Inspection on 28/06/06 for Kenroyal Nursing Home

This inspection was carried out on 28th June 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Kenroyal Nursing Home 14/10/05

Kenroyal Nursing Home 20/06/05

Kenroyal Nursing Home 27/10/04

Kenroyal Nursing Home 15/06/04

Kenroyal Nursing Home 02/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Kenroyal Nursing Home 6 Oxford Street Wellingborough Northants NN8 4JD Lead Inspector Irene Miller Unannounced Inspection 28th June 2006 11.15 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 DS0000012621.V301673.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. DS0000012621.V301673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenroyal Nursing Home Address 6 Oxford Street Wellingborough Northants NN8 4JD 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) 01933 277921 01933 277781 kenroyalnh@aol.com Mr Mukesh Patel Mrs Saila Bala Das Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places DS0000012621.V301673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home should be registered to accommodate 34 service users in the category of OP for either personal care or nursing care. 14th October 2005 Date of last inspection Brief Description of the Service: This home is situated on a major route in the town of Wellingborough. It is privately owned and the Registered Provider is not based on site. The homes organisational structure includes a manager and an administrator with responsibility for running the home on a daily basis. Nursing care is provided to service users over 65 years of age. The majority of rooms are singles with en suite facilities. Communal areas comprise 2 lounges and a dining room. The building can be described as refurbished Victorian, and there are maintained grounds. The Registered Provider is currently seeking planning permission for a major extension that will enable the home to accomodate thirty-two more residents within a dedicated Dementia Care Unit. Fees are negotiable ranging from £350.00 to £500.00 per week. DS0000012621.V301673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This inspection was a ‘Key Inspection that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The primary method of inspection used on this unannounced inspection was ‘case tracking’ that involved selecting at least three residents and tracking the care they receive through review of their care plans, records, discussion with the residents, staff on duty, visitors and general observation of care practices and the environment. The registered manager Mrs Saila Bala Das was not available at the home on the day of this unannounced inspection, however the registered provider Mr Mukesh Patel was available to speak with over the telephone, and a senior member of staff was available throughout the whole of the inspection. The Commission for Social Care Inspection sent out to the home a preinspection questionnaire; service users and visitors/relatives comment cards, prior to the inspection The pre-inspection questionnaires was returned to the Commission for Social Care Inspection along with twelve residents, thirteen visitors and five general practitioners feedback cards which provided information on the management systems and outlined the general satisfaction of the residents living at the home and their representatives. The inspector spent two and a half hours planning the areas to focus on at this inspection, based upon information gained from reviewing the homes service history and the last two inspection reports and information from the pre inspection data collection. The inspection took place over a period of approximately six hours. What the service does well: DS0000012621.V301673.R01.S.doc Version 5.2 Page 6 Information about the home is made available to all residents, copies of the homes Statement of Purpose (that outlines the qualifications and experience of the registered provider and manager, and the range of care that the home is registered to provide) are made available to all prospective residents and their representatives and all residents are provided with a copy of the Service User Guide (that outlines the range of services available within the home, and daily routines) Copies of the latest inspection report from the Commission for Social Care Inspection are made available to residents and their representatives. Risk assessments for the prevention of falls, pressure, nutrition, movement and handling are carried out and regularly reviewed and the daily records/evaluation reports indicated that staff observe and monitor the resident’s needs and that action is taken to address changing needs The storage and administration of resident’s medication is well managed. A programme of organised activities is available and individual activities take place between the residents and staff. Photographs were seen to be on view within the front entrance of the home, of Christmas parties and other seasonal and special occasions that had taken place within the home, involving residents, staff and visitors. Visiting times are flexible, residents are encouraged to bring in personal possessions and make choices about their daily lives. There are residents living at the home from diverse, cultural and religious backgrounds the home uses an outside catering company that specialises in providing foods to meet the dietary needs of residents faith and some residents have arrangements with their families for their meals to be brought into the home on a daily basis. There is a commitment to on-going staff training, almost all staff have achieved a National Vocational Qualification level 3. What has improved since the last inspection? What they could do better: DS0000012621.V301673.R01.S.doc Version 5.2 Page 7 The care plans identified the physical needs of the residents but lacked detailed information on how individual residents needs and wishes were to be met, particularly in relation to residents who have very limited communication skills. The use of bedside rails (cot sides) must only be through a detailed risk assessment that is completed in full, taking into consideration any hazards and the suitability of the equipment in relation to the use of bed rails with the bed occupant. The registered provider was advised to seek guidance from the Medical Healthcare Products Agency www.medical-devices.gov.uk on the safe use of bedside rails. 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. DS0000012621.V301673.R01.S.doc Version 5.2 Page 8 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 DS0000012621.V301673.R01.S.doc Version 5.2 Page 9 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): 3, Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process enables prospective residents to make a fully informed choice as to whether the home will meet their needs and expectations. EVIDENCE: The homes statement of purpose and service user guide is made available to all prospective and existing residents. A notice was on display within the front entrance of the home to inform residents and visitors to speak with the homes manager should they require a copy of the latest inspection report. Residents spoken to confirmed that they were satisfied with the homes admission procedures and that they had had an opportunity to visit the home prior to moving in. DS0000012621.V301673.R01.S.doc Version 5.2 Page 10 The care plans looked at had pre admission assessments that had been carried out by the home prior to the residents moving and in there was also copies of assessments of needs that had been carried out by the placing authorities. DS0000012621.V301673.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. The information contained within the care plans, identified the resident’s immediate needs, however to fully establish the level of staff support in meeting the identified needs, the care plans would benefit from containing more detailed instructions for staff to follow. EVIDENCE: The residents care plans are produced from the pre admission assessments, there was documentation that they had been regularly reviewed and signed by the resident, where this had not been possible they were signed by the residents representative. The care plans demonstrated that risk assessments for the prevention of falls, pressure, nutrition, movement and handling are carried out and regularly reviewed. DS0000012621.V301673.R01.S.doc Version 5.2 Page 12 Within the care plans the input from other professionals such as the district nurse and general practitioner was recorded, and the treatment and action taken to address any health care needs was recorded. The care plans identified the physical needs of the residents but lacked detailed information on how the residents wished to have their needs met, particularly in relation to residents who are unable to verbally communicate their needs and wishes. For example in the care plan of one resident who did not speak any English it stated that the resident was to be offered a bath/shower, on speaking with the staff it was identified that the resident preferred a bath at 05.00 am every morning and always used the specialist assisted bath, it was also explained that the resident had chosen that only the Registered General Nurses employed at the home were to assist them when bathing In another care plan it stated that the resident required a high fibre diet, however there was no eating and drinking care plan in place to inform staff on what foods the resident liked or disliked, what high fibre foods were to be offered, where the residents preferred to eat their meals or what level of staff support was required. The daily records/evaluation reports indicated that staff observe and monitor the resident’s needs and that action is taken to address changing needs Information within the individual care plans demonstrate that pressure ulcers are managed well and that external specialist advice is sought appropriately. Staff were observed to treat residents with respect, knocking on doors before entering and speaking with residents in a courteous and polite manner. Within the care plans there was signed consent from the residents, who had chosen not to have locks on their private accommodation. Within the care plan of one of the resident’s case tracked, the home had gained the consent from the relative for the use of bedside rails (cot sides). On a form entitled ‘patient assessment for the use of cot sides’, however the assessment had not been fully completed and their introduction was through a judgement made by a senior nurse as to the need for the bed rails. No formal risk assessment had taken place, to identify the safety measures for their use or any potential risks or hazards in relation to the bed occupant due to the bedside rails being in place. The storage and administration of residents medication was looked at, medication was stored securely and all records seen demonstrated that the medication systems were well managed, and pharmacy visits had taken place recently and no areas of concern were raised. DS0000012621.V301673.R01.S.doc Version 5.2 Page 13 Staff spoken with were very knowledgeable of the individual residents needs in relation to their medication, closely observing the residents healthcare needs, ensuring that any changes are communicated with the residents general practitioner. Staff were observed treating residents in a respectful and courteous manner. Residents were addressed by their preferred name; residents said that they were very happy with the care they received at the home. DS0000012621.V301673.R01.S.doc Version 5.2 Page 14 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 judgement has been made using available evidence including a visit to this service. The lifestyle in the home meets the resident’s needs and expectations. EVIDENCE: The home employs an activities person and within the care plans there was documentation that this member of staff had consulted with residents individually to plan and provide personalised activities. There was a programme of activities available and as advertised on the morning of inspection there was an activity taking place, a visiting entertainer was spending time with residents, singing old time songs. The residents appeared to enjoy the entertainment. Minutes of residents meetings were seen and confirmed satisfaction with the existing scheduled arrangements. DS0000012621.V301673.R01.S.doc Version 5.2 Page 15 Collections of photographs were seen to be on view within the front entrance of the home, these were of Christmas parties and other seasonal and special occasions that had taken place within the home, involving residents, staff and visitors. Residents confirmed that visiting was flexible, that they were able to bring in personal possessions and make choices about their daily lives, and those having the capacity to be independently mobile were observed moving around the home as they wished, chatting with staff and visitors, choosing were to spend their time. Residents said that they were very pleased with the quality and the choice of food provided. The lunchtime meal was minced beef and dumplings with mashed potatoes and mixed vegetables followed by semolina pudding or fresh fruit salad and cream. The meal was well presented and the dining room was clean and pleasant. There are residents living at the home from diverse, cultural and religious backgrounds the home uses an outside catering company to provide foods to meet the dietary needs of residents from the Hindu faith and some residents have arrangements with their families for their meals to be brought into the home on a daily basis. Some residents require their meals to be pureed and need full staff support with eating and drinking, this support was observed to take place with sensitivity to the residents needs and was well managed. Visitors said that the staff cared for their relatives very well and were pleased with the home. Resident’s outings take place on an individual one to one basis. DS0000012621.V301673.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be assured that any concerns they may have about the service will be taken seriously and acted upon, and that residents are protected from abuse. EVIDENCE: The complaints procedure was available within the front entrance lobby of the home, and within the homes statement of purpose and service user guide. Procedures for addressing any concerns or complaints are followed. One complaint had been received by the home and this had been dealt with appropriately by the home working in partnership with the Local Authority and the Commission for Social Care Inspection. Training on the protection of vulnerable adults takes place during induction and refresher training. On speaking with staff it was demonstrated that they had knowledge of the protection of vulnerable adults policies and procedures. DS0000012621.V301673.R01.S.doc Version 5.2 Page 17 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 judgement has been made using available evidence including a visit to this service. Residents living at the home are provided with a pleasant, homely and comfortable environment. EVIDENCE: Staff said that the fire tests are conducted weekly, through discussion it was demonstrated that they were fully aware of the homes fire procedure. On a day-to-day basis the staff record any faults or repairs, which they come across that require attention by the maintenance worker, for example replacement light bulbs, adjustments to water and heating temperatures. A limited tour of the building was conducted and all communal areas were pleasantly furnished and welcoming. Residents rooms viewed were personalised. DS0000012621.V301673.R01.S.doc Version 5.2 Page 18 During a tour of the building and residents personal rooms, many of the residents beds had bedside rails (cot sides) fitted, several of the bedside rails were of the metal universal telescopic design, intended for use on divan style beds, there was concern raised about the compatibility of this style of bedside rail being used on metal framed hospital style beds. The registered provider was advised to seek guidance from the Medical Healthcare Products Agency on the safe use of bedside rails. Residents said that they were pleased with the standard of the communal areas and their private accommodation. The home has obtained planning permission for an extension to the premises, which will also include refurbishment of the existing facilities. The main kitchen was viewed and the Staff working within the kitchen environment were knowledgeable of the dietary needs of the residents Food safety standards were followed and record seen demonstrated that the kitchen environment was well managed. The laundry was viewed and the staff working within this environment were knowledgeable of cross infection policies and procedure, and confirmed that full training had taken place, to enable them to carry out their duties, and that support was always available from the manager. The home was clean and hygienic. DS0000012621.V301673.R01.S.doc Version 5.2 Page 19 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 judgement has been made using available evidence including a visit to this service. There is a commitment to staff training that ensures that the residents receive a quality service. EVIDENCE: The staff rota was seen and staffing levels were sufficient to meet the current needs of the residents. The care staff have the support of at least one Registered General Nurse on duty, in addition there is daily administration, maintenance, domestic, laundry and catering staff support. The home has achieved the national minimum standards target of 50 of staff being trained to National Vocational Qualification level 2. National Vocational Qualification training is rolled out to all staff and team leaders trained to National Vocational Qualification level 3. Staff files seen demonstrated that robust recruitment processes are followed the files contained appropriate documentation including references and Criminal Record Bureau Clearances. DS0000012621.V301673.R01.S.doc Version 5.2 Page 20 Staff spoken to confirmed that the home provides access to appropriate training, such as induction, National Vocational Qualifications, fire safety, movement and handling, health and safety, food hygiene, infection control and first aid. There is a training plan in place and training records available, evidenced that staff receive mandatory induction training on moving and handling, food hygiene, fire procedure, health and safety and first aid. DS0000012621.V301673.R01.S.doc Version 5.2 Page 21 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 judgement has been made using available evidence including a visit to this service. Residents live in a home that is well managed and promotes the residents rights to choice, privacy and dignity and respect. However risk assessments in place for the use of bedside rails are inadequate. EVIDENCE: The registered manager was not available on the day of inspection, however the registered provider was available to speak with over the telephone. The member of staff in charge on the day of inspection was a Registered General Nurse that had been employed at the home over the past four years and demonstrated full awareness of the managerial systems in place within the DS0000012621.V301673.R01.S.doc Version 5.2 Page 22 home, the communication and support available to staff in a senior position from the registered manager and registered manager was good. Quality assurance systems take place through residents meetings and formal resident satisfaction surveys and results are collated and residents are given feed back. The results are used to influence service developments and are displayed on the notice board in the main entrance, however the results on display within the front entrance were of the survey conducted in 2004. Comments received at the Commission for Social Care Inspection through the returned feedback questionnaires were in the main very positive, with comments such as ‘a lot better since the last inspection’, ‘quality of care seems good’, and ‘staff are very good’. Areas that could be improved were staffing levels, and improved communication with less senior staff. Staff spoken with confirmed that supervision takes place. Appropriate risk assessments are in place however the use of bedside rails requires a more formal assessment to be made, addressing any hazards surrounding the use of such equipment, with the bed occupant, such as the risk of entrapment, use of protectors, compatibility of the rails with the type of bed and mattress, maintenance, staff training and observations that must be made to ensure the safety of residents. The registered provider was advised to seek guidance from the Medical Healthcare Products Agency www.medical-devices.gov.uk on the safe use of bedside rails. DS0000012621.V301673.R01.S.doc Version 5.2 Page 23 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 X 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 DS0000012621.V301673.R01.S.doc Version 5.2 Page 24 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 Standard OP38 Regulation 13 (4) Requirement Risk assessments for the use of bed rails must be reviewed and based on the guidance issued by the Medical and Healthcare Products Regulator, to ensure the health and safety of resident. Following the inspection visit of 14/11/05 the timescale for action of this requirement was 31/12/05 this has not been met. Timescale for action 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 Refer to Standard OP12 Good Practice Recommendations The individual needs and preferences on the routines of daily living should be included within the care plans. DS0000012621.V301673.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 DS0000012621.V301673.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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