Inspection on 23/11/07 for Lotus House

This inspection was carried out on 23rd November 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lotus House 11/12/06

Lotus House 20/12/05

Lotus House 12/05/05

Lotus House 15/10/04

Lotus House 20/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Lotus House 34 Lansdowne Road Bedford Bedfordshire MK40 2BU Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 23rd November 2007 01:05 Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 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 Lotus House DS0000057612.V347461.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 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. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lotus House Address 34 Lansdowne Road Bedford Bedfordshire MK40 2BU 01234 350600 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) no email july 07 www.mentauruk.com Mentaur Limited Marianne Kimani Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service users who need the assistance of a mobility aid shall be admitted to the home. 11th December 2006 Date of last inspection Brief Description of the Service: Lotus House was first registered in April 2004 to provide care for up to seven adults with learning disabilities. The purpose of the home is to provide care to people with complex needs, which may include those who have a mental health need and/or behaviours that challenge, in addition to their learning disability. Due to the physical environment, the home is not able to take people who have any mobility difficulties. The home aims to provide a 24-hour package of care, including day activities where necessary. The accommodation is in a converted Victorian semi-detached house in the centre of Bedford. The accommodation is arranged over three floors and all service users have their own bedroom with en-suite facilities. There are three communal areas, one on each of the floors, and bathing facilities on each floor. The home has a small patio to the side of the house. Mentaur Ltd, who also owns a number of other similar homes in Northamptonshire and Leicestershire, owns the home. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection carried out on 23/11/07 by Pursotamraj Hirekar over 5 hours 35 minutes. The manager coordinated the inspection. The method of inspection included study of care plans, risk assessments, personnel records, staff deployment duty rota, relevant care delivery documents, discussions with staff, conversation with service users’ and partial tour of the building. The annual quality assurance assessment selfassessment information provided by the home is included for analysis and preparation of this report as well. What the service does well: What has improved since the last inspection? What they could do better: Each service user must be provided with an individual written contract or statement of terms & conditions in a suitable format, which must include the break up of amount and method of payment of fees and signed by the service user and or the representative as appropriate. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 6 The home should ensure that service user plans are in a suitable format for service users to understand. Also evidence that they are drawn up with the involvement of others, such as family, friends, or advocates as appropriate. The home should complete service users’ risk assessment with regard to providing service users with a front door key and allow unrestricted access to the home and grounds. 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. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided sufficient information for prospective service users. However, the contract sometimes failed to identify the fees payable, which did not allow all service users to be aware of the fee and what they may need to pay. The information needed to be presented in a suitable format, to ensure service users could understand them. EVIDENCE: The homes service user guide was made available in a suitable format with pictorials for the service users intended, and provided information to enable prospective service users to make an informed choice about where to live. There was evidence that the home had assessed the needs of the service users. However, for one service user assessment carried out was not dated. The home was able to demonstrate that it could meet the assessed needs of individuals admitted to the home. Staff individually and collectively demonstrated that they had the skills and experience to deliver the service and care which the home said it could provide. Each service user had an individual contract, which had been signed by them as well as their relative, and the company’s operational director. One service user or a representative did not sign the contract of a service user. However, the company on 02/10/07 signed the same. The contracts were not in an Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 9 appropriate format for service users to understand. 2 service users’ contracts were seen and found that 1 service user’s fee details were not made available and for other service user an additional sheet with fee details was attached to the contract. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user plans and risk assessments were sufficient. However, further development was needed to ensure they are drawn up involving others as appropriate, in a suitable format for the service users to understand. Therefore, minimising risk to service user’s and supporting them to understand and participate in decisions about their needs and personal goals. EVIDENCE: A sample of 2 service user’s plans and supporting documentation were examined and found to contain suitable and sufficient information to help meet generally their changing needs and personal goals that were identified and reflected in their individual plan. Risk assessments were in place for service users within the home, which supported individual service user plans. They had been reviewed regularly, and scoring has been revised to reflect the current risk in relation to the proposed care plan. There was evidence that the plans had been reviewed at regular intervals. The plans included individualised procedures for a service user who was likely to be aggressive, for example for a service user specific risk assessment and care plan was prepared, and the Christmas time behavioural management guidelines preparation was in Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 11 progress, the manager informed on the inspection. There was evidence from speaking with service users and records examined that service users were assisted as necessary to make decisions about their daily lives. There was inconsistent evidence that the service user’s family, friends or advocate had been involved in completing the plans and none were available in a suitable format that the service user could understand, although the individual service user had signed service user’s plan. However, one service user who was case tracked neither he or nor his representative had signed service user plan. Service users were observed participating in daily routines of the home and service user meetings are held within the home and documented. The home had used complaints procedure, service users guide, service users questionnaire, and health action plan in a suitable pictorial formats. Whereas, one service user had communication book that was pictorial designed to communicate for food, personal hygiene, hospital appointments etc. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and staff support the service users to pursue meaningful leisure activities, relationships & community links, to ensure that their health and wellbeing was maintained EVIDENCE: It was evident that service users were given the opportunity for personal development. The home supported service users to attend a local college during the week and many were also supported by the home to regularly visit a local day centre, which provided planned educational and training activities. Staffs were observed supporting those service users who wished to, to go for Christmas shopping during the evening in the local community, which demonstrated a flexible approach to their support. Several service users spoken to said they were supported by the home to use local facilities such as the cinema, pubs, leisure centres, shops, and churches. One service user said ‘staffs are nice friends’ they help me whenever I ask for’. The service users meetings sampled, evidenced that, the service users were able to choose what they wanted to do during the day and evenings. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 13 There was evidence that the home supported service users to maintain family links and friendships inside and outside the home, in accordance with their wishes. Several service users spoken to have said they were supported by the home to visit and phone their family. A service user was getting ready to visit his family for a night and was very happy, that his mother had prepared a special dinner for him. Another service user was observed whilst; he was happily engaged in arranging tables for the dinner for all the service users. Service users were offered a choice of menus and were actively supported to help plan meals at a weekly meeting. There was evidence that service user’s nutritional needs had been assessed. Referral to a dietician was made when a service user’s weight loss was identified and appropriate actions were taken including regular weight monitoring as well. Several service users had their own room key, but not all, which was dependent upon their risk assessment and those who did not, was demonstrated by the home as not in their best interests. Staffs were observed knocking on service user’s bedroom doors before entering and waiting to be invited into their bedrooms. Service users had restricted access to the home and grounds and the front door was kept locked. The home was in the process of concluding a service user specific risk assessment and had planned to install a new locking mechanism for the operation of the front door by the service user, which would be based on the individual specific risk assessment outcomes, the manager informed. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a suitable medication policy and staff had received satisfactory training in medication administration. The procedure to record the delivery of the medication systems within the home had been revised to safeguard the wellbeing of the service users, to prevent placing them at potential risk. EVIDENCE: Service users spoken to said they enjoyed living at the home and that they felt supported by the staff. Records viewed suggested service users received personal support in the way they preferred and most were encouraged to maximise their independence. This was supported by observations and discussions held with service users. Each service user had a key worker, who they were each able to identify and those service users spoken to said they were happy with the support from them and the relationship they had developed with them. The home had made appropriate arrangements for the service users sexual needs being respected regarding their privacy and the staffs have been made aware of the same. There was evidence that the home accessed outside healthcare professionals and services as required; in order to meet the Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 15 healthcare needs of the service users. Service users were supported by the home to attend outpatient and other appointments. Samples of medication records, storage, and procedures were checked, of those service users whose lives were being tracked as part of this inspection. Staff administering medication was observed in part. Staff had received satisfactory training in medication administration. No service users were responsible for administering their own medication within the home. The homes procedures for the administration of medication have been revised. The home had introduced a new system of recording medication, which include a staff member who administer and the other staff member who checks, both sign a separate record of medication. Also, a separate record book has been introduced to check and verify the stocks for reconciliation with the MAR sheet. The home had no controlled drugs on this day of inspection. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for protecting service users were satisfactory to protect service users from possible abuse. EVIDENCE: The home had maintained a record of all complaints. The home had a satisfactory complaints policy and procedure in place, which enabled them to deal with complaints received. The complaints procedure had also been produced in an illustrated, picture format for service users with limited communication skills. All service users are spoken to as part of this inspection said they had no complaints to make and were happy. However, the home had received a complaint from the neighbour regarding throwing objects/personal items over the fence into their compound and roof tops. The manager had got in touch with the neighbour and assured that these incidents would not be repeated. Further, the home was also in the process of exploring alternatives, such as to erect a fence to prevent any throwing of objects/personal items. The home had a Safeguarding Vulnerable Adults policy in place, which included whistle blowing and staff spoken to have said they were aware of the procedure. Several staff had also attended Safeguarding adults’ awareness training. Evidence examined, supported a process that had been followed to safeguard and protect service users. Staff spoken to said they felt confident following their training, in dealing with physical or verbal aggression by a service user. The homes policies and practices regarding service users money and financial affairs were generally satisfactory and protected service users from abuse. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 17 Service users cash and money management records reconciliation was carried out and was found satisfactory. All the receipts had 2 staffs’ signatures. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had made appropriate arrangements for the maintenance of the premises and the home was free from any offensive odours. EVIDENCE: There was evidence that the environment had been well maintained and as a result of refurbishment and maintenance 3 bedrooms and hallway flooring has been changed, 4 bedrooms, kitchen and hallway has been redecorated. The home was close to local amenities and transport if required. Service users spoken to have said that they had everything they needed and wanted in their bedroom. A couple of service users bedroom were observed to reflect their needs and lifestyle. All rooms were single occupancy with en suite provision. Service users spoken to were clearly happy with their individual bedrooms and were encouraged to take responsibility to maintain their cleanliness. One service had limited furniture and restricted access to his bedroom and parts of the home. However this was agreement with the service user, their family and intervention with external clinical professionals supporting the service user’s needs. The home was able to clearly demonstrate that this Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 19 environmental restriction placed upon the service user was in their best interests, to prevent them and others from potential risk and harm. Toilets and bathrooms appeared adequate and provided sufficient privacy. The home appeared clean and free from offensive odours, service users, care staff and night staff were responsible for ensuring this was maintained. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff morale was high resulting in an enthusiastic workforce that works positively with service users, to improve their quality of life. EVIDENCE: The home has had qualified and competent staff. Staff spoken to have identified varied training which they had undertaken at the home and this was supported by evidence in their training records. The home’s training register, which was examined, evidenced staff that had attended training events since the beginning of the year. Approximately 60 of the care staff had achieved NVQ at level 2 or above. There was evidence that some staff had received specialist training to support them to meet the needs of the service users. Observations made and staff spoken to had a good understanding of physical and verbal aggression as a way of service user’s communicating needs, preferences, and frustrations. Staffing level numbers within the home were maintained to meet the appropriate ratio based upon the needs of the service user. Staff files that were examined, demonstrated that the home had obtained satisfactory checks and clearances on staff before their commencement, therefore the home was able to demonstrate that service users were protected by the home’s Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 21 recruitment policy and practices. The home was able to access a structured corporate training plan. Which offered them the opportunity to nominate staff to attend varied statutory and specialist training, relevant to their roles and service user’s needs. Staff spoken to and records examined, provided evidence that staff received regular supervision. There was evidence that regular staff meetings took place. Morale within the home was high amongst staffs, which was reflected by staff spoken to, one staff member said, “the home runs well, we work as a team and we feel supported by our manager”. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was managed well in the best interest of the service users’. EVIDENCE: The manager was present throughout the inspection. The manager demonstrated that she possessed the knowledge, skills, and experience to run the home. The home had made arrangements for the internal monitoring and maintaining quality assurance system within the home that had been successfully achieved. The home has had regular regulation 26 visits and reports presented. Basing on the feedback and inputs from various stakeholders including service users’ the home had prepared an annual report. The manager, staff, and the service users’ had good working relationships; this was evident from the observations made and discussions held during the inspection. Staffs’ supervision was regularly carried out and this appears to have benefited the service users and the staffs as well. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 23 There was evidence that the home maintained general risk assessments, including health & safety and fire. Various records were examined to support adequate compliance with the following safe working practices, regarding health & safety including; accident records, water temperature checks and fire test and inspection records. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 25 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. Standard YA5 Regulation 5 (1b) & (1c) Requirement Each service user must be provided with an individual written contract or statement of terms & conditions in a suitable format, which must include the break up of amount and method of payment of fees and signed by the service user and or the representative as appropriate. (Previous timescale 19/03/07). Timescale for action 31/12/07 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 YA6 Good Practice Recommendations The home should ensure that service user plans are in a suitable format for service users to understand. Also evidence that they are drawn up with the involvement of others, such as family, friends, or advocates as appropriate. The home should complete service users’ risk assessment with regard to providing service users with a front door DS0000057612.V347461.R01.S.doc Version 5.2 Page 26 2. YA16 Lotus House key and allow unrestricted access to the home and grounds. Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Inspection Team Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Lotus House DS0000057612.V347461.R01.S.doc Version 5.2 Page 28 - 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!