Inspection on 08/11/07 for Highfield House

This inspection was carried out on 8th November 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield House 20/02/07

Highfield House 15/12/05

Highfield House 06/06/05

Highfield House 20/01/05

Highfield House 20/07/04

Highfield House 10/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Highfield House 118 Church Road Bishopstoke Hampshire SO50 6DQ Lead Inspector Anita Tengnah Unannounced Inspection 8th November 2007 10:00 Highfield House DS0000037583.V349421.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 Highfield House DS0000037583.V349421.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. Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Address 118 Church Road Bishopstoke Hampshire SO50 6DQ 023 8062 0177 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) Hampshire County Council Mrs Tina Fagan Care Home 5 Category(ies) of Learning disability (0) registration, with number of places Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: Highfield House is a registered care home providing respite care service for adults with learning disabilities who live in the Eastleigh and Romsey District. The home is situated in the village of Bishopstoke within easy reach of Eastleigh town centre where there is a range of shopping and leisure facilities available. Hampshire County Council owns and runs the service. The service has recently completed a refurbishment programme and provides accommodation and care to five people. The residents are provided with a homely and well-designed accommodation with facilities to accommodate those physical disabilities on the ground floor. The service also benefits from a level and secure garden where seating is available. Fees charged are according to the financial assessments. Some people do contribute to the whole nightly charge. The current fee charged is £4.80-£9 per night. Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the service was undertaken as part of the inspection on the 8th of November 2007. There were currently three residents accommodated at the service and one of them was discharged on the day of the visit. The service provides respite care and the number of days that the people are allocated was dependant on their needs and the funding available. The process included a tour of the service where a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. As part of case tracking 4 staff, resident and relative views’ were sought and care records were looked at. Questionnaires were also sent to the people using the service in order to seek their views. Information gained from the Annual Quality Assurance Assessment (AQAA) was also used and included in this report, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. Positive comments were received from the two people who responded to the questionnaires regarding the care that they were receiving at the home. Care practices observed at the time of the visit showed that the staff and people using the care service and their relatives had developed good relationships and care was provided in a respectful manner. What the service does well: What has improved since the last inspection? The home has been extended to provide care to five residents. The lounge, dining room and kitchen form part of the new extension. The ground floor Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 6 accommodation is light and spacious and appropriate for people using the service. The access to the garden has been improved and is secure. 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. Highfield House DS0000037583.V349421.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 Highfield House DS0000037583.V349421.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 2 The pre admission assessment process is comprehensive and ensures that people using the service needs are assessed and the home can meet them. EVIDENCE: The care records of two recently admitted service users were looked at as part of case tracking. Detailed pre admission assessments of needs were carried out and staff reported that this information is used to formulate their care plans on admission. Assessments of needs included medication, personal risk taking, maintaining independence, personal hygiene and road safety. Care manager’s assessment was also sought at the time of referral. The manager or a senior staff also would assist the family and prospective resident with transport to enable them to attend the service prior to moving in. This is important as the people using the service often came in for short respite care. The present system of place allocation is done centrally and the people have been sent to different homes for respite. However the system was being reviewed to ensure that there is continuity of care and people are placed in the same service for respite care. Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 9 Comment card received indicated that information was available and one of the comments was “ already knew the service from respite care”. One of the care record showed that as part of the assessment process one of the people came in for 2 hours and had a meal to “test out the service” prior to moving in. Comments were that information was provided and staff are “very helpful” if they needed anything. Highfield House DS0000037583.V349421.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 6,7,9 Care plans were formulated on admission. Further development in care plans would ensure that they are person centred and in appropriate formats. Service users are supported to live independently within a risk assessment framework. EVIDENCE: The care records of two people were looked at as part of this visit. The care plans contained information about personal care, medication, diet and included risk assessments. There was evidence that the carer/ relative inputs were sought as appropriate and were involved in the formulation of the care plans. Risk assessments included personal safety, medication and managing finance. There was evidence that the residents had a yearly review of their care and records of these were maintained. Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 11 The records seen indicated that staff assessed the residents on each admission to ensure that any changes in their needs are identified and record of care developed. The care plans would benefit from further development with details of how the individual assessed needs would be met and their outcomes. This was discussed with staff and would ensure that the information is detailed to inform practice. Another consideration would be to ensure that the care plans are in the appropriate format to enable the residents to participate in their care planning and is person centred. The care record of another person was looked at and contained detailed information and in pictorial format that was appropriate to his needs. The manager reported that she was planning to introduce this type of care plans for more people that were using the service. Staff reported that as part of providing respite care, people are supported to continue with day care and accessing the community. The service has its own transport and staff said that this was used regularly and benefited the residents. They are supported to take risks as part of independent living within a risk assessment framework. This included assessment for one person in road safety and managing finance for another resident. Highfield House DS0000037583.V349421.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 12,13,15,16,17 There is a range of activities available to meet their needs and people are encouraged to be part of the local community. The care practices ensured that people’s privacy and rights are respected. Meals were good and provided them with variety and choices that met with the residents’ satisfaction. EVIDENCE: It was evident from discussion with people spoken with and comments received that they are supported to take part in activities of their choice. Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 13 Some of the activities included attending clubs in the community, going to the local pubs, visit to the New Forest and bowling evenings. As the service provides respite care some of the residents attended day care out of the immediate local community, however staff ensured that they were supported to continue with these activities. Comments received indicated that they were treated with respect and their rights to privacy respected. A staff member was observed to knock prior to entering the people’s bedrooms. Comments received and interaction observed on the day the day indicated that the staff and the resident and their family had developed good relationships. Comments included “the staff are wonderful”. The staff are proactive in ensuring theta the residents are part of the community. The staff had compiled a detailed list of activities including contact numbers and named people to contact for further information, cost, opening times and whether support workers needed to attend that was made available to the residents. Information from the AQAA indicated that the manager had been proactive in tailoring staff rotas to accommodate the residents’ activities. The manager reported that the home, as part of planning their respite care and tried to offer the residents’ boyfriend/girlfriend respite care during the same period. Others were offered respite care on a day basis so that their carer/ family could continue to wok or pursue their own activities. Staff said that this worked very well and was part of the ethos of meeting individual needs of people. The service had a menu that was varied and offered choices. The staff reported that the menu was flexible and the residents were involved in the choice of the menus. The care plans included food shopping and food preparation as part of their learning/ developing life skills within a risk assessment framework. Staff discussed that the open plan layout on the ground floor meant that people were more involved, as they could smell and see the food being prepared. Hot and cold drinks and snacks were available at all times. The service had pictorial menus that staff said was very useful as part of the information they provided. Any areas of concerns regarding dietary needs are addressed through referral to dieticians as appropriate. Comments included “the food is excellent”. Highfield House DS0000037583.V349421.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 18,19,20 Support was provided that met with the satisfaction of the residents. Medication records were good. Procedures to support medication management were in place for the protection of people accommodated. EVIDENCE: Care records seen indicated that the people are independent in their personal care, however where prompts are needed these were recorded in the plans. All personal care are provided in private and where resident’s wishes indicated for care to be provided by person of the same gender this is respected and recorded in plan of care. All the residents are accommodated in single rooms and staff stated that keys to their rooms are available to them as requested. The residents have the support of the local GPs and staff reported that although they are at the service on short- term respite care the primary care team continued to support them. The manager reported that some of the residents have been registered as temporary patient with the local surgery. Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 15 Other support included training from the health care team for staff in supporting the new resident with a colostomy. The service has procedures in place for receipts of medication that was brought in on admission. Records seen indicated that these were recorded on the Medication Administration Record (MAR) sheets. Two staff signatures were recorded for medication received and returned. Accurate records of medication administered were maintained as required. Staff reported that they contacted the family if there was any discrepancy/changes in medication. It was noted that some of instructions from families came in inappropriate format at times. Staff should ensure that they record this information in the residents’ care plans on admission as part of their records and to inform practice. There was a detailed medicine resource system in place and guidance for staff. These included information of medication of residents and gave details of what these are used for and what to do in case of adverse reactions. Staff reported that these are updated for new medication brought in on admission. Review of self- medication assessments should be completed, as some of these were out of date. Highfield House DS0000037583.V349421.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 22,23 People using the service are confident to raise any concerns with the home. Procedures were in place for the prevention of abuse and ongoing training ensured that staff had the necessary information to record and report any allegation. EVIDENCE: The home has a complaint procedure that was available to people using the service. Comment cards received and people spoken with said that they would be comfortable to raise any concerns with the manager, or other staff members. Comments included “the staff are excellent”. Another comment was “ you can talk to the staff”. The manager maintained a complaint log. Record seen indicated that there have been two concerns raised. One of the se had been resolved. The other concern was referred to the service manager to investigate. Action had been taken and estimate sought to resolve the concern raise. However there was no record to indicate whether any response to the complainant has been made. The complaint log must contain details of action taken and any correspondence with the complainant to inform them of the action to be taken. The home has in place the adult protection policy and procedure. Staff spoken with were aware of the procedure and the need to report any allegation of Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 17 abuse. Training in the protection of vulnerable adult was available and the manager reported that this formed part of the induction programme for staff. The service did not manage any of the residents’ financial affairs at the time of the visit. Staff reported that the residents brought in small amount of money for personal use and this was returned to them on discharge. Highfield House DS0000037583.V349421.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 24,30 The people were provided with a well- maintained and homely environment that met their needs. The infection control procedures ensured that people are protected. EVIDENCE: The service had recently completed an extension of the communal lounge, dining room and kitchen. The home was well maintained, warm, bright, clean and homely. Furnishing was of very good standard and appropriate to the needs of the residents. The service users are provided with comfortable communal areas where activities are undertaken. The bedrooms were nicely furnished, however the bedrooms would benefit from some wall pictures to give them a homely feel. The manager reported that although the residents are encouraged to bring in items of personal belongings, this did not happen as they came in for short periods. Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 19 The home has a small laundry room that was on the first floor. The laundry area was clean and satisfactory state of repair. The manager reported that the residents undertook their washings as part of their independent living skills. However the laundry would not be suitable to people with limited mobility/ physical disability, as this area would be difficult to access. Infection control procedures were in place and staff training in infection control was available. Highfield House DS0000037583.V349421.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 32,34,35. The staff ratio and skills are adequate to meet the present needs of people living at the service. The induction programme for all new staff must be improved. There is a robust recruitment process in place that ensures that people using the service are safeguarded. EVIDENCE: The home has a planned staff roster in place that the manager reported varied according to the numbers and dependency of residents. On the day of the visit there were two staff on duty and the manager. The sleeping in staff worked for part of the morning. Staff and a relative spoken with said that the staffing was sufficient. Comment was “there is always someone around when you need them”. Other comments included “they are a wonderful bunch”. Staff stated Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 21 that the duty roster worked around the residents needs and one of the staff reported that she would be coming in earlier the next day to assist a resident with her bath. It was evident that the service has staff experienced a high degree of satisfaction in their work and were committed to maintain a high standard of care. This can only be for the good of people accommodated at the home. The home has an ongoing training programme in place that included basic food hygiene, first aid three- day course, moving and handling and use of hoist. A training matrix was maintained that helped to monitor training and identify any shortfall. Information from the AQAA indicated that of the 10 permanent staff, 7 of them had completed NVQ level 2 or above. The manager reported that all the new staff undertook the company’s induction programme. Following the induction staff are then put on the Learning Disability Award Framework (LDAF) training programme. It was noted that there were two staff members had been employed since September 07; the manager confirmed they would be undertaking their induction in December 07. There was little evidence of induction in the interim period for these staff. This is of concerns as the carers undertake sleeping in duty and responsible for people’s care. Some of these residents as staff reported could have complex needs. The registered person must ensure that staff have structured induction to include training in the principles of care, safe working practices, needs of particular service users’ group are completed for the safety of people accommodated. The service has a recruitment procedure in place. Information received indicated that all new staff completed an application form and human resources department completed all necessary checks prior to employment. The two staff case tracked had their CRB clearances prior to them starting work. Highfield House DS0000037583.V349421.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 37,39,42 The management at the home is good and supported the people using the service. There is a satisfactory internal audit in place that forms part of the service quality assurance programme. The health and safety of people using the service are promoted. EVIDENCE: The service has a registered manager with a number of years experience in the caring of people in the registered client group. Staff and residents/ family Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 23 spoken with said that they would be confident to address any concerns with the manager. The manager operates an open door policy and interaction observed with people using the service and staff showed an open and inclusive relationship. Staff said that they are motivated and are supported in their works. The manager demonstrated clear lines of accountability for the service and staff support. Information form the AQAA indicated that the manager received regular supervision and undertook regular training to update her skills. The service has recently undertaken an audit of the service users’ views as part of their quality assurance. The service manager also completed unannounced monthly visits to the service and records of these are maintained. Any accidents/incidents that are detrimental to the welfare of the people living at the service are recorded and reported to the commission as required. Information received and a sample of records seen indicated that there is an ongoing programme for the servicing of equipment and emergency lighting. There is a robust system of fire prevention that included fire training for staff, risk assessments, fire drills and regular checks of fire equipments. Records of these were maintained at the service. Regular reviews of policies and procedures are in place to meet with current regulations and good practice guidance. Some of these had been last reviewed in February 07. All substances that are hazardous to health were maintained safely. Highfield House DS0000037583.V349421.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 X 2 4 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 2 36 X 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 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 Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 25 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. 1 Standard YA35 Regulation 12(1) 18(1) Requirement All new staff must have a structured induction to the service on employment to ensure that the people using the service are not put at risks. Timescale for action 15/12/07 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 Highfield House DS0000037583.V349421.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Highfield House DS0000037583.V349421.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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