Inspection on 11/09/06 for Hammerwich Hall Nursing Home

This inspection was carried out on 11th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hammerwich Hall Nursing Home 11/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Hammerwich Hall Nursing Home 105 Burntwood Road Hammerwich Nr Lichfield Staffordshire WS7 OJL Lead Inspector Mrs Joanna Wooller Key Unannounced Inspection 11 September 2006 09:15 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.V307299.R02.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.V307299.R02.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 OJL 01543 686376/675529 01543 677240 Evansvi@bupa.com www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited 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.V307299.R02.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 19th October 2005 Brief Description of the Service: Hammerwich Hall is a 51 bedded Care Home. The registered manager Vicky Evans has been in post since November 2004. 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 range from Highest £687.99 to £412.00. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key Inspection was carried out on Monday 11th September 2006. The inspection was undertaken using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including pre and fieldwork, amounted to 10hrs. Two Inspectors inspected the home. The Registered Care Manager was in the home for the visit and two Registered Nurses supported her. Eight care assistants were on duty along with the regular ancillary staff, which included the administrator, the cook and two catering assistants, three domestics, one laundry person, and a maintenance person. Staffing levels were evidenced as adequate to meet the needs of current 46 residents in the home. The inspection included the following elements, A tour of the building, Observation and inspection of records relating to provision of care, Discussions with several residents, Discussions with all the staff members on duty, Observation and sampling of other services provided such as catering and laundry. An inspection of the managerial aspects required by the National Minimum Standards with regard to staffing issues, quality assurance and health & safety. Since the last inspection on 19th October 2005 there had been no changes to the management of the home, the Commission For Social Care Inspection had received two complaints but no additional visits had been necessitated. Service users comments were as follows: “Care always appears to be of a very high standard” “Living environment is superior to anything I have seen” “The home provides a wonderful variety of activities and is clean and friendly” “The home is very tidy and clean” “The staff are very kind to me” One set of relatives commented that they were very satisfied with the care of their mother/wife. The staff were always polite and friendly, nothing was too much trouble for them. There relative was kept clean and her self-esteem was considered at all times especially when she had her hair done. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 6 One relative visited as often as she could, would have liked the option to stay in at the home in some form of relatives room. She was entirely satisfied with the home and the care her mother received. Service Users told the inspector that they were well fed and that the staff were exceptional in their attention to them. The group of Service Users going on holiday for four days realised and appreciated the amount of effort arranging this type of outing needed. The adverse comments received from Service Users in one lounge were in respect of the cockatiel in the lounge and it’s screeching which was upsetting some of the Service Users even when covered up. When mentioned to the management the bird was taken out of the lounge. What the service does well: What has improved since the last inspection? What they could do better: For many years now the home has been in need of refurbishment to meet the National Minimum Standards and this has been mentioned in the last few reports. Plans have been drawn up and finances have been agreed prior to planning permission being sought. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 7 Redecoration of some rooms and replacement of certain fixtures and fittings has been put on hold due to these plans and certain carpets for example are in urgent need of replacement now. Please inform the Commission For Social Care Inspection of the stage that this development is presently at. 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. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.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.V307299.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are followed to ensure that the correct information is gained prior to admission to ensure that Service Users needs can be met. EVIDENCE: Service Users confirmed when asked that they with the support of their relatives or social worker had been part of a pre admission assessment process prior to moving into the home. Through case tracking the documentation made available to the inspector evidenced that the care plans are based on the information gained in this important process. A registered nurse completes all assessments and discussions take place with the team of management prior to admission. Confirmation is given in writing to the Service Users or their representatives that the individuals needs can be met in the home. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 10 No changes have been made to the documentation since the last visit and the inspector raised no issues. All documentation was well written, up to date and reflected the Service Users current condition. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 This quality outcome in this group is good. This judgement has been made using available evidence including a visit to this service. Service Users individual needs are set out in care plans and evidenced as being met. Appropriately trained and compassionate staff respects Service Users privacy and dignity. The homes medication policies and procedures protect the Service Users supported by the staffs’ professional attitudes. EVIDENCE: The Service Users individual care plans and associated documentation was again as previously evidenced well written, meaningful and reflected the current condition of residents. The documentation seen at the visit and following discussions with both Service Users and staff members the inspector was able to evidence that health and personal care needs were being well met. Throughout the inspection it was observed that privacy and dignity were being afforded to residents, and there was again very good interaction with staff. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 12 Care staff were seen knocking on Service Users bedroom doors before entering. When asked specific questions relating to the standards Service Users told the inspector that they were treated with respect, and that the staff were always very good, even though they were busy. NHS facilities and professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded within the care records. A local GP practice and a local pharmacist service the home, and there is a good working relationship with them. Records of their visits and outcomes were seen documented. Some relatives spoken to commented positively about the care being provided, the friendly staff and open management. The medicines within the home were administered with a safe system following medicines policy documentation. No resident was ‘self medicating’ at this visit, but individual locked facilities were available. The pharmacist had completed an audit and the systems were found in order. The Deputy manager continues to complete monthly audits with regard to administration and documentation of medication. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 This quality outcome in this group is excellent. This judgement has been made using available evidence including a visit to this service, speaking with relatives, Service Users, viewing menus and observing the daily routine. The service users at Hammerwich Hall were provided with an exceptional choice of continuing their social interests and life style. Service users were served a well balanced diet from a varied menu, which is reviewed on a regular basis and based on the service users preferences. Contact with relatives and friend was maintained, the home had an open door policy for visiting. EVIDENCE: Four service users were waiting to go on a four-day holiday to Butlins in Minehead; staff and the activity organiser accompanied them. This is the third trip this year. Further arrangements had been made for one person to fulfil his ambition to fly and go abroad later in the year. One service user was to go to Lourdes later this week. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 14 There was evidence of skills retained within the home with some Service Users with diverse needs painting on glass. A grand auction had been planned for the end of September; some of the monies raised will go to charity. The activity organiser spends time doing a persons life biography to gain an insight into the individuals interests. Sessions of craft etc, in house have an evaluation sheet agreed by the service users that had partaken in the exercise. Musical entertainment was arranged in house on a regular basis. At the time of the inspection the hairdresser was attending to both sexes of service users, the results were very pleasing, with service users telling the inspector that they felt much better when their hair was set. The activity organiser had received two awards presented by BUPA for her promotion of social interests at Hammerwich with the service users. It was obvious during the inspection that the staff welcomed visitors at any time. From the three relatives spoken with, only positive comments were received. Each person was very satisfied with the care his or her particular relative received. The food was good and the home clean. Their relative was kept clean and the self-esteem recognised in their daily dress. The inspector had sight of the recently reviewed menus; the manager will further review them before they are implemented. The present menus provided a well balanced diet of choice and varied content. The manager had purchased special plates for the presentation of softer/pureed meals. Two of the service users had chosen a different meal from the menu; the catering staff would prepare their personal choice. The kitchen had recently been deep cleaned, there had been no visit from the Environmental Health Department; the previous visit made no requirements. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome is in this group is good. This judgement has been made using available evidence including a visit to this service. The home follows a robust BUPA complaints procedure and this was followed at all times. Service Users rights are protected and staff were trained to ensure that Service Users were protected from abuse. EVIDENCE: The inspector examined the complaints book and this was found to be satisfactorily completed. Relevant policy and procedure documentation is adhered to as required. Following a discussion with staff and Service Users the Inspector was able to evidence that complaints were listened to and dealt with in the correct manner. Since the last inspection two complaints had been recorded and brought to the attention of this Commission For Social Care Inspection. These were now fully rectified. No requirements were made. ‘Thank you’ cards and complimentary greetings cards were seen displayed from appreciative relatives. One reported incident had been dealt with through the Vulnerable Adults procedure and this had been followed correctly and no recommendations were made. Relevant policy documentation was seen, and a discussion with staff confirmed that residents are protected from all forms of abuse. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 16 All issues relating to complaints and abuse are been discussed at length during staff induction, training and on-going supervision. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 23 24 25 26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a tour of the home, sampling bedrooms, laundry and the external facade. Parts of the internal surroundings were not acceptable; the carpets were aged and did not present a pleasant environment. A potential hazard to service users was evidenced in some bathing/toilet area with toiletries not secured/stored away. EVIDENCE: Located on the periphery of the town of Burntwood, Hammerwich Hall stands in its own grounds. For many years there have been extended/on-going plans to refurbish and reconstruct areas of the home, this has still not been finalised. As one relative told the inspector “ I have been coming here four years and nothing has happened”. There are areas within the home that have been Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 18 mentioned in previous inspection reports. The conditions of certain carpets have now become unacceptable and detract from the pleasant surroundings for service users. This report makes it a requirement that the carpets are replaced. A sample of the bedrooms identified that many personal possessions were displayed. The housekeeping staff worked as a team to promote an odour free home. External decoration to the home had commenced at the rear; the front of the Hall was in desperate need of painting. The inspector observed within a number of the toilets and bathrooms that there were personal toiletries that had not been secured or returned to the service users bedroom. This practice was a potential hazard to other service users. This report makes this occurrence a requirement. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. The assessed needs of service users had been met by an adequate number of suitably trained staff. Recruitment of new staff had followed the BUPA policies and procedures and had been correctly addressed which had then contributed to the protection of service users. Staff training continues to be given, monitored and recorded appropriately. EVIDENCE: Staffing levels were appropriate to meet the individual Service Users present needs. Staffing rosters were checked and were in order. In addition to the Manager and two trained nurse there was eight carers on the morning shift, two nurses and six care assistants on each evening shift, and two nurses and three care staff on each night shift. Adequate ancillary staff had been provided each week. Service Users when asked by the inspector stated that staff were available when they wanted them for assistance and although they were busy all the staff in the home were caring. The homes recruitment policy, procedures and documentation remained the same as previously inspected and recruitment issues had been handled correctly. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 20 Staff had been subject to POVA/CRB checks, and these were seen recorded. Staff that were asked had stated that they had job descriptions and contracts of employment. Training had been given a priority in the home and the training records of individuals were seen. The records evidenced that care assistants had again benefited from ‘in house’ and external training, which had covered the information necessary to meet the needs of the registered client group. The Deputy Manager had attended a BUPA Developing Excellence Course to ensure she is being developed in her role in the home. The home is presently awaiting a visit by ‘Investors In People’ team. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by closely following the BUPA policies and procedures and quality assurance systems were in place. Financial aspects had been correctly addressed and recorded with safeguards to Service Users. Health and safety issues had been well managed and recorded as required. EVIDENCE: The manager has been assertive in her style of management in the home and has made many positive changes to the home during her two years in post. The staff, Service Users and relatives appreciate her open door policy. BUPA quality systems are in place and monthly audits are submitted to head office. Regulation 26 visits are made by the operations Manager to ensure acceptable standards are maintained. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 22 Financial systems were checked by the inspector including the method used for the saving of personal funds, the funds saved were placed into a service users account the interest is paid monthly to the individuals; this was evidenced from the records provided. Staff spoken with confirmed that they received supervision of their training and development needs. They also confirmed that the obligatory training was current with more planned. Health and safety issues had all been addressed including all the necessary checks to ensure the health, welfare and safety of all the staff and Service Users is promoted and protected. The maintenance man keeps wellmaintained records to evidence his duties and ensure safety is maintained in the home. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 2 2 X 3 2 3 3 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 3 X 3 Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 24 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 OP21 Regulation 13(4)(a) Requirement The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Personal toiletries must be stored away for the safety of the service users and to prevent communal use. The registered person shall, having regard to the number and needs of the service users, ensure that all parts of the home are kept reasonably decorated. To replace the carpets in certain areas as identified at the time of the inspection. The Registered Person shall ensure that all care plans are reviewed and signed by the Service User or a representative. Timescale for action 10/10/06 2 OP19 23(2)(d) 01/11/06 3 OP7 15 11/11/06 Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 25 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 OP38 Good Practice Recommendations Outdoor garden furniture should be risk assessed and a record kept. Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Hammerwich Hall Nursing Home DS0000022330.V307299.R02.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!