Inspection on 25/07/06 for Meadow Acres

This inspection was carried out on 25th July 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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Acres 20/07/07

Meadow Acres 02/11/05

Meadow Acres 17/05/05

Meadow Acres 04/11/04

Meadow Acres 02/09/04

Meadow Acres 24/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Meadow Acres 7 Crabtree Lane Harpenden Hertfordshire AL5 5TA Lead Inspector Julia Bradshaw Key Unannounced Inspection 25th July 2006 1:00 Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Acres Address 7 Crabtree Lane Harpenden Hertfordshire AL5 5TA 01582 768098 01582 768268 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) Caretech Community Service Limited Sheryl Ann Soen Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (8), of places Physical disability over 65 years of age (8) Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: Situated at the end of a private drive, Meadow Acres is a bungalow that has been extended and converted for its present use. It offers six single occupancy bedrooms, a dining room, a lounge, a multi-sensory room, two bathrooms, two toilets and a shower. There is also a kitchen, an office and a laundry. Each bedroom has a hand basin and is personalised to reflect the character of each service user. The home is surrounded by mature gardens, parts of which have been constructed to a theme. There is also a large patio area, much used by service users in clement weather. The home is located close to a local parade of shops and within walking distance of Harpenden town centre with its range of shops and amenities. The fees range from £950 to £1390.50 per week. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was carried out on the 25th July and over one day. This was an unannounced visit. There were three service users at home during this inspection and therefore an opportunity to speak to the service users about the service they receive at Meadow Acres. One service user also volunteered to show the inspector around the home. The home appeared both comfortable and welcoming. The manager and staff have worked hard since the last inspection took place and have implemented the requirements made at the last inspection. The service users now have access to a computer. The manager has worked hard to fill the vacant staff posts within the home and stated that there were now only two remaining full time posts vacant. What the service does well: What has improved since the last inspection? The manager has worked hard to improve the levels of recruitment and reported that various posts have been filled since the last inspection took place, which has helped in providing consistency of approach to the people living at Meadow Acres. The manager has devolved some responsibilities to the rest of the team in order to provide some experience and opportunity throughout the staff team. The service users now have access to a computer within the home. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 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. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. A detailed Statement of Purpose and service user guide is held within the home. Generally there is a good system of pre-admission assessment in place to ensure that the care needs of people who may want to move into the home are fully understood and can be fully met. Risk assessments were up to date. EVIDENCE: A detailed Statement of Purpose and service user guide is held within the home and all current and prospective service users are provided with a copy. Both these documents were updated in June 2006. The Statement of purpose contains information for the service user to make an informed choice about where to live. However the provider should endeavour to further develop all relevant documents into a more “user friendly” format, which is accessible to all current service users and also to prospective service users and their families and carers. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 9 Full assessments of each service users needs and aspiration are made before the service user moves into the home and reviewed as part of the care planning process. The assessment package for the most recent admission into the home (March 2006) was inspected and was both was detailed and informative about the care this service user requires. Individual risk assessments were in place and had been reviewed since the last inspection took place. The staff team will be implementing the Person Centred Planning approach into the home. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Individual needs and choices within the home are being promoted to encourage and empower user self-determination. Service user plans fully reflect the service users needs. Service users have the opportunity to contribute to some decisions taken within the home. Service users risk assessments are in place and reflect risks in relation to personal health and safety. EVIDENCE: All service users have an individual care plan and an allocated key worker to support them within the home. Individual daily notes and guidelines for the service userswere available. All service users are supported within the Whole Life Review framework to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the care plans of each Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 11 individual are owned by the individual, some service users spoken to during the inspection were aware of their individual care plans. Each service user is encouraged to take part in all daily living tasks, where able. All information is handled with care and respect. All personal notes and files detailing information on the service user are locked away. The home has good risk assessment procedures and all risk assessments were up to date and accurate regarding generic risk assessments. There were also some individual risk assessments in place. The home has good systems of communication with both the service users and their carers and information is made available. There is a general policy on confidentiality. Service users’ individual records are accurate and they are stored securely in a locked filing cabinet. All staff should sign each document to confirm they have read the necessary policies and procedures. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Personal development opportunities are encouraged for all service users Individual rights and opportunities are recognised and supported, where possible. Restrictions on service users independence and rights are recognised and respected. Personal and sexual relationships are supported in a mature and professional manner. Service users are provided with a varied and wholesome diet. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 13 EVIDENCE: The home supports service users to access a range of social and leisure activities outside of the home. Service users are all offered an annual holiday, which is organised by the staff and in consultation with the service users. Holidays planned for this year include going to Butlins in Skegness and a group of service users are going to Minehead. All service users are encouraged to retain their independence and are assisted in developing links and opportunities within the local community. Service users, who choose to attend day-care, attend the Butterwick Centre in St Albans for an average of three days a week. One service user remains at home for day care, which is provided by the care staff. Service users at Meadow Acres are unable to manage their own finances therefore staff are responsible for managing and auditing both the personal allowances and financial contributions. A random check of three services users monies proved accurate and reconciled with the individual ledger held. Service users spoken to during the inspection were positive about the care and support they receive at the home. Family and friends are welcomed into the home subject to the service users wishes. Service users are able to develop relationships and are supported to ensure that appropriate action is taken. Service users confirmed that staff adhere to a knock and wait policy. The service user group is encouraged to undertake the menu planning on a weekly basis, although this can prove difficult on occasions, due to communication issues, however the staff assist in service users making informed choices by using pictorial aids for menu planning. Shopping is carried out on a weekly rota basis. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18-21. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The current medication practices and maintenance for medication are detailed and comprehensive. The ageing, illness and death of a service user is handled with respect and information recorded is accurate. Service users emotional and physical needs are being met adequately. EVIDENCE: The current service users all require support with in personal care. All service users living are Meadow Acres are female and the gender mix between the staff team is reflective of this. Service users can choose when they get up and go to bed, and are assisted to choose and pay for their own clothes and attend local hairdressers within Harpenden. For those who are assessed, the services of the community health services are accessed. Service users are currently registered with GP practices within the Harpenden area. They visit a local dentist, optician and chiropodist when required. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 15 The home currently uses a monitored dosage system for dispensing medication. None of the current service user group is self-medicating. The medication was suitably stored and the disposals book was up to date. All new staff receives a full induction, which includes three observation sessions with a senior member of staff before they are able to administer medication and assessed as competent. The home does not currently hold any PRN medication. Service users last wishes are recorded within their care plan and in consultation with families, where appropriate. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22-23. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. Robust policies, procedures and training are in place to ensure service users are protected and safe. EVIDENCE: A comprehensive complaints procedure is in place, which details that the manager responds to all complaints. A record is maintained of complaints made detailing actions and outcomes as necessary. The complaints procedure is produced in a pictorial format in order to ensure the current service user group have the opportunity to fully understand how to complain. The home has received no complaints since the last inspection. The complaints procedure includes the correct contact details of the CSCI. Robust procedures are in place to ensure that service users are protected from abuse and harm. Staff receive adequate Protection of Vulnerable Adults (POVA) training. The last training was held on the 9/3/06. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Staff personnel files were inspected and contained all the required information. Service users finances were checked on the day of the inspection and all monies were reconciled with the individual ledgers. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The interior of the home offers a pleasant, comfortable and safe environment to its service users. The home is adequately maintained and generally clean. The garden area however is poorly presented. There are adequate toilet, bathing and communal facilities. The home is maintained within health and safety standards. EVIDENCE: The overall environment is generally of an acceptable standard. Staff and service users, where appropriate are responsible for the domestic tasks. The home is of domestic style and in keeping with the local community. It is accessible and suitable for wheelchair users or those with mobility problems. Furnishings, fittings and equipment are of a reasonable standard. The bathrooms are adequately maintained. The manager and staff have taken an active role in planning and improving the current environment for the service Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 18 users, including creating an additional two placements within the home. These rooms have been designed with kitchenettes and en-suite bathrooms. One of these rooms is occupied and the other room remains vacant. There is adequate communal space with a large lounge and dining room. Service users bedrooms have been personalised and reflect their interest and hobbies. All rooms offer single occupancy Generally the standard of hygiene throughout the home was good. The inspector identified a new carpet is required in one of the bedrooms where it is badly stained. There is also an area of the ceiling, which has bubbled due to a leak, which requires attention. The home has adequate specialist aids, including hoists, specialist beds and chairs and toileting aids are also in place for the service users who require this support. The garden area currently appears shabby and uninteresting for the service users. The inspector was informed by the manager that there has been some planning work being undertaken and it is hopeful that this work will be completed before the next inspection takes place, in order and that the service users can benefit from the garden area during the remaining summer months. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Individual needs and choices are being promoted to encourage and empower user self-determination. The management is secure and effective ensuring that changing needs of service users are met and that the home is running meeting its aims and objectives. Some quality assurance systems are in place Health and safety standards within the home are good. Documentation in relation to the recruitment and employment of staff was complete. EVIDENCE: Staff spoken with during the inspection appeared very clear of their individual roles and responsibilities. Staff were seen to support the main aims and values of the home. There are clearly defined job descriptions and person Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 20 specifications in place. All staff have received a series of mandatory training course in order for them to meet the needs of the service users. Training includes, Adult protection (9/3/06) Health and safety (24/2/06) food hygiene (2/6/06) moving and handling (17/3/06) first aid (104/06) Training records are maintained, using a matrix planner. There is one person with NVQ level 4, six people are currently studying for their NVQ level 2, one staff member already has NVQ level 2 and the manager has NVQ level 4. Recruitment practices were inspected and proven to be accurate and the three files checked contained all the required information. Appraisals are currently being implemented for all staff and these will be completed by December 2006. The staffing levels appear to be adequate. The total compliment of staff is currently 15 including the manager and there are currently two full time support worker vacancies. Staff recruitment has improved since the last inspection took place. Meadow Acres also benefits from having some very loyal and committed staff who have been at the home for several years. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42,43. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home is generally well managed. Service user views are valued within the management of the home. Generally health and safety is promoted although minor shortfalls have been identified in the report. EVIDENCE: Service users appear to be generally happy and were observed to be relaxed within their environment. The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach creates an open, positive and inclusive atmosphere, staff and the service user spoken to commented that they feel supported and valued and that they feel the home is well managed. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 22 A clear commitment is made to equal opportunities, with staff and service users expressing positive views with regards to this. The service users appeared to benefit from this well structured and well run home. The staff and manager are adequately and suitably trained in order to meet the complex changing needs of the service users. The manager has daily contact with each service user and therefore assisting in any issues of concern being dealt with immediately. Some service users at the home have difficulty in communicating verbally and therefore staff have ensured they have implemented suitable non-verbal systems of communication in order that service users have the opportunity to raise issues or concerns. All records are secure and were up to date and held in accordance with the Data Protection act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. Records regarding staff recruitment were inspected and there was adequate evidence to confirm that the recruitment and selection procedures were being adhered to. A random check on three service users personal monies proved to be accurate. Individual and generic risk assessments were in place, with all external required safety checks occurring. All fire records were up to date and all health and safety records were in place and being maintained appropriately. The manager must ensure there is a current fire risk assessment and fire certificate in place. There is a concern that the exterior/garden area of the home is currently unsafe and only part completed. This could present a health and safety risk to service users and staff. Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 x 3 2 3 Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 24 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. 1. 2 Standard YA24 YA25 YA24 Regulation 23 (2) (d) & 16 (2) (c) 23 (2) (d) Requirement Timescale for action 30/09/06 3 YA24 23 (2) (o) 4 YA42 23 (4) The manager must replace the badly stained carpet in one service users bedroom The manager must arrange for 30/09/06 the ceiling to be repaired where it has “ bubbled” and is in a state of disrepair. The manager and proprietor 30/09/06 must establish the timescale for the garden work to be carried out as this currently appears unsafe and shabby in appearance and is restricting service users accessibility. The manager must provide an up 31/08/06 to date fire risk assessment and fire certificate. 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 YA8 Good Practice Recommendations Visual aids and user-friendly props are recommended to illustrate the changes to the building and décor such as DS0000019463.V297959.R01.S.doc Version 5.2 Page 25 Meadow Acres photographs and theme boards with paint and fabric swatches. 2. YA12 It is recommended that individual staff are identified to structure meaningful activities for service users who remain at home. Professional advice regarding menus is recommended to ensure a variety of meals are available to meet nutritional requirements. 3. YA17 Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Meadow Acres DS0000019463.V297959.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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