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Inspection on 16/05/06 for Manor Place Nursing Home

Also see our care home review for Manor Place Nursing Home for more information

This inspection was carried out on 16th May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides care and support in a pleasant environment and service users spoken to were happy living at the home. Comments received from service users living at the home included: " I like living here" "Everyone is very friendly" " My room is lovely" " meals are good" "staff are always very busy but they have time for me". Care is provided flexibly and there was good interaction between service users and staff and the atmosphere was relaxed and friendly. The home employs more than 50% of staff that have obtained NVQ qualifications and staff spoken to stated that they enjoyed working at the home and found the management very approachable. Medication procedures were clear and the homes complaint policy and procedures ensured that any concerns or complaints were responded to quickly.

What has improved since the last inspection?

Since the last inspection a great deal of work has been carried out to improve the care planning procedures at the home. Care plans are now clear and easy to follow and these give staff clear information on what support is required and how it should be given and this is beneficial to service users and staff. The homes recruitment procedures have been improved to ensure that all staff have appropriate checks carried out on them before they are allowed to work in the home and this helps to protect service users. Record keeping had improved and all records checked by the inspector were clear and up to date.

What the care home could do better:

On the first day of the inspection the inspector identified the need to improve the homes assessment procedures that are carried out before any service users moves into the home and also identified the need to inform those service users who are diabetic of the availability of free foot care treatment through the local health service. When the inspector visited on the second day the homes manager had addressed these issues. At present the training records for staff are kept in individual staff files and this makes it difficult to identify when staff are due to undertake refresher training. It was recommended that the home develop a simple method for identifying which staff require additional training and on what date.

CARE HOMES FOR OLDER PEOPLE Manor Place Nursing Home 116 Church Lane East Aldershot Hampshire GU11 3HN Lead Inspector Michael Gough Unannounced Inspection 10:00 16 & 17th May 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Manor Place Nursing Home Address 116 Church Lane East Aldershot Hampshire GU11 3HN 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) 01252 319738 01252 327899 Dr Zyrieda Denning Care Home 52 Category(ies) of Dementia (52), Old age, not falling within any registration, with number other category (52) of places Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 Brief Description of the Service: Manor Place is a care home with nursing providing care and support for older persons. The house is a late 19th Century Victorian mansion, which until the 1980s was St Michaels Vicarage. About 15 years ago a 17-bedded extension was built and in February 2006 a further extension was completed to increase the number of beds available to 52. The home is divided into 3 wings, Victoria wing is in the older part of the home and has four shared rooms and 10 single rooms and accommodates 18 people. Nightingale wing has 17 bedrooms all with ensuite facilities. The new extension is Churchill wing and has 16 single rooms and one double room, which is occupied by a married couple. All rooms in Churchill wing offer en suite accommodation. The home also has a landscaped rear garden with raised borders and is easily accessible from all of the accommodation wings and there is seating for use by service users. The front of the property is tarmac and provides parking for 8 vehicles. Fees at the home range from £550 - £780 per week and service users are responsible for paying for their own toiletries, hairdressing, chiropody and items of a personal or luxury nature. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over two days and took a total of 8.5 hours to complete. The inspection was unannounced. The homes manager assisted the inspector throughout. Evidence for this report was obtained by speaking with 9 of the service users currently living at the home, 6 members of staff and also the registered provider. Additional evidence was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and service users. The home is registered for up to 52 service users and at the time of the inspection there were 44 service users living at the home. What the service does well: What has improved since the last inspection? Since the last inspection a great deal of work has been carried out to improve the care planning procedures at the home. Care plans are now clear and easy to follow and these give staff clear information on what support is required and how it should be given and this is beneficial to service users and staff. The homes recruitment procedures have been improved to ensure that all staff have appropriate checks carried out on them before they are allowed to work in the home and this helps to protect service users. Record keeping had improved and all records checked by the inspector were clear and up to date. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 6 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. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is “good”. This judgement has been made using available evidence including a visit to the service. Prospective service users have the information they need to make an informed choice about where they wish to live and each service user has a written contract and has the terms and conditions of the home. No service users move into the home without having their needs assessed, however the assessments on file did not always provide all the information that would be required to ensure that all needs could be met in every case and this could be detrimental for service users. The home does not provide intermediate care. EVIDENCE: All service users and relatives are issued with a copy of the homes statement of purpose and the terms and conditions of the home. The inspectors viewed contracts for privately funded service users and also for those service users who were funded by the local authority. These contracts were clear and gave details of the room to be occupied, the fees payable and by whom and detailed the rights and obligations of the service user and the provider if there was a breach of contract. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 9 Needs assessments were looked at for 5 service users and these did not always contain sufficient information. None of the assessments viewed were dated and there was no information on specific health needs. Some service users had social service assessments and these gave good information. The issue was discussed with the homes manager and on the second day of the inspection she had produced a new assessment form, which prompted the person who carries out the assessment and this form will be used for all future assessments. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is “good”. This judgement has been made using available evidence including a visit to the service. Service users health, personal and social care needs are set out in a plan of care and staff have the information they need to provide the support that service users need and in the way they prefer, this ensure service users receive the support they require. The health care needs of service users are met and the home has policies and procedures to provide protection for service users with regard to medication. Service users at the home are treated with dignity and respect. EVIDENCE: Care plans were seen for 5 residents and these were comprehensive documents and gave clear information to staff on what care is required and how it should be given. There were risk assessments in place and these identified any potential risk and also gave information on how any risk could be minimised. Daily reports were clear and concise and detailed what support had been given throughout the day, there was also information on how well service users had eaten and information on fluid intake. Wound care for any pressure sores was by means of a photograph and this was dated and also had a clear evaluation of progress. There were details of any mental health issues Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 11 and details of non-restraint intervention strategies for service users who had the potential to be aggressive. All of the service users at the home are registered with the local health centre although they may have different GP’s. Service users may keep their own GP if they wish. The health centre provides dental treatment and home visits can be arranged. A visiting optician provides eye care and the home has a visiting chiropodist who calls once per month. The home has appropriate policies and procedures in place with regard to medication and this covers the ordering, receipt, administration and disposal of medication. The home has specimen signatures and initials of those staff that are authorised to administer medication. Medication records were up to date and controlled drugs were kept in a dedicated locked cabinet inside a locked room. The home has a contract for the disposal of medication and clear records are kept of any medication that goes for disposal. The home has controlled drugs destruction kits, which allow for the safe disposal of controlled drugs and clear records are kept. Service users spoken to were happy with the care they receive at the home and those spoken to said that staff were very helpful and friendly they stated that they were always treated with dignity and respect. Observations made by the inspector confirmed that service users and staff get on well together and staff were observed interacting with service users and were seen to treat service users with dignity and respect and staff were seen to knock on service users doors before entering and to use service users preferred form of address when talking to service users. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is “good”. This judgement has been made using available evidence including a visit to the service. The home provides a range of activities for service users, which meets their expectations and the religious and recreational interests of service users at the home are provided for. Service users are able to maintain contact with family and friends and visitors are welcome at any time. Service users are supported to exercise choice and control over their lives and are provided with a wholesome and balanced diet in pleasant surroundings at a time convenient to them. EVIDENCE: Activities at the home include a pat dog that visits the home on a regular basis, armchair aerobics are arranged and there are visiting entertainer’s arts and crafts and the home is looking to introduce a drama therapist. At present the home does not have a dedicated activities co-ordinator but there is an advertisement out for this post and interviews are due to be conducted shortly. Service users spoken to were happy with the activities provided, some stated that they preferred watching TV whilst others were happy relaxing and watching what was going on, some service users preferred to stay in their rooms. Service users interests are documented and there are no restrictions on bathing, getting up or going to bed. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 13 The home has a visiting policy and there are no restrictions on visitors. They are encouraged to stay and have a meal with relatives and are invited to social gatherings held in the home. The visitors book at the home showed that there are a regular stream of visitors to the home. Service users were not always able to confirm that they are able to make informed choices and were able to control their own lives, however the manager stated that a local vicar visits the home once per month and that service users can choose to attend if they wish. There are 3 lounges in the home and service users are able to move around. The inspector was informed that service users were consulted regularly and that staff at the home respected their views and that if they wanted anything all they had to do was ask. A number of service users had bought some of their own possessions into the home and rooms had been personalised. All service users spoken to were happy with the food provided by the home and stated that the food was plentiful and good. The home operates a four week rolling menu and service users are offered a choice at meal times and are able to eat their meals in the dining room or elsewhere if they prefer. On the 2nd day of the inspection lunch was liver and bacon with potatoes and fresh broccoli and carrots, some service users made the choice to have an omelette rather that the main meal and this was followed by fresh fruit and cream. The inspector observed lunch being taken in the dining room and staff provided verbal and hands on support for service users. Service users who remained in their rooms were supported by staff and meal times were unhurried. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is “good”. This judgement has been made using available evidence including a visit to the service. There is a simple, clear and accessible complaints procedure, which includes timescales for the process and any complaints are logged and responded to appropriately. The homes policies and procedures protect service users for any form of abuse. EVIDENCE: Service users spoken to stated that they would address any complaint they may have to a staff member. The home has a policy and procedure for dealing with any complaints and this contained all of the required information and gave details of how to contact the CSCI. Staff members spoken to were also aware of the complaints procedure. There have been 2 minor complaints made to the home since the last inspection and these were clearly documented and were resolved to the satisfaction of the complainant. Staff has received training on adult protection and the home has a whistle blowing policy and also a copy of the Hampshire Adult Protection procedure. Some staff spoken to who were from overseas did not understand the terminology “Whistle Blowing” but when questioned understood the principles and were clear about their responsibilities and understood they would be protected. Staff spoken to know what to do should they suspect any form of abuse or poor practice had taken place. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 15 Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is “good”. This judgement has been made using available evidence including a visit to the service. Service users live in a well-maintained environment and have access to comfortable indoor and outdoor facilities and the home was clean, pleasant and hygienic and free from offensive odours and this provided a pleasant environment for service users and staff. EVIDENCE: The inspector toured the building and all areas of the home were clean and tidy and furniture was in a satisfactory state of repair. The home comprises of 3 wings and each has a lounge area. Service users were seen to be using all of the communal lounges in the home and these were bright and airy. The home has dedicated domestic staff and they were deployed around the premises. One set of stairs in the new wing was not yet carpeted and the Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 17 inspector was informed by the manager that this would be completed shortly. The home has a laundry and has dedicated laundry staff. The home only provides a laundry service for service users personal clothing and there is an industrial washing machine and tumble drier, all other laundry including sheets and towels are sent out and laundered away from the home. All areas were clean and there were no offensive odours. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is “good”. This judgement has been made using available evidence including a visit to the service. Staffing numbers and the mix of staff both qualified nurse, care staff and domestic staff meets the needs of service users, however staffing numbers, particularly with regard to trained nursing staff at night need to be kept under review. Staff morale was good and there was a good rapport between service users and staff. Service users are protected by the homes recruitment procedures. The home provides training for staff; however, it was recommended that systems be put in place to make it easier to access training records. EVIDENCE: The homes staff rota was examined and this showed that the home provides 2 trained nursing staff plus 7 carers between 0800 – 1400. Between 1400 – 2000 there are 2 trained nurse’s plus 5 care staff on duty and between 2000 – 0800 there is 1 trained nurse and 4 care staff on duty. Staffing numbers were discussed with the homes manager and the inspector was told that with the present numbers of service users staffing levels were sufficient. It was agreed that staffing numbers, particularly with regard to trained nursing staff at night would be kept under review and numbers would be amended if required. In addition there are domestic staff on duty throughout the day so that care staff can concentrate on the care needs of service users. The home employs a total of 8 trained nursing staff and 26 care staff, of the 26 care staff 14 have NVQII Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 19 or above and the home was commended for exceeding 50 of its care staff who have an NVQ qualification. The home has policies and procedures in place with regard to recruitment and staff recruitment records were inspected for 4 staff members and those seen contained all the required information including 2 references and a record of POVA/CRB checks. Staff training records were inspected and these were kept in individual staff files, those seen showed that staff were provided with the training required to enable them to support service users effectively, however some staff were due an update in moving and handling in May 2006. Staff records were kept in the administrator’s office and it was not easy to view training records without going through individual files. It was recommended that the home develop a simple system of viewing training records to make it easier to see when staff required refresher training. The inspector was informed that a new computer system was being installed in the next few weeks, which would flag up when refresher training was required. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is “Good”. This judgement has been made using available evidence including a visit to the service. The management arrangements in place at the home are generally satisfactory, although the manager needs to formally apply to be registered with the Commission for Social Care Inspection. The home operates a limited quality assurance monitoring system to obtain the view of service users at the home. Service users financial interests are safeguarded by the home financial procedures. Staff at the home are appropriately supervised and the health safety and welfare of service users and staff are promoted and protected. EVIDENCE: The registered provider and the manager work closely together and the manager has been in post for approximately 3 months, she is currently waiting to start the registered managers award and stated that she will be applying to be registered with the CSCI in due course. Staff spoken to said that the Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 21 manager was very approachable and were confident in her abilities. The manager is working to develop an effective quality assurance system in the home and has organised a relatives get together for Friday 19 May, she intends to hold regular relatives meetings and is looking at ways to get effective feedback from service users on how the home is performing and meeting their needs. The home does not handle the financial affairs of any of its service users; it does however keep small sums of money on behalf of 2 service users, the inspector checked the balances held and these were found to be correct. The hairdresser and chiropodist who visit the home provide an itemised bill and each service user is then invoiced individually. All staff at the home receive formal supervision at least 6 times per year and appropriate records are kept. All records inspected were found to be in order, accurate and up to date. The fire logbook was inspected and this confirmed that all relevant training, and testing is carried out. Private electrical equipment was last tested on 2/5/06, fixed electrical wiring was last tested on 19/01/06 and the approved gas safety engineer called in April2006. Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP30 Good Practice Recommendations It was recommended that the home develop a simple system for viewing training records to make it easier to establish when staff required refresher training Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Manor Place Nursing Home DS0000012150.V289713.R01.S.doc Version 5.1 Page 25 - 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. 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