Inspection on 21/06/07 for Helmsley Road Short Break Service

This inspection was carried out on 21st June 2007.

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

The inspector 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

Helmsley Road Short Break Service 22/10/08

Helmsley Road Short Break Service 21/09/06

Helmsley Road Short Break Service 31/01/06

Helmsley Road Short Break Service 28/09/05

Helmsley Road Short Break Service 11/11/04

Helmsley Road Short Break Service 13/07/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Helmsley Road Short Break Service 27-33 Helmsley Road Rainworth Nottingham Nottinghamshire NG21 0DQ Lead Inspector Rob Cooper Unannounced Inspection 21st June 2007 10:00 Helmsley Road Short Break Service DS0000036300.V339552.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 Helmsley Road Short Break Service DS0000036300.V339552.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. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Helmsley Road Short Break Service Address 27-33 Helmsley Road Rainworth Nottingham Nottinghamshire NG21 0DQ 0115 982 3823 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) sarah.robinson@nottscc.gov.uk Nottinghamshire County Council Sarah Robinson Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That two named existing long-term service users may remain at the home 21st September 2006 Date of last inspection Brief Description of the Service: Helmsley Road consists of four purpose built bungalows three of which provide accommodation, in single rooms, for up to twelve younger adults who have learning difficulties. One is used as an administration centre and also houses the central kitchen and laundry. The service is part of Nottinghamshire County Council’s short-breaks provision. Located in the village of Rainworth, Helmsley Road is close to shops, pubs, post office and a garden centre - all within a mile distance. The bungalows all have level access, and there is car parking available for 12 cars. Each bungalow has a separate front garden, although the rear gardens had not been separated and service users spoken to prefer this layout. Fees: The fee level is on an individual basis following assessment by a Social Worker. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was initially an unannounced inspection site visit as part of the key inspection process – so that no one at Helmsley Road knew that the inspection was going to take place. However it was necessary to return briefly on a second day to meet with the manager of the service who had been on holiday on the first day. The visit took approximately three and a half hours in total through the middle of the day, with one inspector present. The method used to carry out this key inspection was to send out a preinspection questionnaire, which asked questions about the service, to gather statistics, such as how many service users there are, the numbers of staff etc. We also sent out a number of surveys to service users and relatives, and sent Helmsley Road an Annual Quality Assurance Assessment (known as an AQAA) for them to self assess their service; however these had not been completed and returned before the inspection site visit. The information gathering was followed with an inspection site visit to Helmsley Road, where a method called case tracking was used; this involved identifying three service users and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was done by a partial tour of Helmsley Road, looking at the activities on offer, and talking to two residents and three members of staff about the quality of the service, and their experiences of living and working at Helmsley Road. Both service users spoken with had communication difficulties which meant the inspector was not able to ask for specific information. As already stated the registered manager Sarah Robinson was on holiday for the first day of the site visit and therefore one of the team leaders supplied much of the information during the inspection site visit. On the day of this inspection there were eleven service users in residence. Since the last key inspection in September 2006 there have been no further inspections of this service of any kind. Prospective residents can also obtain information about services for people with a learning disability from the Nottinghamshire County Council web site at: www.nottinghamshire.gov.uk/social_care.htm This web site also has a number of links, including a link to the Commission for Social Care inspection’s web site where previous inspection reports for Helmsley Road can be viewed. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Prospective service users at Helmsley Road had sufficient information before they moved in to make an informed choice about where to live. Currently service users are well informed about the services Helmsley Road offers. EVIDENCE: The service user guide for Helmsley Road is in the form of an ‘All about your stay at Helmsley Road’ document. This contains all of the information that a prospective service user would need, and also makes use of signs and symbols so that service users who have difficulties with written English might be able to understand. Service user’s families are routinely contacted approximately one week before the service user is due to arrive for their short break to check that everything is alright, and to update any relevant information. Three service user’s files were seen as part of the case tracking process, each file contained a formal assessment, and two had additional information from healthcare professionals. At the last inspection a requirement was made in respect of service users being formally assessed before being offered a service, the evidence seen in the three files suggests that this requirement has been met. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 9 Helmsley Road Short Break Service DS0000036300.V339552.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. JUDGEMENT – we looked at outcomes for the following standard(s): 67&9 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Service users at Helmsley Road have their needs assessed, and have an individual plan of care containing information about their needs, and risk assessments to support them in leading an independent lifestyle. EVIDENCE: Each of the three resident’s files that were seen contained a detailed plan of care, which had been produced from assessments and identified personal goals and needs and how to meet them. There was clear evidence that care plans were being reviewed, and that there was a plan in place for the service user’s short break. The nature of the short breaks service is that service users tend to be at Helmsley Road for a relatively short period of time (a few days or a couple of weeks) although they may come several times during the course of the year. As a result Helmsley Road are not involved in the ‘bigger’ decisions affecting an individuals life, although there is clear evidence within the service user’s files Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 11 of individuals making decisions about activities and making choices within their stay at Helmsley Road. Each of the service user’s files that were seen contained detailed risk assessments and had support plans attached detailing the action that staff should take to minimise risks, while still supporting service users to enjoy an active and ‘ordinary life’. Helmsley Road Short Break Service DS0000036300.V339552.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 15 16 & 17 Quality in this outcome area is excellent; this judgement has been made using available evidence including a visit to this service. Service users at Helmsley Road are offered a stimulating range of activities, and are offered a varied and healthy diet. EVIDENCE: The Helmsley Road administration bungalow has many photographs of service users taking part in activities. These show that service users are accessing facilities away from Helmsley Road and that the staff are going to some considerable lengths to provide interesting and stimulating activities. The team leader who provided much of the information for the site visit, talked about a new activity – yachting on Kings Mill reservoir, which was proving very popular, and was done in complete safety. When I arrived at Helmsley Road two service users were getting ready to go to Ollerton to watch a demonstration of glass blowing and have a bite to eat. Both service users were very excited, and were obviously enjoying their stay at Helmsley Road. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 13 As already identified Helmsley Road make use of many of the local facilities, and evidence seen in service user’s files showed that among the activities experienced (besides yachting and glass blowing) were trips to the bowling alley, cinema, and local pubs and garden centres plus much, much more. Helmsley Road do have access to a small bus, which is wheelchair accessible, and is used to reach places further away, if not using public transport. The short breaks service is designed to give both service users and their families a ‘short break’, so that contact with families tends to be before and after the stay. There are monitoring forms in place to let families provide feedback about their relative’s stay once they have returned home, but usually there is minimal contact during the actual short break, which is often viewed as a ‘holiday’. There are very few expectations placed upon service users during their time at Helmsley Road, people are able to carry out domestic tasks if they wish, but there is no expectation that service users will clean and tidy. However Helmsley Road does not provide a waiter/waitress service, so some clearing up of personal space is encouraged. Helmsley Road uses a cook/chill method of food preparation. All meals are prepared in the central kitchen and transported to the various bungalows to be re-heated. All of the appropriate records – cooking temperatures, food storage, refrigerator temperatures, menus etc were seen, and all found to be in order and complete, which showed that food hygiene and food safety are taken seriously at Helmsley Road, and there are safe practices in the kitchen area. Two service users were asked about the food at Helmsley Road, and both service users said that the food was very good. There is clear evidence of choice and variety being offered to service users, and efforts are taken to meet service user’s individual likes and dislikes. Use of a pictorial menu helps those service users who are unable to read can find out what food is available. Helmsley Road Short Break Service DS0000036300.V339552.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. 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. Service users at Helmsley Road have their health care well managed, and are supported in a positive manner by the staff. Medication is well managed at Helmsley Road. EVIDENCE: Each of the service user’s files that were seen identified how personal care needs should be met. There was also a very good ‘The things that I like’ sheet, which helped staff to identify preferences and meet people’s needs. The three service user’s files that were seen all contained relevant information about individual’s health care needs. Before coming for a short break, relatives are contacted and any relevant information about the service user’s health is noted. The Health Authority jointly funds Helmsley Road, and there are qualified nurses on site, who are available to offer any advice or training to the staff team. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 15 A review of the medication procedures at Helmsley Road showed that the medication is well managed, and securely stored, with good systems for recording administration. One of the bungalows uses Boots (the chemist) to provide their medication, although the majority of service users bring their own medication with them. Currently no service user at Helmsley Road selfmedicates. Helmsley Road Short Break Service DS0000036300.V339552.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. 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. Service users at Helmsley Road are safe, and feel their views are listened to and acted upon. EVIDENCE: Since the last key inspection two complaints has been received. One complaint at Helmsley Road and one direct to the Commission for Social Care Inspection. Both complaints were found to be groundless. The complaints procedure is displayed throughout the bungalows, and is a sign and symbols format as well as the written word. The complaints procedure also forms part of the welcome pack, and relatives also have access to the procedure. A review of the complaints log suggested that service users and their families did know how to complain, and would use the complaints procedure if necessary. Helmsley Road also keeps a positive comments book, which had several compliments about the service from relatives. Many of the staff at Helmsley Road have received training in safeguarding adults, and evidence was seen in the staff training records, that staff have either learnt about safeguarding adults as part of the Learning Disability Award Framework (LDAF) training, or have taken part in specific safeguarding adults training. This training is aimed at raising staff awareness of abuse, and through raising the issues, offering residents greater protection against abusive practice. At the last key inspection a requirement was made in relation to Safeguarding Adults training, and this has now been met. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 17 Discussions with two members of staff indicated that they had attended the relevant training courses. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Helmsley Road is a clean, safe, homely and comfortable care home, with good quality fixtures and fittings. EVIDENCE: The bungalows at Helmsley Road are comfortable and well equipped, and there is clear evidence of attempts to make a ‘home from home.’ Located in a quiet village street, away from the main road, Helmsley Road is a quiet and peaceful setting. The bungalows have good facilities for people who have restricted mobility, and a pleasant garden overlooking a paddock with horses. The two service users who were spoken with said they liked their bedrooms, and they liked staying at Helmsley Road. A partial tour of the bungalows showed them to be clean and fresh, and there was clear evidence of staff cleaning in a number of areas. Two bathrooms Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 19 were seen, and the baths and toilets showed evidence of having been recently cleaned, and the floors mopped. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 35 & 36 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. A competent, well-trained and supervised staff team that has been professionally recruited supports the service users at Helmsley Road. EVIDENCE: The staffing rota for Helmsley Road shows that there is a structure through the staff team, and different levels of staff have differing levels of responsibility and accountability. The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. A review of the training records showed that currently there are four staff with NVQ level II qualifications, and three more have their NVQ level III in management, with two others currently studying for their NVQ level III qualifications. It is recommended that a minimum 50 of the care team are NVQ qualified, and the staff team at Helmsley Road are currently working towards this figure. Three staff files were seen, and these contained all of the information that would show that staff had been recruited in a safe manner – in that applicants had to fill out an application form, provide two written references and undergo Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 21 a Criminal Records Bureau check. A review of the documentation showed that there were no issues raised in the recruitment process, and that it was possible to prove the process had worked to protect service users. Discussions with three staff members about their recruitment evidenced that they had undergone pre-employment checks, and had not started working until those checks had been completed. A review of the staff training records showed that Helmsley Road does have a training plan for its staff, and that there are staff training courses planned for the coming months. The records showed that staff were receiving the skills training to be able to do their jobs, and discussions with three members of staff supported this view, and provided evidence of the different training courses staff had attended, including training in the mandatory areas – fire, food hygiene etc. This is in addition to the National Vocational Qualification (NVQ) training already identified. Records seen evidenced that staff are having regular formal supervision, and that they are being supported within their roles. Discussions with two staff members showed that they have a regular one to one supervision session with a senior member of staff, and that they feel able to raise any issues at these sessions. Each member of staff said they felt very well supported and there was good team communication. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 & 42 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Helmsley Road is a safe, well managed, and organised care home, with good recruitment and quality assurance systems in place. EVIDENCE: The registered manager – Sarah Robinson has been through the Commission for Social Care Inspection’s ‘fit person’ process, and has been judged to be fit to manage a registered care home. Evidence was seen that the manager is suitably experienced and qualified, having been in post for a number of years and having recently successfully completed her Registered Manager’s Award. The quality assurance system at Helmsley Road is based around the Quality Tree (Nottinghamshire’s approved quality assurance tool in learning disability services) and the monitoring tools used with families before and after each Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 23 individual’s stay at Helmsley Road. Several examples were seen, which evidenced that During 2007 the Commission for Social Care Inspection introduced Annual Quality Assurance Assessments (AQAA’s), which are selfassessments for services, but this had not been completed in time for this inspection visit. A range of health & safety records were seen, including fire records, Control of Substances Hazardous to Health records, and water temperature checks, and these were all found to be correct and complete, and indicate that both service users and staff at Helmsley Road are kept safe by the policies and procedures in place. A recommendation made at the last key inspection that the fire alarm should be tested on a weekly basis has been met. Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 24 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 3 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 3 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 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 3 X Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 25 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. 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. Refer to Standard Good Practice Recommendations Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Helmsley Road Short Break Service DS0000036300.V339552.R01.S.doc Version 5.2 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. 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