Inspection on 16/08/05 for Greengates

This inspection was carried out on 16th August 2005.

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 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

Greengates 26/09/06

Greengates 17/03/06

Greengates 30/03/05

Greengates 12/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Greengates 26 Fore Street North Petherton Bridgwater Somerset TA6 6PY Lead Inspector Judith Roper Unannounced 16th August 2005 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 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 Stationary 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. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Greengates Address 26 Fore Street North Petherton Bridgwater Somerset TA6 6PY 01823 423126 01278 663871 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Somerset County Council (LD Services) Mrs Josephine Gillett Personal Care Home Only 7 Category(ies) of Physical Disability (1) registration, with number Learning Disability (6) of places Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 30th March 2005 Brief Description of the Service: Greengates is a care home providing personal care and accommodation for seven people with learning disabilities and one person with physical disabilities. Greengates is a home run by Somerset Social Services. The responsible individual is Mr. David Dick. The registered manager is Mrs Josephine Gillett. The home is situated on the main road in the village of North Petherton. The home is within walking distance of all the amenities in the large village. The house is set back from the road and has ample parking for staff and visitors. Greengates is a large detached house. All of the bedrooms are single. Bedrooms are located on the ground and first floor. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector and took place over one day between the hours of 9.45 am – 12 midday. 7 residents were at the home on the day of the inspection. There are currently no vacancies at the home. The inspector was able to see and spend time interacting with 6 residents. One resident was out during the time of the inspection visit. There were no relative visitors at the home during the inspection visit. Staff on duty were able to give time to speak with the inspectors. The registered manager Mrs. Gillett was not on duty but the team leader was available for comment during the inspection. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and informal. Staff carried out their duties in a friendly and professional manner. It was a pleasantly warm summers day and several residents had the opportunity to go out of the home with staff escorts. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff and any visiting relatives. Records examined during the inspection were two resident care and support plans, the fire log, accident/incident logs, two resident contracts, staffing rosters, staff fire training records and medication records; other records will be examined at subsequent inspection visits. What the service does well: What has improved since the last inspection? Two requirements were made at the last inspection. These related to fire safety and medication management. Both these requirements have been met. One recommendation was made as a result of the last inspection. The recommendation was that the boiler and boiler control panel sited in one Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 6 resident’s bedroom be re-sited to a more appropriate place. The boiler remains sited in a locked cupboard in the resident’s bedroom. There has been new flooring to the conservatory since the last inspection and repairs have taken place to the roof at 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. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 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 standard(s) 1,3,5. There have been no recent admissions and staff know the needs of the current residents well. Information in the home for residents uses the Somerset Total Communication language aids. EVIDENCE: The home has a Statement of Purpose and guide for residents that is available in formats appropriate to the language abilities and comprehension of residents. There have been no new admissions to the home since the last inspection. Staff reported that the mix of residents is good and staff are aware of trigger factors that may instigate challenging behaviour in individual residents. Current needs were assessed in the care plans inspected very well. Behaviour modification programmes for staff to follow were documented well. Contracts were inspected for the two residents that the inspector case tracked. These contracts between the provider and resident were in order. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10. Care and support plans for residents are holistic, person centred and reflect current assessed needs. Resident’s are supported to make choices about their daily routines in a format of communication that staff working at the home understand. Resident’s can find a common language in which to communicate their needs to staff. Risk assessment recording in the home is good in order to protect residents from unnecessary hazards to their safety. Resident confidentiality is maintained. EVIDENCE: Two care and support plans were examined. The documents were maintained very well. Changing needs had been regularly reviewed and plans amended to reflect a change of circumstances. Residents are not able to demonstrate that they are consulted in the writing of care and support plans but staff were able to verbalise to the inspector examples of meaningful choices made by residents in the way they wish to be treated by staff, communicate, choose what to eat and drink, rise and retire and engage in activities. Care plans are Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 10 stored in resident’s individual bedrooms. Residents are allocated a key worker. This person will coordinate activities and spend quality days out with the individual resident on a 1:1 basis. Key workers support residents with their financial affairs. The inspector observed this during the inspection. Protocols to protect the resident from financial abuse were adhered to and a County Council representative on a two weekly basis audits this. Photographs of staff on duty for each day are displayed in an individual resident’s room in a format that they find useful. The photograph of their key worker is also displayed. Residents are involved in weekly menu planning and shopping at local stores. Resident’s are risk assessed for environmental risks in the home and outside of the home in the local village, nearby town and for trips out. Risk assessments examined by the inspector had good control measures recorded and were recently reviewed. The front door at the home is kept locked, as most residents are a risk of accessing the nearby road where they would not be aware of the dangers of traffic unless a staff member escorted them. Records were stored in an appropriate manner to protect resident confidentiality. Staff training in confidentiality commences during the staff member’s induction. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 11,12,13,14,15,16,17. Opportunities for leisure and socialising and educational activities are plentiful and managed well at the home in order to appropriately stimulate residents. Family and friend contacts are supported and encouraged for residents. Residents are actively involved in the daily routines at the home and participate to the degree that they are able. Meals are relaxed and residents assist with meal planning and food shopping. EVIDENCE: Somerset Total Communication is used at the home. Residents are encouraged and supported to engage in daily living activities such as maintaining their own rooms, laundry, preparing meals etc. During the inspection staff were observed providing residents choices in the daily routine and keeping residents informed if plans had changed for the day such as if an activity was cancelled or if a new activity opportunity arose. Care records indicated that residents enjoy planned activities both on weekdays and Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 12 weekends and evenings. Residents mix with people from outside the Social Services network of home via colleges, pubs and clubs as well as leisure opportunities. Residents are offered an annual holiday and day trips with key workers. There is sufficient 1:1 time for residents and key workers planned as part of the staff duty rota. Very good records are maintained in care and support plans of family contact and staff were talking with residents informally about family issues or forthcoming family member visits. One resident choose to hold the key to their bedroom. Staff lock the other bedrooms are locked when unoccupied in order to prevent residents going into another person’s room. Residents can have free access to their own room at all times. Staff were observed unlocking bedrooms for residents to access when they indicated that they wanted to go to their room. Meals are taken in the kitchen or dining room. Most residents need support or supervision at meal times and staffing levels facilitate this. The dining room would benefit from redecoration, as it is looking tired in décor. Daily fridge and freezer temperatures are recorded by staff and food in fridges is date labelled to protect against food poisoning. The kitchen is equipped sufficiently. Staff reported that they have a three yearly food handling training update. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18,19,20. Residents are supported to attend community health care appointments and care and support plans inspected demonstrated that resident health care needs are anticipated and actioned appropriately. Individualised care is given via the key worker system. Key workers on duty during the inspection seemed to know the needs of their designated residents well. Medication is safely managed at the home. EVIDENCE: Nursing care is not provided at the home. Each resident has a key worker and a co-key worker. Many residents have complex behavioural and psychological care needs. Care and support plans demonstrated regular support from community learning disability and mental health specialists as well as GP support. Care reviews for residents were carried out annually by the care manager for social services. The routines in the home are flexible but reflect the need of some residents to have structure in their days. Sensory equipment is provided in many resident’s bedrooms in order to positively effect moods. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 14 A record is maintained in care and support plans of healthcare appointments and outcomes. No current residents are able to self-medicate. Medication storage, administration dispensing and records were inspected. The inspector gave the shift leader some advice regarding some medication recording. The inspector is satisfied that medication is managed appropriately at the home. Staff reported having training in the administration of medicines provided by a nurse contracted by Social Services. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22,23. There have been no complaints made since the last inspection. Most of the current residents would have difficulty in understanding how to raise an official complaint but families are supplied details of the home’s complaint’s policy. Policies and procedures are in place for the protection of vulnerable adults from abuse. Many staff have not received an update in abuse training for some years and an update training session is recommended. EVIDENCE: The home has not received any complaints since the last inspection. The home has a complaints policy, which includes the name and address of the Commission for Social Care Inspection. The complaints policy is included in the Service User Guide. There are polices and procedures available for staff in the protection of vulnerable adults. Staff were aware of where to access these policies in the home. Staff were also aware of the Whistle Blowing policy of the Council. Staff said that they had received training in abuse awareness and the protection of vulnerable adults but for most staff this was some years ago, usually at induction of via the NVQ training programme. It is therefore recommended that staff at the home receive a training update in the protection of vulnerable adults. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30. The environment at the home is domestic in character, adapted to meet the sensory needs of residents and clean. There is a range of communal space and large garden space. Residents’ rooms are personalised reflecting individual tastes. The home would benefit from some routine redecoration in communal areas to enhance the quality of living space and bathrooms. The boiler currently sited in a locked cupboard in one resident’s room is not ideally located as it can mean that the resident’s privacy can be compromised. EVIDENCE: Single room accommodation is provided at the home. None of the bedrooms have en-suite facilities but all but one bedroom has a wash hand basins. Taps are disabled from some sinks and communal bathrooms for the risk of flooding by residents. Staff enable the use of baths for resident bathing. Only one resident uses a wheelchair and this in only for outside trips. Bedroom sizes are adequate for the needs of the currently independently mobile residents. All bedrooms doors have a photograph of the resident whose room it is. Bedrooms are personalised and reflect individual’s tastes. Many bedrooms have sensory equipment to promote positive moods and tactile stimulation. Rooms are comfortable and warm. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 17 The home’s boiler is housed in a locked cupboard in one resident’s bedroom. The control panel is accessible to the resident who has changed settings from time to time, requiring staff to reset the boiler. Staff also reported that they have to disturb the resident sometimes at night in order to adjust boiler settings. This invades the resident’s privacy. It remains a recommendation that an alternative site for the boiler be found at the home and/or the control panel moved to a more accessible site so that the resident’s privacy is not invaded. There are communal bathrooms on both floors of the property. Although the ground floor bathroom was redecorated in 2004, bathrooms at the home can be described as functional rather than aesthetically pleasing. There are patches of mould on the ceiling by the ground floor shower. The roof has recently been repaired, which may have been a contributing factor to this. It is recommended, however, that the bathrooms are redecorated and upgraded in order to enhance the bathing experience for residents at the home. Communal space at the home offers a choice of areas for residents to relax, socialise or be alone. The gardens are spacious with a raised patio area and a lawned garden. The home is aware that residents require supervision in the garden, as there is a risk of some residents eating garden plans and shrubs. Poisonous plants therefore need to be identified and removed. Staff sleeping-in provision with en-suite facility is provided at the home. This room doubles as the home’s office. At night there is one waking and one sleeping-in staff on duty. The home is adapted to meet the physical and sensory needs of residents. Infection control measures are sufficient and adequate and chemicals are locked away to make them inaccessible to residents. Laundry facilities are sufficient. Staff carry out the cleaning of the home as part of their duties. Residents are encouraged to assist in order to take personal pride in the upkeep of the home. The home was clean to a good domestic standard on the day of the inspection. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36. Staff at the home seem confident and supported by managers in their roles. Staffing levels at the home are sufficient to meet the current needs to residents. 1:1 key worker time is allocated for residents. EVIDENCE: In the hall is a notice board displaying the staff on duty for the day. Staff spoken to during the in inspection appeared confident in their roles and understood the responsibilities expected of them. A team leader manages each shift. Staff said that they would seek line management advice if an issue came up in the home that they did not feel able to manage themselves. Staffing rosters were inspected. The home is staffed daily with a minimum of three staff during the day and one waking and one sleeping-in staff at night. The actual number of day staff frequently exceeds three, as 1:1 time is rostered in for residents generally for one day per fortnight. Staff reported that staffing levels rostered were sufficient to enable them to manage resident needs safely and in an unhurried manner. Staff reported that the home has had a computer for staff use for some months now but that it still had not been set up for them to use. They are waiting for someone representing the Council to set up the system. This is a source of frustration for computer literate staff that are having to travel to alternative Council facilities in order to use Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 19 computers. The travelling time could be better used in the home supporting residents. Staff on duty reported that they feel supervised and supported by the managerial team at the home. Staff receive 1:1 supervision on a planned 6 weekly basis. There are also in-house staff meetings held. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41,42. Records examined at the inspection were maintained in good order. Health and safety records were sufficiently detailed. The home manages the needs of residents who may display challenging behaviour very well. EVIDENCE: Records examined were maintained appropriately. Health and safety records examined were accident/incident reports, fire system weekly record keeping, fire system maintenance records and staff fire training records. These were all maintained in satisfactory order. Staff said that they receive a three yearly first aid appointed persons training update. The team leader said that there would be at least one staff member per shift who held a current first aid qualification. The home accommodates residents who may display challenging behaviour. Staff on duty said that they had received appropriate training. Incident records for challenging behaviour indicated that incidents are rare and quickly resolved. Staff had good knowledge of how to anticipate escalating Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 21 challenging behaviour and strategies of deflection and de-escalation of anxiety in residents. Resident risk assessments were detailed and updated as risks changed. As the registered manager was on rostered on duty during the unannounced inspection, access to many of the home’s records was not possible. These will be examined at the next announced inspection. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 N/A 3 N/A 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 4 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greengates Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x 3 3 x D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 23 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 Regulation Requirement No requirements were made as a result of this inspection. Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA16 YA23 YA24 Good Practice Recommendations It is recommended that an alternative site be found for the boiler sited in a locked cupboard in one residents room. It is recommended that staff receive an training update in the protection of vulnerable adults. It is recommended that the communal bathrooms at the home be upgraded and redecorated. Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 Greengates D53 - D02 S33922 Greengates V244796 160805 Stage 4.doc Version 1.40 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. 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