Inspection on 08/11/07 for Holme Lea

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 (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holme Lea 27/02/07

Holme Lea 14/12/05

Holme Lea 06/07/05

Holme Lea 06/03/05

Holme Lea 05/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

SignHealth

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOMES FOR OLDER PEOPLE Holme Lea Astley Road Stalybridge Tameside SK15 1RA Lead Inspector Ann Connolly Unannounced Inspection 8th November 2007 11:30 X10015.doc Version 1.40 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 Holme Lea DS0000005571.V342464.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 Older People. 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. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holme Lea Address Astley Road Stalybridge Tameside SK15 1RA 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) 0161 338 5187 0161 304 0990 Meridian Healthcare Ltd Miss Elaine Bradley Care Home 48 Category(ies) of Dementia - over 65 years of age (18), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (18), Physical disability (1), Physical disability over 65 years of age (3), Sensory Impairment over 65 years of age (13) Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 18 OP up to 18 DE (E) up to 3 PD (E) up to 13 SI (E) and up to 5 MD (E) and 1 named individual PD. 27th February 2007 Date of last inspection Brief Description of the Service: Holme Lea is a purpose built, two-storey building in its own grounds. It offers accommodation to up to 48 older people in single bedrooms, many of which have en-suite facilities. Communal space consists of five lounges, three dining rooms and a patio area to the rear of the building. The building is situated in a residential area of Stalybridge, opposite Stamford Park, and is close to a main road offering public transport links to Stalybridge and Ashton Under Lyne. Car parking is shared with the adjacent home, Stamford Court. The home is run by Meridian Healthcare Limited, an organisation which operates several other care homes in Tameside. Fees for accommodation and care at the home range from £361. 75p to £386.75p. All fees are subject to a financial assessment carried out by the placing authority. Additional charges are made for hairdressing and chiropody services, newspapers, personal toiletries and arranged trips. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 8 November 2007 at 11:30am. During the site visit a selection of records, care plans, policies. and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives who were visiting. Prior to the inspection, questionnaires were sent out to the people who live in the home, asking them to comment on how the home is run and managed, and for their views about how the staff supported them. Some of these were returned and the comments have been included in this report. Several residents living in the home were spoken to in private during the visit, and discussions took place with them to find out what they thought about the home and what they felt about how the staff supported them. Before the inspection, we also asked the manager of the service to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This is one of the ways that we get information from the manager of the service, about how they are meeting outcomes for people using their service. Information that was provided in the AQAA for this service, was detailed and comprehensive, and provided evidence of a service that was committed to focusing on positive outcomes for the people who use the service. Since the last inspection visit, which took place on 27 February 2007, the Commission for Social Care Inspection has not received any complaints about this service. There was evidence during this visit that the manager was managing complaints well, and that procedures were followed appropriately. Over the last twelve months the home’s manager has received six complaints, and information in the AQAA states that these were investigated within 28 days. What the service does well: This is a home that provides a safe clean and pleasant environment for the residents that live there and their family and visitors. The staff in the home are good at making residents and their family feel welcome, and offer a warm welcome to all visitors. There is a good skill mix in the staff team. All staff are given plenty of opportunities to develop their skills, and go on training courses. This means that the residents in the home benefit by receiving care and support from a staff team that have a sound knowledge base. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 6 The home has a robust selection and recruitment procedure, and this means that time and effort is spent in selecting staff that are appropriate for the job. This ensures that resident’s health and well-being is protected as far as possible. The manager and staff team appear to respond positively to any concerns raised about the service, and take all complaints seriously. One visitor said, “I only have to see the manager about a problem, and things are put right straight away”. All of the residents spoken to during this visit were complimentary about the staff, and comments included: “ All the staff are very nice”. “Full marks to the staff, they are very good. There’s always someone there, we never need to panic”. Residents spoke highly of the care and support provided by the staff team. One relative said, “ Staff are lovely, they are friendly and we have no complaints. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 Quality in this outcome area is good. Residents and their relatives are given sufficient information about the home to help them in making a decision about their care arrangement. Residents’ needs are assessed prior to admission to the home so they are confident their needs will be met, and the home is sure it can meet their personal needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this visit, there was plenty of information about the home, and it was readily available in the reception area of the home. Information included the service user guide and a statement of purpose. The latest inspection report was displayed in a prominent position, so that residents and their families could find out how the home was doing, and what residents thought about the support they received from staff. In addition to this information, there was a range of other material about the company, which included their own quality Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 9 assurance document, and the findings from surveys sent out to residents and their families. Three care plans were examined during this visit. All of the care plans included a multidisciplinary assessment, completed by a representative from the funding authority, and a care assessment completed by the manager or a senior staff member. It was evident from the information provided by the manager in the Annual Quality Assurance Assessment (AQAA), that the preadmission assessment was prioritised, so that staff were confident that they could meet the needs of the individual before arranging an admission. All prospective residents were notified in writing if the home was able to meet assessed needs. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Care plans provided details of residents care needs, and the interventions required to meet needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were examined during this visit, and overall, these contained sufficient information to assist staff in supporting residents with their care needs. Some care plans would have benefited from having more detail to ensure that nothing is overlooked when providing support and care. It was evident from discussion with the manager, that the development of care plans was an ongoing process. The manager was in the process of developing a reference booklet for staff, so that they had a guide on how to develop and review care plans. Discussions with staff provided evidence of a team that was knowledgeable about individual care needs. As soon as staff came on duty, they were observed updating themselves by referring to the care plan. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 11 Care plans provided background details of the individual resident, risk assessment, a record of reviews, and contact with external health professionals. During this visit, there was evidence that the staff supported residents to access health care services. One relative said that the staff were very supportive when residents had to attend hospital appointments, and always provided escort if the family was unable to attend. The manager and staff were seen demonstrating a sensitive and caring approach when consulted by residents and their families. They took time to explain any changes in health care needs, and provided up to date information when General Practitioners had visited their relative. This good communication and exchange of information is helpful in ensuring positive outcomes for residents and their families. Residents and their families spoke highly of the care and support provided by the staff team. One relative said, “ Staff are lovely, they are friendly and we have no complaints. They always keep us informed and ring us if they need to tell us anything”. One resident said, “ We are well looked after her. As for the staff- full marks, there is always someone there, we never need to panic”. During the course of the day, staff were observed as they engaged in meaningful conversations and interaction with residents. There was evidence of a sensitive and respectful approach. Medication was administered using a monitored dosage system. Medication administration records (MAR) presented as predominately appropriately maintained. However, some of the stock levels of medication did not balance with the written records. Stock balances are not always carried forward, or added to the receipt of monthly medication received into the home. This shortfall was addressed at the time of inspection. The revised monthly audit checklist, which is completed by the manager on a monthly basis, included the requirement to audit all stock levels. This will ensure that when the monthly audit takes place, the manager and senior staff will be able to track medication and provide a full audit trail for all medication received into the home. This will minimise any risks, and ensure that medication is handled safely. There was evidence that any staff member who is responsible for the administration of medication, receives regular updated training to ensure that medication is handled safely. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and15 Quality in this outcome area is good. Meals served to residents were of a good quality providing a well presented and nutritionally balanced meal Residents are supported to engage in the social activities, and daily life in the home, and the home supports and encourages residents to maintain links with their family This judgement has been made using available evidence including a visit to this service. EVIDENCE: A list of the activities available was on display in the main reception area. The activities on offer in November consisted of special event evenings, visits from a local school and movie afternoons. In addition to the one to one activities carried out by staff, there is a part time activity organiser in post. She is responsible for co-ordinating a range of activities and she has consultations with residents to establish their preferred interests. There were mixed views about the activity programme. Some residents wanted more variety, but overall, most people seemed satisfied with the programme. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 13 One resident said, “You can go out when you want, just tell the staff when you are coming back. In summer we have nice walks around”. One visitor said, “ They try hard to provide activities, there’s always bits of things going on”. Throughout this visit, there was a relaxed and pleasant atmosphere, and there were numerous visitors throughout the day. From observations made, all visitors appeared to be made welcome, and the environment provided various quiet and private sitting places, for residents to enjoy the company of their relatives and friends. The minutes of the residents’ meeting was examined, and showed that consultations took part with residents about meal choices. New menus had just been developed as a result of these consultations. The meal served during this visit appeared nutritious and wholesome. Most residents spoke to said they enjoyed the meals served in the home, and confirmed that there were always alternatives available. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents rights are protected by robust polices and procedures and there is an open transparent approach to managing complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaints procedure in place and this was displayed in the reception area of the building and in all bedrooms. Residents, who were spoken to, confidently expressed that they could raise any concerns with a member of staff. One relative spoke well of all the staff in the home and the way in which they responded to changes in care needs. She said that staff also saw ‘the whole picture’ and supported relatives as well. She was very positive about the manner in which the staff and the manager responded to complaints. She said, “I only have to go to see the manager and things are put right straight away”. In the last twelve months the home have received six complaints, which were investigated within a twenty-eight day period. Documentary evidence was available to demonstrate that the manager took all complaints seriously, no matter how small, and information about the investigation process was documented. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 15 Most of the staff who were spoken to had a good understanding of issues around abuse and what to do in the event of an allegation of abuse. Some staff had a more in depth knowledge than others, and were fully aware of the procedures. They had a sound knowledge that social services must be informed and take the lead in investigation allegation of abuse, and that the Commission must be informed. There was evidence that all staff were being updated on adult protection and safeguarding, to ensure that all staff have a detailed knowledge base, so that they know what happens once an allegation has been reported to the manager. In the last 12 months the organisation has provided a free telephone line so that any person can report an allegation of abuse confidentially. Information in the AQAA states that increased training packages are to be purchased, to increase the delivery of training in safeguarding adults to all staff within the organisation. This commitment to training will help to ensure that residents rights and safety are safeguarded, and that positive outcomes are achieved for all the people using the service. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The home is appropriately maintained, decorated and cleaned to ensure that residents are provided with a safe, pleasant and hygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This was an unannounced visit to the home. As part of the visit, a tour of the building took place. All communal areas and bedrooms were found to be cleaned to a good standard. Information provided by the manager in the AQAA stated that the use of maintenance contractors helps to ensure that equipment, laundry, emergency lighting and fire alarms are safe to use. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 17 It was evident from the tour of the building that several areas in the building had undergone refurbishment, for example decorating, new carpets, new fire doors etc. The programme of refurbishment and decoration is ongoing. The external patio areas had been thoughtfully designed to provide an extremely pleasant and safe external area for residents to enjoy all year round, making good use of the external space. There was evidence that bedrooms had been personalised with personal effects and furnishings. All residents spoken to and visitors at the time of the visit were highly complimentary of the standards in the home. Some security aspects of the building were discussed with the manager in detail, and it was agreed that she should carry out risk assessments in order to satisfy herself that the safety and welfare of residents and staff is not compromised at any time. In the event that any risk is identified, the manager should take appropriate action. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Residents are supported by a well-trained staff team, and are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this visit, there were sufficient staff on duty to meet the needs of residents in the home. In addition to care staff, there is a team of dedicated kitchen staff, domestics, laundry staff and a handyman. From discussions with staff and examination of personnel files, there was evidence that all new staff were given a period of induction prior to taking up their post. The induction included all aspects of good care practice and covered health and safety topics. Staff files included documentation to record staff supervision. All staff spoken to, confirmed that they were in receipt of regular supervision, and said that they could approach the manager at any time with any queries or concerns. One person said, “The manager is very approachable”. Team meetings minutes were examined, and provided evidence that these were used as a forum for discussing concerns in the home, and to promote good care practice. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 19 Staff who were spoken to said that they had received induction prior to commencing their job, and said that this included health and safety, and key policies and procedures. A sample of files were examined and provided evidence that robust recruitment and selection procedures were in place. All documentation examined contained the appropriate paperwork and checks, for example, Criminal Record Bureau checks (CRB), application form, two written references. A declaration of medical fitness was also on file. On the files of newly recruited staff, there was evidence that induction had taken place. Information in the AQAA provided confirmation from the manager, that training and development had been prioritised by the organisation. All staff who were spoken to said that they had been provided with ongoing training and development opportunities. National Vocational Training Qualification training was offered to all staff in the home. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This is a well managed home, in which the rights and best interests of the residents are safeguarded by robust policies and procedures, and a well trained staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA, provided evidence that the registered manager of the home had the experience, the skills and the qualifications to run the establishment. She currently holds the registered manager award. The manager is supported by the operations director, and has support from a deputy manager. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 21 There are policies and procedures in place, which are set up to safeguard the interest of the residents. Through discussion with the manager, it was evident that she had a good understanding of their operational value, and the experience of operating the procedures in the day-to-day running of the home. A system of annual satisfaction questionnaires are in place, which allowed residents and their family or friends to express their view on the delivery of care and support services in the home. The results are made public, and a copy of the findings is available for people to view. There was evidence that action was taken following these consultations, to ensure that findings and recommendations are acted on. There have been no changes to the management of the finances of residents who are unable to do this for themselves. The home has systems in place to protect the financial interests of individuals. Small amounts of personal allowance are retained for safekeeping. Records with receipts covering all expenses are retained for auditing and inspection purposes. Information in the AQAA provided confirmation from the manager that all policies and procedures relating to health and safety have been updated, and that all equipment in the home is regularly maintained. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The manager should carry out risk assessments of the building in order to satisfy herself that the safety and welfare of residents and staff is not compromised at any time. In the event that any risk is identified, the manager should take appropriate action. Holme Lea DS0000005571.V342464.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Holme Lea DS0000005571.V342464.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!