Inspection on 01/09/05 for Hazelwell Lodge

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 Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Hazelwell Lodge 07/06/07

Hazelwell Lodge 24/07/06

Hazelwell Lodge 27/01/06

Hazelwell Lodge 12/01/05

Hazelwell Lodge 21/06/04

Hazelwell Lodge 29/01/04

Hazelwell Lodge 14/05/03

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

CARE HOMES FOR OLDER PEOPLE Hazelwell Lodge 67 Station Road Ilminster Somerset TA19 9BQ Lead Inspector Barbara Ludlow Announced Inspection 1st September 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hazelwell Lodge Address 67 Station Road Ilminster Somerset TA19 9BQ 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) 01460 52760 01460 52384 MISS FEDILIA MAXWIN MRS NICOLA ANN OVERD Care Home 35 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. REGISTERED FOR 35 OLDER PERSONS IN CATEGORIES OP AND DE (E) 12th January 2005 Date of last inspection Brief Description of the Service: Hazelwell Lodge is a late Victorian property with a purpose built extension to the rear and an enclosed garden to the side. The home is situated at the edge of the small town of Ilminster, close to local amenities. The home accommodates 35 people in two separate areas of the building. The Bay provides personal care for older people and The Lilies provides personal care for older people with dementia care needs. The Lilies is accredited by Somerset Mental Health and Social Care Partnership under the specialist residential care arrangements and supported by a development nurse from the mental health care services. Platinum Care (previously Recovery Care) operates the home on behalf of the proprietors. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by B Ludlow and J Poole for CSCI. The homes Registered Manager Mrs N A Overd and Mr E Pyatt (Platinum Care) were present throughout the day and received feedback at the end of the inspection. This was a very positive inspection, immediate requirements were made and a prompt response indicating the action taken was made to CSCI. The inspectors had discussions with the management and toured the premises. Service users and staff were seen and were spoken with. Activities were observed during the day. Records and care plans were sampled and medications management was seen. Very positive feedback was received. What the service does well: What has improved since the last inspection? The home have installed two more en-suite facilities and continued with their redecoration programme for bedrooms. A dining room has been redecorated and has new furniture. The kitchen had some peeling paintwork identified at an Environmental Health Inspection; this has also been attended to and redecorated. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 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. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, NMS 6 does not apply. The home provides a good level of clear information about the home to aid prospective service users and their families/carers to make an informed choice of care home place. Visits to the home can be made. Pre-admission assessment is made. Contract information is satisfactory. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 9 EVIDENCE: The home displays the Statement of Purpose and Service User Guide and a copy of the last report in the entrance to the home. There is also an A-Z of Services Directory serving as a Service User Guide. The home has a dedicated administrator who works each day and deals with all invoices, personal monies held and contracts. Contracts/financial records were sampled for three service users. Terms and conditions had been issued to two service users. Contracts were in place for all three. The home has fifteen block contracted Special Rate Care (SRC) beds for dementia care clients in The Lilies. Records were seen and case tracking was used to look at the admission process and specialist input. The manager has considerable experience in care needs assessment and caring for older people with mental health conditions such as dementia. All service users have a pre-admission assessment and the home requests the community care assessment documentation prior to admission of the service user to ensure assessed needs can be met. It was demonstrated that community health care professionals, including a mental health nurse, support the home. The Specialist Care Development Nurse (SCDN) visiting to support the home and advise on care in The Lilies. The layout of the home has been designed to provide for service user’s needs whilst providing an appropriately secure environment. There are keypads to external doors, between The Bay and The Lilies and at the top of the stairs. Service users are able to have the keypad code where appropriate. Orientation cues have been developed to assist people to find their way around the home. There are handrails and aids available to assist daily living. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The home offers a good level of specialist and personal care for its dementia care clients. Discussion, observation and written feedback to CSCI from carers and service users confirmed that service users are treated with dignity and respect. EVIDENCE: Care plans were sampled for service users in both The Bays and The Lilies. The care supervisor and key worker draw up care plans in consultation with the specialist development nurse, to meet the needs of those in The Lilies. The care plans for service users on the SRC unit were more developed and thorough than those seen for the service users living in The Bays. It was noted on one care plan that more information in the life history section would be valuable to the assessment for care and social care provision on The Bays. On two other care plans it was noted that the more details for the manual handling risk assessments should be included, for example bathing information. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 11 Good practice was demonstrated, one care plan seen for a service user on the The Lilies where an equipment need was identified at a multi disciplinary care review, this was followed up and was evidenced within care plan as a needs review. There was clear evidence of community health care input for service users within their care plans. The home has a medicines policy and uses the MDS system of administration. Storage and recording of medication was found to be satisfactory. The deputy manager audits practice to monitor standards. Staff receive MDS training and are observed administering medication to ensure competency. The medication administration records were examined and a small number of deficits were identified. Hand transcribed entries did not all have two signatures and two alterations had not been countersigned. The medications room must be kept locked. A replacement controlled drug cupboard outer lock /cupboard is recommended. Service user/Staff interactions were observed to be kindly and appropriate. Service users were treated with respect and were addressed, as they preferred. The written feedback to CSCI from six service users confirmed their satisfaction with the way they are cared for and that they are treated well and their privacy is respected at the home. The response to CSCI from sixteen families and carers supported privacy and respect when visiting from all respondents and comments on care and consultation about care, was positive from fourteen of fifteen respondents. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The home offers a good range of well-supported and appropriate activities for service users. Families and friends commented to CSCI that they are welcomed. The menu served and attention to dietary needs was satisfactory. EVIDENCE: The home has a welcoming environment and even though a secure environment it is very homely and appealing. The home has an activities coordinator. There is a well-structured programme of activities and outings. A member of the care staff is allocated each day to assist with activities. Activities were observed during the inspection day and this confirmed good practice and service user enjoyment. The written feedback from service users suggested that all five respondents enjoyed the activities, although one said only sometimes. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 13 Service users were able to choose how they spend their time and whether or not to participate in the activities. Some service users were observed to be enjoying watching others who were participating in a group activity. Visitors responding to CSCI all confirmed that they are welcomed. Service users commented that they enjoyed their visitors and being able to go outside with them into the garden. The catering staff were seen and spoken with. All catering records seen were up to date. Staff informed the inspector that they have attended training sessions for ‘food and dementia’ and ‘war time food’. Lunch was seen served in well presented dining rooms. Roast gammon, roast potatoes, cabbage and cauliflower followed by banana dessert or a choice of jellies. Drinks were served with the meal. Service users confirmed that the food was enjoyable. All written responses to CSCI confirmed that the food offered was liked. The special diets seen to be catered for were for diabetics and one person with known sensitivities. An alternative choice of menu was not displayed but can be requested. Staff are aware of particular dietary likes and dislikes. Birthday cakes are made for service users and buffet teas can be arranged for families at cost. Home baking of cakes was evident and the catering staff confirmed that they bake cakes on six days each week. The dining room in The Lilies has a toaster, this was seen mid morning, it was plugged in and switched on. This posed a hazard and a risk to the safety of service users and must not be left switched on. This was brought to the attention of the Manager at the time of the inspection. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The home has policies in place to enable complaints to be made and heard. Service users are protected from harm. EVIDENCE: The home has a complaints procedure in place. The procedure is displayed in several areas of the home. There has been one complaint made to the home since the last inspection. No complaints have been made to CSCI. Four service users commenting in writing said that they felt safe at the home, one said sometimes. All feedback from families/carers said that they knew of the homes complaints policy. There are whistle blowing policies and recruitment policies in place to protect service users from harm. Staff receive training and all had Criminal Record Bureau checks made. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 This home is improving and developing its environment. The SRC unit, The Lilies and the ground floor of The Bays are overall very pleasant environments. The first floor of The Bays is in need of modernisation and redecoration. Immediate Requirements issued at the time of the inspection brought the Managers attention to health and safety issues. A prompt response was made and the action taken was confirmed to CSCI by letter from the homes Manager. EVIDENCE: The garden development continues, improving access and stimulation for all living at the home; there are still areas that will need to be made safe for example where there are accessible open buildings and where uneven walkways remain. The home was overall comfortable, clean and tidy. The Lilies has been decorated to provide a living area that aids orientation. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 16 The toaster in the communal dining room was seen mid morning, it was still plugged in and switched on. For the safety of the client group this must be left safely switched off when not in use. Two bedrooms on the first floor were in a poor condition, their shower cubicles were unusable, full of debris unsightly and unsafe. Two widely opening windows were also identified and excessively hot water (50 degrees Celsius) from a bath hot tap outlet was detected. Immediate requirements were made at the inspection and the Manager made a prompt response to CSCI (received 06.09.05) to confirm the action taken to address these safety deficits. This area requires redecoration and updating. One bed did not have a headboard and an armchair was seen that looked dirty. This was brought to the attention of the Manager at the time of the inspection. The bedrooms sampled on the ground floor of The Bays looked comfortable and homely, one wall clock was seen that displayed the wrong time. One bedroom needed attention to its decoration. The Manager reported in her pre-inspection questionnaire that a further two en-suite facilities have been built since the last announced inspection. Redecoration was reported to be ongoing in bedrooms. The dining rooms have been redecorated and new dining furniture was purchased. The kitchen was identified for re-decoration at the last Environmental Health Inspection; this work was confirmed as having been undertaken. The communal areas were nicely presented and provided a comfortable space for service users. The bathing and toilet facilities were satisfactory, not all en-suite toilets have handrails to aid independence. The home does not have a sluice room with a bedpan washer. This will remain as a recommendation for infection control good practice. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 There was sufficient staff on duty on the day of the inspection. The home has sufficient care and ancillary staff to run the home to a good standard. Recruitment records sampled demonstrated satisfactory practice. Staff receive training to undertake their work. EVIDENCE: Staff recruitment files were sampled, overall recruitment practice was satisfactory. Care must be taken to ensure that two references are received before the staff member commences work. CRB checks have been undertaken for staff working at the home and have been received for all except one; this member of staff was reported to have POVA First clearance. Staff rotas were provided pre-inspection and at the inspection. These demonstrated planning for adequate staff cover in all departments. The written responses to CSCI indicated that twelve people felt there were always enough staff on duty and four indicated that there are not always enough staff on duty. It was reported by the relatives and carers that staff are ‘premium quality’, helpful and kind and provide a very good level of care. The pre-inspection questionnaire indicated that five care staff have an NVQ Level 2 in care, six are working towards Level 2, four are working towards Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 18 Level 3. The catering and domestic staff also hold NVQ qualifications in Catering or Cleaning and Support services. The percentage of care staff calculated by the Manager included staff working towards their NVQ qualifications and this projected figure was 62 . Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,37,38 The home is well managed and is run with consideration for the best interests of all service users. All pre-inspection documentation was well prepared by the Manager and was posted to CSCI in advance of the inspection. The occupancy levels are good and there are systems in place for financial procedures to be carefully managed. All records are stored appropriately. The home has policies and procedures in place for all aspects of managing the safe running of the home. EVIDENCE: The Registered Manager has over 16 years care experience and has managed Hazelwell Lodge for over 5 years. Mrs Overd has commenced NVQ level 4 in Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 20 Management. The pre-inspection paperwork was received at CSCI in advance of this inspection and was well prepared and informative. The manager operates an open door policy. All feedback from staff and families/carers indicated that the home is well run. The home has a newsletter to keep people informed and involved in the life of the home, a copy of the very informative Summer Newsletter was sent to CSCI with the pre-inspection information. The home clearly displays the CSCI Certificate of Registration. The home has an administrator who spoke with the inspectors. Service user accounts were examined and were well managed. Three files were sampled and two held sufficient information, the third file did not have a copy of the terms and conditions, it was confirmed that these had very recently been sent out. Staff training is encouraged and was in place. Accident records were sampled, there is an accident audit reported on a monthly basis, this was seen for July 2005. Falls are audited to identify risk, interventions and prevention. Fire records were examined, these demonstrated attention to weekly fire alarm checks. Emergency lighting checks and smoke detector checks were recorded for 26.04.05. The fire alarm system servicing took place on 08.07.05. Fire training was discussed, this is a ‘four-pack’ course, the most recent lecture was held on 08.03.05 for 13 staff and the next lecture planned is for 08.11.05. All service user hoisting equipment was seen to have been serviced on 04.03.05. PAT testing was checked for on the toaster in the dining room the sticker date was 08/06. Care must be taken with denture cleansing agents and other hazardous substances; these items were seen in bedroom en-suite facilities. Suitable safe storage must be available and there must be a risk assessment in place for the safe use of such items and access by each individual service user. Records were seen to be stored safely and appropriately. Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 3 2 3 3 3 1 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 3 3 3 Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13(4)(a) • Requirement Two wardrobes were identified for securing. • Hot water at one bath outlet required to be adjusted down to a maximum temperature of 43 degrees Celsius. • Two first floor windows were identified to be restricted in opening, 100mm All above were confirmed as actioned by letter-dated 05.09.05. First floor bedrooms must be made comfortable and safe. The toaster in the SRC dining room must not be left switched on after use. Safe storage and risk assessment must be in place for denture cleansing agents and other hazardous substances in individual en-suite facilities. Timescale for action 08/09/05 2 3 4 OP19 OP15OP38 OP38 23 (2)(b) 13 (4)(b) 13 (4)(b) 01/11/05 01/11/05 01/11/05 Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 23 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 OP26 OP9 OP9 Good Practice Recommendations It is strongly recommended that a sluice room including a bedpan washer be installed following consultation with Somerset and Dorset Health Protection Unit. Where the controlled drug cupboard outer lock has broken, a replacement lock or cupboard is recommended. Local hospitals and GPs, who now expect prescribed medications for a person being admitted to hospital to be given to the ambulance service, should be consulted. On confirmation and clarification of their expectations, a protocol for practice to allow medicines to be safely transferred and receipted should then be introduced. There should be a clear audit trail for safe practice. Hot water bath outlets must have fail-safe temperature regulator valves fitted to prevent scalding by excessively hot water. These should be tested regularly. Care staff should continue to check and record bath water temperatures as instructed on bathing, to minimise the risk of scalding, particularly with the specific needs of the service users at the home and the possible problems with the temperature regulators. 4 OP25 Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Hazelwell Lodge DS0000016068.V254417.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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