Inspection on 11/03/06 for Giles Shirley Hall

This inspection was carried out on 11th March 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Giles Shirley Hall 13/07/09

Giles Shirley Hall 12/12/07

Giles Shirley Hall 13/11/06

Giles Shirley Hall 20/09/05

Giles Shirley Hall 29/04/04

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

CARE HOME ADULTS 18-65 Giles Shirley Hall York Street Bromborough Pool Wirral CH62 4TZ Lead Inspector Beate Roth Unannounced Inspection 11th March 2006 10:00 Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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 Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Giles Shirley Hall Address York Street Bromborough Pool Wirral CH62 4TZ 0151 643 5563 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) Wirral Autistic Society Mrs Helen Louise Rudd Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 2005 Brief Description of the Service: Giles Shirley Hall is registered to provide personal care for eleven adults with a learning disability. The home consists of four flats, which are accessible to one another and share the same main entrances. All bedrooms are single and have en-suite facilities. Each flat has a communal area comprising of a domestic style kitchen and dining/lounge area. There are gardens to the front and side of the home. The home is close to local shops and to public transport services. Parking is available on the main road. The home is run by Wirral Autistic Society who have several care homes for adults with a learning disability in the area. Wirral Autistic Society provides a range of day services and facilities, which are fully utilised by the service users, accommodated at Giles Shirley Hall. The home is contained within a converted village hall. Wirral Autistic Society has a conference hall and technology suite also housed within the building. These facilities are open to the general public. There is a separate point of access to the building for the general public. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6 and half hours. During the inspection time was spent in the office examining records and policies and procedures. Staff and service users were spoken with. A tour of the home was undertaken. Staff were observed delivering care to service users. What the service does well: What has improved since the last inspection? What they could do better: The content of the contracts/terms and conditions and the way they are drawn up could better support the interests of service users. Improvements are needed to some of the risk assessments that are available for staff to refer to. Improvements are needed to the risk assessments around transporting service users who can display challenging behaviour and around service users staying at home and going out without staff support. The safety of service users in the event of a fire is not adequately promoted. Action must be taken to ensure that at all times there is adequate means of escape in the event of fire. A record must be made of fire safety training provided to night staff and the fire alarm needs to be tested weekly. Certificates of safety inspections of the gas, electrical wiring and fire systems need to be available in order to demonstrate that the home is safe. Staff are not to be employed at the home unless the Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 6 registered persons are satisfied that they are physically and mentally suitable for the work they are to undertake. 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. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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 Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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): 2, 4 and 5 A full assessment takes place of prospective service users to ensure that their needs can be met. The contracts/terms and conditions could better support the interests of service users. EVIDENCE: One new service user has been admitted to the home since the last inspection. The records show that an assessment had taken place before the service user moved to the home. Service users are assessed by the manager for the home and where appropriate, by a representative from day services. The manager visits a prospective service user where they are living. Information is gathered from the service user, the service users’ carers, social worker and any other relevant agencies. The service user moved from an existing service within Wirral Autistic Society. There was evidence of consultation with the service user, their relatives and relevant professionals to inform this decision. The service user made visits to the home before moving in. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 9 Since the last inspection the contracts/statement of terms and conditions between the home and the service users have been revised. These documents now indicate the additional costs that are payable when service users go out with staff, as service users sometimes pay for refreshments for staff. A sample of service user records were seen. Two records contained the new contract and indicated that a representative of the service user had been involved in the drawing up of this document. One record did not contain the revised contract. This contract had been signed by the service user and staff at the home and did not indicate the additional costs that are payable when service users go out with staff. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 In general, care planning reflects the assessed and changing needs of service users. Improvements are needed to some of the risk assessments available for staff to refer to. EVIDENCE: A sample of service user plans were examined and in general contained detailed and clear information to enable staff to provide appropriate support around day-to-day living and personal goals. These plans are formulated at a service users review and cover the information required by the National Minimum Standards. A review had in general, taken place within the last 6 months. The documentation available from reviews indicated that the service user, their relatives, social worker and other relevant individuals are invited to contribute to reviews. An examination of the service user plans indicated that service users’ rights to live as independently as possible, in accordance with their abilities, is promoted by the home. Risk assessments are available which indicate why service users’ rights need to be limited in order to safeguard their wellbeing. The risk assessment for a service user around staying in the home without Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 11 staff did not contain sufficient information. The duration for this, what the service user is advised to do in an emergency, how the service user would manage visitors to the home, were issues that were not clearly documented. The risk assessment for another service user indicated that they can stay in the home and go out without staff support. This service user has been displaying challenging behaviour that can be toward other service users and staff. Guidance for staff around whether the risk assessment continues to be valid at present is not available. A risk assessment is needed around staff transporting service users who can display challenging behaviour. Staff have been taking a service user, who can display challenging behaviour, out in the home’s transport without a second member of staff. A risk assessment is needed around this practice. Reactive plans, which detail behaviour management strategies are available. These indicate that as a last resort physical intervention is used. The records made following an incident of physical intervention were in general satisfactorily maintained and indicate that physical intervention is not used frequently. One record did not clearly indicate the nature of the physical intervention used. This is to be addressed. Staff are trained in behaviour management strategies such as supportive holds and breakaway techniques as part of their induction. An accredited trainer is now providing instruction to staff. Service users are encouraged to contribute towards the running of the household. Service users tidy and clean their bedrooms, go shopping and help with meal preparation in accordance with their abilities. Service users’ views are obtained through their individual key workers. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Service users are able to take part in appropriate activities that provide opportunities for their educational, social and personal development. Links with the local community are promoted. The daily routines and arrangements for promoting relationships with family and friends, support service users. Varied and well-balanced meals are provided in homely surroundings. EVIDENCE: Service users attend day services where they are provided with a range of opportunities to promote their personal development. Service users have a timetable of activities, which has been drawn up to meet their needs, skills and individual preferences. Some of the opportunities available are horticulture, craftwork, community work experience, drama and physical education. Activities are provided by either Wirral Autistic Society’s day services or by outside organisations such as local colleges. Service users are provided with work experience opportunities in accordance with their abilities. Records and a discussion with staff indicate that there are opportunities for service users to become involved in the local community in accordance with Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 13 their wishes. The home has access to private transport and there is access to bus services. A number of service users go out independently. Staff and records indicated that family links and friendships are promoted. The arrangements for contact with family are written into the service users’ care plans. Service users have the opportunity to meet people and make friends with people who do not have their disability, through attendance at social clubs and through community activities. Discussions with the staff and observations confirmed that the home’s routines are flexible as much as possible and fit in with the needs and wishes of the service users. The records inspected indicate service users skills and the support service users need in their daily lives in order to make decisions and encourage independence. Care plans indicate the dietary requirements of service users. Advice is obtained from a dietician if this is required. A record is kept of meals provided to service users. The records showed that the meals are well-balanced and varied. A service user spoken with said that they help choose the meals and do the shopping and cooking with staff support. Each flat has a domestic style kitchen and dining area that provide a homely atmosphere in which to enjoy meals. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The personal care and health needs of service users are well met. Service users are safeguarded by the home’s procedures and policies for the management of medication. EVIDENCE: Records detail the support service users need with their personal care. Observations indicated that staff, promote the privacy and dignity of service users. Consistency and continuity of support for service users is provided through the key worker system. Staff receive training on promoting privacy and dignity during their induction. Records of reviews and a discussion with a service user indicated that service users have access to medical/health care professionals as needed. Service users are supported and facilitated to take control of and manage their own healthcare in accordance with their abilities. A medication procedure is available which provides clear guidance. Observations of staff administering medication indicated that they are following this procedure. Medication is stored securely. Two members of staff interviewed reported that they have received training in the administration of medication. A selection of medication administration record sheets and corresponding medication were inspected and found to be in order. A record is Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 15 being consistently made of medication leaving and being returned to the home when service users make visits to their families. Where service users self – administer their medication, they do so in accordance with a risk assessment. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Staff training and policies and procedures are in place to ensure that service users views are heard and appropriate action taken. EVIDENCE: Staff reported that they elicit the views of service users in accordance with their abilities. Information is available to enable a complaint to be made by a service user or on their behalf, by an advocate. The complaint procedure includes the timescales for dealing with each stage of a complaint. The procedure is available in different formats to reflect the abilities of service users. A record is kept of any complaints made. The records indicated that a complaint had not been made since the last inspection. During this time no complaints have been made to CSCI. Observations and discussions with service users indicated that if they wanted to complain or comment about any aspect of the care they receive at the home they would know who to approach. Staff were aware of how to respond to a complaint. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 The home provides a comfortable and pleasant environment for service users. EVIDENCE: Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 18 The home is in general well maintained. At this inspection, some of the paintwork in the communal areas was showing some signs of wear and tear. The premises are accessible to all service users. The home offers access to local amenities, transport and relevant support services. Furnishings, fittings and equipment are of a good quality. The home is contained within a converted village hall. Wirral Autistic Society has a conference hall and technology suite also housed within the building. These facilities are open to the general public. There is a separate point of access to the building for the general public, which the manager has reported at previous inspections, is only open when the community facilities are being used. A homely atmosphere is not promoted by public facilities being housed within the same building. The manager is keeping under review the risk assessment of public access to the building and service users accessing the public areas of the building. Since the last inspection a gate has been erected at the side of the home to further secure the building. An inspection of a sample of bedrooms indicated that good quality furnishings and fittings are provided. Service users have individualised their bedrooms. Each bedroom has en-suite facilities. Service users spoken with reported that they are pleased with the amenities and space provided. A tour of the home showed that the home was clean. There are procedures for staff to refer to about hygiene and infection control. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 19 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, 33 and 34 Service users are supported by competent staff. In general staff are appropriately deployed to meet the needs of the current service users. The recruitment practices need some improvement. EVIDENCE: Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 20 An examination of the rota for the week of the inspection and a discussion with staff indicated that in general staff are appropriately deployed to meet the needs of the current service users. Staff reported that the behaviour that can be displayed by a service user is having an impact on the staffing arrangements. This was evident at the time of the inspection, as due to this, staff reported that they were unable to undertake an activity outside of the home with service users. It is understood from discussion with the deputy manager that steps are being taken to address this. There is a core staff team employed at the home. Bank staff are used to cover absences. Bank staff have been recruited to work for Wirral Autistic Society to cover absences in the homes if needed or to provide support within the day care service. At this inspection a member of the bank staff was spoken with. They were appropriately trained and experienced to work at the home. Wirral Autistic Society provides specialist services for people with autism and is accredited by the National Autistic Society. The prospectus and statement of purpose outlines how the specialist needs of service users will be met. A comprehensive induction and foundation training programme is provided to staff. This includes training around meeting the needs of individuals who have autism. Staff are encouraged to undertake an NVQ in caring for adults with a learning disability. Specialist training is provided to staff to assist them to support service users as appropriate. The records of recruitment for two members of staff were seen. In general, the recruitment records contained all the required information and were well maintained. There was no evidence to indicate that one staff member was physically and mentally fit to work at the home prior to the commencement of their employment. Arrangements had been made for this member of staff to have a medical assessment. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 There are systems in place to ensure that the health and safety of service is promoted, however, improvements need to be made in order to fully safeguard service users. EVIDENCE: Since the last inspection a new manager has been appointed and an application to register the new manager has been made to CSCI. The manager of the home has had several years experience of management in a care setting. The manager has appropriate qualifications in care and management and has undertaken periodic training to maintain and update her knowledge skills and competence. Training around safe working practices such as manual handling, infection control and first aid is made available to staff as part of their induction and updated accordingly. There is a rolling programme of training opportunities provided and staff can access this when required. There are a range of policies and procedures available that promote safe working practices. Wirral Autistic Society has a health and safety advisor who is available to provide advice and Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 22 who has responsibilty for promoting a safe environment within the homes. The records of fire equipment checks indicated that the fire alarm has not been consistently tested on a weekly basis. A record had not been made of fire safety training provided to night staff. The records relating to the checks of the gas safety, electrical wiring, and contractors checks of the fire equipment could not be located during the inspection. These records need to be available at the home to demonstrate that the premises are safe. A risk assessment indicates that a fire door would be very difficult to open in an emergency. The assessment indicates that during a night-time evacuation, both service users and staff struggled to open the fire door, which caused anxiety. It is understood that action is being taken to address this. Steps are to be taken without delay to ensure that at all times there are adequate means of escape. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 23 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 X 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 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 X X X X 1 X Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 24 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. 1 Standard YA9 Regulation 13 Requirement The registered person must ensure that a risk assessment is in place around transporting service users who display challenging behaviour. The registered person must ensure that risk assessments around service users going out and staying at the home, without staff support clearly indicate how this decision was reached and the safeguards in place to support the service user. The registered person must ensure that a clear record is made of the nature of any physical intervention used. The registered person must ensure that staff are physically and mentally fit to work at the home prior to their employment. The registered person must ensure that records of safety checks are available at the home to demonstrate that the premises are safe. The registered person must ensure that steps are taken to ensure that in the event of a fire, there are, at all times, adequate DS0000028492.V285756.R01.S.doc Timescale for action 11/03/06 2 YA9 13 11/03/06 3 YA9 13 11/03/06 4 YA34 19 11/03/06 5 YA42 23 11/03/06 6 YA42 23 11/03/06 Giles Shirley Hall Version 5.1 Page 25 means of escape from the home. 7 YA42 23 The registered person must 11/03/06 ensure that the fire alarm is tested on a weekly basis and that the training provided to night staff around the fire safety procedures is recorded. 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 YA5 Good Practice Recommendations It is recommended that service users be supported by family, friends and/or advocate, as appropriate when drawing up the contract. The service user guide/contract should provide clearer information on the costs service users may have to meet when going out with staff. Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Giles Shirley Hall DS0000028492.V285756.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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