Inspection on 08/08/06 for Glencoe Care Home

This inspection was carried out on 8th August 2006.

CSCI 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 CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Glencoe Care Home 31/07/07

Glencoe Care Home 06/12/05

Glencoe Care Home 10/08/05

Glencoe Care Home 19/10/04

Glencoe Care Home 08/06/04

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

CARE HOMES FOR OLDER PEOPLE Glencoe Care Home 10-11 Chubb Hill Whitby North Yorkshire YO21 1JU Lead Inspector Mavis Pickard Key Unannounced Inspection 8th August 2006 10.00a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glencoe Care Home Address 10-11 Chubb Hill Whitby North Yorkshire YO21 1JU 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) 01947 602944 Endeavour Care Ltd Mrs Linda Magill Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: Glencoe is a care home providing personal care and accommodation for up to 19 older people with dementia. The home has 13 single and three shared bedrooms. 1 of the single bedrooms has suite facilities. The bedrooms, a number of which have pleasant views across Pannet Park are located on the upper floors of the home, a passenger lift provides access to all floors. The dining room and 2 lounges are located on the ground floor. The present fees are £415 a week. Additional charges are made for hairdressing, chiropody, toiletries, papers and magazines. The home provides beauty therapy, manicures and foot spa’s fee of charge. Information about the services provided are made available in the home’s Statement of Purpose, Service Users Guide and through published CSCI inspection reports available from the home and on the CSCI website.CSCI.org.uk. The home is located close to the town centre of Whitby and its leisure facilities and amenities. The premises a large detached house has newly provided off street parking for up to 4 cars at the front and a ramped patio area at the back of the house with a range of seating. Access to the front of the house is via a flight of steps. There is a newly constructed ramp to the side entrance to the home. The service, which does not provide nursing care, is owned by Endeavour Care Limited and was registered in 2003. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The outcomes for residents were evidenced from observing and case tracking 4 residents during the site visit and from feedback about the services provided from relatives, health professionals and other people who have an interest in the welfare of residents. Accumulated evidence was also provided by past inspection reports and other details about the service stored within the Commission for Social Care Inspection [CSCI] records. What the service does well: What has improved since the last inspection? Then registered manager has implemented a new format for the collection of service user information for use before, during and immediately following the admission process. External ramped areas have been constructed that allows residents with mobility problems safer access to these areas. The registered manager is undertaking the Registered Managers Award [RMA] and several carers have signed up to undertake National Vocational Qualifications in care [NVQ]. There is an on call system in place so that should additional support or advice be needed by carers in during weekend days or through the night it is available on a roster so that the registered manager is not always expected to be ‘on call’. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 6 A re-furbishment programme is underway that is providing new carpets and furniture throughout the home. 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. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. [Standard 6 does not apply to this service.] Quality in this outcome area is good. This judgement has been made using available evidence about the service including a site visit. The information provided in the homes documentation is accurate. Good admission systems are in place and prospective resident’s needs are assessed before they move into the home. EVIDENCE: The home’s statement of purpose and service user guide that are provided to prospective residents and/or their representatives prior to admission gives people the information they need to be able to make a decision about the services provided at Glencoe. The home has not admitted residents for some time and although 4 resident’s assessment documents were examined, it was found that they lacked detail about the prospective resident’s needs. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 9 However the manager has formulated a new assessment document that she will use from now on. The document when completed will provide appropriate and detailed information on which she can base her assessment to admit or not. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence about the service including a site visit. Individual care plans set out the health and personal needs of residents and all aspects of health and personal care are well managed. However not all plans are recorded as having been reviewed regularly. People are treated with respect, their dignity is upheld and they are safeguarded by the homes medication policy. EVIDENCE: The service has generated care plans from pre-admission assessments. However not all care plans are recorded as having been reviewed regularly. The manager confirmed that reviews are undertaken but that records sometimes are not made. There was no evidence that evidence that residents or their representatives had contributed to their care plan, however relatives spoken with, in general Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 11 said that they are kept abreast of their loved ones care and were satisfied with the service provided to their relative. 1 relative raised a concern that she was not advised when her relative visits her GP or hospital. The manager was concerned about this and said she would make sure that people are always consulted regarding health issues concerning residents. All residents are registered with a local GP practice. Feedback from GP’s show that they are satisfied with the care provided by the home. Continence needs are met and people are given support to remain continent. The home provides equipment to assist people to bathe and there are sufficient bathing facilities provided Medication is dealt with safely and in accordance with the home’s policy and current legislation. Staff were observed treating residents kindly, people were respected and treated as individuals and their dignity was being upheld. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence about the service including a site visit. Residents are part of the local community and visitors are welcome in the home. People are encouraged to have choice, activities are available and the food provided is varied, plentiful and of a good standard. EVIDENCE: Residents were seen to have visitors during the day, people spoken with said that they are always made welcome by the manager and staff. Although there is no activities organiser employed the manager and care staff do provide a range of activities and pastimes. During this unannounced visit residents and staff were watching TV together, playing dominos, engaging in conversations, reading, having a manicure and having their hair done and using the garden areas. Some residents went out alone and it was discussed that when they are able staff take residents to the park or shops and sometimes on the open-air bus to the seaside. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 13 1 resident’s relative gave feedback prior to the site visit that she is concerned about the lack of activities taking place in the home. There was no evidence of this during this unannounced visit and that manager explained that many activities take place in the afternoon when caring activity is ‘quieter’ and that because of the nature of resident’s condition most activities are spontaneous rather than planned in advance. Residents spoken with, who can make a judgement about the quality and quantity of the food provided, said, “its good” and they “always eat everything” The quality of the food provided was checked out and found to be good with a range of choices. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence about the service including a site visit. The homes complaints procedures are not followed as complaints and concerns are not routinely recorded. However in general complaints are dealt with in a timely fashion. People are protected from all forms of abuse. EVIDENCE: The service has a detailed complaints policy and recorded procedures to follow in the case of a complaint being raised. However there is some confusion about what type of complaint should be recorded and investigated formally. The manager said that should anyone raise a concern she would deal with it immediately but not always record it. Similarly if a complainant said ‘I don’t want to complain but…’ and then raises a complaint this would be dealt with informally. Only if a serious complaint were raised would the complaints procedure guidance of recording it would be followed. Although visitors spoken with said that they know how they can complain and had raised concerns from time to time, they not received any written response and didn’t expect any, they only wanted concerns dealt with properly and generally they were. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 15 The manager agreed that all complaints should be dealt with though the services own policies and procedures, which states that they should be recorded. 1 visitor said they had raised concerns with the home’s staff about what they perceived as very little in the way of activities and nothing had happened. Also they had raised concerns that some of the clothing bought for their relative was never seen to be worn. The manager expressed concern that anyone should feel they could not raise such a concern directly with her and said that she would make it clear to all residents representatives that ‘her door is always open’ and that she will take all concerns seriously. During the inspection process other relatives and visitors were spoken with who said that they know that their relatives are safeguarded at the home and believe that they are listened to and are able to speak to the staff and manager if they were not happy about anything to do with the service provided by the home. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence about the service including a site visit. Not all areas of the home are safe, or readily accessible to residents. The home is clean. EVIDENCE: A short tour of the home was undertaken that showed as recorded in previous reports the environment of the home is good. The owners have provided equipment such as a shaft lift moving and handling aids, a hoist, bathing equipment etc and the furnishings and furniture provided is of good quality and in keeping with the home and its purpose. The provision is adequate and in some parts good. Shared facilities are very pleasant and new chairs and carpets have been provided to the sitting rooms and dining area. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 17 The home has sufficient toilets and bathing facilities where people can be assisted in privacy and their dignity maintained. Individual bedrooms are well appointed. However in the main residents do not have access to their private accommodation throughout the day. Rooms are locked and can only be accessed with staff intervention. Residents case files examined do not show the reason for this being the case nor are there written risks assessments regarding this issue. Heating and lighting including emergency lighting is appropriate. The home is clean. There is an unpleasant odour near the main entrance to the home, however the manager advises that they know the cause and a new carpet is to be fitted soon. Externally work has been achieved in the back garden to provide a ramped exit from the dining area, which means people with mobility problems, or wheelchair uses can access the garden with or without staff help. However the garden still presents hazards to resident’s safety. These issues were discussed with the manager. A ramp replaces the steps to the side of the house however it is very steep. The provider has been asked to provide confirmation that building approval has been sought and received for this and the parking area to the front of the building which although welcome is also very steep. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence about the service including a site visit. Not all staff has current Criminal Records Bureau/Protection of Vulnerable Adults disclosures. Therefore residents are not wholly protected by the home’s recruitment policies. The home employs sufficient experienced and competent staff to meet resident’s needs. EVIDENCE: From observations during this unannounced site visit to the home, staff were noted to be engaging with residents in purposeful ways. All sorts of activities and pastimes such as manicures, dominoes, reading, discussing all sorts of issues including what was on the TV was taking place. Feedback from 1 resident’s relative said that although there is always sufficient care staff available and that staff are kind they do not always ‘do things’ with residents’ that staff had been observed sitting about watching television and talking between themselves rather than providing appropriate activities. During the unannounced site visit there was no evidence of staff being ambivalent about their role, they presented as knowing what their role is and Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 19 understanding the needs of people with dementia. Resident’s seemed comfortable and relaxed with staff. The inspection process used observational ‘tools’ where a record is made of signs of ‘well being’ and ‘signs of ‘ill being’ in residents. These are used where reliable verbal feedback from residents cannot be obtained. The documents showed that in general there is a high degree of ‘well being’ in the home and this can at least in part, be attributed to the way staff interact with the people who live there. The emphasis of the service presents as is not on only providing basic personal care but on ensuring that residents have a good quality of life within the home. The rota showed that for all shifts there was sufficient staff on duty. No shortages were noted. Many staff had been working at the home for some time the service has a low staff turnover. All people employed are put though an induction programme that ensures new staff members are given the right information to be able to do their jobs well. All have several shifts, as many as is necessary as supernumerary to the rota so that they take their induction at their pace. A new training plan that is being developed and should ensure that training is including National Vocational Training [NVQ] will be provided to staff throughout the year. Many staff has already achieved NVQ at level 2 or 3. The above training will include ‘safeguarding adults’ and ‘dementia care’ as well as the mandatory training to meet service users basic needs, such as moving and handling and health and safety. Staff were clear about their role, knew what was expected from them and showed a good understanding of the actions they needed to take to meet and promote equality and diversity within the workplace and in respect to residents. Concerns were raised during the visit that not all chairs used for residents could accommodate the use of the hoist. It was observed that a resident was lifted into her wheelchair without the use of a hoist and in a way, which is not in line with current good practice. This concern was discussed with the manager who has spoken with staff and advised them of the requirements of safe moving and handling. The staff members concerned had only just undertaken moving and handling training, the content of which needs to be reviewed. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 20 Recruitment files were checked where it was found that the homes policies are followed and are appropriate. However not all people employed have Criminal Records Bureau [CRB] and Protection of Vulnerable Adults [POVA] disclosures regarding their current employment. Although staff had satisfactory disclosures regarding previous employment, such disclosures are not portable from employment to employment. This concern needs to be addressed. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence about the service including a site visit. There is clear evidence that the home is managed well on a day-to-day basis and that the provider has an active interest in the service. However there remain some concerns regarding moving and handling practice and safety issues in respect resident’s safe use of the garden. EVIDENCE: During conversations with relatives and/or representatives it became clear that they know the management structure of the home. Staff also understand the structure and said that they see the registered manager as being excellent and the home well run. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 22 1 relative said that when the manager is not on duty “staff do as they like” However from speaking with other frequent visitors and from speaking with staff during the site visit there is no other evidence of this. The atmosphere for people visiting the home and residents is open and inclusive. Staff said that the manager is accessible and open with them about the running of the home and that relatives would always approach staff when things are causing concern and that they would either deal with the situation or take it to a senior carer or the manager. In all cases the manager would be advised although written records may not always be made. The quality assurance systems are in place and the views of visitors/relatives are sought although there is no evidence that the views of service users, staff members or professionals visiting the home are sought on how the service can be improved. The manager says that she is committed to promoting equality and diversity in the service and meeting service users individual needs. There is no evidence that this is not the case. However concerns were raised during the visit that not all chairs used for residents could accommodate the use of the hoist. It was observed that a resident was lifted into her wheelchair without the use of a hoist and in a way, which is not in line with current good practice. This concern was discussed with the manager who has spoken with staff and advised them of the requirements of safe moving and handling. Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Timescale for action The service user’s plan must be 15/09/06 reviewed at least once a month and updated to reflect changing needs and current objectives for health and personal care of the resident, where possible in consultation with the resident or their representative. The registered person must 15/09/06 ensure that a record is maintained in the home of all concerns and complaints raised about the service provision including detail of the investigation and any actions taken. This requirement was made in the previous inspection report of December 2005 and remains unmet. The outdoor space for service users must be appropriately maintained and be designed to meet the needs of all service users including those with physical, sensory and cognitive impairments. DS0000044875.V307837.R01.S.doc Requirement 2. OP16 17(2) Schedule 4 (11) 3. OP20 23(2)(o) 30/10/06 Glencoe Care Home Version 5.2 Page 25 4. OP29 Schedule 2(7) 5. OP38 6. OP38 People employed by the service 30/09/06 must have CRB/POVA disclosures relating to their current employment. 23(4) & The registered person must 30/09/06 ensure that a written Fire Risk The Fire Precaution Assessment is undertaken in s accordance with the ‘Fire (Workplac Precautions [Workplace] e)] Regulations 1997. This Regulation requirement was made in the s 1997. previous inspection report of December 2005 and remains unmet. 13(4) The content and substance of 30/09/06 (b&c) the services moving and 13(5) and handling training must be (6) reviewed. The use of techniques for moving people must be those that avoid injury to services users or staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Glencoe Care Home DS0000044875.V307837.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Glencoe Care Home DS0000044875.V307837.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!