Inspection on 07/04/09 for Eva`s Folly

This inspection was carried out on 7th April 2009.

CQC 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 CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Eva`s Folly 02/05/07

Eva`s Folly 29/11/05

Eva`s Folly 08/06/05

Eva`s Folly 29/10/04

Eva`s Folly 24/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report CARE HOME ADULTS 18-65 Eva`s Folly 33 Parrock Road Gravesend Kent DA12 1QE Lead Inspector Gary Bartlett Unannounced Inspection 7th April 2009 08:00 Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eva`s Folly Address 33 Parrock Road Gravesend Kent DA12 1QE 01474 320653 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) Ms Rosemary McGinty Ms Kay Reeves Ms Rosemary McGinty Ms Kay Reeves Care Home 8 Category(ies) of Learning disability (0) registration, with number of places Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 8. Date of last inspection 2nd May 2007 Brief Description of the Service: The home provides care and accommodation for 8 people with learning disabilities and some mental health difficulties. The owners (who both manage the home) are registered nurses. They maintain close connections with local organisations concerned with developing services for people with learning disabilities. There are staff on duty 24 hours per day to support service users with daily living tasks and the activities they wish to do. The people living in the home are supported to help with the running of the home and are supported to develop their skills. Each person has their own bedroom. There are comfortable facilities that include a kitchen, dining room, lounge, conservatory, garden and an external office. The home is 10-15 minutes walk from the town centre and there is easy access to public transport. There is a walled garden at the rear. The home has its own transport. The base fee for this service is £580 per week. Fees are calculated following the assessment of the persons need. Details can be obtained from the provider. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Eva’s Folly from 8:00 a.m. until 1.00 p.m. and from 3.30 p.m. until 5.45 p.m. Judgements about quality of life and choices were taken from direct observation and by discussion with one of the Managers, residents and staff. Some records and parts of the building and grounds were inspected. The Manager had completed an Annual Quality Assurance Assessment, from which information was used to inform the inspection process. The Inspector would like to thank everyone involved for their contribution to the inspection. What the service does well: What has improved since the last inspection? Some parts of the home have been redecorated and refurbished. A large screen television has been installed in the lounge, which also has a new carpet and new dining room furniture has been bought. A new care planning system has been introduced. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 6 The home is using a different monitored dosage system for medicines that better suits their purposes. Hospital-style beds and lifting equipment are provided for people that need them. A removable ramp is now available for wheel chair users and a low-level access shower has been fitted. A car adapted for wheelchairs has been purchased. More staff are NVQ trained. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 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 Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident they will have an accurate assessment of their needs before they move in to help ensure Eva’s Folly is the right home for them. EVIDENCE: The home has an assessment and admission policy and procedure to help ensure each admission is undertaken in a planned way. The people living at Eva’s Folly have been there for a number of years and there have not been any new admissions in recent times. The Manager described how prospective residents would only admitted to the home after a full assessment of needs. These are inclusive of relatives and health care professionals and are the starting point for residents’ individual care plans. Further assessments are undertaken after the resident had been admitted to the home. The records sampled included assessments of personal support, health care needs, religious and cultural needs and social interests. If prospective Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 9 residents are assessed to be suitable for the service, arrangements are made for them to visit the home, where they can have a meal and attend social functions to enable them to get to know the staff and those who already live at Eva’s Folly. The AQAA indicates the home intends to amend the Statement of Purpose and Service Users Guide to make them more “user friendly”. It is also intended to review the preadmission documentation to ensure it is fully compatible with changes brought about by the introduction of the Mental Capacity Act 2005. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident their needs will be met and that they will be consulted about how this will be achieved. Risk management systems promote their safety and independence. Improvements to recording systems would better show how this is achieved. EVIDENCE: The judgment for this outcome group has taken into account the quality of life for all the residents. It also includes an assessment of the level of knowledge and understanding displayed by staff when providing care. Comments made by residents and staff, observation during the site visit and the previous Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 11 inspection report, all indicate the standard of care provided is good. Residents convey that staff are fully aware of their needs. Staff are aware of far more information than is recorded in care plans and a lot of information is shared verbally. The three care plans sampled included information about individual preferences regarding personal care, interests and activities. The Managers are aware that daily records of care need to be more consistently and carefully written to accurately reflect service users’ current welfare and the care given. Accordingly, the records are being monitored and guidance given where required. Staff should also be encouraged to report positive activities and things individuals have achieved or enjoyed doing. This gives a fuller picture of the person’s lifestyle and helps staff when it comes to reviewing care plans. Risk assessments are in place relating to a range of activities. The Manager undertook to ensure that risk assessments are consistently written or reviewed in response to incidents that occur. Residents have regular opportunities to contribute their views and ideas with regard to activities and menus and are generally well supported in this. Many people at the home have difficulties in expressing themselves. Accordingly, although staff have the knowledge, care plans should be clear about residents’ preferred and most effective ways of communicating. In recognition of residents’ communication difficulties, the AQAA indicates it is intended to encourage them to visit the “well man” and “well woman” clinics at the GP surgery for general health overviews. It is clear that residents have confidence in the staff team and observed interaction was warm and friendly. There are policies and procedures in place in respect of data protection and confidentiality of information. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can take part in the activities of their choice and to be a part of their local community. They enjoy a range of leisure activities and are supported to enjoy appropriate relationships. Residents’ rights are respected and they understand their responsibilities in the home. Residents enjoy a healthy diet with plenty of choice. EVIDENCE: Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 13 Since the last inspection, some people living at Eva’s Folly have become increasingly physically and mentally frail and two are now predominantly confined to wheelchairs. This has resulted in a reduction in opportunities for them to have social interaction. It has also prevented the home from having as many spontaneous outings as previously. In recognition of this, staffing levels have been reviewed and the home is currently advertising for additional staff. The home has also procured a car adapted for wheelchairs recently. Generally, the people living at the home continue to have busy lives and are consulted about the activities they would like to do. Most people attend day centres or colleges. Those spoken with say they enjoy their activities. Some people said they enjoy going to the theatre, cinema and bowling. The home is close to the centre of the town where there are shops, pubs and restaurants and records show that residents are encouraged and supported to use these local community facilities. Individuals do not have keys to their bedrooms as they do not wish to lock their rooms. There are not currently any residents who have expressed a desire to attend religious services or practices. Staff described how they would be supported should they choose to do so. People living at the home can receive visitors when they wish and have use of a telephone to call family and friends. Staff spoken with understand the need to support residents in building and maintaining appropriate relationships. The menus seen offer a balanced and nutritious diet. The menu is used as a guide and is flexible to include choices and people’s lifestyles. People’s likes and dislikes and cultural needs have been considered. Those spoken with said they liked the food and take turns in cooking. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from sensitive and flexible support that meets their individual needs and preferences. EVIDENCE: Discussion with staff clearly shows they are aware of the type and nature of the support required for individuals’ care needs. Staff have a very good understanding of the preferred routines and varying requirements of each person. They provide flexible support to residents based on individual choice and personal care is provided in private to promote their dignity. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 15 Through discussion with the staff and residents and assessing the three care plans, it is evident residents have ready access to health and social care professionals. Residents are supported with any routine and specialist appointments. When the Annual Service Review of Eva’s Folly was done in April 2008, a survey completed by a care Manager indicated good communication and standards of care and the promotion of individuality. The Manager said she is about to review the current facilities for the storage of medicines to ensure they fully comply with the latest guidelines from the Royal Pharmaceutical Society. The Medication Record Administration Record (MAR) sheets seen were completed appropriately. Medications are only administered by staff authorised to do so. No residents staying at Eva’s Folly currently manage their own medicines. Staff said that if a resident wished to do so, there would be risk assessments for this. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected clear policies and procedures. They are encouraged to offer comment or complaints. EVIDENCE: The complaints procedure is readily available to people who use the service. They say they feel confident they are listened to and any necessary action is taken. The Home keeps a record of all complaints received by them, the result of the investigation and how the complaint has been resolved. The AQAA indicates the home has not received any complaints in the last twelve months and the Commission has not directly received any information regarding complaints about the home since the last inspection. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The staff spoken with have a sound understanding of safeguarding vulnerable adults procedures and of the need to be mindful of individuals needs. A senior staff member stated any allegation of abuse would be referred to the concerned agencies without delay. There have not been and safeguarding alerts in the last twelve months. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 17 Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable and clean home. EVIDENCE: Eva’s Folly is a Victorian listed building. This restricts the changes and adaptations that can be made to the environment. Some changes have been made to accommodate the needs of residents who have become more physically frail. Hospital-style beds and lifting equipment are being provided for people that need them. A removable ramp is now available for wheel chair users and a low-level access shower has been fitted. The Manager described Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 19 how she is planning to change the dining room arrangements to facilitate easier access for people in wheelchairs. Eva’s Folly offers a homely and comfortable environment for people to stay in. The lounge is of a good size, has had a new carpet fitted and a large screen television has been installed. There is an ongoing programme of redecoration and refurbishment. Residents say they find the bedrooms comfortable and the bathroom and toilet facilities are adequate for their purposes. The Manager agreed to ensure that all bathroom and toilet locks could be opened from the outside in the event of an emergency. A part time Housekeeper is employed and those parts of the home seen are commendably clean and free from offensive odours. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from the support of enthusiastic and committed staff, who demonstrate a good understanding of residents’ individual needs and preferences. EVIDENCE: Robust recruitment processes are followed to ensure only properly checked people work at the home. People applying to work at the home have to complete an application form, provide two references, have POVA and Criminal Records Bureau (CRB) checks and attend an interview. From observation and discussion, it is clear the staff are very focussed on the needs of the people living in the home and work closely with them. Residents Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 21 like the staff and find them approachable, friendly and kind. Throughout the site visit there was evidence of good relationships between staff and residents. Staff say they enjoy working with the residents and this is reflected in the way care and support is given. Staff clearly know the residents well and how best to put them at ease. There is an induction programme in place for new staff and there is ongoing training for all staff. Staff speak of regular training and there are certificates on their files. The AQAA indicates 80 of staff are NVQ qualified. The Manager acknowledges a training matrix would give a management overview of courses attended and those booked. As detailed earlier in this report, some residents’ dependencies have significantly increased in a short period of time. In recognition of this, staffing levels have been reviewed and the home is currently advertising for additional staff. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Managers are committed to providing a good service and the home is well run in the best interests of residents. There is an open and friendly atmosphere. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 23 EVIDENCE: The two owners jointly manage the home and are both registered nurses. They continue to update their knowledge through training and conferences and networking with Social Services and other professionals. Residents and staff find the Managers approachable and supporting. The Manager described how there is a quality assurance process is in place, which elicits views from residents and their relatives. The Manager said it will be extended to include the views of health care professionals and Care Managers. The standard of cleanliness in the kitchen and surrounding area is as good as the existing facilities permit. There are records of fire systems checks and fire drills and training. Staff and residents spoken with have a good understanding of emergency procedures. The Manager stated that records of maintenance and safety checks are in order. This is confirmed in the AQAA. These were not inspected on this occasion. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 3 X Version 5.2 Page 25 Eva`s Folly DS0000023926.V374841.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It is strongly recommended the Managers proceed with the intended improvements to the care planning system. The system used should give clear evidence of: How care and support needs are to be provided. How they have been met. Give a true evaluation of activities of daily living including how these link to care plan issues. It is strongly recommended risk assessments are more consistently written and reviewed in response to incidents. It is recommended the quality assurance system be developed to include obtaining the views of health and social care professionals. 2. 3. YA8 YA39 Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 Page 26 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Eva`s Folly DS0000023926.V374841.R01.S.doc Version 5.2 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!