Inspection on 20/01/06 for Meera House Nursing Home

This inspection was carried out on 20th January 2006.

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

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

Other inspections for this house

Meera House Nursing Home 01/03/07

Meera House Nursing Home 29/09/05

Meera House Nursing Home 04/01/05

Meera House Nursing Home 12/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Meera House Nursing Home 146-150 Stag Lane Kingsbury London NW9 0QR Lead Inspector Julie Schofield Unannounced Inspection 20th January 2006 08:20 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 Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 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. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Meera House Nursing Home Address 146-150 Stag Lane Kingsbury London NW9 0QR 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) 020 8204 9140 020 8206 2205 directors@meeranursing.com Meera Nursing Home Limited Anil Kumar Sohun Care Home 52 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (17), Mental disorder, excluding learning of places disability or dementia (1), Old age, not falling within any other category (33) Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Up to 1 person over the age of 65 who requires personal care. Up to 51 persons over the age of 65 in need of nursing care. Within the nursing care places up to 17 persons over the age of 65 years who require dementia care. Temporary variation agreed for one named individual (Mrs MJ) aged 63 years EMI for the duration of her stay. Temporary variation agreed for one named individual (Ms GN) aged 56 years for the duration of her stay. Temporary variation agreed for one named individual LN aged 60 years EMI, PD,DE for the duration of her stay. 30th September 2005 Date of last inspection Brief Description of the Service: Meera House provides personal and nursing care for up to 52 residents who are elderly. The home predominantly provides a service for Asian elders, who are vegetarian. The home is located within a short drive from shops and amenities in Kingsbury and Edgware. It is also close to local transport facilities. There is parking on site and it is possible to park in the street close to the home. The home has stood on the site since 1989 and has been extended over the years. The last extension in 2003 increased the maximum numbers of service users from 34 to 51 places. An application for registration of another bedroom was approved in 2005. The home now has 42 single bedrooms (25 of which have en-suite facilities) and 5 rooms occupied on a shared basis (4 of which have en-suite facilities). Bedrooms are situated on ground, first and second floors and there are passenger lifts to assist movement. Bathing and toilet facilities are situated on each floor. There are 2 large open plan lounge and dining areas. The home has a well-maintained enclosed and accessible garden, which includes a paved patio area. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of a visit by the allocated Inspector to the home on the 20th January 2006 and a visit by the pharmacy Inspector on the 14th February 2006. The Inspector would like to thank the manager, deputy manager, members of staff and residents for their assistance and participation during the visit, which started at 8.20am and finished at 1.50pm. During this visit records were inspected and the serving of the midday meal was observed. A site inspection took place. An interpreter assisted the Inspector during the discussions with the residents. What the service does well: What has improved since the last inspection? The statutory requirements that were identified during the last inspection have now been met. Cabinets on the patio area near the lower ground floor have been removed. The home has reviewed its security system in respect of visitors to the home. The home has forwarded a copy of the certificate for the Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 6 Landlords Gas Safety Record test carried out in 2005 to the CSCI. The supply of hot water to the bedrooms has been adjusted so that the temperature does not exceed 43 degrees centigrade. 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. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 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 Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 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): 3, 5, 6 Prior to admission, information is received about the prospective resident and the manager carries out an assessment to ensure that the needs of the resident can be met within the home. Residents and their families are involved in the process of choosing a care home that can meet the needs of the resident and make their decision after an introductory visit to the home. EVIDENCE: The case files of 3 residents who have recently been admitted to the home were examined. Each of the case files included information from the placing authority e.g. social worker’s report, hospital discharge letter, psychiatrist report etc and an assessment carried out by the manager, prior to admission. The manager said that prospective residents and their families are welcome to visit the home. Only a few residents have visited the home prior to their admission but other residents confirmed that their relatives had visited prior to a decision about admission being made. Residents who had visited the home said that they had liked the Asian food, the bhajans and the activities. During Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 9 the visit the manager is also able to show the prospective resident and/or their relatives the room that would be occupied and introduce them to residents and to members of staff. Meera House does not provide an intermediate care service. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 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 Holding regular review meetings ensures that changes in the needs of residents are identified and can be addressed and the home must ensure that these happen. Access to health care professionals visiting the home and to nurses working in the home ensures that the health care needs of residents are met. Standard 9 was inspected by the pharmacy Inspector and a copy of the report of this visit is available in the home. Standard 10 was inspected during the previous inspection in September 2005. EVIDENCE: Six case files were inspected. These were selected from both units. It was noted that files contained care plans, which included an assessment of personal, health and social care needs. The social care needs included religious and cultural needs. Where possible the resident or a family member had signed the care plan. Case files included risk assessments for manual handling, nutrition, pressure sores and falling. It was noted that reviews were outstanding. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 11 A discussion about the health care needs of residents took place with the deputy manager. A physiotherapist visits the home weekly and there are records of the treatment given to individual residents. One resident referred to her as the “lady with the hot packs”. Other residents said that the physiotherapist had helped them to regain their mobility. Another resident said that they had started to walk again since living in the home and that it was due to hard work on her part and on the part of the members of staff. There was a record of six monthly visits to the home by the dentist although the deputy manager said that if necessary an appointment could be made between scheduled visits. There was a record that the optician visits the home on a six monthly basis. The chiropodist calls on a monthly basis and there was a record of visits made by the GP. Two residents said that the GP visited the home each week. On one case file there was a copy of a psychiatric assessment, which had been requested for one of the residents. Support is also given to residents who are diabetic and at the time of the inspection 2 residents had pressure sores. There was a record of their treatment and progress. One resident said that they had left hospital with a blister on their heel and that the nurses changed the dressing for them and that they had been provided with a special mattress. The pharmacy Inspector forwarded a report to the home where she identified 7 statutory requirements. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 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): 14, 15 Opportunities for choice enrich the quality of life of residents and they said that they were able to do what they wanted. However opportunities for activities both inside and outside the home are necessary. Residents have a varied and balanced diet, which respects their cultural and religious needs, and which they found enjoyable. Standards 12 and 13 were inspected during the previous inspection in September 2005. EVIDENCE: The manager said that residents are encouraged to exercise choice in their daily lives and with this the right to say “no”, as Meera House is their home, or to change their minds is respected. He gave examples of choice and said that residents could have a lie in if they did not wish to get up at a particular time in the morning. They could choose to have breakfast in bed if they did not want to have this at the dining table. He said that when outings have been arranged residents have changed their minds and chosen not to take part at the last moment. A resident said that they could decide when to sleep and when to get up and that she could do everything that she wanted to and was not told what to do. Another resident said that he was able to do what he wanted and that if he Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 13 wished, he was able to have a meal in this room. One resident spoke of choosing what to wear each day and that she “had her wishes”. A fourth resident said that they could do what the wanted and that staff asked them what they wanted to wear. A number of residents said that they would like to go out of the home when the weather was better either on an outing or to the temple but would either need an escort or transport. A resident said that staff listen to her if she wants different foods and will change the menu for her. Another resident said that they would make him something if he wanted it. All of the residents who took part in the inspection said that the food was good. One resident commented that they liked the food and didn’t feel the need to ask a relative to bring anything in with them. During the inspection a meal was served, which included mixed vegetables, dhal, chapattis, rice, yoghurt and pickles. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 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 The welfare of residents is promoted and protected by having a complaints procedure in place. An adult protection policy and in depth protection of vulnerable adults training for staff contribute towards the safety of residents. In-house training needs to be supplemented by access to external training. EVIDENCE: The complaints procedure was on display in the home and a copy is contained in the service users’ guide. It is written in both English and Gujarati. The procedure informs the complainant of their right to contact the CSCI, local councillor and the Ombudsman. It includes timescales for the acknowledgement of a complaint and for notifying the complainant of the outcome of the investigation. One complaint has been recorded since the last inspection and the records included the outcome of the investigation and details of the response given to the complainant. Residents said that they saw the manager and the proprietors and that they were able to speak to them. Residents also said that they can talk to the manager and that the manager listens to them. During the last inspection a statutory requirement was identified that staff have access to external training courses in respect of adult protection procedures. The timescale for this has not expired. The manager said that the home was liaising with the local authority regarding training for staff. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 15 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, 20, 26 Residents live in a safe and well-maintained environment. Residents are able to enjoy a garden that is attractively set out, well maintained and pleasing to the eye. Level access makes this a facility that can be used by residents in either lounge area. The health and safety of residents is promoted through a clean and hygienic environment although the clinical waste containers in the bathrooms must be regularly emptied so that the systems in place to control the spread of infection are maintained. EVIDENCE: The home is smartly decorated and is well maintained. A programme of routine maintenance is in operation. It is decorated in a homely manner and one of the residents said that the decorations are purchased by the proprietors from India and that they are changed on an annual basis. Decorations respect the religious and cultural needs of residents. During the last inspection a statutory requirement was identified that the cabinets on the patio area near the lower ground floor are removed. This area was inspected and the cabinets were no longer there. Although the site visit Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 16 took place in January the garden was well kept with shrubs that provided areas of interest. It was noted during the inspection that all corridors, communal areas and bedrooms where the doors had been left open were clean and tidy and free from offensive odours. The clinical waste container in one of the bathrooms was full to overflowing and needed emptying. Residents confirmed that the home was always kept clean. The laundry room is situated on the ground floor and is entirely separate to any areas where food is prepared or consumed. The facilities consist of commercial appliances and are appropriate for the size of the home. Washing machines have sluicing cycles and there are handwashing facilities in the laundry room. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 17 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): 28, 29, 30 NVQ training enhances the quality of care provided to residents and the home needs to ensure that staff undertake and complete this. The safety and welfare of residents is promoted and protected when the home’s recruitment policy includes all the necessary checks and safeguards. Two written references are needed for each new member of staff. Staff supporting residents that have dementia need to undertake training in dementia care. Training enhances the ability of staff to meet the needs of residents by developing their understanding, knowledge and skills. . Standard 27 was inspected during the previous inspection in September 2005. EVIDENCE: During the last inspection a statutory requirement was identified that 50 of carers achieve an NVQ level 2 qualification. The timescale for this has not expired. The manager said that 3 staff are due to complete their NVQ training at the end of January 2006 and 4 staff are due to complete their preparatory studies (English language classes) at the end of January and will then commence NVQ training. Two members of staff have commenced duties in the home since the last inspection. Their personnel files were inspected. Both members of staff had satisfactory enhanced CRB disclosures on file. There was an employment history for each member of staff, which included details of their qualifications and experience. Where previous employment had been abroad the manager Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 18 had obtained verbal references. It is recommended that reference requests are faxed, emailed or posted. A discussion took place with the manager in respect of recent training undertaken by the nurses and by the carers. He said that nurses have undertaken wound management, manual handling and first aid training. Carers have undertaken training in manual handling, fire safety, food hygiene, infection control and diabetes. Not all staff have received training in dementia care. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 19 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, 38 The registered manager continues to develop his knowledge through further training and this contributes towards understanding the needs of residents and staff. There is a commitment to complete the NVQ level 4 training. Quality assurance systems identify satisfaction with current services and changes in the needs and expectations of residents. Up to date records of transactions and the setting up of a savings account safeguard the financial interests of residents. Security in the home benefits both residents and staff and arrangements for giving access to visitors has been reviewed. Maintaining and servicing equipment and systems in the home to a satisfactory standard promotes the safety of residents and staff. There are records and certificates to demonstrate this. EVIDENCE: During the previous inspection a statutory requirement was identified that the manager achieves an NVQ level 4, or equivalent, in management and care. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 20 The timescale for this has not expired. The manager already holds a DMS, has a masters’ degree in social policy and administration and is a qualified RGN. The college has advised him that he only needs to complete 2 of the modules of the RMA to meet the requirements of the course. A discussion took place with the manager regarding quality assurance systems in the home. He said that feedback is obtained from residents either on a 1 to 1 basis or in small group discussions. The manager and proprietor talk to all the residents on a regular basis and ask for their comments. Relatives are sent a satisfaction survey on an annual basis and the information gained from these is developed into an action plan, which is then discussed with relatives at the next relatives meeting. Although the manager asks for feedback from the placing authority when they attend a review meeting it is recommended that a questionnaire is used and that it is distributed at the end of the review meeting. The manager said that the home only has involvement in the financial affairs of 2 of the residents and the records were available for inspection. Records were up to date and complete. One resident has a savings account in addition to the money kept in the home for day-to-day expenditure. The savings book was available for inspection. A member of staff witnesses and confirms the amount of money given to the other resident by the manager, as the resident can be forgetful. During the previous inspection a statutory requirement was identified that the home reviews its security system in respect of visitors to the home. Discussions have taken place between the proprietor and the manager. A new system for the front door is being considered. During the previous inspection a statutory requirement was identified that the home forwards a copy of the certificate for the Landlords Gas Safety Record test carried out in 2005. This has been done. During the previous inspection a statutory requirement was identified that the supply of hot water to the bedrooms is adjusted so that the temperature does not exceed 43 degrees centigrade. This has been done. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 21 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 N/A 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X X X 2 STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 22 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 Standard OP7 Regulation 15.2 Requirement That the care plan and placement is reviewed at least on a six monthly basis and that a copy of the minutes is kept on the case file. That the resident, key worker, family and representative from the placing authority are invited to the review meeting. That there is compliance with the requirements identified by the pharmacy Inspector during her visit on the 14th February 2006. That discussions take place with residents about their wishes to go out of the home either for a walk or for an outing. That staff have access to external training courses on adult protection procedures. That clinical waste containers in bathrooms are emptied on a regular basis to prevent overflowing. That 50 of carers achieve an NVQ level 2 qualification. That each staff file contains 2 written references. That all staff receive training in DS0000022933.V269493.R01.S.doc Timescale for action 01/09/06 2 OP9 13.2 14/03/06 3 OP14 16.2 01/05/06 4 5 OP18 OP26 13.6 13.3 30/06/06 01/04/06 6 7 8 OP28 OP29 OP30 18.1 19.1 18.1 31/12/06 01/05/06 01/07/06 Page 23 Meera House Nursing Home Version 5.0 9 OP31 9.2 dementia care. That the manager achieves an NVQ level 4, or equivalent, in management and care. 30/06/06 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 2 Refer to Standard OP29 OP33 Good Practice Recommendations That reference requests to previous employers who are abroad are faxed, emailed or posted. That a questionnaire is given to the representative from the placing authority when they attend the resident’s review meeting. Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Meera House Nursing Home DS0000022933.V269493.R01.S.doc Version 5.0 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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