Inspection on 15/06/06 for Lynden

This inspection was carried out on 15th June 2006.

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

Lynden 10/07/08

Lynden 11/02/06

Lynden 24/05/05

Lynden 04/11/04

Lynden 03/06/04

Lynden 23/02/04

Lynden 09/10/03

Lynden 28/10/02

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

CARE HOME ADULTS 18-65 Lynden 18 Thornton Road Morecambe Lancashire LA4 5PE Lead Inspector Ms Jenny Hughes Unannounced Inspection 15th June 2006 10:15 Lynden DS0000009678.V295509.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 Lynden DS0000009678.V295509.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. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynden Address 18 Thornton Road Morecambe Lancashire LA4 5PE 01524 420762 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) Mrs Kathryn Lesley Regan Mr Robert John Murray Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th February 2006 Brief Description of the Service: The Lynden has been registered for a number of years to care for up to 11 adults with a learning disability The home is a large terraced property in Morecambe, situated close to the promenade. There are two lounge/dining rooms for the use of the people who live at The Lynden There are 9 single bedrooms and 1 flat, which has a double bedroom. A married couple currently occupy the flat. There is a patio to the rear of the home where the residents may sit out, weather permitting. Information about the service the home provides is available in the form of a clearly written and easy to understand guide. This can be found in the entrance hall of the home, or from the manager. The latest CSCI report is also available in the same place. As at 26th May 2006, the fees for the home were standing at £347.50 a week, with additional charges for chiropodist and hairdresser visits, and extra toiletries requested. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit to the home, in that the owners were not aware that it was to take place. The length of the visit was for 4 hours. Before the visit took place, the manager was asked to complete a preinspection questionnaire, and surveys were received from residents and their relatives, and visiting professionals. During the inspection visit, staff records and resident care records were viewed, alongside the policies and procedures of the home. The manager, residents and care staff were spoken to. Their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining rooms, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the service does well: The information about the home is easy to understand and information is in written and pictorial format i.e. pictures and symbols are used to help the reader understand the information. The home provides a relaxed, homely atmosphere with the group of residents, with staff who are trained and experienced. The residents said that they can do what they want, and were seen to be given the opportunity to make decisions and act on them. One resident wanted to help put shopping away, and happily sorted out where things were to be stored. One resident planned to go for a walk after lunch, and another told the staff what he wanted for lunch, and another wanted food out of the fridge, so got it out and showed the staff member who helped him serve it. Daily life is varied, with activities in the home and trips out providing stimulation. Staff work tactfully alongside residents, making it a home from home. Clear and up to date information about the residents makes it easy for staff to give the right care. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 6 Meals are home-cooked, varied, with well-balanced choices. Meal times are pleasant and unrushed. A resident said “I like it because I’m near the sea. Everybody talks all the time. They’re all good here”. Meals are home-cooked, varied, with well-balanced choices. They are well presented, with meal times being pleasant and unrushed. 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. Lynden DS0000009678.V295509.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 Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Information about the home is very good, providing residents and prospective residents and their families with details of the service the home provides, enabling an informed decision about admission to the home. The home has a good assessment procedure that is carried out for all residents. This means that a service is provided that is tailored to the individuals needs and preferences. EVIDENCE: There is detailed information available about the home for all residents, or possible residents, which has been developed over time into a very clear and easy to read description of the services provided, and who provides them. It is available in written and pictorial format, used to help the reader understand the content. This information, including the latest CSCI report, is placed in the entrance hall of the home for anyone visiting to view. Individual records are kept for each resident, and the staff discussed the way anyone new would be initially invited to visit the home and meet the residents. A social work assessment would be used to help the owner decide whether the Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 9 home was the right place for the new person, that the staff were able to give the right care, and that the present residents were compatible with them. Assessments were seen for three residents in this home, and were all based on each individuals different needs, to make sure the right care and support is given to each person. There was information on the service users strengths, needs, personal goals, and choices on how they wanted their support to be provided. The residents, and families, were included in deciding what the best care for them was. “I tell them what I want”, and “They ask me if I’m alright”, were some responses from residents. Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a system in place, carried out together with each individual, which produces detailed and up to date care plans showing how each person should be cared for to achieve the personal goals set. Generally, residents can make decisions on what they want to do. EVIDENCE: The care planning system is detailed and structured, with each individual’s plan telling staff how to best look after them, giving information which includes areas covering their physical and mental health needs, dietary needs, and a personal profile. The information creates a clear mental picture of each person. Regular reviews and updates of these take place. Surveys returned from the residents stated that they knew they had a care plan, and they told the inspector about their care plan. “Staff have no choice but to listen to me” stated a resident, “I tell them if I want something”. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 11 The owner and staff constantly talk with the residents, who clearly feel free to say or signal if they want something, when staff check straight away if there is anything they can do to help. “I like to go out. I’ve got a bus pass and I like to go on the train as well. I go to lots of places on my own. I’ve come back today now because its dinner time”, said a resident. The staff said that the residents were gently guided to help them make their own decisions, and risk assessments are carried out on residents activities. Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can choose from a variety of activities to help develop their skills. Their decisions are respected, and daily routines promote independence. The meals in this home are good, offering both choice and variety. EVIDENCE: The residents were looking forward to their holiday in Blackpool, and one proudly showed all of his drawings of the trams and buses he had seen there previously, and which covered his bedroom walls. One resident excitedly spoke about the “dancing, walking, trams, and the circus”, in Blackpool. One of the residents was in one of the lounges, concentrating on completing a complicated jig-saw puzzle, to the accompaniment of the music they enjoyed from a radio at their side. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 13 One resident was watching television in his room, but liked to know what was happening when a delivery man arrived at the home. Staff made sure the resident was attended to and his needs were a priority over the less important event of the delivery of paper tissue. Another resident comes and goes freely from the home, using public transport confidently. “I go lots of places”, he said. “I’ve got a girlfriend. We have meals together”, he added as he showed her photograph. Residents meetings are recorded, and possible activities are discussed, and the staff confirmed the residents surveys which stated that they enjoyed doing arts and crafts. The ‘music man’ was also popular. Records show visits to Emmerdale, Blackpool lights and football matches have taken place. Two of the residents have developed their relationship to the point of getting married while at the Lynden, enabled and supported by the owner and staff. Each resident is offered a key to their own bedroom door ensuring his or her privacy is respected. Residents quietly tucked into their freshly cooked lunch time meal in both the upstairs and downstairs dining areas, with staff offering more if they wanted. Residents told the staff what they wanted for lunch, from a wide variety of choice to suit differing tastes and appetites. On this day the favourite was sausage and mash with vegetables. A record is kept of what has been eaten by all of the residents at every meal. “We always get plenty to eat. I just ask if I want a drink”, said a resident. Some of the residents like to help around the home, and are enabled to do so. One resident likes to help put the shopping away, and staff make sure some of the shopping is left out following delivery so that the resident can do this. A grocery delivery arrived during this visit, and the resident liked to take responsibility for her job, telling staff what she was going to do. The staff can look after someone who has special needs, for example someone with special dietary needs and who uses a PEG feed. All of the staff have had professional training on how to use the equipment, and the resident is very clear on what can and cannot be eaten. Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of the resident’s support needs. This is evident from the positive relationships which have been formed between the staff and the residents. The medication at this home is well managed, promoting good health. EVIDENCE: The home is run as a family home, with a low turnover of staff. This means that both staff and residents know each other well, and so changing needs are easily noted by staff, and passed on by residents. Residents come and go to their rooms as they wish, some choosing to stay there for a while to watch television or play music, or just spend time on their own. “They do knock before they come in” said one resident, of the staff. Staff tactfully suggested to one resident that they would help with some clothing in the resident’s own room, and the task was quietly carried out. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 15 The residents individual plans of care have a detailed record of all professional visits, such as Doctor, Dentist, Chiropodist, Psychiatrist and the District Nurse where appropriate. If residents have appointments, they are accompanied by a member of staff. During this visit a resident was taken by a staff member to see the GP. On their return, the resident explained that “I’m alright aren’t I?” as the staff member showed the resident the new medication to be taken. There is a system where all residents have a risk assessment before it is decided whether it is safe for them to be in charge of their own medication, or whether care staff take control of administering the medication. Staff helping with the administration of medication had attended a medication awareness course. The records were all correct and up to date on records printed by the pharmacist with the medication taken by the residents. Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns will be listened to and acted upon. Staff have an understanding of Adult Protection issues, which protect residents from abuse. EVIDENCE: There is a complaints procedure in place, with a complaints book to record any complaints, which may come to the manager’s attention. All the residents and/or their family receive a copy of the home’s complaints procedure, and copies are available in the entrance hall of the home. There were no formal complaints recorded. Any minor problems raised by the residents are also recorded, and how they are dealt with. For example one resident did not like doors being shut, so staff explained about fire risk and prevention, and fire release catches were fitted to the doors, which will allow them to automatically close if the fire alarm is activated. Residents spoken to said they would tell the staff if they did not like something. Staff said that they would note any changes in mood of residents which would indicate that they were not happy about something, and would try to find out what it was and put it right. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 17 Staff spoken to knew about the Adult Protection procedure, and what to do if they had any concerns. Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment, and ongoing maintenance plans mean that this will continue. EVIDENCE: The home owners try to maintain the décor and furnishings to a good standard. The two lounges are homely, comfortable and clean, with large televisions in both. One resident often occupies a corner of one lounge with her jig-saws, while the other lounge was a smoking area for residents to use. One resident in the upper lounge said “I like sitting here. I like this room. I can see all of the cars in the road”. Residents’ bedrooms are full of their own belongings. Pictures and drawings, football shirts and toys, whatever the whim of the resident. One resident has a goldfish in a small tank to care for. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 19 One bedroom, which needed decorating at the last inspection, had been completed, although the standard of the work was not good. The room was clean and cosy, and the resident said she liked it. The manager confirmed some difficulties when residents did not wish to move out of rooms while the work was going on, but stated that several windows were to be replaced and the décor would be redone then. The manager stated that there is ongoing maintenance, and parts of the home were refurbished as they were needed to be done. The main bathroom has been refitted and has a hoist, and the shower room and toilet has been redecorated. The manager discussed future plans for the home’s decoration. The manager considered that it may take up to two or three years to achieve the standard of environment they were aiming for. Steps to the front door, and stairs inside the home, mean that residents must have fairly good mobility to stay there, and the needs of all of the present residents are met. Outside space to the back of the home was being concreted at the time of this visit, making a sheltered patio area. Garden furniture had been purchased, and planting areas have been planned, to encourage any residents who may be interested in gardening. Fire and environmental health checks have been carried out. Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates a good recruitment policy, which ensures that only people who are suitable for this type of work are offered an appointment. Training is provided and this means that residents are provided with appropriate care and attention EVIDENCE: The staffing rotas were checked and they showed that an adequate number of staff are on duty during each shift. The staff said there are enough of them to provide a good quality of care to the residents. All of the staff undergo induction training when starting work at the home, using the Learning Disabilities Award Framework. Eight of the thirteen care staff hold an NVQ qualification, which is 61 of the total staff, and meets the standard required. Other specific training is attended as required, for example Dementia Care, or PEG feeding. Moving and Handling, First Aid, and Food Hygiene courses have also been attended by staff. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 21 One staff member commented that “I really enjoy working here. We are all attending various training courses. I think staff get on well together, and work to enable residents to do what they want in the home – with tactful supervision”. No new staff have started at the home since the last inspection, when procedures for recruitment were examined. The manager confirmed that the procedures were the same for checks on staff, through written references, and Criminal Record Bureau disclosures. She stated that she would make sure any verbal references are followed up with written ones. Lynden DS0000009678.V295509.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home reviews aspects of its performance through seeking service user’s views, and acting upon them. Systems and practices in the home promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The manager stated “We’ve been providing care for many years now, and have developed our systems along the way. We want this to be the clients home, where they can choose to do as they like, as they would in any family home” The residents were all relaxed and choosing to do whatever they wanted, clearly telling or signalling the staff about what they did not want to do. This ongoing feedback is dealt with immediately, and recorded for future reference. Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 23 Records of residents meetings were seen. These are held every four to five months, and cover areas such as: the care given, the environment, menus, and activities. One resident asked that tomato juice was provided, and the following week it was added to the shopping list. Surveys are sent to residents in an easy to understand format. Those seen showed that the residents thought the staff were friendly, their room was clean, they were able to make choices and take part in everyday activities, and the staff listened. A survey returned to CSCI from a relative commented, “The Lynden has a warm and welcome atmosphere. I have been impressed by the kindness and caring attitude of all the staff I have encountered”. The staff stated that the residents’ are encouraged to manage their own finances whenever this is possible. However some people due to their disability are unable to understand their finances. The management keep individual, thorough records of all transactions. The money is securely stored, two staff witness each entry into the record and check the balance is correct. All files and records are structured and complete. All accidents are recorded on file. Appropriate fire precautions are taken with a fire alarm system, and extinguishers. all which are checked regularly. All staff are instructed on what to do in case of fire, with regular fire drills. Lynden DS0000009678.V295509.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 3 2 4 3 X 4 X 5 X 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 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 X 3 X X 3 X Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 25 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. 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. Refer to Standard Good Practice Recommendations Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lynden DS0000009678.V295509.R01.S.doc Version 5.2 Page 27 - 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!