Inspection on 20/12/06 for Maple Lodge

This inspection was carried out on 20th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maple Lodge 15/07/09

Maple Lodge 29/08/07

Maple Lodge 30/01/06

Maple Lodge 01/08/05

Maple Lodge 14/01/05

Maple Lodge 25/05/04

Maple Lodge 16/03/04

Similar services:

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Maple Lodge Rotherwood Drive Rowley Park Stafford Staffordshire ST17 9AF Lead Inspector Mrs Sue Mullin KEY Unannounced Inspection 20 December 2006 13:30 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 Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple Lodge Address Rotherwood Drive Rowley Park Stafford Staffordshire ST17 9AF 01785 255259 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) www.schealthcare.co.uk Southern Cross Healthcare Services Limited Mrs Julie Ann Anderson Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (20) Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30 January 2006 Brief Description of the Service: Maple Lodge is a purpose built detached care home, which stands in its own grounds. The home is registered to admit 40 residents over the age of 65 in the above category, who require personal care only. There are 40 single bedrooms all with en suite facilities and a passenger lift is available. Two bright and spacious lounges are available with two lounge/dining areas. There is a hobbies room which doubles up as a hairdressing salon on the first floor. The home has patio doors that open onto attractive enclosed grounds with established trees; seating has been provided some with pergola cover. A bus service runs from the end of the road half a mile from where the home is situated into the centre of Stafford, where all local services and shops are to be found. There are ample car parking facilities. Weekly fees are from £374 up to £550 Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced key inspection; the registered care manager was present throughout the course of the inspection. The methodologies used to examine the quality of care and the general service delivery, involved the inspection of records and systems. A sample tour of the premises was undertaken to ensure that the environment was conducive in meeting the needs of the service user group. The inspection process also included discussions with service users and staff members to establish their views and opinion with regards to the service provided at the home. Three service user surveys were returned to the CSCI and two service users quoted ‘I am alright thank you for asking’ and ‘I am happy as I am well looked after’. One comment card from a community mental health nurse stated’ The home are currently providing training following a vulnerable adult incident’. Three comment cards were received from three GP surgeries, that although did not make specific comments, one negative point from one GP was noted. He stated that there was not always a senior member of staff on duty to confer with. Eleven comment cards were received from relatives and all comments are outlined below: ‘I have no complaints about the care my mother receives, it is really good, however the homes accounts department keep billing us for invoices we have already paid’. ‘It would help if the laundry turned the clothes the right way round instead of leaving garments inside out, as residents are not able to do this for themselves’. ‘I think the staff at Maple Lodge are wonderful, my mother is so happy and well cared for’. ‘I would prefer to see more mature staff and a better air deodoriser’. ‘My relative died in the home some time ago and the care she received when she was dying was faultless – nothing was too much trouble for the staff. I still visit there and I am made to feel welcome, staff are so warm and friendly. The home is always clean and tidy, we were so very glad that we picked Maple Lodge for Auntie’. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 6 ‘Not all staff can speak or understand English and the food is poor in flavour and nutritional value’. What the service does well: What has improved since the last inspection? What they could do better: Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 7 There were no requirements or recommendations made on this key inspection. The home continues to meet all the National Minimum Standards. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 8 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 Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose provided relevant information relating to the service and provisions available at the home, to enable prospective service users to establish whether the home would be able to meet identified needs. The home’s admission procedure encouraged a trial visit to the home. EVIDENCE: The homes Statement of Purpose provides up to date information relating to the service and provisions available at the home. Information contained within this document was in compliance to Schedule 1, of the Care Homes Regulations. The homes admission procedure incorporated a full pre admission assessment, to establish whether the home would have the capacity to meet the individual’s identified care and social needs. This process was very thorough and due care and attention was paid to ensure that no service users would be admitted to Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 10 the home, that would have a negative effect on the service users already in their care. The management had a clear picture of the type of service users and associated problems that they could offer a good service to and knew what boundaries they had in caring for people with dementia who had forms of challenging behaviour. The ambience of the home and the contentment of the service users were high on the agenda. Discussions with the care manager confirmed that prospective service users were encouraged to visit the home prior to admission, having the opportunity to view the premises and meet the staff team. Information derived from the pre admission assessment provided the foundation for the development of a comprehensive care plan and appropriate individualised risk assessments. Discussions with the care staff identified that there were no service users within residence with any specific cultural or religious needs. Service users would be able to continue to practice their religious faith if they so wished. Maple Lodge House does not provided intermediate care. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care planning processes are robust, current and protect service users health and welfare. The homes policies, procedures and care practices ensured that all service users had access to relevant healthcare services when required. EVIDENCE: As previously identified within the contents of this report, information derived from the pre admission assessment provided the foundation for the development of comprehensive care plans. Two care plans were randomly selected for examination, information contained were detailed, relating to the specific care, physical and social needs of the individual service user, providing information with regards to the degree of support and assistance required to enable the individual to live a fulfilled lifestyle. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 12 The examination of care plans and discussions with the care manager and care staff confirmed, that the plan of care was reviewed on a monthly basis to reflect the changing needs of the individual service user. Records were maintained of all healthcare professional intervention, service users had access to relevant healthcare services for routine health screening. All service users were registered with a General Practitioner and where possible, they were able to maintain their own General Practitioner. All care plans included a photograph of the service user, social profile, bodymapping record, long and short-term problems, care plans implemented and evaluated regularly. Nutritional/continence/malnourishment/pressure sore/bowel/falls risk assessments were in place and all service users were assigned a key worker to monitor their records. Weights were recorded regularly and dependency charts were completed monthly. There was evidence that relatives were actively encouraged to take part in the programme of care implementation. With reference to promoting the privacy of service users, all bedroom doors were fitted with a locking device and service users were able to have their own key if they desired and were competent to do so. Staff were observed during the process of the inspection knocking on bedroom doors prior to entering. Discussions with the service users and feedback from comment cards confirmed that the staff were very nice and respected their privacy. Staff were seen laughing and joking with the service users in a warm and affectionate manner. Service users looked very well groomed with a lot of attention paid to personal hygiene care. Laundry was undertaken and the responsibility of the sister home Maple Court next door. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There was a positive focus on social activities and to ensure that service users had access to leisure services within the community, to maintain social inclusion. Service users had freedom of movement throughout the home with limited restrictions with regards to health and safety. Service users were provided with the necessary support to ensure that they were able to maintain contact with their family and friends. EVIDENCE: The home has a dedicated activity organiser who is very enthusiastic about her work. Information identified on the notice board and discussions with staff confirmed that a wide range of social activities is available. They included, shopping trips/visits the garden centre/visits from the local adopted school/craft work/bingo/library visits/quiz/music/reminiscence days/ Pat the dog therapy/women’s fellowship Trinity church visits/visits to local sheltered accommodation/ walks in the park and in town and Holy Communion. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 14 On the day of the inspection the activity organiser had decorated the home with a real festive theme and introduced a raffle, the proceeds of which were to go to the residents comfort fund. Discussions with the care manager and care staff confirmed that sufficient staffing was provided at key points of the day, to ensure that service users were provided with the necessary support and assistance in relation to their care and social needs. Service users meetings were undertaken giving the individual the opportunity to discuss the general service delivery and to obtain information relating to forthcoming social events. Service users were able to maintain contact with their family and friends of who were able to visit the home at any time within reason. Service users were able to entertain their guests within the privacy of their bedrooms or utilise the communal areas. The home operated a four-week menu; meals provided were varied and well balanced. There were no special dietary requirements in relation to cultural and religious needs. All main meals were prepared and cooked at the sister home Maple Court, next door. Catering staff were also supplied from there but staff in the ‘Lodge’ ensured that all the dietary needs were met in accordance to service users likes, dislikes and special dietary requirements. This entailed effective communication with the main kitchen staff. Service users (who were able to comment) and relatives reported that meals were nice and that the quantity was adequate. Only one comment card stated that the food was poor in flavour and nutritional value, all other comments were positive. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure was in place of which was accessible to all service users and their representatives. The homes procedures, policies and recruitment process ensured that service users were protected from abuse. EVIDENCE: There was a clear complaints procedure in place of which, was located by the main entrance to the home. The document identified that any complaints would be addressed within 28 days. The complaint procedure also provided information relating to the Commission For Social Care Inspection, in compliance with regulation 22(6)(a), of the Care Homes Regulations. The homes Statement of Purpose also contained information relating to the complaint procedure. There had been no complaints referred to the CSCI since the last inspection. The home was in receipt of the Staffordshire Inter Agency Vulnerable Adult Policy. An informal interview with two care assistants confirmed that staff were aware of the appropriate actions to take in the event or suspicion of abusive practices. The Registered Manager informed the inspector that there had been one POVA incident relating to allegations of abuse, which had been investigated appropriately and unsubstantiated. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was conducive in meeting the needs of the service user group, the installation of appropriate aids and adaptations promoted their independence. Health and safety procedures in place protect both the service users and the staff group. EVIDENCE: Maple Lodge is situated in Stafford, Staffordshire having easy access to public transport and local amenities. The two storey property is situated within it own grounds, (Shared by its Sister Home Maple Court) providing 40 single occupancy bedrooms, all of which were equipped with an en suite facility. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 17 Bedrooms were located on both the ground and first floor; bedrooms that were inspected were equipped with essential furnishings and items to provide a comfortable area. Efforts had been made to personalise bedrooms to reflect the individual’s personality and interests. A locking device was fitted to all bedroom doors, promoting the privacy of service users. Nurse call alarms were installed in all service user areas and on request a telephone can be provided within bedrooms (the cost of which is levied to the service user). Bathrooms and toilets were located on both the ground and first floor and were in close proximity to bedrooms and communal areas. All bathrooms were fitted with an assisted bath to promote the independence of service users with limited mobility. One passenger lift was in place allowing access to all facilities within the home; the corridors and doorframes were of a suitable width to accommodate wheelchair access and to facilitate the use of a hoist. Grab rails were situated throughout the home. Ramp or flush access was available at all external entrances. The examination of records relating to the servicing of appliances identified that hoists were serviced/checked on a six monthly basis. The care manager confirmed that all staff had received training in the use of hoisting appliances. There are two lounges provided on each floor equipped with suitable furnishings. Adequate lighting, ventilation and heating were provided throughout the home. All radiators within service user areas were guarded. The garden was well maintained and was accessible to all service users; car parking was available at the rear side of the property. The general cleanliness and hygiene of the home was of a high standard. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels ensured that service users were provided with the necessary support and assistance. The homes procedures and practices with regards to staff recruitment, induction and training ensured the protection of service users. EVIDENCE: There were 37 service users in the home with 3 vacancies and one person in hospital and staffing was adequate on the day of the inspection, to ensure the continued supervision and support of those service users. Discussions with the staff and the examination of staff rotas evidenced that adequate staffing levels were maintained over a 24-hour period. Domestic staff were employed in sufficient numbers, to ensure that the standard relating to the cleanliness of the home was maintained to a high standard. The home had 24 hours a week administration cover. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 19 The pre inspection information identified that 33 of the workforce had obtained the National Vocation Qualification. 5 staff hold a current first aid certificate. Discussions with care staff confirmed that the home had a positive approach to staff development and training. The homes registration category enabled the home to provide a service for individuals who have dementia and staff are provided with training with regards to dementia care. The files of two staff recently recruited were seen and identified that two written references, a POVA 1st clearance and a Criminal Record Bureau check was undertaken prior to appointment. Induction was undertaken over a suitable time period and overseen by a more senior member of staff. All staff have received mandatory training, COSSH, manual handling, food hygiene, protection of vulnerable adults, fire and infection control. Other areas of training already provided includes: • • Yesterday, today and Tomorrow (Alzheimer’s) Administration of medication Further training planned includes: • • • Pressure sore prevention Continence care Dementia awareness Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management style within the home promoted the welfare, choice and independence of the individual service user. Appropriate safety checks relating to the environment and systems were undertaken to ensure the health, safety and welfare of both the service users and the staff group. EVIDENCE: During the process of the inspection the registered care manager demonstrated extensive knowledge of individual care needs of all service users under her care. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 21 She has been in post as care manager for 4 years and knows duties and responsibilities well and has used her supernumerary time to complete all her managerial tasks in line with the National Minimum Standards. There was a positive emphasis focused on providing high standards of care and a service that was diverse in meeting the specific needs of the individual service user. The care manager was observed throughout the course of the inspection to interact and communicate with both the service users and the staff group in a respectful and professional manner. Staff spoken to informed the inspector that the care manager was very supportive and approachable. Some of their comments are outlined below: ‘This is an enjoyable place to work, the residents are nice’ ‘The standard of care is good here’ ‘We have a good staff team here, we all get on well’ ‘We can’t grumble about anything really’. Staff also reported a good level of stocks and supplies. Regular formal supervision sessions were undertaken to ensure staff were provided with the necessary support and training to undertake their duties. To ascertain the views and opinions of the quality of service provided within the home, questionnaires were distributed on a regular basis to all stakeholders. This is an ongoing process. From the pre inspection information provided by the home the following were identified: • • • • • • • • • • Gas appliances and systems were checked on 22/08/06 Hoists were serviced/checked 29/10/06 Electrical installation certificate 12/01/05 Emergency lighting checked 21/11/06 Certificate of maintenance of fire extinguishers 03/11/06 Fire safety training was undertaken on 15/09/06 Passenger lift was serviced on 07/06/06 Central heating system was serviced on 22/08/06 Nurse call systems services on 03/11/06 Legionella testing 03/08/06 The fire alarm systems were checked on a regular basis. Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 X 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X X 3 X 3 Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 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. Refer to Standard Good Practice Recommendations Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Maple Lodge DS0000005120.V321056.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!