Inspection on 22/08/07 for Haslewood Avenue (1)

This inspection was carried out on 22nd August 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haslewood Avenue (1) 30/08/06

Haslewood Avenue (1) 19/10/05

Haslewood Avenue (1) 27/04/05

Haslewood Avenue (1) 21/12/04

Haslewood Avenue (1) 10/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Haslewood Avenue (1) 1 Haslewood Avenue Hoddesdon Hertfordshire EN11 8HT Lead Inspector Jan Sheppard Unannounced Inspection 22nd August 2007 10:00 Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 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 Haslewood Avenue (1) DS0000019407.V349278.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 Adults 18-65. 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. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haslewood Avenue (1) Address 1 Haslewood Avenue Hoddesdon Hertfordshire EN11 8HT 01992 479 171 01992 479 171 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) Hightown Praetorian & Churches Housing Association Nichola Jane Larner Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (8) of places Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate people with a physical disability (only when associated with a mental handicap). 31st July 2007 Date of last inspection Brief Description of the Service: Haslewood Avenue is a purpose-designed bungalow in the centre of Hoddesdon built in 1995 to accommodate 8 adults with learning disabilities who had formally lived together in a long stay hospital. It is an attractive, compact building, surrounded by a small garden that provides eight single bedrooms, two assisted bathrooms, three wheelchair accessible WCs, a laundry, lounge, kitchen and dining room and an office and storage areas. The home has a very homely appearance and feel. The facilities of the local town are easily accessible by foot from the home, as are the local transport services. The home, which is run by Hightown Praetorian Housing Association, a voluntary organisation, provides full care services in an integrated and safe environment for its residents who all have learning and physical disabilities and who may present a moderate degree of challenging behaviour. The Statement of Purpose is available and each individual has a copy of the Service Users’ guide. The Local Authority sponsors all the residents. The current weekly fees range from £1098. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on one day when one inspector visited the home and spoke with all the staff on duty and with all the residents. A tour of the building was made and a number of the homes records were spot-checked. The comments in this report reflect the findings made by the inspector during that visit and also take account of information gathered over the past months from the homes management and by way of pre inspection questionnaires completed by the residents. This was a positive inspection with the majority of the key standards examined met. The requirements from the last inspection have been met or are in respect of the bathroom improvements are in process of being met. See text for this standard. The home had a very calm and friendly atmosphere and staff were observed to be delivering care to the residents in a very kindly manner anticipating their needs whilst at the same time encouraging them to retain the greatest level of independence that they could safely manage. What the service does well: What has improved since the last inspection? Since the last inspection because of the increased and changing care needs of the residents the manager has in conjunction with the Local Authority commenced a review of all the residents current care needs, a review as to how the facilities of the building may need to be changed to meet these increased needs and a review of the residents day activity programmes and a review of staffing levels. Since the last inspection a number of works of improvement and maintenance have been carried out to the building. Improvements have also been made to the use and development of speech and language communication systems. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience good quality outcomes in this area This judgement has been made using a variety of evidence including a visit to the service. Before their move into Haslewood Avenue the resident’s needs were fully assessed ensuring that the service was a suitable placement for them. There is an up to date Statement of Purpose and Service Users Guide so that people who currently use the service or may wish to use the service can get appropriate information. EVIDENCE: The records evidenced that the admission and initial assessment policies and procedures were followed for the one new service user who had moved into the home since the last inspection. This resident had quickly settled into their new environment and was able to confirm to the inspector that they were very happy living there. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents care plans are individually focussed and provide an up to date record of their needs, how these may be changing and how they will continue to be appropriately met. Comprehensive risk assessments to maintain peoples safety are regularly reviewed to accommodate changing need and ability. EVIDENCE: The care plans were found to be very detailed and to be recorded using a person centred planning format and to give good evidence of the residents involvement with the compiling of their plans. The manager explained that because of the recently changing care needs of many of the residents all their plans are currently being reviewed so as to ensure that their current needs are being fully met and that the information about these new needs was filed in a readily accessible manner. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 10 The records gave evidence of the weekly one to one ‘talk time’ meetings that the key workers have regularly with their residents to ensure that they are consulted and that as far as it is possible to do so (many of the residents have no or limited speech) their views are understood and acted upon. Comprehensive risk assessments are in place and they provide guidance, which ensures staff can safely manage risks. They also detail what action is required should a risk occur. Staff encourage the residents to express choices and take appropriate risks which are recorded. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The diverse social and activity needs of the residents are well supported but further developments are needed to this aspect of the service so as to fully meet their changing needs. Visiting Guidepost staff assist the residents to use and access local community facilities. A varied diet of healthy freshly prepared good quality food is provided. EVIDENCE: All the residents have an active and interesting weekday activity programme, which is led by staff from the Guidepost Trust who visit the home and take the residents out to participate in their activities. Programmes are planned to meet the needs and take account of the interests of each individual resident. Because of their recently changing needs of several of the residents the manager explained that she has commenced a review of all the residents Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 12 current activity needs so as to ensure that what is offered fits in with their changed levels of ability. For example some activities need to be of a shorter duration than previously planned to accommodate the residents lessening abilities and other more active activities are now longer suitable for residents with increased mobility restriction. Also the manager recognised that the lack of formally planned activities at the weekends and during Guidepost holiday periods is a deficiency which needs to be addressed. The home benefits from being situated close to the town centre so that the residents have easy access to the local community facilities and the home also has its own transport. Residents are encouraged and assisted to maintain relationships with family and friends. On the day of this inspection staff were taking a resident to spend the day with their family at the family home. Another resident happily told the inspector of their regular weekend visits to their family. All the residents have had at least one staying away holiday since the last inspection (in Norfolk) and the programme of holiday visits planned for individuals this summer has included diverse activity holidays to meet individual needs and interests including horse riding and boat and train rides. A number of photographs around the home evidenced the resident’s enjoyment with their holidays. The residents are given good opportunities to choose their menus via the use of pictorial menu planning. Some residents enjoy assisting the staff with some of the food shopping duties. On the day of this inspection the residents were helping the staff prepare for a farewell luncheon buffet for a long-standing staff member who was leaving. The manager discussed with the inspector how the nutritional needs of the residents and their weights are monitored now that the dietician service has been discontinued. The changing needs of some of the residents and the requirement of one to be fed with soft food was seen to be being well managed with support from the GP. A healthy eating diet is followed with fresh vegetables and fruit seen to be freely available. The home has a good awareness of the problems associated with over weight for this client group and has enlisted the help of their local doctor. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personal care is provided for the residents in a way that meets their needs and takes account of their own preferences and expressed or known choices. To ensure continued well-being the residents have good access to all health services. The medication system is robust thereby ensuring safety for the residents. EVIDENCE: The care plans were seen to include full details of the care needs of the residents and how these should be met in ways that the residents prefer. Staff explained to the inspector about the very detailed understanding of the resident’s wishes that they had built up through visual means to ensure that their care could be delivered smoothly. Care and assistance was seen to be being delivered in a calm and kindly manner with emphasis being given to enabling the residents to do as much for themselves as it was safely possible for them to do. At the luncheon party it was noticeable how one more able Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 14 resident was helping the others. The relationship between residents and staff was open and warm and clearly some residents who have lived together for many years had great affection for each other. The care plans gave ample evidence of the involvement in the residents care of a range of health professionals. One resident has been referred to a diabetic clinic and all are able to access community dental and optical services. The manager has worked hard at developing a closer working relationship with the local GPs. Since the last inspection the medication system has been relocated to a recently developed small office where it is very well housed with adequate specialist storage cupboards in a secure environment, which is thermostatically controlled. The home continues to use an MDS monitored dosage system provided by a local chemist. Staff who administer medication have received appropriate training. Spot-checks of the MAR (medication administration records) made on the day of this inspection found these to be accurately maintained. A management system for checking these records could be evidenced. None of the current residents is able to administer their own medication but the home has the appropriate policy and procedures for if this should ever be the case. The home does not currently have any facilities for the storage of controlled medication. Although no controlled medication is currently being prescribed for any resident in the home this situation could change suddenly and without any warning. The manager must satisfy herself that in such an eventuality legally acceptable storage and administration arrangements could be in place in time to ensure that the required standards for the storage and administration of such controlled medication would be met. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to protect residents from abuse neglect and self-harm. Residents are actively encouraged to make their views known. Staff observe the residents (none of whom have speech) closely so as to understand their moods and wishes. EVIDENCE: A comprehensive complaints policy and procedure is in lace and is well published in the home and to the residents. A copy of the visual complaints procedure was seen on all the residents’ files. There have been no complaints since the last inspection. The service has received a number of complimentary letters. Staff have a good awareness of the Safeguarding Adults (adult protection) policy and the Whistle blowing procedure which ensure service users are protected from abuse. All staff undertake regular training about this. There have been no adult protection issues in the home since the last inspection. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The physical layout of the home enables the residents to live in a safe, reasonably maintained and comfortable environment where their independence can be encouraged as far as it is safely possible to do this. EVIDENCE: The home which was purpose designed some ten years ago is well appointed and regularly maintained. It is quite spacious and has a very homely atmosphere. On the day of this unannounced inspection the residents bedrooms were seen to be attractively decorated very well personalised with comfortable furnishings each reflecting the individual tastes and styles of each resident. Since the last inspection the home has been subject to various works of improvement and refurbishment including redecoration, new flooring in several of the bedrooms, new seats in the lounge and a new cooker and redecorations in the kitchen. The re-decorative works in the hall and passageways along with fresh carpeting in these areas gives the home a Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 17 welcoming and well-kept appearance. A new hoist was delivered to the home during this inspection and training for the use of this new equipment had been arranged for 22/8/07. The works to refurbish the bathrooms have had to be re-planned to meet the changed needs of the residents e.g. the need for full wheelchair and hoist accessibility. Following an assessment from a specialist OT these facilities are now going to be completely replaced with new equipment chosen to meet the specific needs of the residents rather than just refurbishing the old equipment that was already there. This should ensure that the needs of the residents and the safety aspects for the staff are fully met. The manager said that these works are planned to commence on the 24th September 2007; the Commission must be informed when these works are completed. The home was found to be clean and hygienic; the manager discussed with the inspector recent changes that had been made to the cleaning routines and the provision of paper towels to ensure good infection control measures are met. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff in the home are experienced and trained and have sufficient skills to support the people who use the service. There are sufficient staff to maintain the smooth running of the service and meet the residents needs. The recruitment policies and practices of the home provide adequate safeguards for the residents. EVIDENCE: This home retains a stable group of very dedicated staff who are well trained and who work very well together as a team. Training is given a high priority in this home. Individual training needs are planned following the staffs individual monthly supervision meetings and annual appraisal. Training is arranged both on an individual basis and for the home as a whole. Extra group training has been planned covering such subjects as manual handling and the use of new hoists and wheelchairs, these to meet the increased needs of the residents whose care needs are escalating. Staff confirmed that they receive a generous level of training and encouragement to develop through the achievement of Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 19 NVQ awards. New staff are fully inducted and their competence is assured before they work unsupervised. The manager said that following a staffing review to assure that the changed and more complex needs of the residents could be safely met the Local Authority, who funds the service, had been asked for an increase in staff hours and this is also to include two waking night staff. Recruitment records were checked and found to be in good order. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home benefits from the calm and consistent approach of the experienced manager. The quality assurance system is adequate and enables the management to assess information to enable them to improve the care experience for the residents. The good record keeping in place promotes the health safety and welfare of the residents. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service and aims to continually improve the quality of life for the residents and to enable them to maintain as much independence as possible. She operates an open door policy and works some shifts. This ensures a good insight into the residents needs whilst balancing the management requirements of the home. Spot checks were made of various of the homes records including fire testing, accident recording, risk assessments and water temperatures and these were found to be well maintained there by ensuring the health safety and welfare of the residents. Records evidenced that staff are appropriately supervised and that regular staff meetings are held (last on 16/8/07). The manager confirmed that she is well supported by the company managers. Throughout this inspection the manager demonstrated a good awareness of current good practice, national trends and recent development in the service. She appeared to have a good understanding of equality and diversity issues and a grasp of the complexity and varying strands of these issues. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 X CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 25 26 27 28 29 30 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 3 x 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 3 17 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000019407.V349278.R01.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Haslewood Avenue (1) Score 3 3 2 x 3 x x x x x 3 Version 5.2 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA12 Regulation 16 (2) (m) & (n) Requirement Sufficient activities which are appropriately meet the needs, interests and abilities of the residents must be available at all times (including the weekend). Timescale for action 30/11/07 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 Refer to Standard YA6 YA20 Good Practice Recommendations The changed needs of the residents should be fully met in a safe manner. The arrangements for the safe keeping of controlled medications should be reviewed to ensure that if required it meets legislation and guidelines. Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Haslewood Avenue (1) DS0000019407.V349278.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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