Inspection on 28/04/05 for Kingston House

This inspection was carried out on 28th April 2005.

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

Kingston House 08/05/07

Kingston House 19/05/06

Kingston House 30/11/05

Kingston House 08/12/04

Kingston House 13/05/04

Kingston House 19/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Kingston House 7 Kings Road Clacton on Sea Essex CO15 1BG Lead Inspector Gaynor Elvin Announced 28 April 2005 th 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 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. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kingston House Address 7, Kings Road Clacton on Sea Essex CO15 1BG 01255 473513 01255 473513 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Marie F Baya Mrs Marie F Baya Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) Variation to condition of registration for of places continuation of care to 10 existing service users with dementia. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The service is registered to provide accommodation and personal care to eleven persons of either sex, over the age of 65 years, not falling within any other category. A variation to the current registration was approved by CSCI in December 2004, for the purpose of continuing to provide care to ten long term named service users who were experiencing symptoms associated with dementia. Date of last inspection 8th December 2004 Brief Description of the Service: The home is a detached house located in a pleasant, quiet residential area of the seaside town of Clacton on Sea, Essex. It is situated within walking distance to the town centre, local amenities and the sea front. The home has a large well-maintained garden with a ramp access from the lounge. Seating is provided in the garden. Accommodation is provided on both the ground floor and the first floor; a passenger lift provides access to the upper floor for those service users with mobility difficulties.The home is well equipped to meet the needs of the current service user group and provides the apropriate aids and equipment to assist service users with limited mobility. The home is owned by Mrs Marie Fran Bayer, who is also the Registered Manager. Mrs Bayer also lives the majority of the time at the home, in private accommodation on the second floor. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place on the 28th April 2005 and lasted for 5 hours. The inspection process included: an inspection of the bedrooms, communal areas, bathing and toileting facilities, kitchen, laundry room and garden; discussions with the manager and two members of staff; indirect and direct observation; an examination of a sample of staff and resident’s records. All the residents were seen and spoken to during the inspection, many had difficulty in recalling recent events and experienced some disorientation to time and place and therefore it was not possible to conduct an interview. However a view of the resident’s general feelings and emotions was obtained. Three relative comment cards were received. Twenty six outcomes were looked at, and two recommendations and one requirement has been made. What the service does well: The service is run like a small family home, providing a calm, reassuring and friendly environment. It has a tight, good caring staff team, which is shown by the low staff turnover and staff that have left have done so for genuine reasons such as retirement. The staff have received appropriate training and have a sound knowledge of the residents and how to meet their needs. The residents interacted comfortably with the staff and expressed praise and satisfaction for the help and kindness shown to them. The manager and staff focused on the person with dementia and did this by communicating with an understanding of each individual’s behaviour and treating them with respect and empathy, good examples of this were observed. The home had formed links with health and voluntary organisations such as the Older People Community Mental Health Team and Alzheimer’s and other dementias Society for professional advice and guidance in support of the home’s changing focus of care. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 6 All of the residents spoken with on the day stated that the manager and staff were ‘kind and caring’ and the home was ‘very nice’. Relatives and visitors are welcomed into the home at all times. Some of the activities provided in the home were specifically designed to provide stimulation for residents with dementia including carpet games to promote physical exercise and interaction with the other residents and staff. The staff were observed to chat continually with the residents and involve them as they went about their work throughout the day. The residents were observed to be involved and singing along to the all time favourite The Sound of Music video. The residents all said the food was good and the mealtime was seen to be an enjoyable social occasion. What has improved since the last inspection? What they could do better: A lot of thought and effort has been given to providing daily group activities to stimulate residents thought, physical activity and social skills. During discussion, the manager and staff agreed that the residents would also benefit if there were more opportunities to participate and continue past interests or carry out familiar tasks. Additional resources would also afford the opportunity to take the residents out individually. The manager has requested on two occasions, a review by the placing authorities, to assess the residents’ changing needs. No further progress had been made in developing a quality assurance and monitoring system to look at care practice and outcomes for the residents and this has been made a requirement. A recommendation has been made with regard to considering a reduction in shared accommodation especially with the home’s changing focus of care to dementia. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 7 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. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 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 standard(s) 1, 3, 4 & 5 Appropriate written information about the home is provided to prospective residents and/or their representatives to enable an informed choice. A thorough pre admission process was in place to ensure the home was able to meet the individual’s entire assessed needs. The care home demonstrated that the service was able to meet the assessed needs including specialist/changing needs of the current individuals accommodated at Kingston House. EVIDENCE: The Statement of Purpose had been reviewed and updated to meet a requirement identified at the last inspection. It was seen to reflect the services and facilities provided by the home to meet the needs of the residents, including those who have developed needs beyond the existing conditions of registration. Unplanned admissions were avoided and prospective residents were offered a trial visit. The manager was experiencing difficulties in filling a vacancy in the home due to it not being registered for dementia and 99 of the current residents having widespread changing needs associated with dementia. Discussions took place with regard to a variation to the registration category of the home to providing care for all residents with dementia. The manager is preparing an application to the CSCI with regard to this change. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 10 Completed and thorough pre admission assessments were evident within the residents’ files examined, which included social, psychological, health and religious needs. Staff had recently attended a dementia awareness workshop. They were looking forward to the opportunity to further develop their knowledge and skills, to meet the changing needs of the current residents, by attending a booked advanced workshop in dementia. Standard 6 is not relevant to this service. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 & 11 The home’s ethos encourages a ‘home for life’ and the residents were looked after well in respect of their health and personal care. Individual care plans clearly detailed the care and support required by each resident. Staff engaged positively with each individual and demonstrated a good understanding of the residents they were supporting and treated them with dignity and respect. EVIDENCE: Resident files contained a clear and detailed care plan, which gave precise information for care staff on how to meet personal, social and psychological needs, ensuring consistent and structured support. They also provided evidence of the resident’s choices and preferences with regard to their personal support needs. Individual night care programmes were in place for residents detailing individual preferences such as time, pillows, warmth and hot drinks and how needs were to be met to promote a good night sleep. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 12 Preferred terms of address and personal likes and dislikes were recorded in individual care plans. Respectful and helpful interaction was observed between the staff and the residents, delivered with understanding and using a person focused approach. All the residents appeared calm and relaxed and said what ‘a very nice place this is’ and ‘everybody is so kind and helpful’. Policies and procedures on death and dying were not inspected on this occasion. A recent notification of death to the CSCI demonstrated that the home supported the resident to remain in the home until their death and that the home had sought support from the appropriate healthcare professionals to ensure comfort and dignity for the resident. The manager and staff reinforced the home’s ethos saying, ‘this is their home and in a lot of cases we are their family’. The staff had recently attended bereavement training, which covered issues related to death, dying and the bereavement process within a care setting. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 13 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 standard(s) 12, 13, 14 & 15 Although group activities are organised to stimulate physical activity, thought and social interaction, one to one opportunities for residents to participate in personal interests or go out into the community are fairly limited. Residents’ religious needs are met. Visiting arrangements were open and relaxed and staff welcomed relatives to the home. Bedrooms were personalised with own belongings and photographs. The home supplied sufficient quantity and quality of food and provided a well balanced diet that met individual needs and choices. Mealtimes were a dignified social occasion. EVIDENCE: A fairly regular routine was kept to help the residents to remember what happens during the day. There were some good elements of practice, which included staff’s cheerful and positive attitude. Continual short interactions and constant verbal exchange was observed between staff and residents. Staff gave gentle reminders throughout the day of what was happening next, to give the residents some conception of time. Staff used the validation approach and actively listened and acknowledged the residents feelings and concerns. At Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 14 lunchtime one resident became concerned about her husband’s dinner, and felt she had to go home to cook it for him, the member of staff reassured her that his meal had also been prepared and was being kept warm in the kitchen. This relieved the resident’s anxieties, who, then sat down and ate her own meal and soon forgot her concerns. The staff organised a group activity each day, which stimulated thought, physical activity and interaction, such as carpet skittles and ball throwing games. All time favourite music and videos provided light entertainment, on this occasion the residents were observed to be actively involved in watching the video The Sound of Music. Arrangements were in place to attend church if they wished and friends of the church visited the home. The activity programme should be reviewed to include working with individuals and smaller groups as well, taking into account individual capabilities and past interests and maintaining daily and social skills. During discussion the manager and staff indicated that the service would benefit from additional staff, for more one to one activities including going out. The residents were still awaiting a review of changing needs by the appropriate placing authorities, which has been requested on two occasions by the home. Relatives confirmed they were always made welcome and that there were no restrictions on visiting. Residents were observed to receive visitors throughout the day. Comment cards from three relatives confirmed they were kept informed of important matters affecting their relative and were consulted about their care when the relative was not able to make a decision. Details of independent advocacy services were available. Bedrooms were personalised and accommodated many personal possessions and photographs. Those residents who spoke about the food described it as good. The mid day meal was discreetly observed; sausage casserole with fresh broccoli, carrots and potatoes followed by a choice of chocolate mousse, yoghurt or fresh fruit; was seen to be of good proportion, nutritious and well balanced. Fresh fruit was offered regularly and a bowl of fruit was freely available in the lounge. Meals were freshly prepared and cooked each day by either the proprietor/manager or the assistant manager. Residents chose where they would like to take their meals. Assistance was given, to those who required it, with dignity and patience. Records of daily dietary intake and monthly weight were kept to monitor and assess health and well being. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 15 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 standard(s) 16 & 17 Arrangements for responding and acting upon any complaints were satisfactory. Residents were enabled to exercise their legal rights directly and participate in the civic process if they wished. EVIDENCE: The CSCI and the home had not received any complaints within the last two years. Three relatives stated that they had never had any cause to complain, one of the relatives was unaware of the complaint procedure. Residents, relatives and staff comments showed that they all felt comfortable discussing any concerns with the manager. A member of staff was observed to give all the residents the opportunity to participate in a postal vote for the local and general election. Those that chose to vote, spoke of past political interests and candidates and voted for the party that they used to vote for as they had no recall of the names of the present parliamentary candidates. This process was appropriately managed and residents were appropriately supported in making their own choice without any persuasion or cohersion. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 16 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 standard(s) 19, 22, 24 & 26 The home was well maintained and provided a homely warm and welcoming environment. The accommodation was of a comfortable and safe standard. Specialist equipment and aids were available to promote optimum independence and well-being. EVIDENCE: The home was clean, bright and airy and had a homely feel. A running redecoration and maintenance programme to further improve the environment and safety for residents included; electrical re wiring, the installation of radiator covers to reduce the risk of burns and the redecoration of four bedrooms; and more recently included the redecoration of two further bedrooms and the bathroom, replacement of a toilet and a hand washbasin and painting of the exterior of the home. The doors to the toilets, bathroom and shower room have been altered to open outwards in an emergency situation, enabling staff access to a resident within a risk management strategy. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 17 All bedrooms clearly presented individuality with personal possessions and photographs around them. Beds had pressure-relieving mattresses for those at risk grab rails, walking frames, an assisted bath and hoist and a passenger lift were available for those with mobility needs. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The correct number of staff met residents’ needs. Appropriate training is accessed to give the staff the understanding, knowledge and skills to meet the needs and specialised needs of the current residents. There is a stable, loyal staff team, which ensures consistency in the delivery of care. EVIDENCE: The staff rotas reflected staffing hours were maintained at the recommended levels produced from the recommended Residential Forum calculation with additional hours for domestic duties. Relatives indicated on the comment cards that there was always sufficient numbers of staff on duty. Although the Manager’s hours were supernumerary, Mrs Baya spends the majority of days and nights at Kingston House, where she has a room and resides most of the time as the sleep in carer. Five care staff were working towards NVQ level two in care, delays in achieving this qualification by the required time have been due to the college not having an adequate amount of assessors to sign off modules already completed. Staff had attended a dementia awareness workshop, which provided a basic understanding of diagnosis, symptoms and management of dementia related illnesses. Basic skills were reflected in the interaction observed between some staff and residents. Staff training records demonstrated an appropriate range of training to promote the knowledge and skills required by staff to maintain health and Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 19 safety, such as First Aid, Fire Safety, Moving & Handling, Food Hygiene, infection Control, Medication, Continence and catheter care, Pressure ulcer prevention, Bereavement and Falls Prevention. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 & 36 The Registered Manager is well qualified and updated in her knowledge and skills and runs the home in the best interests of the service users and staff. She demonstrates clear leadership within the home, and promotes an open, positive and supportive atmosphere. EVIDENCE: The Registered Manager, Mrs Baya, has operated Kingston House for many years. Mrs Baya is a qualified Registered Nurse in Adult Care and Mental Health. She has just completed NVQ level 4 in care and management, (The Registered Managers Award), and is now looking to commence a specialist dementia course. She has already done a lot of research around the subject area and works closely with the staff through inhouse training and supervision. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 21 The Proprietor/Registered Manager resides at the home for the majority of the time and there was evidence of good day to day contact between the manager and the staff and the residents. The manager has a hands on approach to managing the home, frequently working alongside the care staff; staff therefore receive ongoing practical supervision through this daily contact. The staff felt well supported in their roles and any issues identified were dealt with as they arise. The manager had spent individual time with the staff in support of their NVQ, and boosted their morale and motivation when there had been a high turn over or absence of college assessors. Staff confirmed they also received regular formal supervision, which related to good care practice and continuing professional development, supervision files reflected this. Residents spoke highly of the manager and a warm relationship between them was observed. One relative wrote that she had always found the manager and staff to be kind, caring and approachable. Action has progressed within the agreed timescales to implement requirements identified in the last two CSCI inspection reports. The Registered Manager needs to further develop quality assurance and monitoring systems to look at care practice and outcomes for the residents. Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 3 2 3 x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 2 x x 3 x x Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 23 Are there any outstanding requirements from the last inspection? No 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 33 Regulation 24 Requirement The Registered Manager must establish and maintain a system for reviewing,improving and monitoring the quality of care provided and the outcomes for service users within the care home. Timescale for action 31st October 2005. 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 12 Good Practice Recommendations The Registered Manager should review the activity programme for service users to include more one to one activity with individuals tailored to their assessed cognitive and dependancy levels and personal interests. The Registered Manager should give further consideration to reducing shared accommodation facilities to single accomodation facilities especially with the homes changing focus of care. 2. 23 Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ 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 Kingston House I56-I05 s17863 Kingston House v221402 280405 stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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