Inspection on 11/08/08 for Hammerwich Hall Nursing Home

This inspection was carried out on 11th August 2008.

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

Hammerwich Hall Nursing Home 11/09/06

Hammerwich Hall Nursing Home 19/10/05

Hammerwich Hall Nursing Home 11/05/05

Hammerwich Hall Nursing Home 06/10/04

Hammerwich Hall Nursing Home 26/04/04

Hammerwich Hall Nursing Home 09/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Hammerwich Hall Nursing Home 105 Burntwood Road Hammerwich Nr Lichfield Staffordshire WS7 0JL Lead Inspector Key Unannounced Inspection 11th August 2008 09:00 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 Hammerwich Hall Nursing Home DS0000022330.V369896.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. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hammerwich Hall Nursing Home Address 105 Burntwood Road Hammerwich Nr Lichfield Staffordshire WS7 0JL 01543 686376/675529 01543 677240 Evansvi@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd 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) Mrs Victoria Louise Evans Care Home 51 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Old age, of places not falling within any other category (45), Physical disability (10), Physical disability over 65 years of age (10) Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. OP Minimum age 60 years 2 MD Minimum age 45 years 10 PD Minimum age 60 years 8 may be nursing 8 PD (Physical Disability) - Minimum age 45 years on admission Date of last inspection 11th September 2006 Brief Description of the Service: Hammerwich Hall is a 51 bedded Care Home. The new manager has been in post since June 2008. She along with her deputy and a team of experienced nurses and care staff deliver 24 hour nursing care. Currently the home is being run by BUPA Care Homes and was first registered in 1988. The home is situated in the rural location of Hammerwich village. It comprises of one building, built in 1870. Presently the home is registered to take those service users identified on the page two of this report. There are four separate lounges and one spacious, airy dining room. Other facilities include a hairdressing salon, extensive gardens with gazebos and a sun lounge. All areas of the home have access by stairs, ramps and or a passenger lift. There are 10 Physically Disabled service user beds available. (Minimum age 60 Years). Fees Highest £660 Lowest £348 The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that that people who use this service experience good quality outcomes. This unannounced inspection took place on Monday 11th August 2008 by the lead inspector. The Manager was in the home and participated in the inspection process. The inspection included the following elements; A walk around the building, Observation and inspection of records relating to provision of care, Discussions with people, who use the service, Case tracking whereby we select several people who use the service, chat to them and look at their care plans and lifestyle in the home. Discussions with several of the staff members on duty, Observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, training, recruitment and health & safety. We were made very welcome in the home and all assistance was given to gain the evidence required for the report. We had dealt with 3 complaints since the last inspection, two of which were anonymous. All three complaints had been investigated and one had led to a safe guarding meeting. No evidence to substantiate the complaints was found. People who use the service commented ‘The food is very good’ ‘ Chef talks to me everyday’ ‘There is an air of friendliness which meet you’ ‘Nurses and carers treat everyone with respect, and people are made to feel part of the family’ The home manager sent us their annual quality assurance assessment (AQAA) when we asked for it. This document was completed to a good standard and gave us all the information we asked for. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: • • • • • Care plans were not signed by the individual or any relatives should they need to. Short-term care plans were not being updated correctly. A risk assessment or disclaimer was not in place for an individual who had been on holiday with family. Unlabelled creams were seen in one bedroom cabinet and these were not prescribed. Wheelchair and cot side checks were not up to date. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 7 Although the refurbishment was taking place areas of the home could have been less cluttered and untidy. The manager is to discuss this with all her staff in the form of an environment audit. 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. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 8 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 Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 9 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): Standard 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service do have the information they need to make an informed choice about the home. People who use the service move into the home following their individual needs being assessed and agreement made. The home does not admit people requiring intermediate care. EVIDENCE: The Service User Guide and Statement of Purpose were available in the home. The new manager is planning to further personalise these documents to her preferred format. The information assists prospective people who may use the service to make a decision about moving in to the home along with a visit planned at their convenience and a meal if they wish. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 10 One lady spoken to at the visit said that the staff was very friendly on admission and they helped her settle in and feel at home and she had all the necessary information to allow her to make a choice about the home. Care records that were seen evidenced that people do have preadmission assessments prior to moving into the home and letters of confirmation are sent to the individual. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 11 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): Standards 7 to 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs set out in an individual plan to ensure their needs are met. People are protected by the homes policies and procedures for dealing with medication. People feel that they are treated with respect and their privacy is upheld. EVIDENCE: The BUPA care planning system ‘Quest’ is now established at the home and the care records are fully in place. The people who use the service each have an individual care plan, which was up to date and reflected the peoples’ current condition. Some short term care plans were not being reviewed appropriately and the manager will follow this up. There was evidence from care records and talking to people that their individual needs were being met and that they were satisfied with the care they received. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 12 Through case tracking it was identified that care needs were being met, reviewed and monitored. No signatures were evident within the care records from the individuals or their relatives and this is one area that the manager wishes to improve upon. Intervention from nurse specialists was requested when needed and the doctor visits the home weekly. Comments received from ‘Have your say’ feedback included ‘The nurses have been excellent at making referrals’ ‘The staff always listen and take action’ Relatives commented that ‘The nursing care is exemplary’ Medication policies, procedures and audits are closely followed and adhered to. The home manager has to report on a monthly basis to the head office of BUPA with data collected from audits and carried out in the home. No errors have been noted and the staff are vigilant to adverse effects of medication and any other side effects. One prescription cream was seen unlabelled and not prescribed in a persons bedroom along with two barrier creams – the manager removed these. No administration gaps were seen at the visit and the medication was stored in trolleys to assist the process. One relative commented ‘Nurses and carers treat everyone with respect, and people are made to feel like part of the family’. One lady spoken to said that the staff are generally friendly and cheerful. She said they are polite and respectful. She sees the manager on a daily basis and welcomes her involvement in the home. She went on to say she felt that she was settled and content in the home and could not ask for more. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 13 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): Standard 12 to 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service find that their lifestyle experiences in the home match their expectations and preferences. They maintain contact with family and friends and they are able to exercise choice and control over their lives. People who use the service receive a well-balanced wholesome diet in pleasing surroundings at times convenient to them. EVIDENCE: On admission to the home people who use the service are asked their preferences with regard to activities, their daily routine and food. One lady spoken to said ‘Everyone encourages you to make ‘it’ feel like their home’ she went on to say ‘I am happy living at Hammerwich, I like this place and the staff. I prefer to stay in my room as I like to be quiet but I do join people for some activities.’ She mentioned that the activity lady is very motivated to find things that are suitable for our age group and she always brings new ideas to the home. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 14 A few people had been to Blackpool for the day and thoroughly enjoyed it. One person told us ‘I enjoyed the theatre visit.’ There were photographs and social diaries available to evidence that the people who use the service have the opportunity to lead an active social life in the home. Some people who use the service are less interested in activities than others, however the activity coordinator has activities for all preferences and she does take part in one-to-one activities. Activities planned or already enjoyed were as listed: Fresh flower arranging for sensory involvement Pat a dog Land army - presentation for one lady Cruise Nights – themed evenings Fund raiser for relatives – Quiz and dancing at local club Blackpool for day Barge trips from local marina A meal at local garden centre Fete – 20th July Monthly communion takes place as a group and individually and the people who use the service benefit from visits from local parishioners. There is an individual activity file for each person who uses the service, which is updated weekly by the activity organiser. Many complimentary statements are written about the activity organiser in thank you cards received at the home. Two relatives meetings have been held recently– one to introduce the new manager and one about the refurbishment. The kitchen has been awarded a 5 star rating by the visiting Environmental Health Officer – new menus have been put in place and discussed at relative meetings. The people who use the service said they enjoyed the food and the choices were varied and served in a nice manner. One person explained via the Have your Say – feedback ‘The food is very good’ ‘ Chef talks to me everyday.’ The menus are displayed on the dining tables and in the entrance to dining hall. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 15 Some people who use the service prefer to be fed in their own rooms due to requiring assistance but the staff sympathetically assists these people. Modified cutlery is available to assist independence along with plate guards. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. People who use the service are protected from abuse. EVIDENCE: We asked people who use the service about making complaints or raising concerns in the home and they were all confident that they would be dealt with appropriately. Three events were brought to the attention of Commission For Social Care Inspection since the last inspection; One safeguarding issue was raised; this was resolved in the home and dealt with correctly. The Commission For Social Care Inspection received two anonymous complaints and these were investigated by the manager and involved the relevant social worker. All three issues were not substantiated. The staff had received protection of vulnerable adults training, however within the regional plan it is scheduled in next three months that all the staff will receive the companies new training package. The staff were confident about their ability to whistle blow and were aware of the whistle blowing policy. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 17 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): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a safe, well-maintained environment, which is clean, pleasant and hygienic. EVIDENCE: After many years of planning and decision-making the company have commenced the refurbishment of the home on a rolling programme. The bedrooms and communal areas refurbishment commenced on 31st June and this is to be completed by the end of November with the bathrooms upgrade being the last area of the plan. Those bedrooms seen were finished to a good standard and a lot of thought had gone in to the colour schemes and planning. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 18 Four bedrooms are completed weekly, which includes redecoration and replacement of soft furnishings and carpet. Prior to the people being moved – they and their relatives are informed. All safety and clinical equipment is transferred with the individual. One lady spoken to told us that she had her room redecorated whilst she was on holiday with her family and she was very impressed as it was decorated so well and now looked beautiful. No issues had been raised with regard to infection control. The home was very clean and generally tidy, however some areas were cluttered due to the refurbishment moves but this was rectified during the visit. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 19 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service needs are met by the numbers and skill mix of staff and they are in safe hands at all times. The people who use the service are supported and protected by the homes recruitment policy and practices and staff are competent and well trained. EVIDENCE: The staffing levels were appropriate for the needs of the people who use the service. Staff spoken to were feeling tired due to the refurbishment and the moves within the home. Some staff was able to discuss their training that they have completed and they felt they are encouraged to gain further qualifications such as NVQ. Staff spoken to was able to discuss the people who live at the home and they had a good understanding about how to meet their needs. People who use the service were very complimentary about the staff and how friendly they are. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 20 Staff recruitment was evidenced as being correctly completed with new staff commencing induction following receipt of a clear Protection of Vulnerable Adults check and a Criminal Record Check. Staff files were in good order and the company audits these. Have your say feedback comments included the following statements: ‘The nurses have been excellent at making referrals’ ‘The staff always listen and take action’ ‘Never had any concerns regarding medication’ ‘Very prompt to respond to concerns’ The staff had undergone all the mandatory training required and updates for this was continuous. NVQ training for carers was presently at 56 . Further relevant training was planned for the rest of the year including dementia awareness and End of Life Pathways. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a home, which is managed by a person who is fully aware of her responsibilities. The home is run in the best interest of the people who live there and their finances are safeguarded. The health, safety and welfare of the people living in the home and the staff working there is protected and promoted. EVIDENCE: The manager has been in her new post for several weeks now and is beginning to settle into her role. She is yet to be registered with the Commission For Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 22 Social Care Inspection but the process has commenced with the completion of the application forms. She has met with the people who live in the home and their relatives and also held staff meetings and home updates. Her management style ensures that everyone will be informed about what is happening in the home and also with regard to the refurbishment. She demonstrates an open door, ‘hands on’ style of leadership, which the staff commented that they liked. The refurbishment will be the main focus over the next few weeks but this must not distract from the care delivery and safety of those living and working in the home. Some areas of the home were slightly cluttered but this was addressed during the visit. The financial procedures of the home are fully audited by the company and receipts and statements are issued to the individuals. No cash is kept in the home. The quality of the home is priority to the manager including the care delivery and outcomes for the people living in it. Customer satisfaction / Quality assurance questionnaires are completed by an independent company and audited by them before sending the results to head office and then to the manager. The manager carries out night visits, ensures that she talks to relatives; carry’s out audits on care records and addresses any pharmacy issues. Many thank you cards and letters of appreciation were available as evidence of the staff delivering a quality service. People who use the service told us that they felt the quality of the home, care and food was very good and the manager informed us that a survey was due to be commenced shortly. The Health and Safety and welfare of the staff and people who use the service are paramount to the manager. Safety checks should be recorded as per company policy, however the wheelchairs and cot sides’ checks had not been completed for the previous month and the manager was going to ensure these were kept up to date. Safe working practices were evidenced in the home. The staff received regular updates for manual handling training and fire safety training. Fire drills were recorded and signed by the staff. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement 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. 4. Refer to Standard OP8 OP9 OP38 OP38 Good Practice Recommendations The people who use the service should see their individual care plans and sign to agree that their needs are identified and being met through the review process. The staff should ensure that any creams and lotions are labelled and prescribed within the home. When individuals leave the building risk assessments or disclaimers should be agreed and signed to ensure safety and an understanding of the care needs. Wheelchair and cot side checks should be checked, recorded and signed as per company policy to ensure safe practices being followed in the home. Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Hammerwich Hall Nursing Home DS0000022330.V369896.R01.S.doc Version 5.2 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. 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