Inspection on 21/07/06 for Headonhey

This inspection was carried out on 21st July 2006.

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

Headonhey 18/10/05

Headonhey 07/07/05

Headonhey 29/10/04

Headonhey 27/07/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Headonhey 34 Harboro Road Sale Manchester M33 5AH Lead Inspector Michelle Moss Key Unannounced Inspection 21st July 2006 1:30 Headonhey DS0000005612.V302028.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 Headonhey DS0000005612.V302028.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. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Headonhey Address 34 Harboro Road Sale Manchester M33 5AH 0161 969 3527 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) Stockdales of Sale, Altrincham & District Ltd Mr Simon Andrew Shaw Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users have a learning disability and may have an associated physical disability. 18th October 2005 Date of last inspection Brief Description of the Service: Headonhey is a care home providing personal care and accommodation for 7 young adults with complex needs (registered for learning disabilities and associated physical disabilities). It is managed by Stockdale’s of Sale, Altrincham and District Limited, which is a charitable organisation. The home is located in an established residential area in Sale, close to shops, bus and train routes and other amenities. The home was opened in 1992 and consists of a two-story building. The communal areas are located on the ground floor, including a lounge, kitchen and dining area. All bedrooms are single and situated on the first floor with a passenger lift provided for access. Bathroom and shower facilities are provided on both the ground and first floor. The home has a drive and patio area to the front of the property and a paved patio area to the rear. All outdoor areas were accessible for wheelchair users. The weekly fees changed at time of this inspection were £968.39 –1,178.35 approximately. The home’s inspection reports are made available to residents’, families and professional on request. A copy of the home’s Statement of Purpose and Service Users Guide is always made available to read at the home. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector went to the home without telling anyone she was going to visit on the afternoon of Friday 21st July 2006. The inspector spent 2 hours visiting the home and also had spent previously a further hour looking at staff records at the organisation’s head office. All residents were sent a questionnaire. With the help of staff all 7 questionnaires were returned. During the visit to the home the inspector also: • Spoke with residents • Spoke with the staff on duty • Looked at some residents care plan records. • Looked around the home. To help the inspector to write this report the home provided a self-assessment report /questionnaire which was completed by the manager and it was received by the Commission 22 June 2006. This report has also taken into account other information, which the Commission knew about the home. There were some important things the inspector wanted to find out about the care given by the home. These were: • • • • How the health needs of residents were met. How the personal care needs of residents were met. How the staff helped to kept residents safe and promoted community involvement. How the home respected the resident’s rights, diversity and identity. The term of address preferred by the users of the service was confirmed as “residents”. What the service does well: These are some of the things that were found to be good about the home from information received in questionnaires completed by the residents. • Everyone indicated they received the care and support they needed • Everyone felt the staff listened and acted on what they said/ indicated through body language. During the visit to the home evidence was seen to support this was happening in practice. • Everyone indicated that they received the medical support they needed. All the information provided through the questionnaire showed that residents felt cared for, they were supported to stay healthy and staff valued the residents’ contribution in decision making. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 6 The staff had been trained in meeting the care needs of residents and were sufficiently skilled to meet the everyday needs of residents, which in turn meant their health and welfare was safeguarded. Residents were supported by the staff team to go on holiday at least once a year and to use a range of community-based activities. This meant residents were being supported to be included in their community and that activities took account of the diverse needs of residents. The residents were seen to be treated as individuals and the staff team provided care that reflected the residents’ rights and preserved their dignity and privacy. This meant that the staff team understood the importance of respecting and seeing the house as the residents’ home. The home was nicely decorated and fitted with aids and equipment that assisted the residents to remain safe. The staff rotas showed that the staffing was set to meet the needs of the residents. This showed there were enough staff to make sure residents were kept safe and adequately supported. Information seen about the support of staff showed they were themselves well supported by their manager and encouraged to develop their skills to better meet residents’ social and health needs. When the home recruited staff they made sure the person was suitably experienced, that checks were completed that showed they were medically fit and suitable to work with vulnerable adults. What has improved since the last inspection? What they could do better: From examining medication charts it was found that on one occasion staff had not signed to confirm they had given a resident their medication. This was important because the medication was liquid and it was not possible to find out if it had been administered or not. Making sure medication records are signed correctly will mean the health of residents will be better safeguarded. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 7 The home needed to have more details in the care plan about the cultural and spiritual needs of the residents and how the home should respect each resident’s beliefs. By having better information the staff would have more understanding about how best to meet the diverse needs of residents. The home needed to make sure they checked all aspects of fire safety more often. By doing this it would make sure the safety of residents and staff could be better safeguarded. 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. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 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 the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ changing needs were assessed which in turn helped the home to plan and ensure their needs were continually met. EVIDENCE: The home had a static resident group, which had resulted in the home not receiving any new admission for some years. As part of the ongoing care of residents at least once a year the assessment of needs was updated which in turn helped to inform the care plan about any changes in needs, including the residents health, social and emotional wellbeing. This process meant the overall needs of residents were being monitored and staff kept updated about any specific changes. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefited from having an informative care plan that highlighted their needs. This included having their care needs recorded and balancing risks that enabled them to maintain a level of independence over their lives. However, the positive aspect of the plan was slightly compromised due to the home not recording sufficient information about meeting the diverse needs of residents. EVIDENCE: A random sample of care plans were examined. The plan covered a number of key areas relating to care. These included dietary needs, health, social and emotional well being and preferred methods of communication. It highlighted daily routines and interests. This extended to likes and dislikes. Consideration about respecting dignity was covered, including residents being asked about who they would wish to have to help them with personal care. Details about activities, social needs and relationships were also found to be included in the plan. A chart was set up that mapped all the various activities a resident was doing on a daily basis. The only weakness in the plan was demonstrating how the home met the resident’s diverse needs. For example, religious beliefs, age Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 11 related issues and social inclusion. From speaking with staff about diversity, they could identify things they did which respected individual identity and doing age appropriate activities. This included helping a resident to attend church and help to style their hair and choosing to wear make up. However, none of these details could be found in the care plan. The home was working towards person centred planning. During the visit to the home two of the residents were attending a meeting to discuss their plans. This included consulting with them about things important to them and how they wished to be cared for and supported. This new approach was commendable practice. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were able to exercise their rights, including having their privacy and their diverse needs valued by Headonhey. The home also enabled residents to choose their own daily routines, maintain family links and have a varied and nutritious diet. EVIDENCE: At the time of the visit the residents were all being supported in various activities. These were either through services operated in house e.g. social therapy service or through attending other outreach day care services. The social therapy staff and the home’s staff were seen to work closely together to ensure the wishes of residents were respected. From observing staff interacting with residents it was confirmed the residents were consulted about what they wanted to do. From talking with staff they were familiar with the various ways diversity should be promoted. By identifying residents’ likes and dislikes, areas such as planning holidays and social outings were all seen as respecting their diverse needs. This included recognising their disability and how this affected them and Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 13 reflecting personal preference. For example the residents’ favourite football team or band and planning trips that best met the residents’ needs. The home positively encouraged family links. Families were consulted about the home through the organisation’s annual Quality Assurance survey and general contact with the home and planned social events. A monitoring chart for activities had been introduced. This showed that residents benefited from a variety of different activities that reflected their personal preferences. A number of sources of information were seen about offering residents healthy food and how the residents’ nutritional needs were assessed. This included the recording of factors associated with eating and drinking disorders and the safeguards that were required to be in place to ensure a resident’s health and well being was not compromised. Where residents required specialised feeding the staff team were found to be competent in the skills required to maintain the residents’ health. This extended to having set protocols to be followed when potential problems arose. A sample of menus and records of residents preferred choices of meals were examined. From examining the two documents side by side it was confirmed that the menu served represented the preferred meals of the residents. Also, within the questionnaire all residents who had meals indicated being satisfied. A range of eating aids were seen to be used by the staff that enabled residents to maintain their independence for eating and drinking. For example offering a straw for a drink. This included staff communicating with residents in a way the resident was able to positively contribute to, in order to make informed decisions. Also, the staff understood the different body gestures made by residents and what they indicated. Throughout the inspection evidence could be seen that the home promoted positive outcomes for residents’ lifestyle. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were having their personal and healthcare needs met by the home. This included ensuring that good arrangements were in place for safeguarding residents’ general health and welfare. EVIDENCE: The medication records of all residents were seen. This was partly completed to follow up a previous weakness found in the medication records where there had been a couple of entries where the staff signatures were missing and time missed off when ‘as and when required’ medication had been given. On examining the records it was again found that on the evening of 19th July 2006 medication had not been signed out at 9pm. It was not possible to check the dosage monitoring system to confirm the medication had been administered because the resident required liquid medication. The home needed to have a system in place that identified any potential problems in residents medication to ensure at all times staff were able to confirm medication had been administered to a resident as instructed by their doctor. The home responded to this by introducing new protocols for the management of medication which meant that an audit was completed at each staff handover . This means the health of residents is better safeguarded. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 15 The home supported residents with complex health needs. Their care plans were a good source of information about how their needs were required to be met by the staff team. A member of staff met who had started employment in March was able to confirm they were receiving training in all areas where they were required to assist a resident to keep healthy and safe, for example Gastrostomy care. The home was found to be well equipped with aids that ensure the health of residents could be safeguarded. This had included having overhead tracking fitted throughout the home. The daily care plans examined gave a detailed record of the health needs of the residents including the joint care between the home and health professionals to ensure the residents’ health needs were appropriately met. The home had introduced a health summary care plan which was designed to go with the resident if or when they required emergency medical treatment. On examining a sample of these records it was noted they were person centred, provided a picture of the residents and gave information to professionals about things which were important to the welfare of the residents. For example, the way the resident communicated, understanding of their emotional well being by informing the hospital of the resident’s fears to injections. This was a commendable piece of work. The only recommendation made was about ensuring the medication list was checked regularly so that the information provided to a hospital would not be out of date or to add a standard statement to refer to the resident’s medication chart. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ views were listened to and acted on. Policies and procedures and training programmes were in place which the staff were required to attend and follow. This ensured that residents were safeguarded from all forms of abuse. EVIDENCE: From examining staff training records evidence was found which demonstrated a number of staff had completed courses on POVA (Protection of Vulnerable Adults). Staff spoken with were familiar with the importance of safeguarding residents from all forms of abuse. The home had a complaints procedure which was made available to residents. The residents had indicated in their questionnaires that they knew how they could let staff know if they had a worry or concern. This included shouting or using certain body gestures. From examining the findings of the organisation’s 2005/06 survey it was noted that aspects of complaints were low with families and stakeholders all indicating an overall rating of excellent regarding the provision of care. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents lived in a homely, comfortable and safe environment. Their health and well-being was being protected by the design of the premises and by having a good state of cleanliness. EVIDENCE: The home was found at the site visit to be furnished to a good standard and reflected a domestic character. Since the last inspection all parts of the home had been fitted with overhead tracking. This had improved the safety of both the residents and staff and provided greater options about where residents wanted to relax. The home completed monthly health and safety audits of all the various equipment, aids and things which residents could be harmed by e.g. hot water. The findings indicated that the safety of residents was positively promoted. Headonhey DS0000005612.V302028.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were good practices in staff training and staffing levels which reflected the needs of the residents. This meant that there were adequate staff to make sure residents are well cared for and their welfare protected. EVIDENCE: The relationship between the residents and staff was observed as very positive. The staff team were skilled in effective communication with residents. This meant that the residents could be actively involved in their home and in deciding about their daily activities. The staff team spoken with confirmed that staff meetings took place on a regular basis. From the sample of staff records examined they showed that the staff team were supported through regular supervision. Training was well delivered by the organisation. The range of training included: - Care of Medicines, Gastrostomy Care, Dietary Care including associated disorders affecting swallowing, Infection Control, Child Protection, Loss & Bereavement, Airway Management and First Aid. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 19 A sample of staff files were examined during a visit to the organisations head office in June 2006. The findings of this visit concluded that the recruitment of new staff was found to be completed through a rigorous process that ensured all prospective staff were suitable to work with vulnerable adults. Headonhey DS0000005612.V302028.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, areas of management and health and safety were good, although the failure to check the fire system and equipment did pose a risk to the residents’ health. However, areas of quality assurance systems and internal monitoring of care provided were good and demonstrated that the service was sufficiently self-assessing their quality of care. EVIDENCE: The organisation was completing good internal monitoring of the service. This included the manager doing checks on records within the home and the chief executive and the responsible individual completing unannounced checks on the running of the home. Each year the organisation completed an annual survey where families and other stakeholders were asked to comment on the quality of the service. 2005/06 findings were examined. The findings indicated that areas of care, friendliness, meals and staffing were all overall rated as excellent. Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 21 Although areas of monitoring health and safety had appeared to be good. It was noted that the testing of the fire alarm system, means of escape and visual check of fire fighting equipment were not being completed on a regular basis. It was strongly recommended that this was improved to ensure the safety of residents and staff could be sufficiently safeguarded. Headonhey DS0000005612.V302028.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 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Headonhey DS0000005612.V302028.R01.S.doc 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It is recommended that the home add more details within the care plan about the diversity of residents. This includes the cultural and spiritual needs of individual residents, which will demonstrate how the home should respect the resident’s beliefs. It is strongly recommended in line with good practice that weekly testing of the fire alarm system, means of escape and visual checks of fire fighting equipment are completed. 2 YA42 Headonhey DS0000005612.V302028.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Headonhey DS0000005612.V302028.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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