Inspection on 19/07/05 for Grove (The)

This inspection was carried out on 19th July 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grove (The) 02/02/07

Grove (The) 05/01/06

Grove (The) 28/02/05

Grove (The) 24/08/04

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

CARE HOME ADULTS 18-65 The Grove 72 Grove Road Walthamstow London E17 Lead Inspector Rob Cole Unannounced Inspection 19th July 2005 at 10:00am 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. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Grove Address 72 Grove Road, Walthamstow, London, E17 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) 020 8520 3510 adianspence@hotmail.com Mr Aiden Spence Ms Lisa Goldwater Mr Aiden Spence Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28th February 2005 Brief Description of the Service: The Grove is a care home registered to provide accommodation and support to three adults with mental health needs. The home is located in the Walthamstow area of the London Borough of Waltham Forest. The home is in a residential area, close to shops and other local amenities, and to transport networks. The home is in keeping with other properties in the vicinity. The home is jointly owned by two proprietors who are both qualified psychiatric nurses. One of the proprietors is the registered manager of the home. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 19/7/05 and was unannounced. The inspector had the opportunity of speaking with service users, staff and the homes manager. Overall the inspector was satisfied that this is a well run home, and that service users receive high levels of care and support. There are some areas that must be addressed, and these are highlighted within the report. What the service does well: 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 Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Grove G56 G06 S7318 The Grove V240406 190705 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 The Grove G56 G06 S7318 The Grove V240406 190705 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) 1,3,4 and 5 The inspector was satisfied that service users are provided with sufficient information about the home to be able to make an informed choice as to move in or not. This information is provided through written documentation and the opportunity of visiting the home. EVIDENCE: The home has both a Statement of Purpose and Service User Guide in place. The Statement of Purpose outlines the philosophy of care in the home, stating “We endeavour to create and maintain an environment that is both physically and emotionally safe…by forming positive and supportive relationships that are based on mutual trust and respect.” The Service User Guide, or “Residents Handbook” is more detailed, and includes all information required by the Care Homes Regulations 2001. All service users are given their own copy of the Guide. Both documents are written in plain English, and are accessible to all service users. All service users have a written contract/statement of terms and conditions, which have been signed by both the manager and the service users. The home retains a copy and service users have their own copy. The contracts are in a format that is accessible to service users. They include details of fees charged, what they cover and what is extra, periods of notice required, the rights and obligations of each party and all information required by National Minimum Standard 5. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 9 The home has an admissions procedure, and this states that service users are able to visit the home, including for overnight stays, before making a decision as to move in or not. Due to the nature of the home and the client group, existing service users have the opportunity to meet with prospective service users, and their views are taken into account when deciding whether the person would be suitable for the home. Initially service users move in for a three month trial basis, after which their placement would be reviewed. Although the home has an admissions policy, this needs amending to cover fully the whole admissions procedure, for example, at present it makes no mention of any pre admission assessments that would be done, although the manager informed the inspector that these assessments would always take place. It is a repeat requirement that the admissions procedure is amended accordingly. The home does not take emergency admissions. From observation and discussion with staff and service users, there was evidence that the home is able to meet the assessed needs of service users. Staff are able to communicate with service users in their preferred language. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 and 10 The inspector as satisfied that the home is able to meet service users individual needs. Care plans were of a good standard, and service users are able to make choices over their every day lives. EVIDENCE: All service users have clear and comprehensive care plans in place. Plans are drawn up with the involvement of the service users and staff from the home. Plans include information on health needs, social and leisure needs and cultural needs. Plans indicated that on occasions service users exhibit challenging behaviours, and there were clear guidelines in place around managing this. However, some plans were dated as last been reviewed in May 2003. It is required that plans are reviewed at least every six months. Daily logs are maintained, and these related specifically to care plans. All service users also have clear risk assessments in place. These were comprehensive, including risks associated with substance misuse, arson and violence and aggression. Assessments not only identified what risks there are, but also included clear strategies for managing and reducing the risks. Assessments are drawn up with the involvement of the service users and are regularly reviewed. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 11 The manager informed the inspector that no restrictions were in place on service users choice. From observation and discussion with service users the inspector was satisfied that service users do indeed have a large degree of control over their daily lives, for example they are free to get up and go to bed as they choose, and mealtimes were seen to be flexible and based around individual service users. The home holds regular service user meetings. These are minuted, and there was evidence that decisions taken at meetings are acted upon. For example, at a recent meeting service users agreed they would like to go to Hastings for a holiday, and this was subsequently arranged. The home has recently undergone some building and decoration work, and the inspector was informed that service users were consulted about this. The home has a confidentiality policy in place, which makes clear under what circumstances a confidence may have to be broken in the health, safety and welfare interests of service users and others. At the previous inspection several confidential documents were seen to be left lying around the home, at this inspection all confidential documentation appeared to be stored appropriately in locked cabinets. The inspector was informed that staff and service users can access records as appropriate. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None The standards in this section were not tested on this occasion, but will be tested as part of the next inspection. EVIDENCE: The standards in this section were not tested on this occasion, but will be tested as part of the next inspection. The Grove G56 G06 S7318 The Grove V240406 190705 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 and 20 Generally, the inspector felt that the home is meeting the health and personal care needs of service users. However, more attention needs to be paid to the storage and administration of medications. EVIDENCE: Service users are responsible for their own personal care, although some need encouragement in this area, and guidelines are in place around this in their care plans. On the day of inspection staff were observed to knock and wait for an answer before entering bedrooms, and all service users have a key to their bedroom. Service users are able to get up and go to bed when they wish, and choose their own clothes to wear. All service users were appropriately dressed on the day of inspection. All service users are registered with a GP. There was evidence of the involvement of other health professionals as appropriate, including CPN’s psychiatrists and opticians. Since the last inspection records are now maintained of medical appointments, and the home has made arrangements for all service users to be offered appropriate dental care. The home has a medication policy in place, and all staff receive training before they are able to administer medications. One service user self medicates, and there are appropriate checks in place around this. MAR charts are maintained, and since the last inspection these now include a key to explain what all symbols used The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 14 stand for. However, there were several unexplained gaps on MAR charts, and this must be addressed. Further, not all medications were appropriately labelled, for example one service user has been prescribed Procyclidine tablets, these were stored in a completely unmarked container, with no indication of what the medication was, who it belonged to or what the prescribing instructions are. This is unacceptable and must be addressed. The Grove G56 G06 S7318 The Grove V240406 190705 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 and 23 It is the view of the inspector that appropriate policies are in place around adult protection and complaints. However, more must be done in this area, for example appropriate staff training, to ensure service users are not placed at unnecessary risk. EVIDENCE: The home has a complaints log, although the manager informed the inspector that the home has not received any complaints within the past year. The home also has a complaints procedure, this included timescales for responding to any complaints and makes appropriate reference to the CSCI. However, the procedure was not on display within the home, and this is recommended. The home has a copy of the Local Authorities adult protection procedure, and also its own policy on adult protection. This appeared to be in line with current legislation. Staff spoken to informed the inspector that they had not received any training in adult protection, and those spoken to demonstrated only a limited understanding of their roles and responsibilities in this area. It is required that all staff receive appropriate adult protection training. The home holds money on behalf of service users, this is kept in a locked cabinet. Records and receipts are kept for transactions involving service users money. The inspector checked service users monies held in the home, one was found to be 90p short, while another was 58p over. It is required that systems are in place to accurately record and check service users finances held in the home. The Grove G56 G06 S7318 The Grove V240406 190705 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 and 30 The inspector was satisfied that the home is suitable to meet its stated purpose. There is adequate private and communal space to meet service users needs, and the home is generally well maintained. EVIDENCE: The home is situated in the Walthamstow area of the London Borough of Waltham Forest, and is close to shops, transport links and other local amenities. The home is in keeping with other homes in the area. At the time of the inspection the home was in the process of a major rebuilding programme, to extend the home from three bedrooms to five. At the previous inspection a requirement was set that risk assessments need to be put in place around the building work that was going on. Although building work was still in progress at this inspection, no risk assessments have been done around this, and the requirement is therefore repeated. As a result of the building work, there is now more communal space available to service users. Communal space consists of a sitting room, dining room, kitchen and garden. The dining room is a new room, previously the dining room and kitchen had been combined. Service users spoken to informed the inspector that they were happy with the extra space. All bedrooms are ensuite, with a toilet, shower and hand basin. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 17 There is a separate bath/toilet, with suitable lock fitted, and a separate toilet for staff. On the day of inspection all bathrooms were clean, tidy and free from offensive odour. All service users have their own ensuite bedrooms. Bedrooms have been decorated to service users personal tastes, and service users are involved in keeping their own rooms tidy. Bedrooms had adequate furniture, including table and chair, wardrobe and chest of draws, while bedding, carpets and curtains were all well maintained. Service users had televisions and music systems in their rooms as they wished. Bedrooms had adequate natural light and ventilation, and meet National Minimum Standards on size requirements. The home has a designated laundry room, which is domestic in scale and suitable to meet service users needs. COSHH products were stored securely. The home has introduced a policy on infection control. Hand washing facilities were situated throughout the home. The Grove G56 G06 S7318 The Grove V240406 190705 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) 31,32,33,34,35 and 36 Staff in the home appear to have built up good relations with service users, and demonstrated a good understanding of service users individual needs. However, it is important that staff undertake all necessary health and safety training as appropriate. EVIDENCE: The home provides 24-hour support, including an emergency on-call procedure. There was a rota on display within the home, however, this did not record the hours worked at the home by the manager, and this must be addressed. Staff informed the inspector that informal staff meetings are held, but that no minutes are kept of these meetings. It is required that a least six staff meetings are held a year, which are recorded and actioned. The home has policies in place on recruitment and selection and equal opportunities. The inspector checked several staff employment files at random, these contained evidence of satisfactory references and ID checks. However, they did not contain a full written employment history for staff, and this must be addressed. All staff have received a copy of their job descriptions, and also a copy of the General Social Care Council codes of conduct. Through observation and discussion staff demonstrated a good understanding of their roles and responsibilities, and a high level of knowledge around individual service users. Staff were observed to interact with service users in a relaxed and respectful The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 19 manner, and there was evidence that good relationships have been built up with service users. All staff receive induction training, which covers service user and general house issues. Recent training attended by staff includes training on food hygiene and breakaway techniques. However, staff have not received any recent training in first aid or fire safety, and it is required that staff receive all necessary statutory health and safety training as appropriate. Of the four care staff currently employed at the home, the inspector was informed that one was undertaking a relevant NVQ qualification. The manager informed the inspector that it is planned that in time all staff will be given the opportunity of completing a relevant care qualification. Staff receive regular formal supervision, which is minuted, and covers service user and training issues. The Grove G56 G06 S7318 The Grove V240406 190705 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) 37,38,39,40,41,42 and 43 It is the judgement of the inspector that the homes manager is suitably experienced to competently carry out their roles and responsibility. The Grove appears to be a well run and managed home. EVIDENCE: The manager is a Registered Mental Health Nurse and has twenty years experience of working with adults with mental health issues, including fifteen years in a managerial capacity. They informed the inspector that they are planning to start the Registered Managers Award qualification in the near future. Staff and service users informed the inspector that they found the manager to be approachable and accessible, and on the day of inspection staff were observed to interact with the manager in a relaxed manner. Through the homes polices and practices their was evidence that the manager makes a commitment to equal opportunities within the home. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 21 Service user meetings and staff supervisions contribute to quality assurance in the home. Copies of previous inspection reports were available to view in the home, and questionnaires are issued to service users to gain their feedback on the care and support provided. The home has policies in place in line with National Minimum Standards, those checked by the inspector included adult protection and complaints, and these appeared to be satisfactory. Records maintained within the home were generally satisfactory and up to date. The home has in date employer’s liability insurance cover. The home has various health and safety policies in place, including on fire safety and infection control. The home has fire-fighting equipment around the home, and fire exits were free from obstruction on the day of inspection. The fire alarms and emergency lighting were last serviced by an engineer on 25/5/05. The manager informed the inspector that the home testes fire alarms on a weekly basis, however, these testes are not recorded, and this must be addressed. Fire drills are held monthly. There was evidence of recent PAT and gas safety checks been carried out. The home checks fridge/freezer temperatures, and since the last inspection now also checks hot water temperatures. The Grove G56 G06 S7318 The Grove V240406 190705 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 x 3 2 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score 3 3 2 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Grove Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 3 G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 13 and 23 Requirement The registered person must ensure that the home carries out and records weekly checks on all fire alarms. (Timescale 31/5/05 not met) The registered person must ensure that the homes admission procedure is in line with the actual practice of admissions within the home. (Timescale 31/5/05 not met) The registered person must ensure that all medications stored in the home are appropriately labelled. (Timescale 31/5/05 not met) The registered person must ensure that comprehensive risk assessments are in place around any risks associated with building work been carried out at the home. (Timescale 31/5/05 not met) The registered person must ensure that all care plans are reviewed at least every six months and dated. The registered person must ensure that all medications administered are appropriatly accounted for. Timescale for action 30/11/05 2. YA4 15 30/11/05 3. YA20 13 30/11/05 4. YA24 13 and 23 30/11/05 5. YA6 15 30/11/05 6. YA20 13 30/11/05 The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 24 7. YA23 13 8. YA23 13 9. YA33 17 10. YA33 18 11. YA34 19 12. YA35 13 and 18 The registered person must ensure that all staff who work at the home receive appropriate adult protection training. The registered person must ensure that checks are in place to ensure that monies held by the home on behalf of service users are maintained appropriatly. The registered person must ensure that the staff rota accuratly records the hours worked in the home by all staff, including the homes manager. The registered person must ensure that the home holds at least six staf meetings a year, that are recorded and actioned. The registered person must ensure that the home has a full written employment history in place for all staff, which includes an explanation of any gaps in employment. The registered person must ensure that staff receive any necessary statutory health and safety training as appropriate, including fire safety training and first aid training. 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA22 Good Practice Recommendations It is recommended that the home has a copy of its complaints procedure on display within the home. The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ 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 The Grove G56 G06 S7318 The Grove V240406 190705 Stage 4.doc Version 1.40 Page 26 - 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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