Inspection on 06/09/05 for Hazel Mead

This inspection was carried out on 6th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hazel Mead 27/06/07

Hazel Mead 02/11/06

Hazel Mead 09/05/06

Hazel Mead 28/04/05

Hazel Mead 15/12/04

Hazel Mead 18/06/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hazel Mead 3 Elpha Court South Broomhill Morpeth NE65 9RR Lead Inspector Elaine Wright Announced 6 September 2005: 09:30 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. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hazel Mead Address 3 Elpha Court South Broomhill Morpeth Northumberlan NE65 9RR 01670 761 741 01670 761351 elsie@elpha.totalserve.co.uk Ms Elsie Hazel 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 Elsie Hazel CRH 5 Category(ies) of LD Learning disability - 5 registration, with number of places Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There were no conditions applying at the time of the inspection. Date of last inspection 28 April 2005 Brief Description of the Service: Hazel Mead is a purpose built bungalow providing en-suite accommodation for 5 younger adults with a learning disability. Hazel Mead shares the grounds with Elpha Lodge, a care home for younger adults with physical disabilities. The bungalow has level access to all accommodation both internally and externally, and is decorated and furnished to a good standard. The home is close to local facilities and transport networks and service users also have access to transport shared with Elpha Lodge. Respite care and nursing care are not provided. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was carried out by Elaine Wright on Tuesday 6 September 2005, at 08:40 and lasted until 12:40. The focus of the inspection was to follow up on progress being made to meet the requirements made at the last inspection and Key Standards which must be inspected at least once each year. The records of one service user were examined together with communication books, supervision and training records, staff rotas, menus, medication records, service user and staff meeting minutes, policies and procedures. The Inspector was welcomed into the home by one service user who made coffee and chatted, and spoke to the other three service users currently living at Hazel Mead, the manager and two members of staff. What the service does well: What has improved since the last inspection? What they could do better: Complete the introduction of person centred planning to protect the health and wellbeing of service users. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 6 Provide the Commission for Social Care Inspection with an action plan to achieve completion of the person centred planning process for all service users. Review the admissions policy to help prospective service users make a decision about moving into the home. Staff must receive training in risk assessment to protect the health and safety of service users. Risk assessments for all service users must be in place to ensure their safety. Review the confidentiality policy to ensure staff are aware of the consequences should they breach the policy. Expand the opportunities service users have to be involved in the local community, education, employment and leisure activities enabling them to lead more fulfilling lives. Promote the privacy of service users and their right to see friends and relatives in private. Review the policy and guidance for administering medication to ensure the health, safety and welfare of service users. Staff must receive training in the processes of ageing, death and dying. Review the financial policies to ensure they are consistent and protect service users. Review the managers job description to ensure the responsibilities are clearly identified and include supervision and appraisal thereby protecting service users and promoting staff confidence and capabilities. Ensure that any staff employed within the home are trained and suitably skilled to carry out their role whatever their nationality. Staff rotas must include details of absences from duty to protect service users. Progress the quality assurance system to ensure all interested parties and service users are consulted and know the outcome of the consultation. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 7 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. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 8 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 Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 9 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) 2, 4 and 5. Person centred planning enables the aspirations and needs of service users to be identified and addressed improving their daily lifestyle. Opportunities to “test drive” the home help prospective service users to make decisions about moving to the home. Individual contracts protect service users living in the home. EVIDENCE: The admissions policy forwarded to the Commission for Social Care Inspection is incomplete. One service users new person centred plan was reviewed. The pen picture was not dated. The service user told the Inspector how the plan had been put together and described the sections of his pictorial plan that he was going to put up on his bedroom wall that evening. The plan showed care needs, achievements and future plans and wishes. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 10 The service user spoke with much more confidence and ease than on previous inspections and came back to speak to the Inspector 2 or 3 times during the day. Care plans and evaluations were signed by the service user and recorded outcomes. Travel contingency plans are in place for one service user who regularly uses the local buses. The service user visited the bus depot to meet staff so that he would know who to speak to in the event of a problem arising. More risk assessments were in place and contained evidence of evaluation. A service user contract is in place and a copy is held on the service users file. A more user friendly contract could be produced. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 and 10. Service users are consulted about the running of the home and are being encouraged, through the process of person centred planning to make life plans promoting their growth and independence. Service users involvement in the development of care plans is evidenced by them signing them. Service user meeting records show are kept and show their involvement in decisions made about the running of the home and events/activities that take place. EVIDENCE: A planned approach to the introduction of person centre plans has started. Monthly service user and key worker meetings are in place to look at the months achievements and to identify future targets. Plans include “trigger points” which may point towards a change in a service users health needs. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 12 The service user whose person centred plan had been started said he was going to put his pictorial plan on his bedroom wall. He had chosen the people he had wanted to be included in his person centred planning group. The service user had signed his plan. Service users and staff were heard negotiating about money and activity issues. Risk assessments and care plans now show the choices and wishes of service users and how they would like their care to be given. Records of service user meetings were seen. One service user chairs the meeting and all service users sign the notes. These meetings are held monthly. The most recent minutes included details of a discussion on how service users could access an advocate. Posters, notices and newsletters are received regularly and include details of local events, concerts and shows. Outings had recently included trips to see Meat Loaf, Grease, Queen and Annie Get Your Gun. A holiday in Bassenthwaite was planned for later in September. The policy on confidentiality does not include details on the action that will be taken should a breach occur. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 13 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) 12, 13, 14,15, 16 and 17. Opportunities to access employment, education and leisure/social activities are limited and restrict the development of service users and relationships. Service users rights to privacy are not always respected. Transport is available and enables service users to get out in the local community. Menu planning and shopping involves service users enabling them make choices. EVIDENCE: One service user has a job and one said he would like one. Service users also said that they attended college courses, went to ATC and that activities included art, gardening, crafts. Help for service users to increase their opportunities for employment, education and leisure activities is still limited. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 14 Visits are made to local pubs, shops and the bowls club and service users said they join with other homes in the group to have parties, go to shows and concerts. The home has transport available and some service users travel independently on local buses. Shopping is also done in the wider community including Ashington, Cramlington and Newcastle. A leader from a local group has visited the home and is going to talk to service users about what they would like to do that they currently can’t. Staff rotas allow for service users to spend time in and outside the home, but access to more individual opportunities is still limited. Service users were seen freely approaching the manager and staff on duty on a variety of issues. Conversations were heard to be light hearted and friendly. Feedback on one questionnaire said that a service user and their visitors were not always given privacy. One service user said they would like to meet a wider group of friends of both sexes. Daily routines are flexible taking into account service users commitments to college, work etc. Bedroom doors within the home are fitted with locks and service users have keys if they wish. All post is delivered to Elpha Lodge and then delivered to individual houses after sorting. Post is given to each service user but some need help opening and reading it. Recordings and observations on the day of the inspection showed that service users choose how, where and with whom they spend their time within the home. A range of tasks in the home are shared by staff and service users. One service user in particular was very proud of how he kept his bedroom polished. Service users choose what they want to eat and are involved with planning, shopping for and cooking meals. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 15 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 and 21. Staff who act as key workers and deliver personal care are chosen by service users. Policies and procedures supporting the administration of medication are not complete/consistent and could place service users at risk. Training in the administration of medication for staff promotes the health, safety and welfare of service users. The process of ageing, illness and death need to be supported with training to ensure that service users wishes are carried out and handled respectfully. En-suite bathroom facilities ensure that service users care is delivered in a private and sensitive way. EVIDENCE: Each bedroom has an en-suite bathroom which is fitted with a shower, toilet, wash hand basin, and any equipment required by a service user. Daily routines are flexible depending on service users commitments to work, college or health appointments. Recording showed evidence of service users choosing when they wanted to get up. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 16 A hairdresser and beautician visit the home but service users also go out to local salons. Records of service users visits to the GP, hospital, or with other health care professionals were seen. Each service user is registered with a GP at the local health centre and all had had health care checks earlier this year. One service user is able to use oxygen therapy independently. A service user was seen being helped to meet with a visiting health care professional in private. A new policy and guidance on medication is incomplete. In particular it does not deal with the retention of medication in the event of a service users death. A staff signature and initial list is in place. All staff have received training in the newly introduced “blister pack” for dispensing medication. Records to support training are in place and individual staff photographs are also available. There are no controlled drugs in the home but recording and storage systems are in place should these be needed. Training is planned to take place before the end of the year for all staff on the subject of ageing/death and care of the terminally ill. Staff have completed in house training on bereavement. The wishes of service users and/or their relatives (where appropriate) in the event of their death are recorded. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. Training has been carried out to protect service users from the risk of abuse. Inconsistent financial policies could place service users at risk of abuse or allow the miss-administration of their finances. The complaints policy and procedure encourages service users to speak up and to know that they will be listened to. Lockable bedroom doors and personal facilities promote the privacy, dignity and security of service users and their personal belongings. EVIDENCE: A complaints policy, recording system and register are in place to support the investigation of any concern/complaint made. Evidence was seen of a service user raising issues with staff and the manager. All staff have completed training in the Protection of Vulnerable Adults (POVA). A system is in place to refer staff considered “unfit to work with vulnerable adults” to the POVA register. The policies for “Handling of Service Users Money”, “Funding for Fees” and “Recording in Individual Account Books” are not consistent in their guidance. Service users have access to a lockable facility in which they can store personal items. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 18 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 and 30. The home provides and comfortable and safe environment that is well maintained and protects the health, safety and wellbeing of service users. Cleanliness, hygiene and laundry routines promote the health and safety of service users. EVIDENCE: The physical standards within the home continue to be high. Service users have chosen the decorations for their bedrooms which are very individual and personal. Laundry facilities are sited in Elpha Lodge and a timetable has been put in place to that service users know when they can do their laundry. Washing machines are equipped with a range of suitable programmes including a 65 degree wash for soiled laundry. Separate dryers are also available. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 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) 31, 33 and 35. The managers job description is incomplete and could compromise the welfare of service users. The home is run by a consistent team of staff who are qualified and undertake regular training to support the health, safety and welfare of service users. Supervision is carried out in line with the minimum standards and records actions/training required to support service users and ensure their safety. EVIDENCE: The managers job description does not include details of supervision and appraisal responsibilities. Staff are issued and comply with the General Social Care Council Code of Conduct. Concerns raised with the Commission for Social Care Inspection about the introduction of foreign workers into the home were discussed with the proprietor. Staff rotas did not include details of absences but additional staff shifts were recorded. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 20 Staff have completed Challenging Behaviour and Listening Skills training. Staff appraisals have been carried out and a training plan is being drawn up. Supervision is on target to meet the minimum standard. Training needs were seen to be being identified through appraisal and supervision. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 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 and 42. The quality assurance system is not fully developed and does not allow for service users, the Commission for Social Care Inspection and other interested parties to know that comments are welcomed, evaluated and acted upon. Access to health and safety guidance and maintenance of the home promotes the safety of service users and staff. EVIDENCE: The proprietor/manager intends to reduce her role within the home in April 2006. The quality assurance year has been identified to run from October to September. Questionnaires had recently been sent to a small group of professionals. No evaluation of quality has yet been undertaken. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 22 Staff have access to a range of health and safety policy, procedures and legislation. Maintenance and servicing records were seen to be up to date. Oxygen used within the home is securely stored. Service user friendly safety posters can be seen in the home. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 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 x 2 x 2 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 2 3 2 2 3 3 Standard No 31 32 33 34 35 36 Score 2 x 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hazel Mead Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 and 9 Regulation 18(1) Timescale for action Staff must receive training in risk 30 assessment. December 2005 (Previous timescale of 31 May 2005, not met.) The admissions policy must be 30 reviewed to ensure it meets the December criteria of standards 2 and 4. 2005 An action plan for the completion 30 of PCPs must be provided to December CSCI. 2005 The confidentiality policy must 30 be reviewed to include actions in December the event of a breach. 2005 Service users choices/wishes and 30 March opportunities must be expanded 2006 and clearly identified in the service users plan. (Previous timescale of 28 April 2005, partially met.) The privacy of service users must be promoted. The policy and guidance for administering medication must be reviewed against the requirements of the Royal Pharmaceutical Society. Staff must receive training in the processes of ageing, dying and Requirement 2. 3. 4. 5. 2 and 4 2 10 12 and 14 12 15 12 15 6. 7. 15 20 12(4) 13 30 November 2005 30 December 2005 30 December Page 25 8. 21 18(1) Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 death. 9. 23 13(6) The financial policies and procedures identified must be reviewed to protect service users. The managers job description must be reviewed to clearly identify responsibilities with regard to staff supervision and appraisal. All staff employed within the home must be suitably trained and qualified to carry out their role. Staff duty rotas must clearly identify staff absences and replacement workers. CSCI must be provided with a training plan to ensure training in conditions and behaviours associated with a learning disability is planned. The quality assurance system must be reviewed to ensure that it meets the requirements of Regulation 24. (Previous timescale of 18 July 2005, not met.) 2005 30 December 2005 30 December 2005 30 November 2005 30 November 2005 30 December 2005 30 March 2006 10. 31 9 and 18 11. 33 18 12. 13. 33 35 18 18(1) 14. 39 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 2 5 20 Good Practice Recommendations Ensure that all documentation including pen pictures are dated. Consider the introduction of a service user friendly contract. The medication policy should include the need to retain medication for 7 days in the event of a service users death. Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Northumbria House Manor Walks Cramlington NE23 6UR 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 Hazel Mead B53-B03 S40943 Hazel Mead V235738 060905 Stage 4.doc Version 1.40 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!