Inspection on 06/01/06 for Garthowen

This inspection was carried out on 6th January 2006.

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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garthowen 01/10/07

Garthowen 09/05/07

Garthowen 14/11/06

Garthowen 16/05/06

Garthowen 14/06/05

Garthowen 28/01/05

Garthowen 06/08/04

Garthowen 12/02/04

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

CARE HOME ADULTS 18-65 Garthowen 78 Barrowgate Road Chiswick London W4 4QP Lead Inspector Mr Gavin Thomas Unannounced Inspection 14.15h 6 & 25 January 2006 th th Garthowen DS0000022889.V260580.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 Garthowen DS0000022889.V260580.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. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Garthowen Address 78 Barrowgate Road Chiswick London W4 4QP 0208 995 9702 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) garthowen@together-uk.org www.together.org.uk Together Working for Wellbeing Oluminde Ojudun Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2005 Brief Description of the Service: Garthowen is a detached, three storey building situated in a residential area in Chiswick, close to local facilities and transport. The home is registered for twelve service users with mental health problems. The London Borough of Hounslow is the main purchaser and has blocked purchase seven of the bed places. The home is owned and managed by “Together Working For Wellbeing”. The accommodation has nine single bedrooms on the first floor. There is a selfcontained flat on the ground floor. Service users who are ready to move on to more independent living use the latter. The lounge is a designated smoking room. The dining room is comfortably furnished and can be used as a quiet area in between meals. There are no lifts in the building so it is only suitable for service users with good mobility. Service users are expected to participate in cooking, looking after their own laundry and helping with some domestic tasks around the home. After a settling in period, service users are expected to become more involved in some form of activity outside the house during the day. This is specified in their care plans. Key workers support service users to learn new skills and work in conjunction with other professionals in helping them to move on to independent living. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days for a period of 6.5 hours. The Registered Manager was on annual leave on the first day of this inspection. The Senior Support Workers were responsible for the day to day running of the home in the absence of the Registered Manager. All service users and staff spoken to were co operative throughout this inspection. What the service does well: What has improved since the last inspection? Out of the twenty – five requirements made at the previous inspection 11 requirements were met, 12 requirements were partially met and two requirements were not met. The home has done well to improve the management of medication. Controlled drugs are now being recorded in a hardback register. The home has also arranged for pharmaceutical audits to be carried out periodically. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Garthowen DS0000022889.V260580.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 Garthowen DS0000022889.V260580.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): 1&5 The Statement of Purpose presented for inspection purposes, lacked sufficient information about the services the home provides. EVIDENCE: A Statement of Purpose and Service User Guide were in place. The Statement of Purpose did not include all of the criteria as set out in Schedule 1 of the Care Homes Regulations 2001. Details of the former Regulatory (Lead) Inspector for this service must be removed from the Service User Guide. The frequency and types of statutory inspections must also be updated. The Senior Support Worker confirmed that written contracts were in place for all service users. Contracts are known as Resident’s License Agreement. One completed contract was examined for the purpose of this inspection. The content of the contract met with the criteria as set out in standard 5.2 of the National Minimum Standards for Care Homes for Adults (18-65). It was noted however, that the service user’s name was not added to the contract. The Inspector advised that the service user’s name should be added to the contract. Garthowen DS0000022889.V260580.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): 7 Service users are supported in ways to promote their rights to decision making unless agreed otherwise. EVIDENCE: Service users are required to attend key worker meetings. This gives service users an opportunity to discuss personal issues and matters in private. Outcomes of key worker meetings are recorded. Daily house meetings are held every morning. This gives service users an opportunity to discuss matters, which affect them as a household. Staff explained that any restrictions with regards to service users rights to make decisions are agreed with the service user prior to admission or at reviews. None of the current service users were attending self – advocacy groups. With the exception of one, all other service users were responsible for the management of their finances. Monies are kept for safe keeping by the home if individual service users request this. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 10 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): 15 & 16 Good systems were in place for enabling service users to maintain and where necessary re-establish relationships with families and significant others. Support in this home is offered in ways to promote service users rights to choice, individuality and independence. EVIDENCE: A visitor’s policy was in place. The policy included rules for over night stays. The home does not have separate sleeping facilities for visitors choosing to stay over night. Visitors are required to stay in service users bedrooms. Service users are supported for maintaining and re – establishing relationships with families and significant others. Contact arrangements are normally agreed with service users and families /significant others prior to admission. This includes any restrictions or frequency of visits. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 11 Where possible, service users visit families/significant others away from the home. Two service users spoken to said they had no concerns with regards to visiting arrangements. One service user also confirmed that they were able to meet up with friends away from the home. One service user explained that they would be less anxious if contact with their family was more regular. The Inspector advised the service user to discuss these matters with their key worker. The service user also agreed for the Inspector to address their comments with the Senior Support Worker on duty. All service users have keys to their bedrooms and the front door of the home. Service users receive their mail unopened. Service users are required to sign for their mail. This is judged to be good practice. Service users can choose to be alone or in the company of others. This was observed at the time of the inspection. All service users are required to contribute to daily tasks such as cooking and cleaning. A daily programme is agreed with service users to determine who is responsible for specific tasks. Staff carry out checks on service users bedrooms on a weekly basis. The Senior Support Worker said that all service users are aware of this procedure. Two staff carry out room checks at all times. Rules on smoking, alcohol and drugs were in place. These details are not included in the Residents License Agreement but issued to service users separately. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 12 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 Personal support is offered in such a way to promote service users’ dignity and privacy. EVIDENCE: Support systems were in place for service users to take more control over their lives including support strategies for promoting independence, confidence and maintaining relationships. Opportunities are available for service users to discuss personal and sensitive matters on a one to one basis. All service users are responsible for maintaining their personal care needs. However, there are occasions when staff may need to prompt service users. Service users receive specialist support and advice when required. This was observed at the time of the inspection when the Occupational Therapist was visiting one service user. All service users have regular appointments with the Community Psychiatric Nurses at the home. Service users also registered with clinical specialists at St Bernard’s Hospital. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 13 Service users are required to attend meetings which are scheduled at set times throughout the week. This includes house meetings, therapy meetings, key worker meetings and meal times. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 14 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): 23 Although the complaints procedure is clearly displayed in the home and issued to service users, the home must devise a proper complaints record. All documentation relating to adult protection procedures such as the homes adult protection procedures must be accessible at all times. EVIDENCE: This service has received very few complaints within the last year. Currently, the home does not have a formal process for recording complaints. A proper record must be devised and implemented. This requirement is restated from the previous inspection. The two staff on duty confirmed that they had attended adult protection training within the last six months. There was no evidence to confirm this training. This must be obtained. The home has now obtained a copy of the London Borough of Ealing’s Adult Protection Policy. The home’s adult protection policy could not be located for inspection purposes. The home must also obtain a copy of the No Secrets Guidance document. This requirement is restated from the previous inspection. The two Senior Support Workers confirmed that there were no known concerns regarding service users safety. One service user did speak with the Inspector about their mental health and how they were feeling. The service user agreed for the Inspector to discuss their feelings with the Senior Support Worker. The Inspector advised that the home should speak with the service user about their Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 15 anxieties and for the necessary action to be taken to assist the service user in addressing their mental health needs. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 16 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): 24 & 25 The standard of décor within this home is poor with little evidence of improvement through maintenance or future planning. The home does not, therefore, present as a homely and comfortable environment for service users. EVIDENCE: Some improvements have been made to the premises since the last inspection. The carpet has been cleaned in the lounge. However, this carpet is badly stained and marked from cigarette burns. The front garden has now been cleared and much improved. One service user was of the opinion that the cleanliness of the home had much improved since the last inspection. There are parts of the home, which still requires attention as follows: • Stained flooring in the toilet on the ground floor. • A broken stained glass window in the bathroom on the ground floor is in need of repair. • Stained walls in the lounge need to be redecorated. • Stained and chipped skirting boards and doorframes in hallways and communal rooms require attention. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 17 • • • • Badly stained flooring in the utility room requires attention or must be replaced. Fluid spillages on kitchen walls must be cleaned. Kitchen units and worktops must be cleaned to get rid off the grime. The bathroom and kitchenette on the second floor needs to be redecorated. Although a planned maintenance and renewal programme was in place, there were no timescales for carrying out repairs and redecorating work to the premises. This was judged to be insufficient. Currently, the premises are not judged to be well – maintained and comfortable. Arrangements must be made to improve environmental standards. This requirement is restated from the previous inspection. All service users are accommodated in single bedrooms. Service users are required to maintain standards of hygiene and cleanliness in their bedrooms. Three bedrooms were inspected with service users. The bedrooms were generally well maintained. Some bedrooms were more personalised than others. Service users said this was their choice. Two out of the three bedrooms inspected had large amounts of cobwebs hanging from the ceilings. The home must assist service users to remove the cobwebs to improve the homeliness of their bedrooms. Service users said they were happy with the facilities in their bedrooms. Garthowen DS0000022889.V260580.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): 32, 34 & 35 The Registered Manager is well supported by the staff team who demonstrates an awareness of their roles and responsibilities. Evidence of staff training and development needs must improve through proper planning. EVIDENCE: Recruitment policies and procedures were in place. The staff team consists of the Registered Manager, three male staff and four female staff. A Deputy Manager has been appointed and due to commence employment in January 2006. The home had a vacancy for one part time Senior Support Worker. There were two Senior Support Workers on duty at the time of this inspection, one of whom was a relief worker. A social work student was also on placement at the home. One of the Senior Support Workers confirmed that the staff team are fully supportive of each other and work well as a team. The Senior Support Worker said that communication within the staff team was good. Both staff on duty demonstrated good working knowledge about service users assessed needs and the day-to-day running of the home. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 19 Out of the six staff currently employed, only one staff was working towards the NVQ Level 2 in care. Further progress must be made to ensure that at least 50 of the staff team achieve the minimum of an NVQ Level 2 in care. This requirement is restated from the previous inspection. One member of staff confirmed that some of the training they had undertaken in the last twelve months included mental health, applying the human rights law, diversity and inclusion, personality disorders and understanding self injurious behaviours. An organisational annual training was in place. This programme was comprehensive with a wide range of training courses available to staff throughout the organisation. At the previous inspection, the home was required to devise and implement a training programme specifically for staff working at the home. Although a programme of completed training had been implemented, the home is still required to produce a training programme to show training courses which staff are scheduled to undertake for at least the next year. This requirement is restated from the previous inspection. Garthowen DS0000022889.V260580.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): 39 & 42 The home does not regularly review all aspects of its performance through self – review and monitoring. EVIDENCE: A business plan was in place. This plan was in the form of a report. It was revised and updated in April 2003. The plan gave an account of what the service had achieved over a given period of time. An up to date business plan must be devised and implemented. An annual development plan was not in place. This must be devised in accordance with the home’s business plan including aims and objectives for the service and outcomes for service users. Quality assurance surveys were carried out with service users in September 2005. The outcomes of surveys were addressed with service users and staff. Subsequent to this exercise, staff carry quality performance surveys with service users on a monthly basis. A theme is used for these surveys. This is judged to be good practice. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 21 There were no restrictors on the window in one bedroom on the first floor and one window in the corridor on the second floor. The home must ensure that all windows accessible to vulnerable service users (2metres) above ground level, which can be opened and large enough for service users to fall out, must be restrained. In accordance with NHS guidance, the openings to these windows should be restricted to 100mm. The home is now testing and recording the temperature of hot water delivered to baths and showers. The record of hot water temperatures must include appliances tested. There had been some improvement to the cleanliness of the ovens. However, the microwave must be cleaned more frequently. Garthowen DS0000022889.V260580.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 2 x x x 3 Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 3 X X x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 2 X X X X x LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 2 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Garthowen Score 3 X X x Standard No 37 38 39 40 41 42 43 Score X x 2 x x 2 x DS0000022889.V260580.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4(1)(c) Schedule 1 Requirement Timescale for action 28/02/06 2 YA1 3 4 YA23 YA23 5 6 YA23 YA24 7 YA24 The Statement of Purpose must be updated to include all of the criteria as set out in Schedule 1 of the Care Homes Regulations 2001. (Timescale of 31/8/05 Not Met). 5(1)(a-f) The Service User Guide must include all of the criteria as set out in Regulation 5 of the Care Homes Regulations 2001. (Timescale of 31/8/05 Not Met). 13(6) A record for complaints must be devised and implemented. (Timescale of 31/7/05 Not Met). 13(6) The home must obtain a copy of the Department of Health – No Secrets guidance document. (Timescale of 31/7/05 Not Met). 13(6) The home’s adult protection procedures must be accessible at all times. 23(2)(d) A further review of the cleaning schedule must be carried out to address the shortfalls as stated under the section titled “Environment” of this report. 23(2)(b)(d) The planned maintenance and renewal programme must be updated to include shortfalls relating to the physical DS0000022889.V260580.R01.S.doc 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 31/03/06 Garthowen Version 5.0 Page 24 8 YA25 9 YA30 10 YA35 11 YA35 12 13 YA39 YA42 14 15 YA42 YA42 standards as stated under the section titled “environment” of this report. The programme must also include timescales for addressing the shortfalls. (Timescale of 31/8/05 Not Met). 23(2)(d) The home must assist service users to remove the cobwebs from the ceilings in their bedrooms. 13(4)(c) The home must arrange for work to be carried out as advised by a Plumber to ensure that services and fittings comply with the Water Supply (Water Fittings) Regulations 1999. 18(1)(a) A programme of scheduled (c – i) training for staff must be devised and implemented. (Timescale of 31/7/05 Not Met). 18(1)(a) Further progress must be made (c – i) for registering staff to undertake NVQ training. (Timescale of 31/7/05 Not Met). 24(1)(a)(b) Quality assurance and (2)(3) monitoring systems must be devised and implemented. 13(4)(c) Documentary evidence must be obtained to confirm that bathing and showering appliances are thermostatically controlled. (Timescale of 31/8/05 Not Met). 13(4)(c) The home must provide evidence of the electrical installation test carried out. 16(2)(h) The cleaning schedule must be revised to ensure that the microwave is cleaned more regularly. (Timescale of 31/7/05 Not Met). 06/02/06 31/03/06 31/03/06 31/03/06 31/05/06 31/03/06 31/03/06 28/02/06 Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 25 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 YA5 YA23 Good Practice Recommendations The name of the service user should be added to contract examined for the purpose of this inspection. The home should consult with one service user who expressed concerns about their mental health state. Garthowen DS0000022889.V260580.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST 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 Garthowen DS0000022889.V260580.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. 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