Inspection on 16/08/07 for Holt Farm

This inspection was carried out on 16th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holt Farm 08/08/08

Holt Farm 20/12/06

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Pinta

Hillview Farm

Dalewood Respite Care

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Fairways

Treloar College

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

CARE HOME ADULTS 18-65 Holt Farm Hopcrofts Holt Steeple Aston OX25 5QQ Lead Inspector Andy McGuckin Unannounced Inspection 31st August 2007 10:00 Holt Farm DS0000067215.V345540.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 Holt Farm DS0000067215.V345540.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. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holt Farm Address Hopcrofts Holt Steeple Aston OX25 5QQ 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) 01869 347600 Holt Farm Care Limited Doris Lindiwe Khuzwayo Care Home 5 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (2) of places Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2006 Brief Description of the Service: Holt Farm is a five bedroom detached house in a rural location in close proximity to the amenities of the village of Steeple Aston which include a Post Office, shops, a pub and a church. The home is equidistant between Banbury and Kidlington. The home has good links to the city of Oxford. The home has its own transport which it can transport residents to events of their choice. The home was registered in June 2006 and is privately owned. Entry to the home is by means of a gated, electronically controlled entrance off the busy A 4260. On the day of the inspection this gate was open as it was not working. The home has gardens to the front and rear and there is a swimming pool at the back of the home. Residents are able to walk into Steeple Aston by means of a safe footpath The home is registered to provide accommodation and 24-hour support for five adults with either a learning disability or mental health needs. At the time of the inspection there was only one female resident. A further male resident had been identified as being suitable and was in the process of having pre admission visits. Respite care is not provided. Fees for this service range from £1882.58 to £2,231 depending on care needs. This fee includes transport and one holiday per year. Extras include toiletries, clothes and personal items. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “Key Inspection”. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that the CSCI has received about the service since the last inspection. Visit to the property Inspection of core documentation Consultation with service user, relatives and professionals associated with home. Discussion and feedback from staff Discussion with the registered manager Tour of the building and grounds Direct observation From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs . No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The inspector would like to thank the manager her staff and service users for there co-operation in this process. What the service does well: What has improved since the last inspection? The homes Statement of Purpose, has been amended in line with the requirements of the last inspection report. The home provides training in line with the requirements of the inspection report. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 6 Staff files have been reviewed and are now in line with the requirements of the inspection report. 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. Holt Farm DS0000067215.V345540.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 Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents are encouraged to visit the home to “test drive “ it for suitability. EVIDENCE: The home provides information about the home to prospective purchasers of the service. Information about the suitability and decisions are usually made in a one to one situation giving residents time to gain a good understanding of what is on offer and available to them. The manager is hoping to develop pictorial communication methods to enable service users to be more fully involved. This format needs to be rolled out over all documentation relating to the service user information including care plans. The last resident to join the home transferred from another home within the organisation. The resident had several day visits to the home and overnight stays to assess suitability on both sides. At present there is only one female service user. Evidence was found that a prospective new service user had made several visits to the home and that the original resident has been consulted and is in agreement with him coming. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 9 One resident’s file was viewed and evidenced that residents are being consulted and informed where possible about changes and challenges available to them. The one resident of the home has a good range of recreational and leisure activities. New residents are encouraged to visit the home prior to making a final decision as to the suitability of the home. This also enables the home to assess its suitability to meet the residents care needs. Regular reviews take place to ensure that this is still the case. Service users have individual written contracts and terms and conditions. Relatives or advocates are involved in the contracting process to assist the individual resident to be safeguarded. Holt Farm DS0000067215.V345540.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): 6,7,8,9,10. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Evidence was found at inspection that individual needs and choice is promoted. EVIDENCE: One service users care plan and associated documentation were seen. They included comprehensive information about personal care routines/how much support individuals need, and how to give it. Whilst parts of the care plans are produced in user-friendly formats to assist service users to understand as much of it as they are able this could be greatly improved. The one resident in the home is able to partake in the care plan and have a say about the information held on her. Individual Lifestyle support plans include a short life history, what is vital for staff to know, likes and dislikes, achievements, level of support required, the best way to get to know me, what I like and don’t like and “what worries me “are all included in the residents file. The future needs are noted on reviews Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 11 which service users are supported and encouraged to attend. Families also are invited to attend reviews and sign the review notes. Service users’ care plans are very detailed and include all the necessary information to ensure that staff can meet their individual personal support needs. There is a description on individual files of the service user’s ability/limitations with regard to decision- making and how to ensure that they are given appropriate choices, such as sampling different activities before being asked what they want their daytime activities programme to consist of. Regular one to one meetings are held at which various subjects are discussed, including activities for the week, the rotas, complaints, health and safety and any other issues arising. These meetings are recorded and were seen to be appropriate at this inspection. Staff employ a variety of activities to keep service users interested and occupied. Any specialist communication need is identified and recorded on file. Staff are then informed of these needs and any areas of training are identified. Residents are encouraged to have contact with family and friends Confidential information is kept confidential. Risk assessments seen were detailed and reviewed. Holt Farm DS0000067215.V345540.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): 11,12,13,14,15,16,17. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home encourages residents to have a wide variety of experiences which challenge and enhance the lifestyle of the service users. EVIDENCE: The one service user in the home is very capable of expressing her wants needs and preferences. A weekly programme of activities has been worked out with her and involves both activities in the home and out in the community. The inspector would have liked to see as part of the personal development plan work around travel training and money management at a low level. The service user has many skills which could be further developed. The resident has friends at another home and she is assisted to keep in contact on a regular basis. One resident from this home is being considered for a placement in Holt Farm and is visiting on a regular basis at the moment. The two residents get on very well and it is hoped that the move can take place Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 13 soon. This will ease some of the isolation that comes with being the only resident. Regular activities take place in the community, which includes shopping trips for clothes and food, meals out at pubs and restaurants and a yearly holiday. Activities listed on the care plan were appropriate to the age ability and wishes of the service user. From information presented the service user is being encouraged to have appropriate personal, family and sexual relationships. The current resident has family fairly locally but they have chosen not to have contact, this causes upset to her and her feeling are addressed at one to one sessions, which due to her being the only resident happen daily. Evidence was found at inspection that the resident’s rights are respected and recognised this is reflected in her care plan and personal file. The one service user does not always want to eat and this is respected whilst at the same time her diet and fluid intake is closely monitored. Staff are well aware of her routine and have strategies to ensure that she has a regular intake of food and drink. Meals taken or missed are recorded on a daily basis. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of the residents was found to be met. EVIDENCE: Residents preferred method of address and how they can be best supported is clearly noted in the plans. Care plans are very detailed as to how the resident would like personal care to be provided and how to deal with different behaviours both positive and negative. The home ensures as far as possible that the physical and emotional needs of the resident are being met. A range of activities, outings and time spent with staff exploring her feeling ensures that regular input is given to her physical and emotional needs. Regular visits are made to the local G.P surgery and at present specialist intervention is also available to the home. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 15 The resident requires assistance with her medication and a robust system of administration and recording is in place to ensure medication is taken in a timely manner and that the correct amount and type is administered. Health records are well kept and accurate, service users are supported to have regular health checks and attend the GP/specialists as necessary. Residents also have access to alternative therapies. Incidents and accidents are recorded and immediate action is taken if necessary and appropriate. The medication administration system is robust and all staff receive training to administer it. Evidence was found in resident’s files that information on what should happen in the event of serious illness or death is being recorded and would be acted on. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has appropriate methods of enabling service users or their advocates to comment on the quality of the service. EVIDENCE: The current resident is able to understand the complaints procedure and how to make a complaint and has indeed made a complaint, which was dealt with in a satisfactory manner. A previous recommendation was made that all information relating to service users was to be presented in a format that would be understood by the majority of its service users. Where specialist communication methods were required the home would take steps to address this. This recommendation remains outstanding The Commission for Social Care Inspection has received no information about complaints or safeguarding adult’s issues. All staff have received Protection of Vulnerable Adults Training and staff members were fully able to describe the action that they would take if they had any concerns about the safety or well being of service users. Risk assessment were to be found on the residents file and balanced the wish to do an activity with the need to safeguard the resident. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 17 The inspector was assured that resident’s finances are appropriately managed and monitored by external agents on a regular basis. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,26,27,28,29,30. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home is very well presented and provides a homely environment. EVIDENCE: The house is a large detached house, situated in a country location close to a large village with good local amenities and is on a main route between Banbury and Kidlington. Oxford city is also in easily accessed. The home has its own transport and drivers so all areas are accessed. At present only one bedroom is furnished as each new resident is identified they will be able to select rooms colours and furnishings. The furnished bedroom provides a bright pleasant atmosphere. Many personal possessions were in evidence. The furnishings and fittings were of a good quality. The room was warm and airy With residents permission the inspector was shown all five bedrooms only one of which was occupied. The remaining bedrooms were brightly decorated clean Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 19 and well presented. The home has sufficient toilet and bathroom areas to meet the needs of its residents. The home is set in large grounds and is able to provide a pleasant outdoor environment for its residents. The home has the luxury of a heated swimming pool. The rear garden has a private walkway, which leads into the local village and this is used regularly. The entrance to the home should be through an electric gate, which at the time of the inspection was not working as health and safety measure this should be repaired at the earliest time. Then inspector was informed that the current resident has a tendency to run out into the road without notice. The home has a pond which is filled with water to a depth of approx two feet fencing or a thick wire mess should be provide to stop anyone accidentally falling into it. Specialist equipment would be provided to those who require it. Toilets and bathrooms in the home offer privacy and comfortable safe areas in which to bath. On the day of the inspection the home was clean and hygienic The home is able to provide sufficient space to enable quiet private areas where residents can be quiet or alone. Holt Farm DS0000067215.V345540.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): 31,32,33,34,35,36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home needs to recruit and retain staff to bring it up to full compliment. EVIDENCE: There is a manager, deputy manager and a small team of carers at the present time due to the fact that at present there is only one resident to care for. Recent staffing problems, has resulted in three members of staff resigning or not coming back following disciplinary action. The disciplinary action taken did not warrant referral to the POVA team. This has meant that night- time care, and some shifts, are being covered by the manager or deputy, with some input from the sister home. This means that management time is being used to underpin care time. The home must recruit to these posts in order to provide the 24 hour care required by the current service user. Staff files inspected evidenced that the home are recruiting appropriately and that police checks and references are taken up. The home has an induction for Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 21 all new staff are shadowed until they are considered capable. Further training is provided in arrange of topics pertinent to the role they are undertaking. Previous requirements regarding staff files and training have been addressed. The inspector looked at three staff files who had been taken through the disciplinary process and felt in one case where the manager was part of the process this should have been dealt with by an independent person. The manager did follow the homes procedure. The inspector would recommend that the organisation reviews its procedure in this respect. Staff files inspected evidenced that staff are supervised and supported to do the job expected of them. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager needs to be freed up from providing care to be enabled to manage. EVIDENCE: As previously mentioned in this report the manager has had to spend time working as a carer to cover for vacancies absence and holidays. This situation needs to be addressed as a priority. No evidence could be found that the manager was receiving professional supervision and her only support was peer support from a colleague. The organisation must ensure that the homes manager has the appropriate professional support and guidance she requires. Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 23 The fact that the home has only one resident at the moment causes a catch 22 situation in that more staff are not being employed until more residents arrive and the staff that have been employed are being de skilled as the home is not full and therefore they are not working as they would wish. The home is having difficulty finding prospective residents in a market place, which is buoyant and it may be that the organisation has to look at its fee structure in order to be more competitive. The same could be said for the pay structure, as it seems to be at the low end for the type of experience and training needed to provide care in this environment. The organisation has a senior manager responsible for quality assurance. The quality assurance system consists of regular Regulation 26 visits, an annual audit by managers, formal annual reviews of service user care plans All health and safety records and checks were up-to-date. Staff have updated health and safety training. Accidents and incidents are properly recorded and any remedial action necessary is taken promptly No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The finances of the home and that of its residents are regularly monitored by independent auditors. The homes accounts are open for inspection. The organisations finances were not inspected as part of this process. Holt Farm DS0000067215.V345540.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 2 2 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 2 3 Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA31 YA33 Regulation 26 18 Requirement The manager must receive regular formal professional supervision. The registered manager must ensure that staff are available in sufficient numbers to meet the needs of the residents. The registered manager must ensure that the electric gate to the property is in good working order The registered manager must ensure that the garden pond is made safe from accidental drowning Timescale for action 01/10/07 01/10/07 3 YA42 12 10/09/07 4 YA42 12 10/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The registered manager should ensure that all material used for sharing information with and about service users in presented in a format that would be understood by thre DS0000067215.V345540.R01.S.doc Version 5.2 Page 26 Holt Farm 2 YA11 majority of its prospective service users. The registered manager should ensure that service users are encouraged to reach their full potential in travel money and community Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Holt Farm DS0000067215.V345540.R01.S.doc Version 5.2 Page 28 - 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!