Inspection on 04/10/07 for High Road 73

This inspection was carried out on 4th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Road 73 13/12/06

High Road 73 02/12/05

High Road 73 29/04/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 High Road 73 73 High Road Gorefield, Wisbech Cambridgeshire PE13 4PG Lead Inspector Don Traylen Unannounced Inspection 4 October 2007 10:00 th High Road 73 DS0000063111.V346835.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 High Road 73 DS0000063111.V346835.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. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Road 73 Address 73 High Road Gorefield, Wisbech Cambridgeshire PE13 4PG 01945 870968 01945 871364 Gorefield73@tesco.com www.milburycare.com Milbury Care Services 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) Anita Dawn Blackburn Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2006 Brief Description of the Service: 73 High Road, Gorefield, is a detached house with seven bedrooms situated in the small village of Gorefield, close to Wisbech in north Cambridgeshire. The service is provided by Milbury Care Services. On their website, Milbury aspire to, provide high quality specialist care for adults with learning disabilities, physical disabilities and other specialist needs in family sized houses to give people a sense of belonging and ownership. We regard every house as a home and our staff provide a warm, welcoming environment which enables everyone in our care to live as ordinary a life as possible regardless of their disability. Their homes are typically for three to eight people. The home has been completely refurbished for the service that was first registered in December 2004. The comfortable and spacious rooms and corridors make the home a relaxing and secure environment for service users. There is a large garden area to the side of the property and a large patio area with adequate seating and table arrangement for all service users to use. The driveway provides ample parking space for the homes’ vehicles and for staff to park their cars. Fees are £1432.00 per week Copies of CSCI inspection reports are available at the home or through at the CSCI Website. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector, on one day and lasted four hours. An Annual Quality Assurance report was completed by the home and all service users returned survey forms and four relative completed a survey request. All of the service users were spoken to during the inspection. The registered manager was absent and the senior carer who was acting as manager during the inspection was present during the inspection. What the service does well: What has improved since the last inspection? Five of the seven requirements made in the last report have been met. A permanent gardener and external maintenance worker has been employed on a part time basis. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. High Road 73 DS0000063111.V346835.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 High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, Quality in this outcome area is good. People are assured of appropriate and thorough admission arrangements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The same seven people live at the home who were resident there at the time of the last inspection. Nobody has moved into the home since the last inspection when all the admission procedures and arrangements were assessed and considered good. People had received Service User Guides and the Statement of Purpose. Contracts included details of people’s DWP Benefits amounts. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is good. Care planning is comprehensive and is reasonably person centred and risk assessed for independent living. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people’s care plans were read. One of the plans was a large document containing duplicated information. Some of the plastic covered pages were unattached to the file and fell out. One of the care plans was for a person whose needs had altered. There was a hand written account of the history of events in August 2007, at the front of the file. The senior carer stated that in the future these monthly accounts would be written every month for each person. Detailed and recently written risk assessments had been completed to reflect the changes. Different risks assessments had also been carried out over the past seven months to reflect the changing needs and the methods used to address these needs. A separate file entitled, ‘Health Action Plan’, had been kept and contained details of appointment with health service consultants, specialist Nurses and the GPs and letters relating to Health Service involvement. The arrangements and the reason, or need, for these High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 10 contacts was not recorded in this file and therefore the reasons for Health Service involvement was not obvious. Details of accidents and incidents were maintained in another file relating to the person. The three files were difficult to cross-reference. A general communications book and a daily diary for each person are used to record the detail and events that occur each day. Without the recent initiative to start using a monthly record of the story and history of each individual’s progress and despite the detail that is contained in these three files, there is no easy way to establish the history of what has happened to any person living at the home. There was a financial part of the care plan but it did not account how the person’s money was managed. This plan contained information minimal detail about the personal allowance and how staff support him with his cash transactions. The care plan for another person was read and this contained information about the service contract. Details of DWP Benefit payments and contribution to the cost of care had been recorded. However, neither plan could show clear details of a full and auditable trail of the person’s finances. The senior carer was not able to explain or provide these detail when asked, but understood that these are known by the organisation’s department that deals with the contract and related matters. The financial statements kept at the home of payments made to people were read. The payments differed in timing and amounts and there was no way of knowing what the payments were for, or how they had been calculated, or exactly what they represented. The payments could not be quantified or explained by the senior carer. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17, Quality in this outcome area is good. People are assured of respect and personal achievement and have many opportunities to participate in local community facilities and be part of the community whenever possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was sufficient evidence to decide that people enjoy opportunities to develop and to access local community facilities. Staff encourage and arrange regular activities based at a community gym and swimming pool and for visits to the local pub. One person regularly attends mass at a nearby church. Holidays are planned and people fully involved in choosing and planning how they will finance their holidays. The daily routines in the house are agreed at a weekly ‘residents meetings’ and the domestic tasks are planned and each person has an agreed shared responsibility for some of the communal domestic upkeep and for their own High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 12 personal laundry and personal hygiene and keeping their rooms safe and reasonably clean. People are assisted by staff whenever this is needed, either by encouragement or by practical hands on and sharing the task in hand. There was much evidence of this support and action during the inspection. Family links are strong where families are eager to maintain this relationship. A nutritious and appealing meal was eaten during the inspection and the atmosphere and inclusion of staff in this meal and their respectful assistance towards all made this an experience that appeared to be an enjoyable and happy occasion. It should be noted that there was a happy atmosphere and very lively social interaction throughout the inspection. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, Quality in this outcome area is good. People are assured of personal support and emotionally respectful care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No person self-medicates. Medication Administration Record (MAR) sheets were assessed as accurate. MAR sheets showed some medication “as directed” when this was PRN medication. The senior care said she would refer this to the Pharmacist so it would be included on the MAR sheet. There was observed evidence that personal support and emotional wellbeing are robustly supported and assisted by staff. They showed consideration and kindness in their communication and respect in allowing the person to fully express themselves. All staff were observed to express patience in dealing with a very emotional and busy environment. Care plans contained information about the arrangements for health related care. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 14 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. People living at the home are protected by the home’s adult protection procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People’s views were listened to and acted upon during the inspection. There were many incidences of people making their views known to staff and being asked for their opinions. It was a very open and transparent environment where there was a healthy balance of power and ownership by people living at the home. The home has a record of reporting allegations of abuse in an appropriate and immediate manner. There are instructions in the manager’s office for staff to follow should any member of staff need to report abuse. The registered manager is a key practitioner (trained and verified by Cambridgeshire County Council abuse trainers) who has agreed to be responsible for promoting the prevention of abuse within the home. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 15 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): 24,27,29,30, Quality in this outcome area is good. The environment is a happy place that is generally well maintained and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and appeared to be satisfactorily hygienic. There were no unpleasant odours. One downstairs toilet and bathroom were clean and well maintained. The bathroom was equipped with a hydraulic bath seat and raised toilet seat. The main lounge had been painted the day before the inspection and the senior care stated there were other areas of the home scheduled to be repainted. Furnishings were of a good standard and quality. The home is pleasantly decorated in light colours that reflect the light. The large French doors in the lounge were open and the whole atmosphere felt easy and homely and a very comfortable place. Some aspects of the home need attention and these were the grubby and stained light coloured carpet on the stairs and landing. The doorways are High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 16 scuffed and the paint is broken and chipped off in many places. There were areas at the bottom of the doorframes and skirting boards where dirt was trapped. A gardener, who has recently been employed on a casual arrangement, had recently pruned the overgrown hedge at the front of the property and cleared the parking area. The grass at the rear of the house had been cut after it had become quite overgrown, according to the gardener /maintenance man. There is the suggestion that the external areas had been neglected. There were remains of slices of bread on the paths and an overflowing foaming sink waste trap and bits of old cleaning mops and clothes lying around the drain/sink outlet pipe. The areas between the paving slabs were filled with grass and weeds and all of this generally looked a little neglected and unused as well presenting a hazard. The laundry room had baskets for dirty items to be washed communally. This aspect of sharing the same receptacle is recommended for assessment by the Environmental Health officer, as a matter of health and safety. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 17 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): 32,33,34,35, Quality in this outcome area is adequate. Trained and confident care staff support people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The status of CRB disclosures for two recently recruited care staff could not be determined by the home. The CRB disclosure had been received prior to the start date of employment in both cases, however the actual confirmation of satisfactory status had been removed and it was impossible to determine whether it was a clear disclosure or not. This lack of clarification by the organisation’s recruitment department is the registered manager’s responsibility who must ensure the checks are satisfactory and the information is retained at the home for inspection. This same lack of recording was evident at the last inspection. Staff undertake a sound induction programme. Continuing training in skills related to needs is evident. Training is provided in epilepsy and in administering rectal medication when appropriate. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 18 All staff have been trained in Protection of Vulnerable Adults (POVA) and this is included in the induction standard. The manager is able to train care staff in POVA, although it is also recommended that care staff undergo the local authority training provide by Cambridgeshire County Council trainers in adult protection. Staff are trained in restraint techniques. Over 50 of staff had either achieved or were undertaking NVQ level 2 awards. The inspector was informed by telephone on the 3rd October by the operations manager, that the registered manager had been temporarily seconded to manage another service, although she would be contactable at all times to support staff at 73 High Road. Staff numbers have therefore been depleted because the manager is not at the home and the senior person has been left in charge. This is a clear reduction in the numbers of staff from the previous level and must be adequately addressed, so that people are not left without the same level of support they previously needed. It has also meant there has been a removal of a dedicated manager from the service who had not informed CSCI before the arrangement for CSCI approval. For the service to be managed effectively and for people to be assured of a good standard of care and not be affected by a reduced staffing level, the home must adequately address this issue as a matter of priority. The staff roster showed either 5 or 4 persons working am and pm and this included the senior carer who is now the acting manager. The roster showed many amendments and indicated the home is constantly making new arrangements to staff the home. This is in addition to the temporary arrangements to deploy the manager elsewhere. This is not a good management arrangement in the circumstances or attention to the Care Homes Regulations 2001 that require the registered manager to inform the Commission in writing of any such intentions. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 19 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): 37,38,39,41,42,43 Quality in this outcome area is adequate. The quality of management has not always put people who use the service first. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The comments made about the manager’s lack of communication with the Commission regarding the arrangement for her to be absent from the service is written in the previous ‘Staffing’ section. The Annual Quality Assurance Assessment completed by the home indicated the management is open and inclusive and staff confirmed this in the surveys they completed. The home is well run and people’s best interests are usually promoted and put first by the care staff. However, this was not supported by the management decision to move the manager without at least replacing her. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 20 The home has not produced an annual quality assurance report of the service based on planning-action- reviewing. Monthly staff meetings are held and recorded. One person’s cash that is held by the home was checked and was correctly recorded and included receipt for expenditure and accounts of withdrawals from the bank. Individual bank statements were not seen and were therefore not cross-referenced to any withdrawals. Quality assurance was not demonstrated to be effective although the home provide a good level of care. For instance, the Regulation 26 reports returned to the CSCI contained limited information and little evidence of substantial engagement with staff or with people living at the home. More details would illuminate these visits. However, these reports did suggest action would be implemented when issues had been reported. The policy for the Protection of Vulnerable Adults from Abuse was read. It is recommended that the home consult with the Environmental Health, Health and Safety officer regarding their practice of managing the collective laundry and the routine of facilitating people living at the home to manage aspects of their laundry. All staff, bar one person who started on the day of inspection, had received Moving and Handling training and Fire Safety training. High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 21 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 2 25 X 26 X 27 3 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 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 3 2 X 3 2 2 High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 5(1)(bb)(bc)(b d), & Schedule 4(8)(9) & Section 31, Care Standards Act 2000. Requirement The home must send to the Commission the information about the finances of people living at the home so that an audit of all of their money including all benefit can be made so that people are assured of an open approach to managing their finances, who is acting on their behalf in these matters and they are safeguarded by the organisation’s management of any of their finances. External areas must be safe and reasonably maintained. Timescale for action 25/12/07 2 3 YA24 YA33 23(2)(o) 18(1)(a) 25/11/07 Adequate and appropriate staffing 25/10/07 levels at the home must be maintained at all times and when staff are on leave or absent satisfactory arrangements must be made so that people are assured they will not experience a reduced level of support. The registered provider must ensure the registered manager is able to verify whether a satisfactory CRB and POVA first DS0000063111.V346835.R01.S.doc Version 5.2 4 YA34 19(1)(b) 25/10/07 High Road 73 Page 23 check have been obtained for any member of staff. The timescale of 31/03/07 has not been met and has been extended. 5 YA43 38 The registered manager must 10/10/07 inform the Commission of any arrangement, whether emergency or non-emergency, of her absence from the home in accordance with the Care Homes Regulations. 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 4 Refer to Standard YA6 YA24 YA35 YA39 Good Practice Recommendations Care plans should be redesigned in their file contents and presentation. The stained and grubby carpet on the stairs and landing should be replaced. Staff should be trained by Cambridgeshire County Council trainers in Adult |Protection in addition to the training provided through then organisation or Key Practitioner. Visits to the home for the purpose of complying with Regulation 26 of The Care Homes Regulations 2001 should generally contain a greater depth of information than previously reported and should evidence more thoroughly that people living have been effectively communicated with or have been represented when necessary and a more thorough assessment of the premises should be reported. The home should consult with the Environmental Health Officer regarding the best health and safety practice for managing their laundry. 5 YA42 High Road 73 DS0000063111.V346835.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Road 73 DS0000063111.V346835.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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