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 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 Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use this service experience adequate outcomes in this area. Whilst people living in the home had been satisfactorily assessed, a more robust admission processes would enable the home to meet their needs better. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We inspected the files of three people living in the home and all contained information about their assessed needs that had been carried out by either Local Authority or staff working for service. We were told people are generally visited as part of the home’s admission process to assess their needs, however as no one had moved into the home since the last time we visited, it was difficult to confirm how good this assessment process was. The acting manager told us that intermediate care is not provided in the home. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 9 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): 7, 8, 9 and 10 People who use this service experience adequate outcomes in this area. Whilst care plans had been developed to support the needs of people living in the home, better medication procedures were needed to ensure that their health needs are safely met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw evidence of improvements carried out to develop the care plans of people living in the home to ensure staff had information about how they liked their needs to be met. The care plans were generally of a good standard, with information about a range of their individual physical, emotional and psychological needs. These tended however to focus on the assessed needs of people using the service, whilst ignoring their individual strengths. Whilst some evidence was available people using the service had been consulted about their care plans, it is recommended these are further developed to provide more information, so staff can support them better and help maximise opportunities for the promotion of their well being. Whilst we saw evidence that care plans were generally being reviewed satisfactorily, we saw some evidence this needed to be carried out more consistently in order to reflect the Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 10 changing needs. The case files inspected contained assessments of a range of known risks to people living in the home, however we saw some evidence these needed to be further developed. The accident records contained evidence of a number of falls occurring to people using the service and we observed a number of bed rails in use, but saw no assessments for these, which placed people at risk of potential harm. People living in the home indicated their health needs were met and the case files inspected contained regular recordings about aspects for this. A visiting District Nurse who we spoke to indicated no concerns about the service and we saw evidence of prompt action taken over changes in medical conditions. People living in the home were observed looking clean and well looked after and we saw them being respectfully treated to ensure their dignity was maintained. Staff told us about training received since the last time we visited and we saw evidence of courses planned for the future to ensure they have the right skills needed for meeting the needs of people living in the home. Some improvements had been made in medication storage and supply arrangements since the last pharmacist inspection and good practice existed in the way the home looks after medicines that may be at greater risk of loss or diversion. We saw excellent techniques for giving medicines to people and recording their use on the day of the visit. However their were gaps found during our examination of other records which suggested that medication administration and recording practices in the home are not consistently good enough to show that people always receive their medicines accurately as prescribed. The home still lacked an up to date and sufficiently detailed medication policy to guide staff in precisely how to look after and administer medicines in the home. Further training should be given to update all authorised staff about current best practice guidance. Regular checks should then be made to ensure all staff follow this guidance consistently. This will help to reduce the risk of medication errors. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 11 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): 12, 13, 14 and 15 People who use this service experience adequate outcomes in this area. Whilst improvements had been developed to ensure people living in the home with appropriate activities, further development of these would ensure their needs and choices about these are better met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Requirements had previously been made to ensure people living in the home are provided with opportunities and choices to enable them to take part appropriate activities, and we saw evidence of improvements made concerning these. The hours worked by the activities coordinator had been increased since the last time we visited, and we saw individual “Memory Lane” folders being developed for people living in the home to help staff engage with them better, in order to promote their well being. There was some evidence of external community contact with the service and staff spoken to told us about a trip that some people had recently been on and that a hairdresser visited twice monthly and outside entertainers sometimes arranged. The home has a visiting policy and the case files inspected contained evidence of visits and contacts from relatives. The activities worker told us about a course she was hoping to start to help develop her skills further, but whilst we saw evidence of improvements concerning the outcomes for people living in the home, a Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 12 recommendation is made these continue to be developed to maximise the opportunities for people using the service to take part in meaningful activities. At the last site visit, we made requirements that training is developed to ensure staff have the right skills to work with people living in the home. Staff told us about things recently learnt on a dementia course but whilst staff records provided evidence of the work carried out by the provider, we recommend this is further developed to ensure they have more confidence and skills to engage more fully with people living in the home to ensure their wishes and feelings are respected. We observed people having a mid day meal of freshly prepared fish cake and chips and people living in the home told us the food served was of a good quality. We saw evidence that people living in the home could make choices about what they ate and that alternatives were provided for these. Evidence was seen that kitchen staff were following appropriate health and safety measures and case files inspected contained evidence that people using the service had been assessed for their nutritional needs and that their weight being monitored where this was needed. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 13 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): 16 and 18 People who use this service experience adequate outcomes in this area. The concerns and complaints of people living in the home were taken seriously by staff that had received training to ensure they were safeguarded from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home indicated they were generally happy with the service and would talk to staff if they had any concerns. No formal complaints had been made to CSCI about the home since the last time we visited, and we saw evidence that none had been received by the provider. Staff indicated they would take appropriate action if they had any concerns relating to the protection of people using the service and the staff records inspected provided confirmation of training about this. However whilst the service had an appropriate complaints policy and procedure, their were a number different versions for this which could lead to possible confusion. A minor error was found in the records of monies kept on behalf of people living in the home and we saw evidence that the home’s recruitment practices needed strengthening. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 14 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): 19 and 26 People who use this service experience good outcomes in this area. People living in the home were provided with an environment that was generally very well maintained in order to ensure their needs were met in a comfortable and homely way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was very clean, bright and tidy and there was evidence the provider was maintaining the building to ensure it provided an environment that could comfortably meet the needs of the people using the service. We saw evidence of good progress to implement requirements made at our last visit to the home. Fire safety devices had been installed to bedroom doors and windows throughout were now fitted with restrictors, although a relative commented these sometimes limited the extent ventilation possible. A recommendation was made that the risk assessments for these are reviewed and that specialist advice is obtained about how far these can safely be opened. Repairs had been made to radiators to ensure they did not pose a risk to people using the Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 15 service and a new shower room installed, with further work being carried out to ensure the water supply provides a more consistent flow of hot water. Maintenance records contained evidence of safety checks being generally satisfactorily carried out and plans were seen of the provider’s intentions to upgrade the building further. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 16 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): 27, 28, 29 and 30 People who use this service experience poor outcomes in this area. Whilst staff training had been developed to ensure the needs of people living in the home were met, poor recruitment practices placed them at risk from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed interacting with people using the service in a friendly and sensitive manner and we saw evidence of improvements made to ensure they could do their jobs. Since the last time we visited the provider had developed the staff training and development plan to ensure they are provided with mandatory training and those staff spoken to told us about various courses they had done and others they were booked to do in the near future. Information given to us by the provider indicated plans for this developing this programme further and whilst we saw evidence in the records that staff were receiving professional supervision, a recommendation is made this is carried out more regularly. The home had recruitment policies and procedures to ensure staff are safe to work with people living in the home, however we saw evidence these need to be followed more robustly. The file of a newly recruited member of staff we inspected failed to provide evidence of satisfactory checks carried out before they had started to work in the home. This is a poor recruitment practice, which potentially places people using the service at risk of harm. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 17 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): 31, 33, 35 and 38 People who use this service experience adequate outcomes in this area. The management and administration systems for the service needed further development to ensure the smooth and efficient running of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We made previous requirements that the service has a manager who is registered with the Commission for Social Care Inspection and saw evidence the provider had interviewed someone they were hoping to appoint for this post. However, whilst good progress had been made in carrying out improvements to the service since the last time we visited, we saw evidence that more work was still needed to ensure its smooth running. We saw evidence that some of the home’s administrative systems needed improving, Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 18 as a number of policies provided inaccurate or inconsistent information and some had not been updated or reviewed for a number of years. Whilst the home had quality assurance systems that enabled it to consult people using the service about their views on its provision, their was some evidence more effective checks were needed on aspects of the service, to ensure it is run in their best interests. The records of monies kept on behalf of people living in the home that were inspected contained a minor error and we saw evidence that staff meetings were not taking place very regularly. Whilst previous requirements about safe working practices had been carried out and safety checks were generally being carried satisfactorily, we saw evidence that some risk assessments relating to the use of bed rails and risks of people falling which were needed in order to ensure their health, safety and welfare. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 19 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 X X 1 Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 20 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 OP9 Regulation 13 Requirement The registered person must ensure that an up to date medication policy and set of procedures to ensure all staff know exactly what is expected of them when handling and administering medicines. Previous timescale of 30/04/08 not met. The registered person must ensure all medication is administered as prescribed and a record made at the time it is given. Accurate records must be kept for the receipt, administration and disposal of all medicines. A system must be in place to check expiry dates of medicines including those with limited use once opened. Together, this will help to make sure that people receive their medicines correctly and that medication is safe to administer. The registered person must ensure the staff are fully inducted into the home and are competent to do their jobs and the potential for recording errors is minimised. DS0000067250.V365686.R01.S.doc Timescale for action 30/06/08 2. OP9OP9 13, 18 30/06/08 3. OP28OP28 18 30/07/08 Eastwood House Version 5.2 Page 21 4. OP29OP29 19 5. OP29OP29 18, 19 6. OP31OP31 4, 12, 24, 26 7. OP31OP31 10, 12 8. OP35OP35 12, 17 9. OP38OP38 15 The registered person must make sure that all staff have undertaken a CRB or POVA first check prior to commencing work in the home in order to ensure they are safe to work with people living in the home. Previous timescale of 31/12/07 not met. The registered person must make sure that the staff files contain evidence of positive identity to ensure staff have been checked they are safe to work with people living in the home. The registered person must ensure that the service has a manager who is registered with the Commission for Social Care inspection. The registered person must ensure that there is a consistent set of policies and procedures which are updated and reviewed to ensure people using the service are safeguarded from potential harm The registered person must ensure accurate records are maintained of monies kept on behalf of people using the service in order to ensure their financial interests are safeguarded. The registered person must ensure the use of bed rails are assessed and that people using the service have been assessed for risk of falls to ensure the health and safety of people living in the home. 30/06/08 30/06/08 30/07/08 30/08/08 30/06/08 30/06/08 Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 22 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. Refer to Standard OP3OP3 OP7OP7 Good Practice Recommendations The registered person should ensure that there are robust admission procedures developed to ensure the service can meet the needs of people living in the home. The registered person should develop the care plans belonging to people living in the home to include more information about their individual strengths and abilities in order to help staff support and promote their well being better. The registered person should ensure handwritten entries and changes to MAR charts are accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The registered person should ensure that a system is in place to record medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. The registered person should ensure the temperature of the medication room is regularly monitored. This makes sure that medicines are being stored at the temperature recommended by the manufacturers. The registered person should ensure the prescriber or community pharmacist is asked to provide further information when a medicine is labelled ‘as directed’ or ‘when required’. This makes sure that the medication is given correctly as intended. The registered person should continue to develop the activities programme in order to maximise opportunities for people using the service to take part in meaningful activities. The registered person should ensure staff are equipped with the confidence and skills needed to engage with people living in the home about their wishes and feelings. The registered person should review the risk assessments about the dangers to people from unrestricted windows and seek professional guidance concerning how far these can safely be opened. The registered person should continue to ensure that 50 of the care staff are trained to a National Vocational DS0000067250.V365686.R01.S.doc Version 5.2 Page 23 3. OP9OP9 4. OP9OP9 5. OP9OP9 6. OP9OP9 7. OP12OP12 8. 9. OP12OP12 OP19OP19 10. OP27OP27 Eastwood House 11. 12. 13. OP31 OP31OP31 OP33OP33 Qualification (NVQ) level 2 in care or equivalent. The registered person should ensure that regular staff meetings are held to ensure that a clear sense of leadership is communicated to staff. The registered person should ensure staff supervision is regularly carried out to ensure that professional career development is provided to them. The registered person should develop the quality assurance systems to enable regular checks of the service in order to monitor and evaluate the smooth running and effectiveness of the home. Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Eastwood House DS0000067250.V365686.R01.S.doc Version 5.2 Page 25 - 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. 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