Inspection on 26/09/07 for Leycester House

This inspection was carried out on 26th September 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

Leycester House 27/09/06

Leycester House 01/02/06

Leycester House 28/07/05

Leycester House 03/11/04

Leycester House 10/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Leycester House Edensfield Road Mobberley Knutsford Cheshire WA16 7JG Lead Inspector Bronwyn Kelly Unannounced Inspection 26 September 2007 10:00 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 Leycester House DS0000006512.V345450.R01.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. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leycester House Address Edensfield Road Mobberley Knutsford Cheshire WA16 7JG 01565 872496 01565 880086 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) www.clsgroup.org.uk CLS Care Services Limited Mrs Zena Meyer Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 40. Date of last inspection 27th September 2006 Brief Description of the Service: Leycester House is a purpose built home providing care and accommodation for 40 older people. The home is part of CLS Care Services Limited, a not for profit organisation that owns a number of care homes in the Northwest of England. Leycester House is in the village of Mobberley, close to the local shops, GP, pub, chemist and bus stop. Mobberley is approximately mid-way between the Cheshire towns of Knutsford and Wilmslow. Leycester House is a two-storey building and there is a passenger lift for access between floors. Residents accommodation consists of 40 single bedrooms all with wash hand basins. There are sufficient communal rooms such as lounges, dining rooms, activities area and a smoking lounge. The home also provides day care for up to 2 or 3 people per day and a separate lounge is available for this purpose. A central courtyard includes a pleasant garden area with outdoor seating for residents and visitors to use and a new raised patio area. This is fully accessible to service users. The current weekly fees range from £353.91 to £450.00. Further details regarding fees are available from the manager. Additional charges are made for newspapers, toiletries and the hairdresser. Prospective residents are able to read the latest CSCI inspection report, which is available in a copy of the Service User Guide in the entrance hall. A copy of Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 5 this guide is also available in each resident’s bedroom. Other information about the home and CLS is available in leaflets on display in the hall. These outline the lifestyle that residents can expect when they move into the home. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit by one inspector took place on the 26 September 2007 and lasted 6.5 hours. This visit was just one part of the inspection. Before the visit the home manager was asked to complete a questionnaire to provide up to date information about services in the home. CSCI questionnaires were also made available for people who live in the home, families, and health and social care professionals such as doctors, nurses and social workers to find out their views. Other information received by CSCI since the last inspection was also reviewed. During the visit, various records and the premises were looked at. A number of people who live in the home and relatives were also spoken with and they gave their views about the service, which have been included in the report. What the service does well: What has improved since the last inspection? A new policy has been introduced, called ‘Marvellous Meals’, where TVs are turned off, pleasant music is played and staff are encouraged to sit and have a meal with the people who live at the home so that mealtimes are more relaxed and enjoyable. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 7 People who live in the home are now involved in interviews when staff apply for jobs in the home, helping to make sure that the right staff are employed. Staff are continuing with their training and being well supported by their employers, ensuring there is a well trained staff group to care for the people that live in the home 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. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are assessed before they move into Leycester House, so that the individual, their relatives and staff know that these needs can be met when they move into the home. EVIDENCE: The manager or a senior member of staff visits people before they move into the home to carry out an assessment of their needs to ensure they can be met at Leycester House. Records and discussion with people who live at the home and their visitors confirmed that this was done. Four care plans were seen and all contained assessments completed before the person moved into the home which were thorough, dated and signed, providing good information about the person’s needs. Other assessment documentation completed by social services or the health department also helps to ensure people’s needs can be met at the home. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 10 People are also encouraged to visit the home themselves and stay for a meal or the whole day if wished. A trial stay in the home can also help people make up their mind about moving in on a permanent basis. Two people had come into the home for short breaks for rehabilitation prior to returning home. The local community physiotherapist and occupational therapist had been providing support. Intermediate care is not usually provided at the home, but this was arranged as an emergency situation due to no other placed being available in other homes. The manager is aware of the standards required for the admission of people for intermediate care, and is also aware that Leycester House is primarily a home for people, not a rehabilitation centre. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home are well looked after, ensuring their health, social and personal care needs are met. EVIDENCE: Four care plans were checked during the inspection. The standard of recording was varied, with two being better than the others. Two had no evidence of regular, meaningful reviews of the care provided. This means that some staff may not be aware of the most up to date care needs of some people who live in the home. There has been a lot of senior staff sickness and the manager said this was why some care plans were not up to date. The manager intends to monitor this more closely to ensure peoples’ needs are regularly reviewed. Only two files seen had information about previous lifestyles and past history, which enabled staff to have a better understanding of individual people. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 12 There is evidence in the care plan of health care treatment and intervention, and a separate record of visits by GPs or nurses. People in the home have regular access to health services, and a visiting GP said she was very happy with the care that her patients receive in the home. A social worker commented on a questionnaire “District nurses visit as needed. The care staff appear to know their residents well and contact GP etc as needed. They support a lady to do her own insulin injections. This encourages independence and encourages self worth”. A relative commented that her mother’s GP is always called immediately there is a problem, and she is informed. Staff have recently had training in dementia care to help them have a better understanding of the specialist care needs of some of the people who live in the home. The manager’s plans for the next twelve months include improved communication, written and listening skills for staff and to establish more comprehensive life histories of people who live in the home. She also plans to involve relatives in reviews of care plans. The storage of medication was satisfactory with access only to authorised senior staff. No large stocks of medication are being held. A fridge was available for medication that needed to be kept cool. Policies and procedures are available, and staff confirmed that these are followed. There is extra security for controlled drugs, with a register kept as required. Medication is no longer given to people at mealtimes, but individually according to their assessed needs and medical instructions. The medicine administration records showed some blank boxes that had not been filled in by staff with no explanation as to why, in spite of regular audits by the manager. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although the people who live in the home have the opportunity to choose their preferred lifestyle and food, further developments of activities, with consultation with people who live in the home, would enhance their available choices in this area. EVIDENCE: The activities available in the home were discussed with a number of people who live there. The general opinion was that there was not enough going on at present to keep them occupied, although some were quite satisfied. One person spoken with said “Not much happening with activities at the moment.” Another said there was nothing to keep him occupied. This view was also echoed by a number of relatives who filled in questionnaires. One relative wrote “They could provide more games etc to keep their minds more active”. Another wrote “On occasions, I feel there needs to be more variety for people in the day, especially if they are unable to do things”. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 14 The manager said that they had been without anyone organising activities for a while this year, but two of the existing care staff had now been given extra hours for arranging activities with the people who live in the home. Care staff spoken with said that these staff were often asked to do caring duties instead of activities in times of sickness, holidays or when the home was short staffed. Consequently, the people that live in the home have not had their needs met in relation to the choice of activities available. There has been various things arranged – bingo, word search game, painting, cheese and wine, karaoke, harvest festival and various trips out, but some people who live in the home feel there is nothing on a regular basis. Tai Chi exercises are arranged fortnightly and people go out for pub lunches regularly. Staff are planning to inform people by putting up notices about forthcoming events. A social worker commented on a questionnaire, “I feel that the care staff are always respectful and I have had no concerns raised from residents during my visits. Care staff encourage their residents to make their own choices and only guide them if necessary. They have regular residents meetings and encourage families to be involved in events/activities. Everyone spoken with was very complimentary about the food. The cook speaks to people who live in the home daily to ask their preferences, and it was evident he has a very good relationship with those who live in the home. The daily menus have two or three choices at each meal, plus a light snack supper before bedtime. There is one main dining area in the home plus a smaller dining area where food is served from a hot trolley. Some people choose to have their meals in their bedroom. The food served for lunch looked appetising and well cooked, with plenty available for second helpings for those who wanted some more. There was roast lamb and mint sauce or steak and kidney pudding, roast potatoes, carrots, green beans and gravy, followed by homemade marmalade sponge with custard or rice pudding, or yoghurt/fruit/ice-cream. Cooked breakfasts are available and thoroughly enjoyed by some residents. A new initiative by the company – Marvellous Mealtimes - aims to make mealtimes more relaxed and enjoyable for people who live in the home and staff are encouraged to sit and have a meal with them. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for making complaints and protecting people who live in the home from abuse are satisfactory, so they are not at risk from harm or poor practice. EVIDENCE: The complaints procedure is available in the service user’s guide, a copy of which is in each bedroom and the entrance hall. Information about how to contact CSCI is displayed. People who live in the home said they knew who to speak to if they had any concerns. One person confirmed that staff listen to her when she has a query. CSCI has not received any complaints about the home since the last inspection. The information sent to CSCI before this visit took place indicated that the home has received and investigated three complaints in the past year. One referral have been made under Safeguarding Adults, and this was dealt with appropriately by the manager. Policies and procedures for safeguarding people who live in the home are in place. Care staff have received training on awareness of adult abuse, and those spoken with had a good understanding of the issues. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 16 A social worker commented on a questionnaire, “They are willing to be flexible and address any concerns quickly and efficiently”. One relative spoken with said, “If we have mentioned any concerns to staff, they always sort it out”. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 17 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leycester House provides a satisfactory standard of accommodation for people that live there, and further refurbishment to parts of the home is planned to make sure that people continue to live in comfortable, homely surroundings. EVIDENCE: The home is reasonably well maintained and suits the needs of the residents. It is decorated and furnished in such a way as to create a homely environment for the residents. A programme of refurbishment is in place, and bedrooms are refurbished on change of occupier. The home was clean with no noticeable odours. The manager has identified some areas of the home that are now in need of refurbishment, and has plans to deal with these. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 18 The home has a number of different sitting areas, including a lounge for people who smoke. People who live in the home spoken with were happy with the facilities provided. A number of bedrooms were seen and all were in good order. People have been able to personalise their rooms making them comfortable and homely. However, it was noted that some of the beds do not look very homely as they have metal legs showing. There is a courtyard and a raised patio provided for residents, furnished with chairs and sunshades so people can sit out in the warmer weather. Policies and procedures are in place for the control of infection and health and safety, protecting staff and people that live in the home. The various bathrooms and toilets are fitted with appropriate aids to meet the needs of the people in the home. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have had training to help them develop their skills and provide safe care. Recruitment procedures are thorough enough to ensure that residents are protected from possible harm. EVIDENCE: Some long-term staff sickness in the home has meant a succession of agency staff working at the home, although this has now improved since further permanent staff have been employed. This will provide a better continuity of care for the people who live in the home. In paperwork received from the manager before the inspection visit, she wrote that “staff receive a comprehensive induction programme, leading into NVQ training and awards”. To date, the home has achieved the government target of at least 50 of care staff trained to NVQ level 2, which ensures that people who live in the home are cared for by a well trained staff group. A social worker commented on a questionnaire, “The care staff are very willing to try new things and are always easy going. The care staff are generally happy and appear to enjoy working in this environment. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 20 A relative commented, “My mum likes all the staff and they have a good relationship with her” One person in the home wrote on a questionnaire “Excellent staff relations help to make the home a happier place”. Good policies and procedures are in place for the recruitment of staff. Four staff files were seen and each contained evidence of an interview, two references and the necessary POVA and CRB checks having been obtained before the staff member started working in the home. This provides a level of security and safety for residents and helps to protect them from possible harm. The manager has recently started to involve people that live in the home in staff recruitment interviews and an interview was taking place on the day of inspection. Both people who were included in the interview enjoyed the experience and felt it was a very good idea. The manager also wrote, “We have achieved the Investors in People Award. Regular staff meetings are held to raise awareness of standards, polices and procedures. ‘Succession training’ of senior care staff takes place to ensure a supply of potential care team leaders.” The manager has recently completed training in Equality and Diversity. She has cascaded this to staff at staff meetings and raised awareness generally throughout the home. Two staff spoken with demonstrated a good understanding of the issues. Both have undertaken training as part of their NVQ training. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 21 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): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well so that people live in a well run, safe home where their views are listened. EVIDENCE: There has been a change of manager at Leycester House this year, and the new manager transferred from another CLS home. The manager holds the Registered Managers Award, and has had a number of years management experience. The staff spoken with said she supports them well. A quality assurance system is in place, and people who live in the home and/or their families completed a satisfaction questionnaire last year. A new quality survey has recently commenced, and the views of the people who live in the Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 22 home and their families, local GPs and district nurses are being sought. The results will be collated and a copy made available in the home’s service users guide. Regular residents’ meetings are also held, enabling people who live in the home to voice an opinion about their lives at Leycester House. Comments or suggestions from visitors to the home are encouraged, and forms for this are available in the entrance hall. Staff supervision is not carried out for some staff as regularly as recommended in the national minimum standards. The home works to a good system for safeguarding peoples’ money, and clear records with receipts are kept. Policies and procedures for safeguarding peoples’ money provide security. The paperwork received from the manager before inspection visit confirmed that equipment and installations at the home are serviced regularly. A handyman is employed at the home and attends to maintenance issues such as checking fire equipment, water temperatures and other health and safety matters, providing a safe environment for staff and residents. Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should be reviewed monthly and updated to reflect any changes required in people’s care. This will ensure that people receive care according to their needs and that all staff are aware of any changes. The medicine administration records should always be completed fully to ensure that people receive their medication as prescribed and in a safe way. People who live in the home should be consulted about their lifestyle and recreational activities and more opportunities for stimulation provided. The manager should ensure that staff supervision arrangements are carried out at the recommended intervals, so that all staff have the opportunity to discuss their work and their personal development within Leycester House. 2 3 4 OP9 OP12 OP36 Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Leycester House DS0000006512.V345450.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!