Inspection on 15/08/05 for Lester Hall Apartments

This inspection was carried out on 15th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lester Hall Apartments 22/01/07

Lester Hall Apartments 01/12/05

Lester Hall Apartments 13/10/04

Lester Hall Apartments 26/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Lester Hall Apartments 15 Elms Road Stoneygate Leicester LE2 3JD Lead Inspector Helen Abel Unannounced 15 August 2005, 10:00am 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 and 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. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lester Hall Apartments Address 15 Elms Road Stoneygate Leicester LE2 3JD 0116 2745400 0116 274 5400 None Lester Hall Apartments Ltd 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 Marina P Lester Care Home 19 Category(ies) of Past or present alcohol dependence (19), Past or registration, with number present alcohol dependence over 65 years of of places age (19), Past or present drug dependence (19), Past or present drug dependence over 65 years (19), Dementia (19), Dementia - over 65 years of age (19), Mental disorder, excluding learning disability or dementia (19), Mental Disorder, excluding learning disability or dementia - over 65 years of age (19), Old age, not falling within any other category (19), Physical disability (19), Physical disability over 65 years of age (9) Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No person under 50 years of age falling within categories MD, DE, A or D may be admitted to the home. No person under 55 years of age falling within category PD may be admitted to the home. No person falling within category PD(E) may be admitted to the home when 9 persons of that category are already accommodated within the home. The home may accommodate the person identified in correspondence with the previous registration authority dated 18th March 1998. Date of last inspection 13th October 2004 Brief Description of the Service: Lester Hall Apartments is situated on Elms Road, Stoneygate off London Road and is registered for 19 service users of multi categories. The home is close to local amenities, bus routes and places of worship. The accommodation is made up of spacious apartments and single and double accommodation. The home has a service users kitchen on the third floor. The home is furnished and decorated to exceptionally high standards with period furniture/furnishings. There is an attractive private garden accessible for service users. A minibus exclusive to service users is also provided with a driver. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced during a Monday morning over a four hour period. Care and accommodation is offered to both younger and older people. Five residents, staff and managers were spoken with. A full tour of the premises took place and staff and care records were inspected, as well as some policies and procedures. What the service does well: What has improved since the last inspection? What they could do better: Residents care plans must be regularly reviewed and updated to reflect the changing needs of the resident. One area of the accommodation was noted in poor decorative state. Attending to this area will ensure a more comfortable environment for residents. Obtain key recruitment information for all staff that meets regulations ensuring residents are not put at risk. To review and update the residents self-administration medication risk assessment. This will confirm residents are consulted and understand they are responsible for self- administering their own medication. Develop regular written checks for: Hot water outlets used by residents for sink baths and showers; and the cleaning of showerheads to reduce the risks of Legionella. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 6 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. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) 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 The admission process works well, which ensures that resident’s needs can be met EVIDENCE: A Statement of Purpose is available to new and existing residents. The Registered Manager confirmed that visitors sit and read the written information when visiting. Residents are assessed by the Registered Person before entering the home. The staff group have an ongoing training programme that equips them with the skills and experience to deliver the service. The Managers spoke of their commitment to good communication between staff and residents and the residents spoken with confirmed this. There are regular team/manager meetings, written handovers and regular staff verbal exchanges of information. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 9 The Registered Manager confirmed residents are offered trial visits before entering the home. A new resident confirmed that a trial visit had been made available, but that this option had not been taken up. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, Residents health, personal and social care needs are met. EVIDENCE: Care plans were examined and found to hold the appropriate and relevant information. Residents with significant health care needs were found to be given good support and care by staff. A new resident had not received a review of her care plan; this may mean that staff are not meeting the person’s needs. The Registered Person must keep residents care plans under review. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 11 The administration of medicine systems were in good order; self–administering medicine risk assessments were examined and had not been reviewed or updated to ensure that this was being undertaken safely. Senior staff responsible for the administration of medication have received accredited medication training. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with asssistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 There are sufficient, social, cultural, religious and recreational interests to meet the expectations and preferences of residents. EVIDENCE: Residents spoken with confirmed they use the home’s minibus and driver to travel locally. Comments received from residents were as follows: “I go to lunch at the local pub most days. A lady hairdresser comes to do my hair each Tuesday.” “We play snakes and ladders and other board games in the dining room. The staff join in.” “I am given privacy and time alone in my room.” Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 13 A trip to a local monastery was organised in August and various trips to local shops. An afternoon garden party is organised for the 21st August with live music, and refreshments available. Menus were varied, appealing and offered choice. Some residents prefer to take their meals in their rooms. A sweet trolley was available at lunchtime displaying around five choices. One resident said, “The quality and balance of food is excellent”. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Resident’s complaints are listened to and taken seriously; and are protected from abuse by the policies, procedures and staff training in place. EVIDENCE: Residents spoken with confirmed they were able to complain to staff if they were unhappy with anything. One resident said, “I would tell the Deputy Manager if something was wrong and she would sort it out nicely with the staff”. Policies and procedures are in place around protecting adults. The staff group have received training for protecting adults from abuse and felt this had been useful. The Registered Manager confirmed being in receipt of the current version of the Department of Health guidance No Secrets a document that will be part of the home’s procedures and further safe guards residents from abuse. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,23,25,26 The premises are generally well maintained safe, clean and comfortable. EVIDENCE: Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 16 The premises are in keeping with the local community and have a style and ambience that reflect the home’s purpose. Large attractive artificial flower decorations are displayed in communal areas and changed at seasonal intervals. The lounge and dining areas are decorated to high standards. Chandlers and ornate lighting is used throughout the home. The Astoria lounge is a communal area with mainly period furniture available to residents and visitors. The third floor hallway lacked ventilation and presented with a stale smoke odour originating from the residents kitchenette /smoking area. The resident’s kitchenette was found to be dirty and in need of decoration. Kitchen furniture was old and worn. A keep clean sign was displayed but no soap, detergent, dishcloths, towels were provided. The fridge was worn and unclean. The Registered Person confirmed she had already identified that this area needed redecoration and would address the ventilation and cleanliness aspects immediately. Issues around identified risks with cleaning materials were discussed with the Managers. All residents suites viewed were bright, clean, and comfortable. A resident confirmed,” We have an excellent cleaner here.” An outside contractor does the laundering of sheets. The laundry area was clean and deals mainly with the washing of resident’s clothes. Hot water testing to reduce risks of scalding, and the cleaning of showerheads to prevent Legionella should be carried out regularly. Current testing and recording systems are unsatisfactory. See recommendations. Radiator covers are still in the process of being fitted and will protect residents from hot temperature surfaces. A handyperson is employed full time. A contract gardener was attending to the front garden on the day of inspection. A well maintained lawn and a garden seating area is available at the rear and side of the home, and a small fountain ornament. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Staffing levels were in sufficient numbers to meet the needs of the residents; but recruitment procedures have the potential to put residents at harm. EVIDENCE: All residents spoken with were very complimentary about the staff group. Staff were observed speaking very politely and in a friendly manner when caring for residents. The staffing rota demonstrated staff are employed in sufficient numbers to ensure standards are fully met. The Registered Person Mrs Lester is present at the home each day. Residents confirmed she is helpful and nice to talk to. The Registered Person is required to hold information and documents in respect of persons carrying on managing or working at a care home including; proof of the person’s identity, including a recent photograph, the person’s birth certificate, the person’s current passport (if any) and documentary evidence of any relevant qualification of the person. This requirement remains outstanding since the last inspection. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 18 Written references and Criminal Record Bureau (CRB) checks for staff were sampled and were in order. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s polies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36, 38 The health, safety and welfare of residents and staff is promoted and protected by the systems in place. EVIDENCE: Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 20 Staff records were sampled with evidence of inductions, regular supervision, and identification of training needs. The pre- inspection questionnaire confirmed all maintenance and associated health and safety records are in order. A handyperson is employed full time and will attend to all light maintenance issues as they arise. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 21 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 3 2 x 3 3 4 4 5 3 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 x 3 x 3 x 3 3 Score Standard No 7 8 9 10 11 Score 2 3 3 x x Standard No 27 28 29 30 3 x 2 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 x 36 3 37 x 38 3 Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 7 19 Regulation 15 23 Requirement The Registered Person must keep residents care plans under review. To redecorate the residents kitchenette and replace worn kitchen furniture; maintain clean and hygenic standards; provide adequate ventilation on the third floor. The Registered Person is required to hold information and documents in respect of persons carrying on managing or working at a care home. Schedule 2 as follows: 1. Proof of the person’s identity, including a recent photograph. 2. The person’s birth certificate. 3. The person’s current passport (if any). 4. Documentary evidence of any relevant qualification of the person. This requirement remains outstanding from the 13th October 2004 inspection. Timescale for action 15th September 2005 31st October 2005 3. 29 7 15th September 2005 Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 23 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 9 Good Practice Recommendations Self-administer medication risk assessments should be reviewed and updated; and include the residents written consent. Residents responsible for their own medicines must undertstand that medicines must be locked away and ensure that this happens. For the residents kitchenette risk assess cleaning materials in line with COSHH regulations. This should be carried out as part of a risk assessment framework for all safe working practice topics within the home. Develop regular recorded checks for: Hot water outlets accessible to residents to reduce scalding, and the cleaning of shower heads to reduce the risks of Legionella. 2. 19 3. 25 Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX 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. Lester Hall Apartments C51 C01 S6347 Lester Hall V241511 150805 Stage 4.doc Version 1.40 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. 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!