CARE HOMES FOR OLDER PEOPLE
Kenwyn Newmills Lane Kenwyn Hill Truro Cornwall TR1 3EB Lead Inspector
Diana Penrose Announced Inspection 26th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kenwyn Address Newmills Lane Kenwyn Hill Truro Cornwall TR1 3EB 01872 223399 01872 223884 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) Barchester Healthcare Mr Richard Hawes Care Home 108 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (34), Old age, not falling within any other category (60), Physical disability (14), Terminally ill (60) Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Pencarrow & Trelissick - Service users to include 60 adults of old age (OP) Pencarrow & Trelissick - Service users to include up to 60 adults with a terminal illness (TI) Tresco Unit - Service users to include up to 34 adults aged over 65 with a mental illness (MD{E}) Tresco Unit - Service users to include up to 34 adults aged over 65 with dementia (DE{E}) Glendurgan Unit - Service users to include up to 14 adults aged 18 to 65 years on admission with a physical disability (PD) Total number of service users not to exceed a maximum of 108 To include one named service user under the age of 65 in Tresco unit Date of last inspection 9th August 2005 Brief Description of the Service: Kenwyn Nursing Home is situated on the outskirts of the City of Truro and is owned by Barchester Healthcare. It is a large home that offers both residential and nursing care for up to 108 people. The service provides care and accomodation for service users who experience differing care needs; older people, nursing, dementia, mental disorder, physically disabled and terminally ill. Accommodation is on two floors and divided into four separate units. There are two lifts accessible to service users. There are four double bedrooms the rest are single, all have en suite facilities. All rooms have accessible call bells. Meals are prepared in a well-equipped kitchen on the ground floor. There is a secondary kitchen on the first floor. Meals are served in the dining rooms on each unit or individual bedroom if preferred. The extensive grounds are attractive and well maintained but there are some access issues for residents that use wheelchairs. There are patios with seating and tables. Car parking space is provided. A Senior Nursing Sister supported by a team of qualified nurses and care staff manage each unit. The Hotel Services Manager is responsible for the catering and domestic staff. Two Recreational Therapists are employed to organise activities and trips out. There are opportunities for socialising and visitors are actively encouraged. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Three inspectors visited Kenwyn Nursing Home on the 26 January 2006 and spent eight hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance with the requirements and recommendations identified in the last inspection report dated 09.08.05. In addition the inspectors focused on the following key areas of care: assessment and care planning, medicines, meals, adult protection, some of the environment, staffing, training, and health and safety. On the day of inspection 99 residents were living in the home. The methods used to undertake the inspection were to meet with a number of residents, visitors, staff, the manager designate and the regional operations director to gain their views on the services that Kenwyn offers. The home’s records, policies and procedures were examined and the inspectors toured the building. This report summarises the findings of this inspection. What the service does well:
The home is a purpose built property that is well maintained. It provides a spacious environment that is warm, clean and well furbished. Residents spoken with were happy in the home and had their own possessions around them. The grounds are extensive and very well maintained. The home has won several awards for its gardens; they won a local competition in the summer 2005. A member of the management team assesses prospective residents to ensure the home can meet their needs. The assessment involves relatives and health professionals as necessary and records are kept. An individual plan of care is compiled from the initial assessment. A number of risk assessments are undertaken, for example to prevent pressure sores, to ensure adequate nutrition and to prevent falls. The nurses maintain daily records, and they are informative. There is a medicines policy and system in place for the ordering, storage, administration and disposal of medicines. A qualified nurse administers the medicines at all times. Residents said they are treated with respect and their privacy is upheld and this was seen to be so during the inspection. Each service user has a nutritional needs assessment to identify any specific dietary needs. The menu is varied with fresh fruit and vegetables on offer every day. There is a variety of finger food and omelettes and a sweet trolley. Hotel services staff deal with the food and refreshments. Residents and visitors said the food is very good and well presented. There is a robust recruitment process in place with relevant checks made and records kept. There are sufficient numbers of staff on duty and English lessons are provided for the overseas workers to help communication difficulties. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 6 There is an induction programme for new employees. Statutory training takes place and other training is on offer. The management strive to improve services and the care provided by a range of monthly audits and questionnaire surveys of the residents and staff annually. Regular meetings take place with staff, residents and GP practices. There is a comments book in reception and residents said they could talk freely to the staff and management if they needed to. The home only holds money for residents if really necessary and has an appropriate system in place. What has improved since the last inspection? What they could do better:
The residents’ care plans must be written in sufficient detail to instruct the care staff on how to meet the needs of the resident. Care planning should involve
Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 7 the resident or representative and be signed when possible; this is not evident on all units. There should be information as to how identified risks will be managed and risk assessments must be reviewed. It is good practice to obtain consent for the use of restraints such as cot-sides. The food provided is to a high standard but residents with diabetes pointed out that the pudding offered to them are unimaginative; the manager said she would discuss this with the chef. A local medicines policy must be developed as referred to in the corporate policy. This will detail exactly what the homes procedures are. The adult protection policy must be reviewed and include the local inter agency procedures. The providers meet the current minimum staffing levels they have determined. A review of the staffing arrangements and deployment of staff is required to make sure that sufficient numbers of staff are on duty at all times. This will also include the cover provided during staff meal breaks. Staff receive training but would benefit from more training specific to the individual units. Suitable first aid training must be provided as only four staff have done this training, the manager did say this was in hand. The induction process needs to be more structured with records kept up to date. The management endeavour to ensure the safety of residents, staff and visitors, however there are some areas that require attention. Flammable liquids in the laundry must be stored in a locked facility rather than in an open area. Some areas of the laundry room need to be tidied and unnecessary items stored elsewhere. The risk assessment process must be improved; the moving and handling risk assessment format in particular requires more information. Catering staff must use the changing facilities provided; they have been changing in a toilet. The décor in the home is of a good standard however the colour scheme and signage on Tresco unit should be reviewed to benefit those residents with a dementia. 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. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 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 Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 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 Service users are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care. EVIDENCE: The Manager explained the procedure for the initial assessment of prospective service users and completed assessment documents were inspected. The assessment forms have been revised since the last inspection and more detail is now recorded. There is evidence of who was involved in the assessment and information from Social Services and hospital staff is obtained when appropriate. An individual plan of care is compiled from the initial assessment. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Individual care plans are generated for each service user but do not fully inform and direct the staff in their care provision, the new system should do this. There are suitable systems and policies in place for dealing with service users medicines and assure service users safety. Systems are in place to ensure that service users are respected and their privacy is upheld at all times. EVIDENCE: Each service user has a written care plan; not all sections give specific and clear instruction to staff. The coverage of social, religious and emotional needs has improved. The care plans are reviewed monthly and changes are recorded. The Standex system is used along with the homes own documentation; a new system is to be implemented following staff training. Risk assessments include Waterlow scoring, nutrition, moving and handling and falls. The moving and handling risk assessment format must be improved this was discussed with the manager. There is not always information as to how an identified risk is to be managed and the risk assessments are not always effectively reviewed. Risk assessment for the use of cot-sides is evident but there is no evidence of consent for the use of any restraint. The use of restraints should have written consent of the resident and/or representative, relevant staff and GP. There is evidence that care plans are compiled with the service user or representative
Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 11 and signed in some cases but this is not consistent throughout the home. Visitors spoken with on Pencarrow unit said they are involved in the care planning for their relative. Daily records are maintained and informative, the care staff do not record in these, they have a chart to complete each day. There is a company medicines policy and system in place for the administration of medicines. There must also be a local medicines policy in place. Medicine reference books are current. Storage of medicines is safe and secure. Medicines received into the home are recorded and signed for on the medicine administration chart. Medicines for disposal are collected by the pharmacy. Residents’ privacy was upheld during the inspection. Residents said they are treated with respect and their privacy is upheld at all times. Shared rooms are provided with appropriate screens. Staff did not always knock on doors but the residents said they did not mind. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Dietary needs of service users are well catered for with a varied selection of food available that aims to meet their taste and preference. EVIDENCE: Standard 12 was not inspected but it is noted that a variety of activities are on offer and plans are in place to improve outings. There are photographs of residents enjoying activities and Christmas festivities. Each service user has a nutritional needs assessment and some likes and dislikes are recorded. There is a varied daily menu; the chef is currently reviewing the menus with the residents. There is a menu for finger food and omelettes and a sweet trolley with fresh fruit each day. Residents said the food is very good but diabetic residents said the puddings served for them are unimaginative; the manager agreed to discuss this with the chef. Meals are served in the dining areas or individual bedrooms. Meals are very well presented and appropriate assistance is given. A new servery is to be built upstairs that will allow meals to be staggered and enable residents to choose their meal at meal times. There is a new catering manual. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 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): 18 Arrangements are in place for the protection of service users; extra training and additions to the homes policy will further safeguard the residents from harm or abuse. EVIDENCE: There is an adult protection policy that requires reviewing to include the local inter agency procedures. The manager said she is trying to get staff onto local training days. All staff receive in house adult protection training that includes a video. Residents said there are no barriers to raising concerns with the management. There is a secure facility for the storage of money in the home. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 14 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 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. The home is very clean and free from unpleasant odours making it a pleasant place for service users to live in. EVIDENCE: The home is clean and well maintained, refurbishment and redecoration is ongoing. Some service users have chosen the décor for their rooms. Comfortable furniture is provided in the lounges and there are facilities for service users to entertain visitors. Residents said they are happy with their rooms and the facilities provided. There are extensive plans for the coming year to improve the premises, these include fitting a servery in the upstairs dining room, replacing the corridor lights, the refurbishment of 20 rooms and the upstairs lounge, replacement of the corridor carpets upstairs, re-pointing the external walls and the fitting of ramps to access the gardens. It is recommended that there be a review of the colour scheme and signage on Tresco unit; the manager said she would consult the Company Dementia Specialist.
Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 15 The grounds are very well maintained, with raised flowerbeds, a garden of remembrance and a sensory garden. The home won a local gardening competition in the summer 2005. All laundry is dealt with on site. One washing machine is out of order; repairs are underway. There is an area for dirty laundry and a separate area for the clean laundry and the ironing. Hand-washing facilities and protective clothing are supplied for staff. Some areas of the laundry would benefit from tidying and this was discussed with the manager. There is a good standard of cleanliness in the home. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 16 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, 29 and 30 Staffing levels generally meet the needs of residents and staff morale appears to be good; arrangements during staff meal breaks could be improved. Recruitment procedures are robust and offer protection to the service users. The home provides training for staff to help them be more competent in their roles; improved structure and record keeping will be beneficial. EVIDENCE: A dependency assessment tool is used to calculate the staffing levels on each unit. Each unit has a Nursing Sister in charge, there is a qualified nurse on duty at all times with a team of care assistants. There appeared to be enough staff on duty during the inspection however staff meal breaks need reviewing to ensure that sufficient staff remain on the units during this period. There are a number of overseas workers in the home, residents and visitors said they are very caring but communication can be a problem. The home has organised English lessons for these workers to aid communication. Personnel files inspected contained the records required by legislation. Interview records are maintained and employees receive terms and conditions of employment. There is a generic induction programme for new employees. Induction records inspected had been signed during the first two days of employment but it was not clear what happened after that. The manager stated that one of the sisters is responsible for induction. She undertakes the initial few days training but has recently handed over the follow up to the individual unit sisters to complete. The induction process must to be more constructive. Staff must also receive training specific to the needs of the individual units. There is no formal
Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 17 training and development programme. Individual training records are maintained for staff and the manager said she is compiling a matrix, which will be beneficial and enable her to see when updates are due. The fire and moving and handling training records were inconsistent; the manager said this was because records had not been updated from the recent training attendance sheets. The records need to be kept up to date. Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 18 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): 33, 35 and 38 The home is run in the best interest of the residents and they benefit from the Quality Assurance systems in place. There is a suitable system in the home for dealing with residents’ money that ensures that the residents’ financial interests are safeguarded. Some systems in the home need improvement to further ensure the health and safety of the residents, staff and visitors. EVIDENCE: There is an annual quality assurance survey undertaken with the residents, a copy of the results must be sent to the Commission for Social Care Inspection. An anonymous staff audit is also undertaken. Regular meetings take place with residents, staff and GP practices. There is a comments book in the reception and thank you letters are kept on the units. It is recommended that these be maintained in a file. There is a monthly audit programme that includes Health and Safety, nutrition, infection control, medicines and documentation, for example.
Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 19 There is a suitable system in place for the handling of resident’s money. Receipts are kept and records are maintained for all transactions. The home only holds money for a few residents and this is stored safely and securely. The management endeavour to ensure that working practices are safe. Relevant service checks and maintenance takes place as required. The moving and handling policy is good but the moving and handling risk assessment format requires improvement. Staff receive statutory training regularly. There should be a person trained in first aid on duty at all times; the manager said she has first aid training in hand. The kitchen staff have all received food hygiene training. Accident reporting complies with data protection and there is a comprehensive audit system in place. The risk assessment process must be improved as it was noted that one resident had had several accidents before his risk assessment was reviewed. Catering staff must use the changing facilities provided and not change in the toilet. The flammable liquids identified in the laundry, at the last inspection, are still not stored securely Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 15 Requirement The care plans must relate to the relevant risk-assessment and give specific, clear instuction to staff Risk assessments must be reviewed There must be a local medicines policy The adult protection policy must be reviewed to include the local inter agency procedures There must be a review of the staff cover during meal breaks to ensure there are sufficient staff to meet the residents needs The induction process must be more structured Staff must receive training specific to the needs of the individual units. A copy of the quality assurance survey results must be sent to the Commission Flammable liquids must be stored safely in a locked facility The moving and handling risk assessment format must be improved The risk assessment process in
DS0000009256.V271634.R01.S.doc Timescale for action 03/07/06 2 3 4 5 OP7 OP9 OP18 OP27 13(4) 13(2) 13(6) 18(a) 03/07/06 03/07/06 03/07/06 27/03/06 7 8 9 10 11 12
Kenwyn OP30 OP30 OP33 OP38 OP38 OP38 18(1)(c) 18 (1)(c) 24(2) 13(4) 13(4) 13(4) 03/07/06 03/07/06 03/07/06 27/03/06 03/07/06 03/07/06
Page 22 Version 5.0 13 14 OP38 OP38 13(4) 13(3) general must be improved Suitable first aid training must be provided for staff Catering staff must use the changing facilities provided and not change in the toilet. 03/07/06 26/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations There should be written consent for the use of any restraint used and restraints should only be put in place after an appropriate assessment by a suitably qualified person. Care plans should involve the resident or representative and be signed whenever possible, if not the reason should be recorded. There should be a review of the colour scheme and signage on Tresco unit. Thank you letters and cards should be maintained in a file for reference Statutory training records should be kept up to date There should be a person trained in first aid on duty at all times 2 3 4 5 6 OP7 OP19 OP33 OP30 OP38 Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Kenwyn DS0000009256.V271634.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!
