Inspection on 01/09/05 for Harry Chamberlain Court Residential Home (12)

This inspection was carried out on 1st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Harry Chamberlain Court... 17/11/08

Harry Chamberlain Court... 29/01/07

Harry Chamberlain Court... 11/01/06

Harry Chamberlain Court... 17/11/04

Harry Chamberlain Court... 19/07/04

Harry Chamberlain Court... 25/02/04

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Pemdale

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

CARE HOME ADULTS 18-65 Harry Chamberlain Court Residential Home (12) 12 Harry Chamberlain Court Telesia Court, Hollingsworth Road Lowestoft NR32 4UG Lead Inspector Jane Offord Announced 1 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Harry Chamberlain Court Residential Home (12) Address 12 Harry Chamberlain Court Telesia Court, Hollingsworth Road Lowestoft Suffolk NR32 4UG 01502 582561 01502 582561 N/A Royal Mencap Society 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) Ms Christine Morgan Care Home 5 Category(ies) of LD Learning Disability (5) registration, with number of places Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17/11/04 Brief Description of the Service: 12, Harry Chamberlain Court is part of a large block of flats owned by Waveney District Council and located to the north of Lowestoft. The main town is a bus ride away but there are local shops and facilities within easy reach. The home provides accommodation for five residents with a learning disability between the ages of 18 and 65 and personal support is provided by the Royal Mencap Society. The accommodation is all on the ground floor and consists of five single bedrooms, a lounge, a kitchen and dining area and open plan garden to the rear of the property. There are adequate bathroom and toilet facilities and there is also a laundry and office space for the staff. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on a weekday between 12.00 and 17.00. The manager was available throughout the inspection and all the residents had returned from their daytime activities by 16.00 and were able to offer their views of the service. Care plans and life files for two residents were seen as well as the policy folder, staff training records, menus, staff rotas and a folder that prepared residents for holidays. The medication administration records (MAR sheets) were checked, the manager gave a tour of the communal areas of the home and three residents showed the inspector their rooms. On the day of the inspection the home was clean and tidy. The furnishings and décor were attractive and appropriate. All the rooms seen appeared light and airy. When the residents returned there was general, relaxed interaction with the staff, some preparations for the next day and plans for future outings and holidays. The relative of one resident visited, was made welcome and included in the conversations. What the service does well: The service makes great efforts to provide the residents with information in a format they can understand. Care plans use pictures to allow the resident to take part in developing their plan. There is a selection of laminated pictures of meals that are used to assist a resident to make a choice when eating in a public place. Individual choice and preferences are clearly identified and documented such as favourite television programmes and outings. The programme of staff training is comprehensive and mandatory training is regularly updated. Training to support the needs of the residents is accessed as required. The manager has supported all the staff to undertake National Vocational Qualification (NVQ) level 2 or above. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 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 Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 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, 5 People who use this service can expect to have an individual contract with the home. EVIDENCE: The personal records of the residents that were seen contained evidence of a contract and the terms and conditions of their occupancy. The documents were written but also in pictorial format. The manager said that key workers went through the information with the residents to ensure that they understood. For example the amount of rent that was paid monthly was written but there were pictures of the notes and coins that made up the amount. One resident has a diagnosis of dementia and the service is not registered to care for people with dementia. An application for variation of registration is being processed by CSCI and the manager is making provision for relevant training for the staff to be able to meet the needs of the resident. A second resident is being assessed for dementia but does not yet have a diagnosis of it. The manager will make a further application for variation if required. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 9 Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 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, 10 People who use this service can expect to be supported in their choices of lifestyle and have a plan and personal goals that reflect their needs. EVIDENCE: Personal files that were seen showed evidence that residents were supported to maintain skills and independence. Each resident has a development plan that is written with their participation and has pictures chosen by the resident to illustrate the activities described. Residents make decisions concerning all aspects of their lives from choice of holiday to what to put in sandwiches for their lunch the following day. One resident has been supported for holidays by Holiday Explorers, which is a group offering help to organise, plan and care for people with a learning disability who wish to take holidays away from home. Two residents said that they were planning a holiday later in September that included attending a music festival offering music from the fifties and seventies. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 11 The manager said that residents’ meetings had been tried in the past but the residents found it difficult to participate in a group. A system of one to one meetings with their key workers, that take place monthly, has been more successful and allows the residents the opportunity to raise any issues of concern and give their views about the service or outings. A record of the meetings and action points from them is kept in individual files and was seen in two files during the inspection. Residents’ files contained risk assessments to support their choice of lifestyle. One resident with a hearing disability had a risk assessment for the failure of their hearing aid but also for road safety and aggression. Another file had a number of risk assessments including ones for nocturnal wandering, falling and burns while ironing. The residents all clearly enjoy being able to go on holiday and there was talk about a recent break that had been taken. A small folder for each resident is being developed to help with their needs when out of the usual routine. The folder documents individual preferences so that some of the anxiety of making choices in strange surroundings or with unfamiliar people is lifted. The folder is prepared with the key worker prior to a holiday and taken when the resident goes away. Residents’ files are kept securely in the office. One resident was observed asking a member of staff to go to the office with them to discuss an issue in private. During another conversation a member of staff suggested that the resident might wish to talk about something later in private. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 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) 11, 12, 14, 15, 16, 17 People who use this service can expect to be encouraged to maintain appropriate family contacts, participate in activities of their choice and have their rights respected within the home. They can also expect to be offered a healthy choice of diet and help in the preparation of meals. EVIDENCE: The personal files seen had details of the next of kin with the relationship to the resident recorded. There was also a list of family birthdays to be remembered. One resident said that they needed to get a birthday card for a member of their family in the next few days. One resident spent time with their parent until the parent had become too frail to manage. They now go out with a carer to see their relative or their relative is invited to the home for a meal. The relative of one resident arrived for a visit and was welcomed by residents and staff. This visitor comes to the home frequently and was able to join in the conversation that was taking place between the staff and residents. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 13 A resident talked about a recent family wedding they had attended and proudly showed the photographs they had of the event. From Monday to Friday all the residents attend day care centres, which offer a variety of activities. Transport is arranged for this to collect the residents in the morning and return them to the home at the end of the day. There was evidence around the home and in residents’ rooms of some of the art and photography work they had done. One resident had painted some attractive abstracts that had been framed and hung. In the past some residents have undertaken courses in subjects such as drama and building self-confidence. The manager had a selection of publicity leaflets for this coming term and shared them with the residents to look at with a view to possibly taking further courses. All the residents’ rooms have a key for the lock but not all the residents choose to lock their rooms. Staff seek permission from residents to enter their rooms. There was evidence that staff sought help to assist residents to manage their behavioural problems that could potentially affect their quality of life. One resident has developed an attention seeking habit that results in the need for additional attention to personal hygiene. The community nurse was asked for advice and a chart, which the resident completed regarding their own behaviour, was devised to address the problem. A selection of recent menus was seen and the way meals were chosen was explained. Each resident chooses a main meal from a range of cookery books with coloured illustrations for one evening in the week. The resident helps in the preparation of the evening meal that is served. One resident said they enjoyed cooking the main meal. They had ‘only been allowed to cook cake’ in their previous accommodation. The menus included a roast meal on Sundays and dishes such as Toad in the Hole and curries. Residents prepare their own sandwiches for the next day when they attend day care. There was a choice of cheese, ham and garlic sausage as fillings on the day of inspection. The refrigerator and freezer were well stocked and there was evidence of fresh fruit and vegetables storage. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 People who use this service can expect to have their care needs met and their medication managed appropriately. EVIDENCE: The care plans are compiled with the residents and cover areas of personal hygiene and managing clothing. One resident said they liked to take a bath in the evening but had a strip wash each morning. Getting up times are governed by the need to be ready for transport but the time of going to bed is flexible. Nighttime records indicate that residents make their own choice of bedtime and will sometimes go to bed to read or listen to music, not to sleep immediately. Records document a resident’s religious background. The manager said that only one resident attends any religious services. The resident does not attend regularly but if they express a wish to go the staff will facilitate it. There was evidence in the files of appointments attended with health professionals. One resident has a diagnosis of dementia and there was evidence that their condition and medication were being monitored by a psychiatrist and reviewed regularly. It was recorded that this resident felt there was something wrong and the staff have made efforts to help them understand the changes that are happening. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 15 Other records showed appointments for residents with opticians, dentist, community nurse and chiropodist. There were weight records and health checks that were gender specific. The medication administration records (MAR sheets) were seen and were correctly completed. Medication was stored in a locked cupboard in the office and a random check was done on one drug and the numbers tallied with the records. There was evidence in the staff training files that staff have undertaken appropriate training to administer medication. Residents’ files contained records of the medication they were taking together with a list of common side effects to observe for. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 16 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) 23 People who use this service can expect to be cared for by staff who can recognise potential abuse but they cannot be assured that the most up to date policy is available. EVIDENCE: The training files seen for staff showed that regular training within the Mencap programme to recognise abusive situations is undertaken and updated. Residents spoken with were able to name their key worker and when asked what they would do if something hurt or worried them said they would talk to the key worker. In the folder that contained information about the resident’s contract there was also information about abuse. This also had pictorial explanations and was used to help the resident understand what could be a difficult situation for them and how they should deal with it. The manager had been on a training update for Protection of Vulnerable Adults (POVA) within the last year however the POVA folder dated back to 2001 and needs to be the most recent version of 2004. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30 People who use this service can expect to live in a clean, comfortable environment, with private and communal space and specialist equipment, if needed, to promote their independence. EVIDENCE: On the day of inspection the home was clean and tidy. The communal areas looked attractive with cotton tablecloths and napkins on the dining tables. There were prints on the corridor walls and one framed abstract that had been painted by a resident. The décor was bright and fresh and there were no unpleasant odours. The bedrooms seen were all decorated in colours chosen by the resident and had personal details in them. Some had a television and music centre. There were framed photographs and posters in some rooms. The furniture in each room was arranged differently to suit the needs or preference of the resident. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 18 There are two bathrooms in the home, one that has a walk-in shower. The domestic bath has had an adjustable bath seat fitted to meet the needs of one resident who has mobility problems. There is also a raised toilet seat in one of the two toilets. The laundry was suitable for the number of residents and tidy on the day of inspection. The gardens are managed by a volunteer and offer outdoor seating for the residents to use. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 19 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) 32, 35, 36 People who use this service can expect to be cared for by a staff team that is trained for the work, competent and supervised regularly. EVIDENCE: The manager demonstrates a positive attitude to training and developing the staff team. There was evidence in the staff files that a comprehensive induction programme, devised by Mencap, was undertaken by all staff in the initial six months of employment. Ongoing training is recorded and covers areas of care such as manual handling, medication administration, first aid, food hygiene, fire awareness, protection from abuse and Health and Safety. All staff have been supported to achieve NVQ level 2. A 100 achievement has not been managed only because of health problems. The manager has achieved NVQ level 4 management. Since one resident has been diagnosed with dementia training on caring for people with dementia has been planned for the autumn. The psychologist who will give the training has furnished the staff team with a learning pack to assist them until the training can take place. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 20 There was evidence in the staff files of regular supervision taking place. There were headings of individual items discussed and then notes of the discussion. Training needs were identified, as were issues of concern in the home or with individual residents. Staff had copies of the notes made of the discussion. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 21 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) 39, 40 People who use this service can expect that the policies of the home will protect their rights and their views will be taken account of in future development of the service. EVIDENCE: All the residents were aware that an inspection was to take place. They had had help to complete or partially complete comment cards prior to the date of the inspection. CSCI also received four comment cards from visitors/relatives. There was evidence in the files that residents’ views are sought and this was confirmed by the conversation that took place during the day of inspection. There was animated talk about where to go for the next holiday or outing. The one to one records showed that residents were able to raise matters with their key worker. One recorded that they had not enjoyed a particular outing and did not want to participate next time. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 22 The home has a copy of Mencap policies, which is maintained up to date by the manager. New or amended policies are left prominently for all staff to read and sign for, before being filed. All policies are available to staff in the office. Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 23 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 x x 4 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 x 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Harry Chamberlain Court Residential Home (12) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 3 x x x I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 24 None 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. 2. Standard 23 Regulation 13 (6) Requirement To protect residents staff must have access to the most recent POVA guidance. Timescale for action 31/10/05 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 Good Practice Recommendations Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 5th Floor St Vincent House Cutler Street Ipswich IP1 1UQ 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 Harry Chamberlain Court Residential Home (12) I54 - I04 S24404 Harry Chamberlain Court (12) V236339 050901 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. 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