Inspection on 01/02/07 for Kingfisher Residential Care Home

This inspection was carried out on 1st February 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kingfisher Residential Care Home 02/06/10

Kingfisher Residential Care Home 01/04/10

Kingfisher Residential Care Home 07/01/10

Kingfisher Residential Care Home 10/03/09

Kingfisher Residential Care Home 06/11/07

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

CARE HOMES FOR OLDER PEOPLE The Ferns Care Home 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET Lead Inspector Kim Cowley Key Unannounced Inspection 1st February 2007 10:30 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 The Ferns Care Home DS0000067924.V328700.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 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. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ferns Care Home Address 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET 0116 2201910 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) Ferns Carehomes Limited Vacant Post Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No one falling within category DE(E) should be admitted to The Ferns Care Home where there are 27 persons within the category of DE(E) already accommodated The 5 persons identified in correspondence dated 2nd December 2004 who fall within the category of OP may continue to be accommodated at The Ferns Not applicable – new registration Date of last inspection Brief Description of the Service: The Ferns is a residential care home providing personal care to 27 older people, most of who have needs relating to dementia. The home is privately owned and is situated in the market town of Raunds, Northamptonshire, close to a range of local amenities. The home is on two floors and has a passenger lift and a stair lift. There are 13 single bedrooms and seven doubles, and four separate lounge/dining rooms. Fees range from £331 to £348 per week. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that included a visit to the home and inspection planning. Prior to the home visit, the inspector spent half a day reviewing information relating to the home. During the course of the inspection, which lasted four and a half hours, the inspector checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means the inspector looked at the care provided to three residents living at the home by meeting or observing them (not all residents were able to give their views due to their dementia); talking with the staff who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. The inspector also met other residents, one of the Assistant Managers, and two carers. What the service does well: The Ferns provides a homely environment for residents with a good selection of ornaments, books, and pictures on display. Bedrooms are well decorated, and personalised with items residents had brought with them into the home. Residents have the choice of four different lounge/dining rooms to sit in during the day. All residents interviewed said they liked the way the home looked. One resident said, ‘The home is very clean as the staff are very particular. And it was redecorated recently.’ The Ferns has an established staff team, some of whom have worked in the home for many years. Discussions with staff confirmed that they know residents well and have a good understanding of their needs. Relationships between staff and residents were good. One resident commented, ‘We have a great banter with the staff’, and another said, ‘The staff treat the confused residents well. They have to be firm sometimes but I have never seen them do anything wrong.’ Staff talk to residents every day and try and involve them, where possible, in their care and in decisions about the home. One of the Assistant Managers said residents are encouraged to make choices, although this can be difficult if a resident is confused. One resident said, ‘The staff do ask us what we want to do and they don’t order us about.’ The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ needs are assessed prior to admission to ensure the home is suitable for them. (Standard 2 was inspected. Standard 6 is not applicable to this service.) EVIDENCE: The home has a mixture of private and social services funded residents. All are fully assessed prior to admission. One of the three Assistant Managers visits them in their own homes or in hospital in order to do this. They also talk to relatives/friends and health professionals to get their views on the resident’s needs. These steps help to ensure the home is suitable for each resident and that staff can care for them properly. Once admitted, each resident has a four weeks trial period to ensure that they are happy with the home, and the home can meet their needs. Records showed that a resident who was recently admitted was properly assessed prior to admission, and that both the resident and their family had the opportunity to view the home before deciding whether it was suitable. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Staff in the home, and in the wider community, meet residents’ health and personal care needs. This judgement has been made using available evidence including a visit to this service. (Standards 7, 8, 9, and 10 were inspected.) EVIDENCE: Three case files were inspected. Most were comprehensive and contained detailed care plans, with clear instructions to staff on how to meet residents’ needs. Appropriate risk assessments were in place. Records included information on residents’ social interests, hobbies, and religious and cultural needs. The Assistant Manager said risk assessments are reviewed every three months and care plans every month, and records confirmed this. Every resident has a six monthly review of all aspects of their care. One resident did not have a care plan for their occasional episodes of challenging behaviour. When questioned, staff knew how to care for this resident at these times, but there was no care plan for them to follow. A care plan should be put in place for this. It is also recommended that all residents’ The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 10 care plans are reviewed to ensure their dementia care needs are being identified and met. The Assistant Manager said residents are well supported by local GPs and the District Nursing team. At present five residents have regular visits from District Nurses. A private chiropodist comes to the home every six weeks and charges £10 for foot care. One resident has chiropody at a local health care centre due to their more complex foot care needs. Dentists and opticians visit the home, or residents go out to them when required. Some residents have CPNs and if a resident is in need of one, staff can refer them via their GP. The Assistant Manager in charge of the home at the time of inspection oversees medication, checking records once a month. She has completed the ‘Safe Handling of Medication’ course. She said that only staff who have completed NVQ Level 3 are allowed to administer medication. The home has a new contract pharmacist who carries out staff training and gives advice when required Staff are trained to treat residents with respect during their TOPSS induction, which has a section on the ‘values’ of providing good care. Residents interviewed said staff were respectful and helped them to maintain their dignity and privacy. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Activities in the home are limited and there is some dissatisfaction with the food provided. This judgement has been made using available evidence including a visit to this service. (Standards 12, 13, 14, and 15.) EVIDENCE: At present there is no programme of activities in the home for residents and the only resources are newspapers, board games, and television. Religious services are held in the home every month. Residents’ comments included: ‘My family come and take me out.’ ‘I would like to go out somewhere with the other residents in a minibus.’ ‘I read the newspaper every day and I like playing dominoes.’ ‘There’s not much to do here.’ One member of staff said activities had been tried, but residents had not been interested. While this is acknowledged, it is recommended that staff talk to residents to find out if there is anything they would like to do, and devise a programmed based on this. Residents with dementia should be included and efforts made to give them the opportunity to get involved. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 12 Visitors are welcome at the home at any time. Residents’ comments included: ‘My family had Christmas dinner in here with me. That was nice.’ ‘The staff made visitors very welcome.’ ‘Visitors can come whenever they want and the staff always offer them tea.’ The home is temporarily without a cook and concerns were raised by staff about the standard of the meals served. The Assistant Manager said the care staff are doing the best they can until the cook returns. There was also a perception amongst residents that the quality of the food had deteriorated in the last few months. Comments included: ‘The food is edible but cheap. It’s gone downhill since the new Owner took over.’ ‘We used to have fish with parsley sauce on Fridays. Now we just get fish fingers.’ ‘Different people are cooking at the moment and some are better than others.’ Food supplies and menus were inspected and found to be satisfactory. Fresh vegetables, fruit, and meat are served on most days, and the menu showed a good range of meals being offered. Despite this some residents and staff are evidently unhappy with the food on offer and this needs to be addressed. An alleged incident was reported to CSCI prior to the inspection that one member of staff allegedly told another member of staff to wrap up uneaten toast from one meal and give it to a resident at another meal. (The second member of staff refused to do this and threw the toast in the bin.) Staff are reminded that using leftovers in this way is completely unacceptable being unappealing to residents, and questionable from a heath and safety point of view Following the inspection the Owner contacted CSCI to say that staff would be reviewing the home’s menus and consulting residents to see what could be done to increase their satisfaction with the food. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents feel able to talk to staff about any concerns they might have. This judgement has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) EVIDENCE: All residents interviewed said they would have no hesitation in speaking out if they had a complaint about the home. One said, ‘If I wasn’t happy about something I’d tell everybody’, and another commented, ‘If I wasn’t happy about something I’d tell any member of staff.’ The Assistant Manager said staff had good relationships with residents’ relatives and friends, and encourage them to raise any concerns they might have. The home also has a written complaints procedure, which is displayed in the home. Two complaints have been received by CSCI since the home was registered. These were followed up during this inspection and have been incorporated into this report. There is an adult protection/whistle blowing procedure in place and the Assistant Manager said all staff were made aware of this. Staff are also trained in adult protection during their induction and NVQ training. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Residents live in an environment that mostly safe and well maintained. This judgement has been made using available evidence including a visit to this service. (Standards 19 and 26 were inspected.) EVIDENCE: On the day of inspection the premises were clean and warm. Efforts have been made to create a homely environment with a good selection of ornaments, books, and pictures on display. Residents have the choice of four different lounge/dining rooms to sit in during the day. Bedrooms are of a good standard. Those inspected were well decorated and had matching furniture. Each was personalised with items residents had brought with them into the home. Some residents share bedrooms, while others are in single rooms. Seven of the bedrooms have ensuite facilities. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 15 All residents interviewed said they liked the way the home looked and the following comments were made: ‘I shared a bedroom at first but now I’ve got a single which I like. I can go there for a bit of peace.’ ‘The home is very clean as the staff are very particular. And it was redecorated recently.’ ‘I’ve got a pull cord in my bedroom and my ensuite which I can use if I need help.’ ‘My room is cleaned every day.’ Improvements are needed in the following areas: • • • The wooden handrail in the downstairs toilet is worn and chipped and needs re-painting or replacing. Both of the bath hoists have rust and corrosion underneath the seats and need attending to. (This is a requirement.) Staff are currently using the conservatory off one of the lounges as a smoking room. This practice must cease. (This is a requirement.) Improvements are also needed to the exterior of the home: • At the back of the larger rear courtyard there is a brick shed used for storage. It has no door and items of furniture, for example an old toilet, mattresses, etc, can be seen. This is unsightly and the area should be tidied up and improved. The small courtyard overlooked by the conservatory is bleak and untended. It would also benefit from improvement. Neither of these courtyards is fenced off which means staff have to constantly observe residents when they are outside. One or both of these courtyards must be made secure garden for the safety of residents. (This is a requirement.) • • Following the inspection the Owner said that his handy person would attend to all outstanding work. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. Most staff are well trained and professional but unsafe recruitment practices have led to some staff being employed without the necessary checks and documentation. This judgement has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) EVIDENCE: The Ferns has an established staff team, some of whom have worked in the home for many years. Discussions with staff confirmed that they know residents well and have a good understanding of their needs. Relationships between staff and residents were good and residents interviewed made the following comments about the staff: ‘We have a great banter with the staff.’ ‘The staff are all good including the young ones.’ ‘The staff treat the confused residents well. They have to be firm sometimes but I have never seen them do anything wrong.’ ‘We have been a bit short-staffed because some of the girls were ill, but we still get everything on time.’ Staff files were inspected and it was found that three members of staff had been employed without either a Protection of Vulnerable Adults First Check or a Criminal Records Bureau disclosure. Additionally one member of staff had unacceptable references (in that it was not clear who the referees were, or The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 17 their status/designation), and one had no references whatsoever. Two had no proof of identity/photographs on files. As a result of this finding an Immediate Requirement was issued. The Owner was contacted by telephone during the inspection and he agreed that the staff in question would not work in the care home until the proper checks and documentation were in place. The staff rota should also be reviewed to ensure there are enough staff on duty at all times and that their duties are clear. Particular attention should be paid to Saturday morning, when there is no cook and staff prepare 27 breakfasts at the same time as caring for residents. This rota should clearly state whether staff are undertaking care or catering tasks, as staff going from one to the other present a health and safety risk due to the possibility of cross-contamination. The rota should also show the actual length of each member of staff’s shift, and if it is flexible the rota should reflect this. Core training in the home consists of a TOPSS induction, and NVQs coordinated by an external assessor. The Assistant Manager said staff also have the opportunity to attend a range of short courses including dementia care. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. At present staff are lacking leadership, as there is no Registered Manager in post. This judgement has been made using available evidence including a visit to this service. (Standards 31, 33, 35, and 38 were inspected.) EVIDENCE: The home was registered to its present Owner in November 2006. It does not have a Registered Manager and this is unfortunate, as staff have gone though a period of change and uncertainty and would benefit from clear leadership at this time. At present three Assistant Managers are responsible for the day-today running of the home. All are experienced carers, and two have NVQ 3 and are studying for NVQ Level 4. Although they appear to be a doing a good job they have to fit management tasks in with their caring responsibilities, and it is difficult for them to have an overview of the running of the home because of The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 19 this. It is recommended that a Registered Manager is put in place as soon as practicable. Staff talk to residents every day and try and involve them, where possible, in their care and in decisions about the home. The Assistant Manager said they are encouraged to make choices, although this can be difficult if a resident is confused. One resident, who was able to give her views, said, ‘The staff do ask us what we want to do and they don’t order us about.’ The Assistant Manager said the home does not currently hold any money on behalf of residents. Residents either look after their money themselves or have relatives or solicitors look after it for them. The Fire Department and the Environmental Health Officer, as part of the home’s registration, have carried out recent inspections of the premises and equipment. The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NA 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 OP19 Regulation 23(2)(c) Requirement Timescale for action The bath hoists, which have rust 01/04/07 and corrosion underneath the seats, must be made good. Staff must stop using the 01/02/07 residents’ conservatory as a smoking room. One or both of the rear 01/06/07 courtyards must be made secure for the safety of residents. No member of staff must work in the care home without the documents specified in 1 to 9 of Schedule 2 (including CRB/POVA First Checks). 01/02/07 2 OP19 23(2)(d) 3 OP19 23(2)(o) 4 OP29 19 The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 22 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 Standard OP31 Good Practice Recommendations A Registered Manager should be put in place as soon as practicable. All care needs should be documented in care plans including those relating to challenging behaviour. Staff, in consultation with relatives, should devise a programme of activities in the home. Menus should be reviewed, in consultation with residents, and improved where necessary. Improvements should be carried out to the following areas of the home: 1. The chipped wooden handrail in the downstairs toilet should be re-painted or replaced. 2. The brick shed at the back of the larger rear courtyard should be tidied up and improved. 3. The small courtyard overlooked by the conservatory should be tidied up and improved. 2 OP7 3 OP12 4 OP15 5 OP19 The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 The Ferns Care Home DS0000067924.V328700.R02.S.doc Version 5.2 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. 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