Inspection on 27/04/07 for Glenfield Woodlands

This inspection was carried out on 27th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Glenfield Woodlands 02/08/06

Glenfield Woodlands 06/01/06

Glenfield Woodlands 16/08/05

Glenfield Woodlands 08/02/05

Glenfield Woodlands 22/06/04

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

CARE HOMES FOR OLDER PEOPLE Glenfield Woodlands 11 Holmwood Drive Glenfield Leicester Leicestershire LE3 9LG Lead Inspector Kim Cowley Key Unannounced Inspection 27th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glenfield Woodlands DS0000006397.V337080.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. Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenfield Woodlands Address 11 Holmwood Drive Glenfield Leicester Leicestershire LE3 9LG 0116 2871696 0116 2871696 daniel.markovic@tinyworld.com 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) Holmwood Residential Care Limited Mrs Rena Lewis Care Home 17 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (17), Physical disability over 65 years of age (5) Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service user numbers. No person falling within category PD(E) to be admitted to the home when there are 5 persons of that category already accommodated in the home. Service user numbers. No person to be admitted to the home in categories MD(E) or DE(E) when 5 persons in total of these categories/combined categories are already accommodated in the home. 2nd August 2006 2. Date of last inspection Brief Description of the Service: Glenfield Woodlands is a privately owned residential home situated off the A50 Groby Road between County Hall and Glenfield Hospital. The home, which was built in the 1920s, caters for older people, some of whom may have mental health needs and/or physical disabilities. The home has 15 single bedrooms and one double, all of which have en-suite facilities. Downstairs there are two lounges and a dining room. To the rear of the home is nearly an acre of landscaped gardens with places to walk and sit. Shops, a post office, bus stops and parks are close to the home. Fees range from £425 to £482 per week. Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that included a visit to the home and inspection planning. It was scheduled following a concern being raised about the quality of care at the home. Prior to the visit, the inspector spent half a day reviewing information relating to the home. During the course of the inspection, which lasted five hours, the inspector checked the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means the inspector looked at the care provided to three residents living at the home by meeting or observing them (not all residents were able to give their views due to their mental health); talking with the staff who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. The inspector also met two other residents, the Registered Manager, a senior carer, and the cook. (Please see ‘Choice of Home’ for details of how the provider makes information about Glenfield Woodlands, including CSCI reports, available to prospective residents and their representatives.) What the service does well: Glenfield Woodlands offers a high standard of accommodation to residents. The premises are immaculate, being maintained, decorated and furnished to a high standard. On the day of inspection the home had a relaxed and peaceful atmosphere. Residents were sitting in the lounges socialising, playing board games, and reading the papers. All residents interviewed said they were happy living at the home. Comments included, ‘They do look after us well. Everything we need is here’, ‘They’re good at this home. You can’t fault it’, and ‘I like everything about this place.’ The home has an established staff team who are able to provide continuity of care. Relationships between staff and residents appeared good. All residents interviewed praised the staff team. One resident said, ‘The staff couldn’t be better’, and another commented, ‘The staff are brilliant, they do what you want them to do.’ Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Glenfield Woodlands DS0000006397.V337080.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 Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area good. Residents’ needs are assessed prior to admission to ensure the home is suitable for them. This judgement has been made using available evidence including a visit to the service. (Standards 3 and 6 were inspected.) EVIDENCE: Prospective residents and other interested parties are sent a brochure about the home on request. This provides basic information about the service and facilities, and includes directions and a map. A copy of the Terms and Conditions is included with this. The home’s most recent inspection report is available on request in the home, or can be accessed via the CSCI website: www.csci.org.uk Residents who are considering coming to Glenfield Woodlands are invited to visit prior to making a decision. Some prospective residents come for respite or day care before moving in so they can get used to the home. The Manager assesses all prospective residents in their own homes, in hospital, or during a visit to Glenfield Woodlands. Information is sought from health and Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 9 social care professionals where appropriate. The home has a waiting list, which is periodically reviewed. Records relating to three recent admissions were examined. The Manager had visited them all and carried out a written assessment. The views of relatives, and assessments carried out by health and social services staff, had been taken into account. Standard 6: This home does not provide intermediate care. Glenfield Woodlands DS0000006397.V337080.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Residents have been put at risk by inappropriate health and social care. This judgement has been made using available evidence including a visit to this service. (Standards 7, 8 and 10 were inspected. [A CSCI pharmacy inspector inspected Standard 9 on 3 April 2007.]) EVIDENCE: Care plans were inspected and staff interviewed and it was found that a member of staff at the home had carried out a nursing procedure on a resident. An ‘Immediate Requirement’ notice was left about this issue, with instructions to the Manager to put measures in place to prevent this happening again. It was also of concern that this procedure did not appear in the resident’s care plan and no record had been made of it being carried out. Nor had a District Nurse been consulted. (See ‘Requirements’.) In future care staff must not, under any circumstances, carry out nursing procedures and health care professionals must be consulted if it appears a resident is in need of an element of nursing care. Furthermore a record must be made of all care given and this must relate to the resident’s care plan. The Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 11 Manager agreed to inform all staff of this and ensure they fully understood their duties and limitations as carers. (See also ‘Complaints and Protection’ and ‘Staffing’.) Other care plans appeared satisfactory, being based on residents’ assessments. They are updated as necessary and at least once a month. Risk assessments are carried out using the home’s risk assessment forms. The Manager said staff always sit and talk to residents about their care plans before they are implemented. Once they give their agreement they have the opportunity to sign the plans if they are able to. The home has an allocated District Nursing Team who work from a local health centre and visit every week or when necessary. The Manager said staff have a good relationship with the District Nurses and go to them for advice whenever they need to. District Nurses provide staff training when required. If residents are unable to keep their former GPs on admittance to the home, they are registered with a local GP practice. New residents have a full audit of their health needs carried out, and every resident is seen routinely every three months for a further health audit. Their medication is reviewed at the same time. The home has a range of equipment to relieve pressure sores. All staff receive training in pressure sore care during induction and have access to a specialist training video to enhance this. The emphasis in the home is on the prevention of pressure sores, and advice is sought from health care professionals where necessary. Residents are weighed on admission, and then as required. The Manager said staff weigh residents regularly if their weight appears to be fluctuating All residents are seen by a chiropodist (private or NHS depending on their preference) at least every three months. A dentist and optician also visit the home when necessary. A CSCI pharmacy inspector visited the home on 3 April 2007 to carry out a full audit of the home’s medication systems, including Standard 9. At this inspection three Requirements were made which the Manager said she is in the process of meeting. Copies of the pharmacy inspector’s report are available from CSCI on request. Staff receive training during their induction on maintaining residents’ privacy and dignity. This is first done through discussions with the Manager or another senior member of staff, and then by giving staff the opportunity to shadow experienced members of staff on duty. All residents interviewed said staff were respectful and caring in all their dealings with them. Glenfield Woodlands DS0000006397.V337080.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Activities are provided for residents who want them, and food is of good quality and mostly homemade. This judgement has been made using available evidence including a visit to this service. (Standards 12, 13, 14 and 15 were inspected.) EVIDENCE: During the inspection residents were playing board games in one of the lounges. This session was organised by a social care student who is currently on placement in the home The Manager said activities are offered in the afternoons if the residents want them, but it is their choice whether they want to take part or not. A barge trip has been planned for August and residents said they were looking forward to this. One resident enjoys knitting and staff provide the materials for this. Some of the residents interviewed said they liked sitting out in the home’s large secluded garden when the weather was warm. A hairdresser visits once a week. The home has a small library. Communion is held once a month. The Manager said visitors are welcome at the home at any time, although they may wish to avoid mealtimes. Residents receive visitors in their own rooms or Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 13 in one of the lounges, the dining room, or the garden. At present all residents in the home have regular visitors. Residents are encouraged to make choices about their lifestyles while in the home. For example, with regard to bedtimes, getting up times, and how they spend their time. The Manager said some residents like to have an identified chair in one of the lounges, which is ‘theirs’. This is agreed by negotiation. Since the last inspection a new full-time cook has been appointed who has 10 years experience in the restaurant trade. She told the inspector she prepares traditional homemade English food for the residents, as this is what they like best. There is a five-weeks rotating menu based on residents’ preferences. Menus were inspected and showed a varied and wholesome diet being offered. Special diets are catered for and diabetic alternatives provided where required. A list of residents ‘likes and dislikes’ is displayed in the kitchen. All residents interviewed were pleased with the food. One said, ‘I find the food very good and have put on weight since I came here’, and another commented, ‘The food is lovely.’ Glenfield Woodlands DS0000006397.V337080.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The home’s complaints procedure should be more accessible and staff training in safeguarding is in need of review. This judgement has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) EVIDENCE: All residents and their representatives receive a copy of the home’s formal complaint procedure at the point of admission. The Manager said the procedure is also explained to them verbally. One resident commented, ‘I have no complaints at all, but if I did I’d tell my relatives or let the Manager know’, another said, ‘If I wasn’t happy about something I’d just tell the staff.’ The Manager said relatives are also encouraged to talk to staff if there was a problem, or speak to herself or the Owning Body’s representative. One complaint has been made about this service since the last inspection. This is currently being investigated by social services. The home has a ‘complaints book’ but there are no entries in it. This was discussed with the Manager who agreed to record all complaints, even if they are informal and apparently minor. This is good practice as it helps to create a culture in the home where residents feel happy to speak out if anything is wrong, without necessarily using the formal complaints procedure. There appears to be a lack of clarity in the home about what constitutes abuse and what staff should do if they discover it. The home does have policies and Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 15 guidance in place on preventing abuse and whistle blowing. During interviews the Manager and two carers demonstrated a good understanding of the relevant issues and knew how to proceed should an allegation be made. However an incident where a member of staff hadn’t used the whistle blowing procedure to report an area of concern was discussed. The Manager agreed to review staff training in this area to ensure staff knew exactly what to do if they became concerned about a resident’s care. (See also ‘Health and Welfare’ and ‘Staffing’.) Glenfield Woodlands DS0000006397.V337080.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Residents live in an environment that is comfortable, safe and well maintained. This judgement has been made using available evidence including a visit to this service. (Standards 19 and 26 were inspected.) EVIDENCE: Glenfield Woodlands provides a high standard of accommodation. The premises are homely, comfortable, and well decorated and furnished. It is evident that great care has been taken to make the home attractive and pleasant. One resident said, ‘‘My bedroom’s lovely.’ The garden is a feature of the home, being nearly an acre in size. It is professionally landscaped and maintained. It has a number of walking and seating areas, extensive lawns, mature trees, and well-stocked flowerbeds. This was an unannounced inspection and all areas of the home were clean and tidy. A part-time housekeeper is employed, and care staff also help with the cleaning. The Manager said cleanliness is a top priority in the home and residents’ rooms are cleaned every morning. Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are satisfied with the staff team. Arrangements for staff supervision would benefit from improvement. This judgement has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) EVIDENCE: The home has an established staff team who are able to provide continuity of care. Relationships between staff and residents appeared good. All residents interviewed praised the staff team and the following comments were made: ‘The staff couldn’t be better.’ ‘The staff are always polite and respectful.’ ‘The staff are brilliant, they do what you want them to do.’ ‘The staff are always polite.’ Recruitment procedures were discussed. Vacant posts are advertised in the local newspaper. The Manager interviews candidates and if successful their references are applied for including one from their most recent employer. The Manager confirmed that no member of staff starts work at the home without a satisfactory POVA check, and that they work under supervision while waiting for CRB clearance. This will help to ensure that residents are safeguarded. A staff induction-training programme is in place. This covers fire safety, food hygiene, moving and handling, health and safety, first aid, and infection control. Staff are encouraged to gain NVQs and other qualifications and their Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 18 certificates are displayed in the home. At present over 60 of the staff team have NVQ Level 2 or above. Staff supervision was discussed in detail. Staff have recorded supervisions every two months with records kept. These consist of the Manager observing staff while they carry out practical care tasks, for example bathing, or dressing. It was suggested that non-practical supervision sessions should also be held so the Manager can ensure staff are working to their job descriptions, and also discuss any training needs they might have. (See also ‘Health and Welfare’ and ‘Complaints and Protection’.) Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents live in a home that appears safe and well managed. This judgement has been made using available evidence including a visit to this service. (Standards 31, 33, 35 and 38 were inspected.) EVIDENCE: The Manager has NVQ Level 4 and has been employed at Glenfield Woodlands for eight years. Good systems are in place to enable the home to run smoothly and consultation with residents is central to this process. The Manager appears to have a good relationship with the staff team, and this could be further improved with a better system of supervision. (See ‘Staffing’.) In April 2007 the Manager carried out a survey of residents’ view. Residents were asked questions about the home by the Manager who made a record of the answers. Thirteen surveys were completed and these showed that, overall, residents were satisfied with the staff, the care, and the premises. It is Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 20 suggested that in future the survey could be given to the residents themselves to complete (if they are able), or to their relatives/friends to complete on their behalf. This would make it easier for residents/their representatives to raise any concerns they might have about the service. Residents look after their own money or have their representatives look after it for them. The Manager will take care of small amounts of cash (for example, for hairdressing/chiropody) and appropriate double-signed records are kept when this happens. Good systems are in place to maintain the health and safety of staff and residents, with records kept. Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NA 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 17(1)(a) Schedule 3(m) Requirement Staff must make a record of any plan relating to a resident in respect of nursing or specialist health care. This will enable the Manager to monitor residents’ care to ensure it is appropriate. Staff must consult health care professionals if it appears that a resident is in need of a nursing procedure. This will help to ensure that residents get the care they need from the relevant professionals. Timescale for action 27/05/07 2 OP8 13(1)(b) 27/04/07 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 OP16 OP18 Good Practice Recommendations All complaints, however minor or informal, should be recorded. This will help to create a culture of openness in the home. Staff training in safeguarding should be reviewed to ensure all staff are aware of their responsibilities in this DS0000006397.V337080.R01.S.doc Version 5.2 Page 23 Glenfield Woodlands 3 OP30 areas. Non-practical supervision sessions should be held so the Manager can check that staff are working to their job descriptions and are appropriately trained. Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Glenfield Woodlands DS0000006397.V337080.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!