Inspection on 17/09/08 for King Edwards House

This inspection was carried out on 17th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

King Edwards House 21/09/09

King Edwards House 06/09/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 King Edwards House 18 King Edwards Avenue Gloucester Gloucestershire GL1 5DB Lead Inspector Mr Simon Massey Unannounced Inspection 17th September 2008 10:00 King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service King Edwards House Address 18 King Edwards Avenue Gloucester Gloucestershire GL1 5DB 01594 840053 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) info@carecommunity.co.uk Care Community Ltd Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection 6th September 2007 Brief Description of the Service: Accommodation for up to six adults with learning disabilities. It is a detached house, which is located approximately two miles from the centre of Gloucester. There is a small garden area to the rear of the property, where there is also a separate laundry room. One bedroom is on the ground floor and the rest are located upstairs. All have en-suite facilities. The home is situated close to local amenities. The fees for the home are calculated on an individual basis depending on assessed needs. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced Key inspection took place on 18th September 2008. The Inspector met with the Acting Manager, the Responsible Individual, several members of the care staff and all the service users. Records relating to care planning, medication, health and safety and staffing were examined. An inspection of the environment was also carried out. A number of surveys were also distributed in respect of this inspection. The service has been in operation for over a year but has only recently admitted its first service users. Two of these people have moved in from the other home run by the same Provider, and with which it shares the same Manager. There have also been a number of management changes during this period and during this visit the inspector was informed that the deputy manager had left their post. What the service does well: What has improved since the last inspection? What they could do better: The home must improve its recruitment procedures and pre-employment checks. The home must ensure that the induction completed by staff covers basic health and safety issues such as fire safety before staff commence work in the home. The service must ensure that the management structure is appropriate and effective for the two homes, which are being managed by the same manager. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 6 The home must ensure that there is an up to date fire risk assessment in place and that all staff have completed fire safety training. The home should provide service users with Health Action Plans. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose provides accurate and accessible information to prospective admissions to the home but could be produced in different formats to increase understanding for some people. EVIDENCE: The home currently has three service users and three vacancies. Two of the present service users moved from a home nearby, which is run by the same Provider and shares the same Acting manager. An assessment was completed and information gathered relating to the one new admission to the service. This has provided the details on which a care plan is being developed, which includes guidance on care and support. This was quite a basic assessment and there is scope for this process to be improved. At the time of the inspection further assessments where being completed on potential admissions. Potential service users would also benefit from the Statement of Purpose and Service User Guide being produced in formats, which included more symbols and gave more of a picture and flavour of what the service is offering. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have care plans in place but their needs could be better met with the development of a more person centred approach to identifying goals and objectives. EVIDENCE: All service users have care plans in place. One of these had been reviewed with the involvement of the placing authority but a person centred approach to reviewing of plans with the full involvement of the service users in yet to be developed. There is also scope to improve these plans by use of symbols and pictures. The involvement of the service user in developing their plans should be clearly recorded. Each service user also has a monthly report completed by their key-worker on the events or developments of the previous few weeks. The files contain pen pictures and one person has a document completed called Forward to Independence, which is an ongoing assessment around various skills. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 10 There are some risk assessments in place which were up to date and provided guidance to staff on how personal care and support should be delivered. One person can communicate using signing and three of the current staff have some training in this. The personal files showed that regular recording is completed relating to daily events and that good records are also kept of any incidents or issues that may arise. Staff demonstrated a reasonable understanding of the care plans and the needs of the individual service users but there is a need for more ownership of the process to be developed and for the link between documentation and practice to be clearer. The Acting Manager explained how they planned to develop a more person centred planning approach as the staff team become more established in their roles. There is a need to develop more specific goals and objectives, both short and long term, for staff to work with the service users towards achieving. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16&17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual routines and activities are being developed and organised but improvements could be made with a clearer link between the assessed needs and identified aspirations of the service users. EVIDENCE: The service users all have individual routines that are followed though these are at different stages of development for each person. The latest admission to the home is still in the process of having opportunities and options identified and planned. At present this person appeared to be doing very little structured activity and this needs to be addressed and a plan put into place. One service user express satisfaction with their routines away from the home and was also observed undertaking some activities within the home with staff. People also have the option of trips out during the day and in the evening. Some staff commented that occasionally a lack of drivers has placed some limitations on these trips out. The manager confirmed this but said that as the home becomes fully staffed, and with more service users, this should only happen King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 12 infrequently. Records show that some evening trips had taken place but these were not that frequent. However there were regular trips out during the day and some staff commented that some service users often were happy to stay in the home in the evening. There is a need to use the care planning system to identify service user needs and wishes in terms of vocational activities and social outings. One person is at college full-time, and courses are also being looked at for another service user. Service users are supported to maintain their family relationships and evidence was seen of trips to visit relatives and also communication between the home and families. Feedback from the surveys distributed to families was generally positive though one commented that occasionally they could be kept better informed. Service users and staff were positive about the quality and quantity of food provided and there was evidence of a healthy diet being promoted. Evidence was seen that choice is respected and the kitchen was stocked with fresh and packaged food at the time of the inspection. All food was correctly stored and labelled. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18 & 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Guidance and recording supports service users to receive their personal care in a way that promotes their privacy and dignity. EVIDENCE: The care plans detail the support that individuals require and also provide guidance to staff on how they would prefer this to be delivered. Individual files contain details of medical appointments and also information and correspondence from outside professionals. Staff record information following appointments into the individual files. There was evidence of health checks being completed and staff supporting appointments and recording outcomes. There is however a need for Health Action Plans to be developed and put into place Medication administration and storage was examined and found to be satisfactory. All staff are required by the home to complete the appropriate training before they are permitted to administer medication. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22&23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has satisfactory arrangements and procedures in place for the protection of service users but these would be improved if information is given to relatives around the formal complaints procedure and staff receive training in adult protection and the managing of challenging behaviours. EVIDENCE: The Inspector was informed that staff had done some training on protection issues as part of their induction but this appears to have been a brief introduction. A requirement has been made that staff are supported to attend the training that it is provided by the local authority Adult Protection service. Staff occasionally have to manage some challenging behaviours but staff stated that so far this has been managed without physical intervention. Staff would benefit from training in this area to ensure they are fully aware and trained to meet needs that require techniques such as diversion and deescalation. One incident that had occurred was correctly recorded, and the correct notification supplied to the Commission. This incident was dealt with appropriately by the staff involved and has also been used to inform future practice. The home has a complaints procedure in place but several staff spoken with were unclear about the formal process. Staff stated that they felt confident about raising issues or concerns with either the acting manager or Responsible Individual. One comment from a relative also said they were unclear about the formal complaints procedure. All the present service users have regular contact King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 15 with families, who are able to advocate on their behalf. One relative also said that the home had responded to concerns or issues that they had raised. Service users are protected in the home but this could be improved by further staff training and ensuring that all relatives and staff are aware of the formal complaint process. The home has a complaints procedure produced in symbol format for the service users, though it would be difficult to be confident they would be able to use this without support from staff. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well maintained and decorated throughout and provides a comfortable homely environment. EVIDENCE: The home has been renovated and decorated to a high standard throughout, with all bedrooms having en-suite facilities. The home has begun to be personalised by the service users and staff, and provides comfortable and homely accommodation. Service users expressed satisfaction with their accommodation. A sample of bedrooms were seen and these were personalised and reflective of personal taste and interests. Staff stated that they were encouraging people to take responsibility for their bedrooms. Service users can have keys to their rooms if they choose. The home was clean and hygienic throughout at the time of this inspection. The home is well situated for accessing local amenities and facilities. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 17 King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is developing a staff team that is motivated and caring but the safety of the service users could be compromised by poor recruitment procedures and inconsistent induction of care staff. EVIDENCE: The home is currently staffed with two care staff on each shift plus the manager, who is also responsible for the other home run by the same Provider. The home is still recruiting staff and having to balance this against the home not yet being fully occupied. There have been occasions when some staff have had to work long hours to provide cover and also times when relief staff are used, but the home has maintained adequate staffing levels. An inspection of staffing recruitment was undertaken and the following shortfalls were identified. Not all staff had two references in place and a complete employment history. Also some references from previous employers were not actually from the employer but from colleagues who worked at the time with the staff member. Some references were also not provided in a formal enough way, being handwritten and not on headed paper of any kind. One person had also not provided a reference from their employment in care. There is also a need to provide the files with a recent photo. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 19 All staff had had POVA first checks and CRBs completed but there is an urgent need for the recruitment process to be organised in a uniform way and ensure that all the correct processes are followed. The service has recently had one staff member complete a training course which would enable them to supervise and assess the induction of new staff. This person has left their post and the current situation was a little unclear as the home were still waiting for certificates for some staff, who have completed various bits of training. The training package purchased appears to be very detailed and covers a wide range of areas and staff who had undertaken part of it were positive about the content. However the basic initial induction to working in the home has been inconsistent. Some staff were not provided with the basic guidance in relation to fire safety and other health and safety issues within the home. There was also no competency-based assessment of staff in relation to basic tasks within the home and staff were undertaking shifts after a minimal period when ideally they should still have been supernumerary. Some staff were working unsupervised after only a few days working in the home. The home needs to produce a clear procedure and process for induction to be followed by all new staff. There is a need for the home to establish a training matrix, which will provide clarity over what training has been completed and what is due. Some staff have completed medication training and food handling training and are enrolled onto NVQ courses. Staff have been receiving regular supervision and were positive about the support they have received from the acting manager. All staff said the manager was approachable and responsive to issues and concerns. Staff also said they thought there was good communication between care staff and that they were working as a team to develop a professional service that met the needs of the service users. Staff were observed relating appropriately and professionally to service users and were able to demonstrate their understanding of the care and support needs of the service users. Staff appeared motivated and caring and the service users appeared relaxed and comfortable in their home. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home provides direction in terms of care and support but shortfalls in various administrative processes could compromise the safety of the service users. EVIDENCE: The home has had an acting manager for several months and they were going through the registration process at the time of this inspection. Whilst the home has been registered for over a year it has only recently taken its first admissions and two of these were from another home run by the same Provider which shares the same Acting Manager. There have been some difficulties due to the needs of building a staff team while the home is not fully occupied. There is now a core of staff who are delivering good care and support and there is evidence that service user’s needs are being met and that further positive outcomes can be anticipated. The acting manager has provided direction to the staff in establishing the routines and care practices that are King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 21 required. All staff spoken to were positive about the support and advice they receive from the manager and it was evident that a positive and team approach was being promoted. There are serious concerns about some of the administrative processes, particularly in relation to staff recruitment and staff training, and requirements have been made in relation to these. Whilst these tasks had been delegated it is the responsibility of the manager to ensure that the correct procedures are in place and also, in respect of staff training, that staff are fully prepared before they work without close supervision. Over recent months the Responsible Individual has been working full time and has been based in the home. This has provided additional support and also allowed the Acting Manager to concentrate on the staff and service users and not on the marketing of the home towards full occupancy. Prior to this inspection the Deputy Manager had left their post but a temporary replacement had been quickly found from within the organisation. This was a positive step as previous inspections of this and the sister home, run by the same Provider, have expressed some reservations about the management structure over the two homes. If one Registered Manager is to run both homes it must be possible to delegate certain tasks to senior staff who are competent to complete these. The home has had regulation 26 visits and also completed some surveys of service users and relatives, but no formal quality assurance is yet in place. Due to the short time it has been occupied this is reasonable, but it is recommended that plans are made for a more formal system to be put into place. There were inconsistencies in the recording of the fire safety testing and evacuations and some confusion as to where information was being recorded. There was also no current fire risk assessment in place and staff were yet to receive any formal fire safety training. These issues were taken on board during the visit and at the end of the inspection the Manager informed the Inspector that a contractor had been hired to compete the fire risk assessment and also provide staff training. All potentially hazardous substances were correctly stored and records were kept of fridge and freezer temperatures. King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 x 34 1 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 3 X X 2 X King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA34 YA34 Timescale for action 19 The home must ensure that pre- 31/10/08 employment checks comply with the regulations 19 The home must ensure that all 31/10/08 current staff have supplied a full employment history and two references including one from their last employer in care 18(1)(a)(c) The home must ensure that all 31/10/08 staff complete a thorough induction process before working unsupervised within the home. 13(1) The home must develop Health 30/01/09 Action Plans for individual service users. 13(6) The home must ensure the staff 31/12/08 complete training in adult protection 23(4)(a) The home must ensure that it 30/12/08 has fire risk assessment in place 23(4)(d) The home must ensure that all 30/12/08 staff complete fire safety training Regulation Requirement 3. YA32 4 5 6 7 YA19 YA23 YA42 YA42 King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 24 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 3 Refer to Standard YA1 YA23 YA39 Good Practice Recommendations The home could produce its Statement of Purpose and Service User Guide in different formats The home should provide the staff with training in the managing of challenging behaviours The home should develop a formal quality assurance system King Edwards House DS0000069195.V371853.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI King Edwards House DS0000069195.V371853.R02.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. 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!