Inspection on 06/08/07 for Lincoln Lodge

This inspection was carried out on 6th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lincoln Lodge 27/11/06

Lincoln Lodge 10/01/06

Lincoln Lodge 31/05/05

Lincoln Lodge 28/03/05

Lincoln Lodge 29/12/04

Lincoln Lodge 09/12/03

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 Lincoln Lodge 2 Lincoln Square Hunstanton Norfolk PE36 6DL Lead Inspector Mrs Geraldine Allen Unannounced Inspection 6th August 2007 09:20 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 Lincoln Lodge DS0000027392.V348115.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. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lincoln Lodge Address 2 Lincoln Square Hunstanton Norfolk PE36 6DL 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) 01485 534570 01485 535163 Mr Brian James Poore Mrs Susan MacGovern Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May from time to time admit one service user who is over 60 years of age, not falling within any other category. 27th November 2006 Date of last inspection Brief Description of the Service: Lincoln Lodge is a care home providing personal care and accommodation for 25 older people. Mr B Poore owns the home. The home is located on the seafront at Hunstanton, close to shops, pubs, the post office and other local amenities. Lincoln Lodge was originally a hotel and accommodation is spread over four floors with the majority of rooms having a sea view. The home has a small passenger lift to all floors. All bedrooms provide single occupancy and 9 have en-suite facilities. There are two lounges and a dining room on the ground floor with a sun lounge on the first floor. The current fee range is between £348:00 & £363:00. Additional charges include hairdressing, private chiropody, newspapers, own telephones and some toiletries, although most are supplied by the service. People are advised of the fee payable at the time of initial enquiry and this is done verbally. The fee is included in the terms of residence that is provided as soon as possible after admission. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the day of 6th August 2007. Prior to this inspection the manager, Mrs MacGovern, had completed and returned to the Commission an Annual Quality Assurance Assessment (AQAA). This document was well written and provided a good overview of the home, the services provided and the plans for the future development and improvement of services and facilities. The contents of the AQAA were considered and used to help focus the inspection and inform this report. Further information was obtained on the day of inspection by looking at some records, speaking with residents, visitors to the home and staff and also observing practice throughout. In addition, a tour of the building was conducted although not all bedrooms were seen. Overall, people had good experiences of living at this home although some records and practices let down the overall standard of the service provision. A total of 5 requirements were set and a further 3 good practice recommendations were made. Three of the requirements were repeated from the last inspection. What the service does well: The service follows good practice as part of the admission process. Good assessments of the person’s needs are completed. People who use the service said the staff were “kind and helpful”. They also said “staff could not do better”. Staff were seen speaking respectfully to residents but in a friendly and warm way. Friendly banter was heard throughout the day. People said they could make choices around their daily living and said staff always respected their choices. People also felt that staff treated them with respect and made efforts to also protect their privacy and dignity. Personal care was conducted behind closed doors and staff ensured that people’s dignity was protected when the hoist was used to move them. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home are not made until a full needs assessment has been undertaken. Admissions only take place if the service is confident staff have the skills and ability to meet the assessed needs of the prospective resident. New residents are provided with a Statement of Terms and Conditions that sets out what is included in the fee. Intermediate care is not provided at this home. EVIDENCE: Mr Poore and Mrs McGovern provided the current fee range and confirmed the items not covered by the fee. These are set out within the Service Information on page 5 of this report. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 9 Three care plans were looked at in detail. Each care plan contained a preadmission assessment, identifying the needs of the person before they moved into the home. Where appropriate, additional assessments and information were obtained from other agencies such as Social Services and the hospital from which the person was admitted. This home does not provide intermediate care. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 10 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The delivery of personal care is individual and is flexible, consistent and reliable. Staff respect privacy and dignity. People who use the service have access to healthcare services. There is evidence each person has their own care plan but there are some gaps although staff are able to give a verbal update. Medication systems do not always follow good practice but the registered person has described how these will be improved shortly. A record kept about people who use the service does not protect their right to confidentiality. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three care plans were looked at in detail. Generally the information contained in the care plan is adequate and staff were able to provide care that was appropriate to each person. However, there is scope for developing these documents further. For example, there needs to be more information recorded about the resident’s personal history wherever possible. There also needs to be more information about the social and emotional needs of the person and how they should be met. Each care plan needs to have an up to date photograph of the resident on file. The daily progress sheets need to contain more information about how the resident spent their day and any significant issues relating to them. The care plans would benefit from a separate sheet to record healthcare interventions so that this information is easier to retrieve. Recommendations have been made. Staff use an appointments/instruction diary that contains confidential information about residents. This information needs to be recorded on the daily progress sheets only as this format breaches resident confidentiality. A requirement was made at the last inspection regarding safeguarding confidentiality. This has not been met and is repeated. A carer was observed dispensing medication. For the most part good practice was seen. The tablet storage system used at the home was causing the carer some difficulty and as a result it was necessary for her to handle the tablets on some occasions. Medications are stored in the kitchen in a locked cupboard. Mr Poore and Mrs MacGovern said it is intended that the medicines and care plans will be moved to another room once some work has been completed. The area described will provide much better storage arrangements. There were no controlled medicines on the premises at the time of inspection and the controlled drugs register was not seen. Mrs MacGovern was asked about monitoring competence of staff who dispense medicines as this is not taking place at this time. Mrs MacGovern said this will be implemented as soon as the medicines are relocated. Evidence was seen that a named carer was to receive training from the district nurse team to administer insulin to a named resident. A recommendation has been made. It was noted that resident’s were given personal care behind closed doors. Residents knees were covered whilst sitting in wheelchairs to preserve their dignity. Staff were seen knocking on bedroom doors before entering. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 12 The interaction between staff and resident’s was observed throughout the day. Staff were friendly and all interactions were appropriate. They spoke respectfully to residents. Lincoln Lodge DS0000027392.V348115.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to develop and maintain important personal and family relationships. The practice of staff promotes individual rights and choice. People who use the service are involved in meaningful daytime activities of their own choice. The meals are varied and balanced, with choices available. EVIDENCE: Five residents were spoken to during the course of the inspection. They all agreed the food was good and plentiful and there were plenty of choices. The residents discussed the planned activity for the afternoon. They said a musician was visiting to sing and play. They generally agreed they enjoyed the musical entertainments, especially 1 resident who said she liked to sing along. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 14 The residents said they could go out when they wished. One said she liked crossing to the green opposite the home and sitting on a bench there. They also spoke about their visitors, saying they were able to visit when they wished. One resident said she did not like the smoking arrangements at the home. Most residents said they was very happy at the home. They said “staff could not do better” and that they were “kind and helpful”. They said visitors were always welcome and were offered refreshments. An ex-carer, who visits the home 2-3 days per week, was seen providing 1:1 activity with residents. On the day of inspection, she was giving residents manicures and talking with residents who clearly enjoyed the time given. Lunch time was discreetly observed. Meals were ready plated and covered and kept warm in a hot cupboard. Trays were properly laid for those eating in their own rooms. All residents were heard being offered a choice for lunch and these choices were respected. All residents were given drinks throughout the day and jugs of drink were in rooms where residents preferred not to use communal areas. The chef was spoken to. He said he has been cooking at the home for the last 9 years and described the choices on offer for lunch. He was seen making scones for tea. The chef said that all food was freshly prepared. He spoke about specialised dietary needs, including diabetic and soft diets. Staff said most people were able to eat unaided although for some meals they needed to cut up meat or roast potatoes for them. One resident had been out during the morning and was late back for lunch. Her meal was kept for her and served on her return. Lincoln Lodge DS0000027392.V348115.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is supplied to everyone living at the home and is displayed within the service. Residents and others involved with the home understand how to make a complaint. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Training of staff in the area of protection is arranged by the home. EVIDENCE: The complaints procedure was clearly displayed in the entrance hall and set out what people could expect in the event they had a complaint about the service. No complaints have been received since the last inspection. Residents said they knew how to complain. The home has adult protection and whistle blowing policies in place. Staff receive training about safeguarding adults. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an environment that is appropriate to the specific needs of the people who live there. The environment is well-maintained. The home is well lit, clean and tidy and smells fresh. EVIDENCE: A tour of the premises was conducted on arrival at the home. All parts of the home were clean and there were no lingering unpleasant odours. A walk around the premises later in the day confirmed that all areas seen were clean and smelling fresh. There were good standards of housekeeping seen, with no chemicals seen in any of the communal facilities. The passenger lift was checked and was smooth in operation and easy to use. The lift was well lit. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 17 The laundry was seen. The whole area was well organised and tidy. It was very well equipped to deal with the laundry done on the premises. Bed linen is dealt with through a laundering contract. The Control Of Substances Hazardous to Health (COSHH) cupboard was located off the laundry and was bolted shut. A COSHH regulation notice was fixed to the outside of the cupboard door. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have confidence in the staff that care for them. There are consistently enough staff available to meet the needs of people using the service. The service has a recruitment process that has some shortfalls in the area of obtaining references otherwise it is thorough. Staff receive relevant and timely training although there is currently some delay providing full induction training that is in line with Induction Standards. EVIDENCE: Three staff files were looked at in detail. The files showed that, for the most part, good recruitment procedures were followed. However, each file contained only 1 written reference. A copy of the staff rota for the week of inspection was provided. This showed that there are sufficient care staff on duty to meet the needs of the people using the service. Ancillary staff are employed to undertake domestic, laundry and catering. An experienced ex-carer visits the home 2-3 days per week to provide 1:1 activity with residents. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 19 Mrs MacGovern said that new induction booklets had been obtained but she felt she needed to work on them to ensure they more accurately reflected what took place in the home. Induction standards training was due to be presented by an outside trainer but this fell through and Mrs MacGovern is currently looking to employ another person to undertake this role. A copy of the training programme for July, August and September was provided. Training to be covered included the new mental capacity act, adult protection, manual handling, infection control, emergency aid, fire training, medication, basic food hygiene. To be arranged is induction standards, foundation standards and death, dying and bereavement. In all, 5 staff were spoken to. The care staff on duty during the morning described their shift. The senior had attained NVQ2, whilst another was working towards it. The third carer had only been at the home for a week but hoped to be able to do NVQ as soon as she was able. The most recently recruited staff confirmed she had been shown fire safety arrangements and was due to do safeguarding training on 8/8/07 Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 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 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required experience and is competent to run the home. The service seeks the views of all stakeholders and these views are taken seriously and included in the home’s improvement plan where appropriate. The home does not hold money on behalf of residents. Staff receive regular assessment of their competence but do not receive formal supervision at least 6 times per year. The home has a consistent record of meeting relevant health and safety requirements and legislation. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mrs MacGovern has applied to do the Registered Managers Award and is hoping to start shortly. Mrs MacGovern confirmed that the home does not hold any money on behalf of residents. A copy of the home’s quality assurance summary dated Jan 2007 was provided. The latest sets of questionnaires were sent out on 3/8/07. A completed Annual Quality Assurance Assessment (AQAA) had been completed and returned to the Commission. This had been well completed and there was evidence that the home’s January summary and improvement plan is reflected in the completed AQAA. There was also evidence that the action plans in the AQAA are being implemented. There was evidence that staff are observational supervision, using a checklist to record competence, on a regular basis. It was established that formal 1:1 supervision where the staff have an opportunity to discuss issues is still not taking place with any regularity. Some staff have not had formal supervision at all. Mrs MacGovern said she was aware the practice needs to be developed further. Doorguards are currently being fitted to all bedroom doors throughout the home so that people can have their door held open safely if they wish. There is an on-going programme in place to ensure this work is completed by the end of the year. The last fire risk assessments were completed on 19th October 2001 and Mrs MacGovern said these were due to be updated as soon as possible. All fire fighting and fire detection equipment is maintained on service contracts. A water bacteriological analysis was conducted on 26th June 2007. Mr Poore said new heating boilers were due to be installed week commencing 13/8/07. The passenger lift was recently serviced and a new door is to be fitted shortly. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A 2 X 3 Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP10 Regulation 12(4)(a) Requirement Timescale for action 30/09/07 2 OP29 19 3 OP30 18 (1)(c)(i) 4 OP31 9(2)(b)(i) Information about people who use the service must be kept so that their confidentiality is breached. This will ensure that people’s rights are protected. The previous compliance date of 26/1/07 has not been met. When new staff are recruited to 30/09/07 work at the home, robust practices must be used that include obtaining 2 written references. This will help to ensure that people who use the service are protected. The previous compliance date of 26/1/07 has not been met. New staff must receive induction 31/10/07 training that is provided in a timely way. This will ensure that they work in accordance with the home’s policies and procedures. The manager must commence 30/09/07 the Registered Manager’s Award without further delay. This will ensure that she works in accordance with professional best practice. Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 24 5 OP36 18(2) Staff must have regular supervision that allows them the opportunity to discuss issues about their work. This will ensure that staff feel supported and any deficits can be addressed without delay. The compliance date of 26/1/07 has not been met. 30/09/07 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 People should have a care plan that reflects and records their social and emotional needs and how they can be met. This will ensure that staff will consistently provide holistic care that reflects the individual’s preferred life style. All health care interventions should be recorded on a dedicated document. This will mean that important health information will be easier to retrieve and will also give an accessible view of any changes in the person’s condition. All staff who administer medicines should have their competence checked regularly. This will ensure safe medicine practices are maintained at all times. 2 OP8 3 OP9 Lincoln Lodge DS0000027392.V348115.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Lincoln Lodge DS0000027392.V348115.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!