Inspection on 18/05/06 for Holyport Lodge Nursing Home

This inspection was carried out on 18th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Holyport Lodge Nursing Home 03/03/09

Holyport Lodge Nursing Home 01/08/07

Holyport Lodge Nursing Home 06/12/05

Holyport Lodge Nursing Home 17/05/05

Holyport Lodge Nursing Home 17/02/05

Holyport Lodge Nursing Home 26/10/04

Holyport Lodge Nursing Home 22/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Holyport Lodge Nursing Home Holyport Maidenhead Berkshire SL6 2JA Lead Inspector Mrs Rhian Williams-Flew Unannounced Inspection 18th May 2006 10:45 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 Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 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. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Holyport Lodge Nursing Home Address Holyport Maidenhead Berkshire SL6 2JA 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) 01628 781138 saylem@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited Mrs Marilyn Sayle Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (4) of places Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Adults with a physical disability will not be admitted below the age of 55. 6th December 2005 Date of last inspection Brief Description of the Service: Holyport Lodge is an elegant, homely Edwardian house, situated on the edge of the Village Green in Holyport, near Maidenhead in Berkshire. The village of Holyport is situated close to the towns of Maidenhead and Windsor. Holyport is owned by BUPA and registered to provide care for up to 45 people. Up to 41 can be people in older age and up to 4 people with physical disabilities can be accommodated. The home has been converted but retains many of its original features and character, including an impressive oak staircase and hand carved oak panelling. There are two lounges, (one of which is used as a quiet room) and a dining room. These areas provide a central meeting place where residents can get together to read, watch television or converse with one another. The gardens are attractively landscaped, and add to the ambiance of the home. Much of the above information has been taken from the homes Statement of Purpose. The Registered Manager has confirmed that and up-to-date and detailed Statement of Purpose and Service User Guide is given to all prospective residents. She has also confirmed that the most recent CSCI report is made available to all prospective residents as it is appended to the Service User Guide. For existing residents the most recent CSCI report is available from the front reception of the home. The Registered Manager confirmed on 11 April 2006 that the current scale of charges is £795 to £1600 per week. Additional charges are made for, hairdressing; newspapers; chiropody; manicurist and toiletries. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used to inform this report includes a pre-inspection questionnaire completed by the Registered Manager of the home; our inspection records held at the local office of CSCI; 13 service user surveys and an unannounced site visit on 18 May 2006. During the unannounced site visit conversations were held with residents, their relatives and members of staff; observations were made of the delivery of care; a partial tour of the home was made, a 10 sample of case files were case tracked and records concerning the management of the home were reviewed. The manager was present throughout the site visit. The site visit took place between 10.45am and 6.45pm and was conducted by one Inspector. What the service does well: What has improved since the last inspection? What they could do better: A previous requirement with regard to the safe administration of medication has not been met. The evidence of the visit to the home demonstrated that similar errors were still occurring. The Registered Manager must ensure that the registered nurses who administer medication are competent and have Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 6 received suitable training to ensure their practice is safe. The registered nurses must follow the homes procedures and their own professional code of conduct with regard to the administration of medication. Residents should have their medication administered to them correctly and safely. The Registered Manager is to investigate why noted injuries to a resident were not brought to her attention when they occurred. Ensuring the protection of residents from harm and injury must be a priority for all staff. Members of staff must be fully conversant with the protection of vulnerable adult procedures and have appropriate training. 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. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 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 Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 (6 is not applicable) Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Of the service user surveys returned 85 of the respondents said they had received information about the home prior to choosing to live at Holyport Lodge. The same percentage of people said they had received a contract once they had been chosen to live in the home. The pre-admission assessments of 4 recently admitted people were reviewed and it was evident that the Registered Manager does ensure that she assesses all prospective residents to ensure that the home is able to meet their needs. In conversations with 3 of these people they all felt that the staff of the home had sufficient skills and equipment to meet their needs. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The case records of 6 residents were reviewed in detail. They were found to be up-to-date and regularly reviewed. They had been devised with the resident’s needs and wishes being seen as a priority. The involvement of other professionals in their care was also evidenced. This is particularly important to ensure that residents make the most the skills and abilities they still have even though they have physical disabilities. A previous requirement to ensure that the psychological and emotional needs of residents were addressed in the care plans has been met. Detailed and individual assessments of the resident’s psychological well-being were seen. During the visit to the home 5 of the 6 residents whose case records were reviewed were spoken with. It was possible to evidence from the conversations and the care plans seen that their needs had been correctly Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 10 identified. Where it is possible, there was evidence to support the inclusion of the resident in their care planning. Within the care plans it was easy to evidence that their health care needs are promoted. 46 of the respondents in the CSCI survey of residents felt that they always received the medical support they needed and 54 said that they usually received the medical support they needed. Previously, a requirement had been made to ensure that medication was administered accurately as dosages of pain relief had been missed and some of the administration records had not been appropriately signed. Evidence was seen in the minutes of staff meetings that the deputy manager had raised this issue and all qualified nurses had been informed of their responsibilities as registered nurses. On this visit the medication administration records for one floor of the home were examined. It was noted that for one resident their pain relief had not been given on the correct day and 24 hours had elapsed before it was administered. This matter had not been brought to the attention of the Registered Manager. In addition, some records did not have signatures on the administration records to qualify whether a resident’s medication had been given or had been omitted. On this evidence it would suggest that the qualified nurses have not heeded the actions taken by the deputy manager following the last inspection. The Registered Manager also confirmed that there is no external audit conducted of the medication used in the home. The pharmacist who supplies the medication to the home does not provide a three monthly audit service. Of all the residents spoken with they confirmed that members of staff treat them with dignity and respect. It was certainly apparent from the observations made during the visit that there was a good rapport between the staff and residents. The only adverse comments concerned the night-time staff. Some residents expressed the view that some of the night time staff were sometimes brusque as they appeared to be hurrying to complete their workload. Residents felt hurried. This issue was discussed with the Registered Manager and she has undertaken to review the allocation of work for the nighttime staff and whether there are sufficient staff. CSCI would anticipate that the Registered Manager would provide feedback to the resident group as to the outcome of the review. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Of the service user surveys returned 85 of the respondents said that they always or usually were able to participate in the activities in the home. The evidence from the pre-inspection questionnaire indicates that there is an extensive and varied choice of activities that the residents are able to participate in. In conversations with residents they confirmed that they all knew of the activities available and made choices as to what they wanted to participate in. Some of the residents commented on their enjoyment about a visit to Cliveden House the previous day for afternoon tea. The Registered Manager confirmed that there are two members of staff who coordinate the activities schedule; both work 20 hours per week. There was evidence to support that local community groups visit the home and relatives and friends are welcome at all times. Some residents confirmed that they visited their friends and relatives in their homes and enjoyed the local community facilities whenever possible. Visits to the local duck pond and public house are enjoyed. The home also facilitates the opportunity for Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 12 religious worship. One resident made the suggestion of having a volunteer companion to accompany them to previous clubs and societies they had previously belonged to. The suggestion was passed to the Registered Manager who agreed to discuss it further with the particular resident. Of the residents spoken with, many were complimentary about the help they receive from members of staff to make informed choices about their lives. However, the majority of residents receive support and guidance from their relatives and friends with regard to their personal affairs. Some residents have chosen to personalise their rooms and adapt the facilities to suit their own comfort and preferences. Of the service user surveys returned 100 of the respondents said they always or usually liked the meals provided. Qualifying comments to this scoring indicated that breakfast and lunch are perceived to be of better quality than the evening meal. Indeed, residents who were spoken with commented that a better choice in the evening meal would be preferred. Less reliance on spaghetti and cheese would be preferred. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: In the completed pre-inspection questionnaire the Registered Manager indicated she had received 6 complaints in the past 12 months. One complaint is still pending an investigation but all other complaints have been responded to within 28 days. These complaints were reviewed during the visit to the home. It was clearly evidenced that they had been investigated appropriately. The completed service user surveys indicated that 93 of respondents said that they always or usually knew who to refer any complaints or comments to. There have been no concerns or complaints reported to CSCI since the last inspection. The Registered Manager is presently investigating an allegation of harm to a resident. She has taken appropriate action in protecting other residents as the investigation proceeds. During the visit two members of staff were spoken with to establish their understanding of the protection of vulnerable adults procedures and both appeared fully conversant with the procedures required. During the visit 5 sets of staff training records were reviewed and no evidence could be found to support that these members of staff had received training in the protection of Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 14 vulnerable adults from abuse. The Registered Manager confirmed that she was awaiting opportunities to send members of staff on such training. Subsequent to the inspection she has confirmed that she has contacted the BUPA professional development centre and has made a formal request for training to be provided to her staff in this area of care and protection. In reviewing the case files of one resident photographic evidence of injuries were filed yet there was little record as to how these injuries had occurred or what actions had been taken and by whom. The Registered Manager confirmed that she had not been advised of the injuries. The Registered Manager agreed to instigate an investigation of this issue as a priority. She will be asked to take appropriate action to protect all residents and to provide the outcome of the investigation to CSCI and any other agencies. This example demonstrates the need for all staff to be aware of what actions they should take and who should be informed if they observe injuries to residents. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: At the previous inspection two requirements were made with regard to the environment of the home. These concerned compliance with the advice and guidance given by the Berkshire Fire Service and the potential for noise in one resident’s room, which was adjacent to the laundry. The Registered Manager has provided evidence to assure that both these requirements have been met. On the evidence seen during the visit and the assurances of the Registered Manager the home is suitable for its stated purpose. It is accessible, safe and well maintained. Residents who were spoken with commented on the comfort of the home. All made favourable comments about the gardens and were looking forward to the opportunity of visiting them in the warmer weather. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 16 The home is clean and comfortable and 85 of the people who responded to the service user survey considered the home to be always fresh and clean. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The staffing rotas for the month of May 2006 were reviewed with the Registered Manager. She considers that she has sufficient staff to meet the needs of the residents who live in the home. As previously indicated she is willing to review the workload of the night-time staff in order to ensure that there are sufficient staff to carry out the tasks required of them in a way that is unhurried and to the comfort of the residents. In the service user surveys 15 of respondents said that members of staff were always available when they needed them; 70 said that staff were usually available and 15 said they were sometimes available. The numbers of care staff achieving NVQ 2 and above was recorded as 45 in the pre-inspection questionnaire completed by the Registered Manager. This is a marked improvement since the last inspection. A member of staff who was interviewed expressed considerable enthusiasm to starting her NVQ qualifications. The recruitment records 5 members of staff were reviewed and found to comply with the regulations required. Therefore, a previous requirement has Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 18 been met. All new staff members receive induction training and then receive additional training within the first six months of their employment. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The home has an experienced and qualified manager. From the comments received by residents and their relatives she is viewed with high regard and they consider her to be always approachable and accommodating. Various quality assurance records were reviewed. These included, care assistant meetings; registered nurse meetings; response to complaints; care plan audits; accident records and their follow-up and interdepartmental audits. There was evidence to support the outcome that this home is run in the best interests of the residents who live there. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 20 The pre-inspection questionnaire confirmed that all the residents or their representatives manage their financial affairs. The home does not act as an appointee for any of the residents. The homes financial officer is responsible for the collection of fees and management of any additional bills that residents may incur. From the information provided in the pre-inspection questionnaire and a random sample of the maintenance records for the home it is clear that the home does employ safe working practices to ensure the health, safety and welfare with the residents and staff. The Registered Manager does ensure that members of staff receive the mandatory training required. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 21 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 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 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 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 Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes 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 OP9 Regulation 13 (2) Requirement Medication administration is to be accurate and in line with NMC guidance to ensure the comfort and well being of the residents. THIS REQUIREMENT HAS NOT BEEN MET. Medication must be administered when prescribed unless there is good evidence to support why it has been omitted. The administering nurse must ensure they sign the medicines administration record. 2 OP9 18(1) The Registered Manager should 31/07/06 review the performance of all the qualified nurses to ensure their levels of competency with regard to the administration of medication. The Registered Manager should ensure that all qualified nurses receive regular training with regard to the safe administration of medication. Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 23 Timescale for action 05/06/06 3 OP18 13(6) The Registered Manager is to investigate why noted injuries to a resident were not brought to her attention when they occurred. The Registered Manager is to investigate how the injuries occurred and take appropriate action to protect all residents. 05/06/06 4 OP18 13(6) The Registered Manager must provide up to date training in the protection of vulnerable adults for all her staff team. 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP10 Good Practice Recommendations The Registered Manager considers the implementation of a regular audit of the pharmacy arrangements for the home. The Registered Manager undertakes a review of the workload of night time staff to ensure they have sufficient time to carry out their tasks in an unhurried way and to the comfort of the residents. If the review reveals that changes are necessary then to implement these changes. The Registered Manager undertakes a review of the workload of night time staff to ensure they have sufficient time to carry out their tasks in an unhurried way and to the comfort of the residents. If the review reveals that changes are necessary then to implement these changes. The Registered Manager continues to promote the training of care staff in National Vocational Qualifications (NVQ’s) so the home achieves the target of at least 50 of the care staff having such a qualification. 3 OP27 4 OP28 Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Holyport Lodge Nursing Home DS0000010993.V291062.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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