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Inspection on 29/09/04 for Manor Park Grove, 5

Also see our care home review for Manor Park Grove, 5 for more information

Care Homes For Adults (18 ­ 65)Manor Park Grove, 5Northfield Birmingham West Midlands B31 5ERAnnounced Inspection29th September 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Manor Park Grove, 5 Address 5 Manor Park Grove, Northfield, Birmingham, West Midlands, B31 5ER Email address Tel No: 0121 476 5821 Fax No:Name of registered provider(s)/company (if applicable) FCH Housing & Care Name of registered manager (if applicable) Ms Maria Hanman Type of registration Care Home No. of places registered (if applicable) 4Category(ies) of registration, with (number of places) Learning disability (4) Registration number E060000261 Date first registered 7th June 2002 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply? Date of last inspection Date of latest registration certificate 7th June 2002 NO NO 19/11/03 If Yes refer to Part CManor Park Grove, 5Page 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 329th September 2004 09:15 am ­ 17.45pm Sue HouldeyID Code074665Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionManor Park Grove, 5Page 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementManor Park Grove, 5Page 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of Manor Park Grove, 5. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Manor Park Grove, 5Page 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. 5 Manor Park Grove is a purpose built bungalow located within a quiet residential road, built upon the grounds of Rubery Hill hospital. The home is close to the local facilities of Great Park and Rubery Shopping Centre. The home is situated within a cul de sac with off street parking available. Each service user has a single bedroom, which have been furnished and decorated to the individual taste with assistance from service users. Each bedroom has a wash hand basin. There is a communal bathroom with an Aquonova bath and there is a separate shower room. In addition to a through lounge/dining room, there is a kitchen, laundry room and an office. To the rear of the home there is a pleasant garden. The home, which is registered with FcH Housing and care currently, accommodates four younger adults with a learning disability.Manor Park Grove, 5Page 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) The inspection took place over one day. It found that many of the National Minimum Standards had been met or partially met. The home currently has 173 vacant staff hours, and the owners assured the inspector of their on-going efforts to recruit to these vacancies. The manager of the home has been covering a service manager post as well as management of two homes. The inspector was concerned that no clear timescales have been set for the return of the manager to the home full time. Staff presented as knowledgeable and able. The interactions observed between staff and service users were seen to be friendly, relaxed and entirely appropriate. The inspector was able to talk with one service user, who remains satisfied with all aspects of care in the home. The inspector received three `comment cards from relatives, who indicated satisfaction with the home. Three `comment cards were received from professionals involved in the home. Two of these contained positive comments, the third raised issues of concern, which were investigated as a complaint at this inspection. The outcome of this investigation was that the complaint was not upheld. Choice of Home (Standards 1 ­ 5) 2 of these 5 standards were met. 3 had minor shortfalls. The home has a draft statement of purpose, which the inspector was advised is now to be finalised. Examination of this document indicated that it met all requirements. In addition the home must ensure that the service user guide is also available. This should be in a style accessible to the service users for whom the home is intended. The home currently has no vacancies; there have been no new admissions to the home. The manager is aware of the need to carry out a full assessment of any prospective service users. The home requires an admissions policy and procedure. All the evidence available at the time of this visit indicates that the home can and does meet the current needs of the service user. The home has sought input from a physiotherapist in relation to the changing needs of one individual, and advice has been sought on individual risk assessment. There is evidence of a more individualized approach to meeting service users needs.Individual Needs and Choices (Standards 6 ­ 10) Manor Park Grove, 5Page 6 2 of these 5 standards were met. 3 had minor shortfalls. Files, which were sampled, contained comprehensive service users plans; daily recording was found to contain good detail. Some requirements were made in relation to nighttime recording. Observation of care practice and sampling of records clearly indicated that service users are enabled to make decisions about their own lives. The ethos of the home is service user focused. One service user is enabled to manage their finances with support from staff members these records were not examined. The remaining three service users financial records were examined for the month July to August. The inspector found three errors relating to payments, which were made by service users and which should have been paid for by the home. Requirements were made in relation to this matter. The level of participation within this home varies from service user to service user. Examination of documentation and observation of the day of the inspection indicates that service users participate at a level to which they are able, which may mean wiping tables, assisting with food preparation or helping in the garden. The inspector sampled risk assessments relating to all service users. These were found to be comprehensive and contained sufficient detail. However, the home must ensure that risk assessments are reviewed at appropriate intervals. Some risk assessments were seen to be one month over their review date. Lifestyle (Standards 11 ­ 17) 1 of these 7 standards was met. 6 standards not examined as they met the standard at the last inspection. Menus and the record of food served demonstrated a nutritious and varied choice of food is on offer in the home. There is a set menu, but there is evidence that service users have chosen alternatives, when they have not wished to have the first option on the menu. Food stocks were seen to be adequate and food was stored appropriately. The inspector noted that the presentation of food for the evening meal was good. Staff joined service users at the table for this meal. Personal and Healthcare Support (Standards 18 ­ 21) 1 of these 4 standards was met. 3 standards not examined (one met the standard at the last inspection). The inspector examined the health notes for two service users. The inspector found evidence of service users being offered a range of checks including dentist, GP, Opticians, podiatry, epilepsy and diabetic support. Concerns, Complaints and Protection (Standards 22 ­ 23) 0 of the 2 standards were met. 2 had minor shortfalls. The home has in place a complaint record and procedure. The procedure must clearly state that the CSCI can be contacted at any point with a complaint. The CSCI received an anonymous complaint and this was investigated at this inspection, this complaint was not upheld. The home has in place procedure for adult protection and physical intervention. The inspector saw completed service users inventories. The home must maintain a record of any valuables held, to include birth certificates, passports etc. The record must be stored separately from the valuables, which should be secured Manor Park Grove, 5 Page 7 Environment (standards 24 ­ 30) 5 of the 7 standards were met. 2 had minor shortfalls. 5 Manor Park Grove is very well presented; it is accessible, safe and well maintained. Some issues were raised in relation to physical standards at the last inspection and these have been addressed. All four of the single bedrooms have a wash hand basin, and measure at least 10 square metres. Currently none of the service users requires the use of a wheelchair inside the home. All bedrooms were inspected they were observed to be very well maintained. They clearly reflect the taste and style of the individual service user. None of the bedroom has a telephone, however, there is a phone for service users use in the lounge and in the office. The home has a bathroom, separate shower room and separate toilet. It exceeds the National Minimum Standard required for the provision of bathrooms/toilets. The bathroom has a high low bath and chair hoist, which is sufficient for the current service user needs. All bathroom/shower/toilets are lockable. The home has a combined lounge/dining area, which is the only shared space available. There is no communal space for service user to receive visitors, take part in activities of have space away from other service users. The home has a separate laundry, which is sited off the main hallway. There is a domestic washing machine and tumble drier; the home must replace the washing machine with a sluice cycle machine in order to effectively manage soiled linen. The inspector was advised that funding for this has been agreed. The home has an infection control policy in place. Liquid soap and hand towels are provided in the laundry, kitchen and bathrooms/shower to prevent the risk of cross infection. The odour evident in one bedroom must be addressed. The home may wish to consider an alternative floor covering be provided, given that the current extensive cleaning programme is proving ineffectual. Agreement for any changes must be sought from family and service user. Staffing (Standards 31 ­ 36) 2 of these 6 standards were met. 3 had minor shortfalls, 1 major shortfall. Two staff files were sampled; job descriptions were available on these files. Two staff were interviewed, the inspector was satisfied that they demonstrated a clear understanding of their roles and responsibilities, and that they know and support the main aims and values of the home. Observations of staff on the day of the inspection supported the view that staff have the appropriate characteristics an attitudes for their post. A number of staff have completed or are undertaking NVQ training. The inspector sampled rotas for a period of time leading up to the inspection. An examination of the rota (which did not in all cases document fully the names of staff working) and daily diaries indicated that the minimum of two staff provided during the waking day and one night waking staff provided sufficient staff numbers to provide appropriate levels of assistance throughout 24hours. The inspector was concerned that the home now has 173 staff hour vacancies. It is recognised that with the use of bank and overtime, the home is maintaining staffing levels. However, this is impacting upon service users, who have not had a holiday this year. The inspector was advised of the steps being taken by the organisation to address these shortfalls and recruitment is on going. The inspector was informed that the owners operate a thorough recruitment process. Two staff files were sampled however, and these did not contain the required information. New staff are accessing the LDAF framework. Induction checklists were seen to be in place for staff new to the home. The inspector was shown evidence of Individual training and development plans for all staff. A number of requirements relating to training remain outstanding from the last inspection Manor Park Grove, 5 Page 8 and are detailed in the requirements section of this report. The inspector examined two staff files and saw evidence of regular supervision being offered. Notes from these sessions indicate that on-going developmental issues are addressed. The manager and staff advised the inspector that annual appraisals are held. Conduct and Management of the Home (Standards 37 ­ 43) 2 of these 7 standards were met. 3 had minor shortfalls. 2 standards not examined. The manager has significant management experience and experience of working with people with learning disabilities. She is in the process of completing her N.V.Q level four in management and care. The registered manager currently overseas the management of two separate registrations; 5 and 25 Manor Park Grove. However, for some months this manager has also been covering some service manager responsibilities, and reports that she probably spends no more than 10 hours in the home each week. The owners must advise CSCI of their intentions in relation to the management of the home. The managers hours must be included in the rota. All evidence available at the time of the inspection indicates that the management approach in this home is service user focused, open and friendly. The inspector sampled a number of health and safety records, which were found to be in order.Manor Park Grove, 5Page 9 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action 1 14 YA2 The home requires an admissions policy and procedure Training for staff is required in: 6 18(1) a YA35 · · · · Basic Food Hygiene Recording Sexuality Adult Protection 3 months 3 months726YA43The homeowners must carry out monthlyunannounced visits. Records of these visits must be maintained in the home The home requires a sluice cycle washing machine to deal with soiled linen Staff Training Required · Staff training in manual handling needs to be given high priority due to the needs of service users. This training must be specific to lifting and handling matters of service users. Other training matters are highlighted below: Diabetes Contract: All service users must have a signed contract identifying the room allocated, the charge and the terms and conditions of residence. The contract must be signed by the registered manager and service users1 month816(2) jYA302 months1318(1) cYA352 months175 (1) b & cYA52 monthsManor Park Grove, 5Page 10 Staff Records: The additional information is required in respect of staff files: 7, 9, 19, Schedule 2 · · · · · Proof of persons ID. Birth Certificate. Current passport. Evidence of qualifications Two written references.19YA412 monthsEvidence that they are physically fit or declaration. 17(2), 4(1) a, Schedule 4(1)21YA1The home requires a statement of purpose3 monthsThe home requires a service users guide to include: · · 17(2) Schedule 4(2) & 5 · · · · Summary of statement of purpose. Terms and conditions in respect of accommodation to be provided, including amount and method of payment. Standard form of contract. Most recent inspection report. Summary of complaints. Details of CSCIC Guide to be given to CSCI and each service user. Three-way agreement must also be supplied.22YA2Manor Park Grove, 5Page 11 The homes written prevention of abuse policy must include: · · · · A statement of the principles committing the home to preventing abuse. Outline of training procedures in abuse prevention. Outline of disciplinary procedures in the event of abuse. Details of organisations, which provide support and advice for service users, supporters and staff. Details of action to be taken in the event of or suspicion of abuse occurring ­including: (i) YA23 (ii) Inform CSCI within 24 hours. In liaison with CSCI establish as far as possible the severity of the situation. Keep a detailed record and where it is obvious abuse has occurred. Seek immediate medical assistance if injuries present/suspected. Safeguard the situation. Inform care manager/Area SSD, Duty SSD. Inform police. 2 months·2312(1) & 13(6)(iii) (iv) (v) (vi) (vii)The policy must include system for support for whistle blowers. 5(1) e & 17(2), 22, Schedule 4(11) The home complaints procedure requires some amendment to ensure: YA22 · Further steps if remaining dissatisfied and information on the CSCI role in dealing with complaints. 2 months25Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented Manor Park Grove, 5 Page 12 No.Refer to StandardGood Practice RecommendationsCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO)Manor Park Grove, 5Page 13 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 1 17(2), 4(1) a, Schedule 4(1) YA1 The home requires a statement of purpose 30/12/04The home requires a service users guide to include: · · 17(2) Schedule 4(2) & 5 · · · · Summary of statement of purpose. Terms and conditions in respect of accommodation to be provided, including amount and method of payment. Standard form of contract. Most recent inspection report. Summary of complaints. Details of NCSC Guide to be given to NCSC and each service user. Three-way agreement must also be supplied. 3 14 YA2 The home requires an admissions policy and procedure 30/12/04 30/12/042YA1Manor Park Grove, 5Page 14 Contract: · 4 5 (1) b & c YA5 · All service users must have a signed contract identifying the room allocated, the charge and the terms and conditions of 30/11/04 residence. The contract must be signed by the registered manager and service users517(1) a YA6 Schedule 3The home must ensure that records maintained at night are · · Maintained within individual diaries Reflect the actual events of the night7/10/04Service users must be re-imbursed for items purchased, which must be provided by the home. This includes: 6 17(2) Schedule 4(9) YA7 · · · Meals purchased Carpet cleaner Telephone calls 14/10/04Staff must receive clear instruction on this issue 5(1) e & 17(2), 22, Schedule 4(11) The home complaints procedure requires some amendment to ensure: YA22 · Further steps if remaining dissatisfied and information on the CSCI role in dealing with complaints. 30/11/047817(2) Schedule 4(9)YA23The home must maintain a record of any valuables held, to include birth certificates, passports etc. The record must be stored separately from the valuables, which should be secured The odour evident in one bedroom must be addressed. The home may wish to consider an alternative floor covering be provided, given that the current extensive cleaning programme is proving ineffectual. Agreement for any changes must be sought from family and service user The home requires a sluice cycle washing machine to deal with soiled linen7/10/04916(2) jYA3030/11/041016(2) jYA3030/11/04Manor Park Grove, 5Page 15 1117(2) Schedule 4(7) 18(1)YA33The staff rota must contain the full names for all staff working in the home7/10/0412YA33The home must recruit to the 173 Vacant staff 30/12/04 hours Training for staff is required in: · · · · Basic Food Hygiene Recording Sexuality Adult Protection Staff training in manual handling needs to be given high priority due to the needs of service users. This training must be specific to lifting and handling matters of service users. Other training matters are highlighted below Diabetes 30/12/041318(1) aYA35··1418(1)YA37The owners must advise CSCI of their intentions in relation to the management of the home. The managers hours must be included in the rota. Staff Records: The additional information is required in respect of staff files:30/10/04157, 9, 19, YA41 Schedule 2· · · · ·Proof of persons ID. Birth Certificate. Current passport. Evidence of qualifications. Two written references. 30/11/041626YA43Evidence that they are physically fit or declaration. The homeowners must carry out monthlyunannounced visits. Records of these visits must be maintained in the home ­ Outstanding requirements not examined at this inspection.30/10/04Manor Park Grove, 5Page 16 All medication must be stored in a separate cabinet within the medication cupboard to restrict staff and service users access to medication. The quantities of all medicines received into the home must be recorded on the MAR charts. This must include balances carried over from the previous MAR chart. Regular audits undertaken must correspond with audits undertaken using the MAR chart. All medication must be date checked on a regular basis and new supplies sought if due to expire. Any mediation secondary dispensed into medi-dose compliance aids must be done against a protocol and checked by another member of staff for accuracy. These must be labelled in compliance with the Labelling Regulations 1976.1713(2)YA2030/11/04RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * The inspector recommends that the home develop Health Action Plans for service users A Health Action Plan is a personal plan about what a person with learning disabilities can do to be healthy. It lists any help people might need to do those things. It helps to make sure people get the services and support they need to be healthy.17YA19* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BManor Park Grove, 5INSPECTION METHODS & FINDINGSPage 17 The following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES YES YES YES YES NO NO YES YES YES NO YES YES YES YES YES YES NO YES 1 2 5 NO NO YES YES X X 29/9/04 09:15 8.5The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: Manor Park Grove, 5 Page 18 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met(Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Manor Park Grove, 5Page 19 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. 1073.53 X Range of fees charged From To £ £ (per week) NO Any charges for extras If yes, please state what the extras are 2 Key findings/Evidence Standard met? The home has a draft statement of purpose, which the inspector was advised is now to be finalised. Examination of this document indicated that it met all requirements. In addition the home must ensure that the service user guide is also available. This should be in a style accessible to the service users for whom the home is intended.Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 2 Key findings/Evidence Standard met? The home currently has no vacancies; there have been no new admissions to the home. The manager is aware of the need to carry out a full assessment of any prospective service users. The home requires an admissions policy and procedure.Manor Park Grove, 5Page 20 Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? All the evidence available at the time of this visit indicates that the home can and does meet the current needs of the service user. The home has sought input from a physiotherapist in relation to the changing needs of one individual, and advice has been sought on individual risk assessment. There is evidence of a more individualized approach to meeting service users needs.Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 3 Key findings/Evidence Standard met? There have been no new admissions to the home. The draft service users guide clearly indicates the homes intention to identify needs prior to admission, and ensure that these could be met on admission to the home. In addition, the guide also details the process of introduction to the home, which would include visits, shared meals and overnight stays where possible. Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 2 Key findings/Evidence Standard met? The inspector was advised that the owners are working towards updating the contacts for service users in order to meet requirements.Manor Park Grove, 5Page 21 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 2 Key findings/Evidence Standard met? The inspector sampled two service users files. These included tenants profiles, which the inspector was able to see being updated. The profiles were found to be comprehensive, and detail the levels of support required. Profiles also included support strategies, individual behaviour support requirements and daytime opportunities. The profiles were seen to be cross-referenced to risk assessments. Daily records for the waking day period were also seen to be well maintained and contained good detail. The inspector was surprised to find two sets of records for the waking night period. One contained in a book, which included details of nighttime chores as well as information on all service users. In addition, records are made within the daily diaries. Cross-referencing of these records showed that details did not always tally. Requirements were made in relation to this recording.Manor Park Grove, 5Page 22 Standard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 2 Key findings/Evidence Standard met? Observation of care practice and sampling of records clearly indicated that service users are enabled to make decisions about their own lives. The ethos of the home is service user focused. One service user is enabled to manage their finances with support from staff members these records were not examined. The remaining three service users financial records were examined for the month July to August. The inspector found three errors relating to payments, which were made by service users and which should have been paid for by the home. Requirements were made in relation to this matter. Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? The level of participation within this home varies from service user to service user. Examination of documentation and observation of the day of the inspection indicates that service users participate at a level to which they are able, which may mean wiping tables, assisting with food preparation or helping in the garden. Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 2 Key findings/Evidence Standard met? The inspector sampled risk assessments relating to all service users. These were found to be comprehensive and contained sufficient detail. However, the home must ensure that risk assessments are reviewed at appropriate intervals. Some risk assessments were seen to be one month over their review date.Standard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 3 Key findings/Evidence Standard met? The organisation/home has a confidentiality policy. Records were found to be stored securely.Manor Park Grove, 5Page 23 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 0 Key findings/Evidence Standard met? Not assessed ­ met standard at last inspection.Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 0 Key findings/Evidence Standard met? Not assessed ­ met standard at last inspectionStandard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 0 Key findings/Evidence Standard met? Not assessed ­ met standard at last inspectionStandard 14 (14.1 ­ 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. Key findings/Evidence Standard met? Not assessed ­ met standard at last inspection0Manor Park Grove, 5Page 24 Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 0 Key findings/Evidence Standard met? Not assessed ­ met standard at last inspectionStandard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 0 Key findings/Evidence Standard met? Not assessed ­ met standard at last inspectionStandard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? Menus and the record of food served demonstrated a nutritious and varied choice of food is on offer in the home. There is a set menu, but there is evidence that service users have chosen alternatives, when they have not wished to have the first option on the menu. Food stocks were seen to be adequate and food was stored appropriately. The inspector noted that the presentation of food for the evening meal was good. Staff joined service users at the table for this meal.Manor Park Grove, 5Page 25 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes 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.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 0 Key findings/Evidence Standard met? Not assessed ­ met standard at last inspectionStandard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) 003 Key findings/Evidence Standard met? The inspector examined the health notes for two service users. The inspector found evidence of service users being offered a range of checks including dentist, GP, Opticians, podiatry, epilepsy and diabetic support. On the whole records were found to be well maintained and contained sufficient detail. One dental appointment had not been recorded in health notes, and this record was updated at the time of the inspection. The inspector recommends that the home develop Health Action Plans for service users A Health Action Plan is a personal plan about what a person with learning disabilities can do to be healthy. It lists any help people might need to do those things. It helps to make sure people get the services and support they need to be healthy.Manor Park Grove, 5Page 26 Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 0 Key findings/Evidence Standard met? th The pharmacy inspector visited the home on 6 October and reported as follows: Some medicines had been signed as administered when they had not been Quantities of medicine received or carried over from previous cycles had not been recorded on the Medicine Administration Record (MAR) chart. Separate audits were evidenced. However these did not tally with the MAR charts. One out of date medicine was being administered despite clearly labelled that it had expired The medicine remained on an open shelf in a cupboard. The cupboard was locked but had no restricted access, as non medical good were also stored there.Standard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 0 Key findings/Evidence Standard met? The inspector was informed that the home is currently consulting with service users regarding their wishes in relation to death and funeral arrangements, This issues not examined furtherManor Park Grove, 5Page 27 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 1 0 0 1 0 1 100 Manor Park Grove, 5Page 28 2 Key findings/Evidence Standard met? The home has in place a complaint record and procedure. The procedure must clearly state that the CSCI can be contacted at any point with a complaint. The CSCI received an anonymous complaint and this was investigated at this inspection. This complainant was concerned about `unexplained bruising to a service user on given dates. In addition concerns were raised about the home not giving adequate medical support. The manager fully facilitated the investigation of this complaint. The following records were examined: · · · · · Accident/incident records Daily records Service user plans Risk assessments Service user health notesThe following items were noted: · · · · · · · · The inspector found incidents/accident records, which would provide sufficient explanation of the bruising or injuries noted as of concern Medication reviews have been held to address the number of falls experienced A consultant is involved in the management of epilepsy for this service user The home has sought advice from physiotherapy, intermediate care team, falls clinic and GP. Advice has been given that the home is to keep mobilising this service user. Risk assessments in relation to mobilising, use of wheelchair, paths and road crossings and use of buses are in place and subject to periodic review. Manual handling risk assessments are in place. The home has reviewed room layout and placement of furniture in order to minimise risk. The home have responded promptly to concerns about this service users welfare, health notes are detailed, and demonstrate follow up of issues raisedThis complaint was not upheld.Manor Park Grove, 5Page 29 Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists YES0 2Key findings/Evidence Standard met? The home has in place procedure for adult protection and physical intervention. The inspector saw completed service users inventories.The home must maintain a record of any valuables held, to include birth certificates, passports etc. The record must be stored separately from the valuables, which should be securedManor Park Grove, 5Page 30 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? 5 Manor Park Grove is very well presented; it is accessible, safe and well maintained. Some issues were raised in relation to physical standards at the last inspection and these have been addressed.Manor Park Grove, 5Page 31 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite YES NO NO 4 0 0 0 400 0 0 0Manor Park Grove, 5Page 32 3 Key findings/Evidence Standard met? All four of the single bedrooms have a wash hand basin, and measure at least 10 square metres. Currently none of the service users requires the use of a wheelchair inside the home.Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 3 Key findings/Evidence Standard met? All bedrooms were inspected they were observed to be very well maintained. They clearly reflect the taste and style of the individual service user. None of the bedroom has a telephone, however, there is a phone for service users use in the lounge and in the office.Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 3 Key findings/Evidence Standard met? The home has a bathroom and separate shower room. The bathroom has a high low bath and chair hoist, which is sufficient for the current service user needs. Both bathrooms/showers are fitted with a suitable lock. The inspector was advised that the emergency call systems in these areas are not functional.Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 2 Key findings/Evidence Standard met? The home has a combined lounge/dining area, which is the only shared space available. There is no communal space for service user to receive visitors, take part in activities or have space away from other service users.Manor Park Grove, 5Page 33 Standard 29 ( 29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 3 Key findings/Evidence Standard met? There is a large bathroom with bath hoist. There is a separate shower room with shower chair. The inspector was advised that advice about the future aids and adaptations requirements of service users is being sought.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 2 Key findings/Evidence Standard met? The home has a separate laundry, which is sited off the main hallway. There is a domestic washing machine and tumble drier; the home must replace the washing machine with a sluice cycle machine in order to effectively manage soiled linen. The inspector was advised that funding for this has been agreed. The home has an infection control policy in place. Liquid soap and hand towels are provided in the laundry, kitchen and bathrooms/shower to prevent the risk of cross infection. The odour evident in one bedroom must be addressed. The home may wish to consider an alternative floor covering be provided, given that the current extensive cleaning programme is proving ineffectual. Agreement for any changes must be sought from family and service user.Manor Park Grove, 5Page 34 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 3 Key findings/Evidence Standard met? Two staff files were sampled; job descriptions were available on these files. Two staff were interviewed, the inspector was satisfied that they demonstrated a clear understanding of their roles and responsibilities, and that they know and support the main aims and values of the home.Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 2 Key findings/Evidence Standard met? The home currently has two staff that are undertaking NVQ II, with a further member of staff completing this training. Additionally one member of staff holds NVQ III and a further member of staff is completing this training. Observations of staff on the day of the inspection supported the view that staff have the appropriate characteristics and attitudes for their post.Manor Park Grove, 5Page 35 Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme 3 1 X X 3 No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X XXX1 Key findings/Evidence Standard met? The inspector sampled rotas for a period of time leading up to the inspection. An examination of the rota (which did not in all cases document fully the names of staff working) and daily diaries indicated that the minimum of two staff provided during the waking day and one night waking staff provided sufficient staff numbers to provide appropriate levels of assistance throughout 24hours. The inspector was concerned that the home now has 173 staff hour vacancies. It is recognised that with the use of bank and overtime, the home is maintaining staffing levels. However, this is impacting upon service users, who have not had a holiday this year. The inspector was advised of the steps being taken by the organisation to address these shortfalls and recruitment is on going. The inspector saw the minutes of staff meetings, which are held regularly.Manor Park Grove, 5Page 36 Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 2 Key findings/Evidence Standard met? The inspector was informed that the owners operate a thorough recruitment process. Two staff files were sampled however, and these did not contain the required information. The manager reported that she is in the process of ensuring these are complete.Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 2 Key findings/Evidence Standard met? New staff are accessing the LDAF framework. Induction checklists were seen to be in place for staff new to the home. The inspector was shown evidence of Individual training and development plans for all staff. A number of requirements relating to training remain outstanding from the last inspection and are detailed in the requirements section of this report. Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 3 Key findings/Evidence Standard met? The inspector examined two staff files and saw evidence of regular supervision being offered. Notes from these sessions indicate that on-going developmental issues are addressed. The manager and staff advised the inspector that annual appraisals are held.Manor Park Grove, 5Page 37 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. NO2 Key findings/Evidence Standard met? The manager has significant management experience and experience of working with people with learning disabilities. She is in the process of completing her N.V.Q level four in management and care. The registered manager currently overseas the management of two separate registrations; 5 and 25 Manor Park Grove. However, for some months this manager has also been covering some service manager responsibilities, and reports that she probably spends no more than 10 hours in the home each week. The owners must advise CSCI of their intentions in relation to the management of the home. The managers hours must be included in the rota.Manor Park Grove, 5Page 38 Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? All evidence available at the time of the inspection indicates that the management approach in this home is service user focused, open and friendly.Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 0 Key findings/Evidence Standard met? Not assessed at this inspection.Standards 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 2 Key findings/Evidence Standard met? The inspector sampled policies and procedures, some amendment to the complaints procedure is required to meet the required standard. Inn addition the home requires an admission policy and procedure.Manor Park Grove, 5Page 39 Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 2 Key findings/Evidence Standard met ? The inspector sampled a number of records in the home. These were found to be largely well maintained. However, the manager must ensure that risk assessments are reviewed at the stated frequencies or more often. Staffing records must be available in the home.Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? The inspector sampled a number of health and safety records which included: · · · · · · · Fire Electrical wring Portable appliance checks Gas Risk assessment for water systems Water temperature Fridge and Freezer temperaturesThese were found to be in order. Standard 43 (43.1 ­ 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 0 Key findings/Evidence Standard met ? Not assessed at this inspection.Manor Park Grove, 5Page 40 PART C(where applicable) Condition CommentsCOMPLIANCE WITH CONDITIONSComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateSignature Signature SignaturePublic reports It should be noted that all CSCI inspection reports are public documents.Manor Park Grove, 5Page 41 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 29th September 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleManor Park Grove, 5Page 42 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan by which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. ,You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required Action plan was received at the point of publication Action plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action plan Other: enter details here YES YESManor Park Grove, 5Page 43 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Manor Park Grove, 5Page 44 Manor Park Grove, 5 / 29th September 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000016800.V146571.R01© This report may only be used in its entirety. 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