Inspection on 02/12/05 for Hollywell House

This inspection was carried out on 2nd December 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollywell House 06/05/06

Hollywell House 01/06/05

Hollywell House 12/01/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hollywell House 63 Clevedon Road Weston Super Mare North Somerset BS23 1DD Lead Inspector Nicola Hill Announced Inspection 2nd December 2005 09:30 Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hollywell House Address 63 Clevedon Road Weston Super Mare North Somerset BS23 1DD 0208 5928264 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) Hollywellhouse@aol.com Mrs Olabisi Mojibade Hill Mrs Olabisi Mojibade Hill Care Home 9 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 8 persons aged 18 - 64 with learning disabilities and 1 person aged over 65 years with learning disabilities. 1st June 2005 Date of last inspection Brief Description of the Service: Hollywell House is a small community home for people with learning disabilities. It is near local shops and amenities. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection of Hollywell House involved the manager, Mrs Hill, staff at the home and the residents. The inspection took place over the a period of seven hours, and the inspector reviewed care documentation and records held at the home, interviewed staff and residents, and spoke with relatives of residents at Hollywell House. The care documentation reviewed included: • • • • • • • • • • • The statement of purpose. Care files. Individual resident contracts. Daily record. Medication records and administration systems. Health and safety implementation e.g. fire alarm systems. Staff rota. Risk assessments. The complaint procedure. Staff files and training records. Record of resident and staff meetings. The inspector did not tour the building on this visit, however it was noted that the stair lift has been removed due to it not working, and that the home appeared cleaner than at the last inspection. The inspector was impressed by the positive changes in some of the residents since the last inspection. The residents were much brighter and much more willing to become spontaneously involved in general chitchat. The home appears to be much more about residents and less about the manager and staff team. The inspector spoke with two relatives, three members of staff and six residents during the inspection. What the service does well: The home has introduced new care documentation for all the residents. The care files now have pictorial representations on them to enable the care resident to understand what is written in the files. The residents who spoke with the inspector were spontaneous, and appeared very relaxed and happy. None of residents expressed any concerns about the home, and majority of them had completed a comment card prior to the inspection. The atmosphere at the home is very relaxed and very much a home that belongs to the residents. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 6 These impressions were confirmed by one relative who stated that Hollywell House couldn’t be faulted for the lifestyle they offered for residents. The staff team at Hollywell House has stabilised and provides a continuity of support to the residents. What has improved since the last inspection? What they could do better: The issues identified by this inspection using the national minimum standards are that: • • • The statement of purpose needs updating. The “when required” medication system requires further staff training. Supervision and training must include all staff. The home was also advised that recording activities as they relate to the personal goals and achievements of the residents could be improved. 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. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,5 The service users guide is a good source of information about life at Hollywell House but information must be reviewed to keep it current. EVIDENCE: The statement of the purpose for Hollywell House should be updated to include the detailed of the current manager/owner, and the new contact details for the commission. It was noted that all the residents have signed a contract for the tenancy at Hollywell House, the agreement is in a pictorial form to allow greater understanding by the resident. The inspector confirmed with residents that they have gone through the contract, and that they signed to agree to the details of the contract. There is any pictorial version of the service user guide available for all potential service users to Hollywell House. This information is used in conjunction with visits to the home to allow potential resident to make a decision about moving there. There have been no vacancies at the home, and therefore no new admissions to the home. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 The home has made significant progress with the consultation and inclusion of residents in the day-to-day running of the home. EVIDENCE: The inspector was able to look at the new care files introduced by Mrs Hill to the home which contain detailed information about resident and the support needs. The inspector sat with four residents and looked at their files with them so that they could have a great understanding of the information kept at the home. During this process the residents confirmed to the inspector their involvement in the plans, and their agreement with the comments contained in them, particularly about goals and aspirations for the future. The format used contains pictures to aid greater understanding of the information for resident. The files are extremely comprehensive and cover information from the admission of resident to their continuing care at the home. The inspector was able to cross-reference the records in the file and also discussed with the resident their weekly activity sheet. The residents confirmed their attendance at day centers and colleges, and they indicated, that they attended outside activities such as Girl Guides, and the Gateway club. The residents were also Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 10 able to identify individual key workers who they interacted with well and who discussed care plans and reviews with them. The level of understanding of the need for the information to be held was variable according to each resident, however they appear to be very pleased to have a personal file that had their picture on. The daily logs within the file record the daily activity of the residents, and this could be cross-referenced with other record sheet such as the health record sheet. The risk assessments contained in the file for the residents who worded so that they supported residents to take risks such as attending activity groups independently. The care plans are a huge improvement on what had been used at Hollywell House previously, and contain far more up-to-date and objective information about the resident and their lives. The manager discussed the inspector the next step with care planning for Hollywell House, which will be to have more person centered information about individuals goals in life and using these to formulate individual development plans. If development plans are to be used then they need to be reviewed on a regular basis to ensure that progress is being made towards to agreed goal. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12 Residents take part in the day-to-day routine in the home and are supported to pursue individual interests. EVIDENCE: The resident all have individual activities identified on their care plan. For some this means a tendon at the day centers or colleges, for others it is oneto-one support through the Brandon Trust Day Service. For residents, where there is no money identified to provide additional daycare, the staff at the home provided low-key activities which support the resident to follow individual preferences to pass their time. For example, one resident does not wish to attend any day services and prefers to remain at home. This resident also enjoys colouring, makeup, music, and one-to-one interaction with staff with whom they are familiar. The inspector and manager discussed the oneto-one interaction for this resident, and the manager agreed that it would be a priority to ensure that this happened on a regular basis so that the progress there has been noted since last inspection for this resident continues. It was observed by the inspector that this resident had benefited greatly from the Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 12 positive relationship formed with the new staff to the home, and that the resident was responding with more spontaneity than had been noted in the past. The level of activities for the residents means that they have a very busy life. Two of the residents have no free days as they attend colleges and day centers during the week, and spend weekend time with relatives. However, they still regularly get together and have meetings to decide what is important to them to happen within the home. The chairmanship of the meetings rotates between the resident, this is show that everybody feels they have a right to say what they think. At the time of the inspection, at the residents were discussing amongst themselves about where they would like to go on holiday, and more importantly what meals they would like to have at the home. The menu has been changed to include the preferences the red resident identify at their regular monthly meetings. Sometimes it is not possible to provide exactly what residents wish, as the whole group has to be taken into consideration. However, both the residents and the staff at the home have commented on the improvement in the quality of food provided by Mrs Hill. One member of staff also commented that it was good for the residents to have things in the home that they actually see every day in shops or on the television. The previous owner had not provided this. The inspector observed the lunchtime meal which was fish and chip (as it was Friday), the residents appeared to enjoy it and you looked very attractive and appetising. The manager discussed with the inspector the amount of activities on offer, as it was raised by a relative. It was noted that the resident went out at weekends and in the evenings to do various activities such as go to the shops, go to the part extra. Some residents join in more readily than other, and the manager was advised that if an activity is offered to resident and they refused then they should be recorded on the daily record. This will then provide evidence should fall the manager should there be any queries about the activities on offer at a home. The area for development in this section would be to ensure that all activities undertaken by resident are recorded fully, and that these are directly related to the goals or life choices of the residents. For example, one of resident had an ambition to go to Disneyland; this was achieved earlier in the year, but is not properly reflected as achieving an aspiration as it had not been recorded effectively. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The home supports the residents to maintain good health. EVIDENCE: The inspector was able to observe the interaction between the residents and between the residents and staff during the inspection. The staff supported the residents with their personal care needs in a discreet fashion, and demonstrated a good awareness of service users and how they like to be treated. The health recording she all residents on the care files is excellent, it is very informative and state the reason for doctors appointment and the outcome which include any treatment to be followed. The inspector discussed this with one of the resident who had recently been ill, and he confirmed all the information that had been recorded on the record sheet. The residents at Hollywell House are registered with the local doctors practice, and have specialist care needs met by the community learning disabilities team. There was evidence on file of regular reviews by the consultant psychiatrist, and letters stating the outcome of the assessment. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 14 The home recently provided 24-hour support to a resident as they were admitted to hospital for a routine operation. This ensured that there was a continuity of care for the resident, the resident was in hospital in Bristol and the impact on the home was huge as Hollywell House has a very small staff team. However, the 24-hour support was achieved and the resident has returned home, and continues to recuperate at Hollywell House. The medication system at Hollywell House was reviewed with the manager. None of the residents are able to self-administer their medication. The NOMAD system is used for medication and this works extremely well where the medication is included in the nomad tray. It was noted that all medication in the unit dosage system was administered correctly, and recorded accurately on the medication administration record sheet. However, the drugs not included in the system have not been administered correctly or recorded effectively. All the staff that administer medication have received training to enable them to use the systems effectively. The additional medication, and when required medication was not reconcilable with the stock book. What appeared to have happened for this medication which is not included in the nomad tray, is that they are have either been overlooked and not given, or that they were given and not recorded on the medication administration sheet. In order to prevent this happening in the future the inspector and manager discussed the use of additional blue strip dispenser so that if, for example, antibiotics have been described for a week and these are put into a blue strip dispenser, which then can be put with the individuals’ nomad tray. This would mean that the medication would be together in one place and can be given at directed. The manager will also review the training for the staff to ensure that they understand the recording of medication when it is given. This will be raised to staff at the next staff meeting. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home has a complaints system, which is available to the residents to use. EVIDENCE: There have been no complaints made to the home, or to the Commission since July 2005. The complaint procedure in place at the home ensures that anyone who complains have their views listened to. It was noted in the minutes of the last resident meeting that the complaints procedure had been read through to the residents again to ensure their understanding of it. When asked by the inspector where they would go if they had a problem, the residents stated that they would go straight to Mrs Hill and talked to her about it. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Hollywell House provides a safe and comfortable environment for its residents EVIDENCE: The inspector did not tour building on this visit as several of the residents were out and it was not necessary to intrude on their private rooms. The stair lift has been removed from the first flight of stairs as it was not functioning correctly and reduced the amount of available space on the stairs available to the residents. Currently there are no residents at the home who need to use a stair lift. It was noted that the home is cleaner than the last inspection and that it appeared very well cared for. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 The residents benefit from staff that are supported in their professional development to improve and enhance the support given to residents. EVIDENCE: The inspector had the opportunity to talk to members of the staff team at Hollywell House. There are two overseas staff employed at the home, whose level of spoken and written English is very good. The overseas staff also attend English lessons at the local college, and both of them have enrolled on the NVQ 2 course in care. The staff team at Hollywell House are settled now and provide more consistently support for the residents. Several of the previous staff at the home when Mrs Hill took over have left, but the new staff replacing them on a full-time basis can provide greater continuity of care to the residents. The staff rota provided indicated that there are minimum of 2 staff on duty and that Mrs Hill is in the home for the administrative and managerial duties. There is one person on sleeping in duty overnight. The inspector checked the staff files and was able to see that the recruitment of staff to the home has improved since lost inspection. The documents in the files included training certificates, work permit information, references, Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 18 application forms, photographic identification, employment contracts, staff training and induction records, and staff supervision records were all available for the new staff to the home. It was noted that the more established staff had not received supervision to the same degree, and this was raised with Mrs Hill for her to arrange supervision for all staff. There was also evidence of the training that had been completed by staff; for example, some staff had completed distance-learning courses in health and safety awareness. The training certificates held on file also indicated that staff had recently undergone specialist training for learning disability awareness and protection of vulnerable adults. Currently three staff are undertaking the NVQ 2 and staff are supported towards completion of further distance learning courses such as infection control. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,41,42,43 The home is run so that residents support needs and wishes are given priority. EVIDENCE: Mrs Hill has been the owner/manager at Hollywell House for just over one year. She has introduced many positive changes to the home particularly around the empowerment of the residents, and introducing resident meetings where they are able to have a say in the day-to-day running and routines of the home. To support her continued professional development Mrs Hill has undertaken distance learning courses in Skills for Life, and stress awareness and supporting strategies, she has also completed the health and safety distance learning course with the staff team. The residents and staff all spoke very highly of Mrs Hill and her management style. One member of staff, who has been at home some time, stated that they felt that the residents were more spontaneous, and that they were less regulated than under the previous management. The residents were allowed Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 20 to talk to people and visitors to the home without being sent to their rooms. The residents all stated how much they enjoyed their life at Hollywell House and that they enjoyed living there. In order that communication between staff team is good the manager has introduced a daily file which contains the staff rota, daily record of the resident (which were quite informative), copies of any specific information on residents such as behavioural charts, and the in-house daily activity plan for staff to complete. In respect of residents and staff meetings, these are held on a monthly basis. The minutes for both meetings were available for the inspector and it was noted that the suggestions from the resident meetings had been taken forward and implemented at the home. From the monthly staff meeting, the staff have decided to nominate a shift leader and this person will take responsibility for directing the shift and having control of the medication keys. In respect of the health and safety of the home, the manager has ensured that: • • • • The water system has been checked for legionella. The alarm system for fire safety has been serviced, as had all the fire equipment. The residents undertake regular fire drills with staff. There was evidence of a weekly test of the fire safety system. The portable appliance testing is due in December 2005. In the past year, four members of staff have undertaken distance learning in health and safety awareness. With respect to accident recording, there has been one recorded accidents since the last inspection and this was an incident between two residents. There has been no serious incident or accident at the home requiring regulation 37 notification. The manager was able to supply the accounts for the home up to March 2005, and demonstrated that the home is financially viable. Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X 3 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hollywell House Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X 3 3 3 DS0000061655.V261712.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement The statement of purpose and other information must be regularly reviewed to ensure it is current. All staff must receive regular supervision and developmental training. The medication system for “when required” medication must be accurately administered and provide an auditable record. Timescale for action 02/01/06 2 3 YA36YA32 YA20 18,19 12,13 02/12/05 02/01/06 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 Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hollywell House DS0000061655.V261712.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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