Inspection on 28/09/07 for Minford Gardens, 35

This inspection was carried out on 28th September 2007.

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Minford Gardens, 35 20/06/08

Minford Gardens, 35 08/02/07

Minford Gardens, 35 15/02/06

Minford Gardens, 35 16/08/05

Minford Gardens, 35 28/01/05

Minford Gardens, 35 08/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Minford Gardens, 35 Minford Gardens 35 Minford Gardens West Kensington London W14 0AP Lead Inspector Tony Lawrence Key Unannounced Inspection 28 September 2007 09:15 th Minford Gardens, 35 DS0000019138.V350879.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 Minford Gardens, 35 DS0000019138.V350879.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. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Minford Gardens, 35 Address Minford Gardens 35 Minford Gardens West Kensington London W14 0AP 020 7603 8768 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) gill.ritchie@yarrowhousing.org.uk Yarrow Housing Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons for whom residential accommodation with both board and care is provided at any one time shall not exceed four people with learning disabilities. 8th February 2007 Date of last inspection Brief Description of the Service: 35 Minford Gardens is a registered care home providing personal care and accommodation for four people with a learning disability. At the time of this inspection 4 men were living in the home and there were no vacancies. Notting Hill Housing Trust owns the property and the care is provided by Yarrow Housing Limited, a voluntary organisation. The home is close to the shops and transport links of Shepherds’ Bush and Hammersmith. The home is well staffed to support residents to take part in activities in the home and the community. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Friday 28th September 2007 from 09:15 – 14:45. The Inspector spoke with all four people living in the home, the home’s manager and staff on duty. The support given to two residents was reviewed by talking with them and staff responsible for their care and checking records kept in the home. The manager confirmed that the weekly fee for the home is £1,108. What the service does well: What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 6 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 Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 7 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed clear information to help new residents understand what specialist services the home can provide. Admissions are not made to the home until a full needs assessment has been undertaken. EVIDENCE: During this visit the Inspector reviewed the care plan files for two people who have moved into the home in the last 18 months. One person moved into the home in March 2006 and their file included a detailed care needs assessment completed by a key worker from Minford Gardens and a good person-centred care plan for 2007. The second person moved into the home in June 2007 and the manager had completed a detailed care needs assessment before he moved. The manager confirmed that the person had a key worker and together they were using the assessment to develop a person-centred care plan. Both care plan files included a tenancy agreement that outlined the residents’ rights and responsibilities and the main terms and conditions of residence. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service involves individuals in the planning of care that affects their lifestyle and quality of life. The care plans are person centred and are agreed with the individual. EVIDENCE: The Inspector saw that one resident’s person-centred plan had been recently reviewed and there was good evidence that the person themselves and other significant people had been involved in the review. The plan was produced using pictures to make some of the information more accessible to the resident. The plan covered all aspects of the person’s daily life and included some good goals. The second person’s care plan file reviewed during this visit included a care plan from the person’s previous accommodation and guidance for staff on how this person preferred to be supported with their care. Staff from Minford Gardens had completed a care needs assessment before the person moved in and were using all of the available information to develop a person centred care plan. During this visit the Inspector saw that staff worked well together to support residents and offer them meaningful choices. Despite some sickness absence, Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 9 the staff team made sure that, throughout the day, each person was offered opportunities to take part in activities in the home and the local community. One person’s care plan file included a number of risk assessments that had been reviewed in June 2007. The assessments covered road safety, access to the community and behavioural issues. The second person care plan file included risk assessments that had been completed by staff supporting him in his own accommodation. The manager should make sure that, as part of the development of the resident’s person-centred plan, that the risk assessments are reviewed and adapted to acknowledge the person’s current care needs. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Help with communication skills is given by the staff team. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. EVIDENCE: The Inspector spoke with all four people living in the home during this visit and checked their care plans. People said that staff supported them to take part in activities and the Inspector saw that this happened during the day. All four people went out, either to planned appointments or for a walk in the local area, usually ending at a café for a drink / snack. One person went with staff support to buy train tickets for a planned holiday. The manager and staff were also arranging adequate support for three people who wanted to go to a party at another care home in the evening. Care records showed that three people living in the home had a holiday this year. One person went to Scotland and another to the Isle of Wight, with staff support. The third person was planning to go to Portugal with relatives for two weeks. The person who moved into the home in June 2007 had also been to Paris, supported by staff from his previous accommodation. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 11 The manager and staff told the Inspector that two residents have a high fibre / low fat diet and this is reflected in the home’s menu plans. The Inspector felt that the menu plan offered a varied choice of nutritious meals for all four people living in the home. Staff said that people were able to eat their meals in the dining room or other parts of the home if they chose. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs, including specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan. Residents have access to appropriate healthcare services. EVIDENCE: During this visit the Inspector checked healthcare issues in two residents’ care plan files and the home’s medication management systems and recording. One care plan file included an excellent occupational therapy assessment completed in March 2007. The assessment covered all aspects of the person’s daily life, with an emphasis on what the person could do for themselves and maximising their independence. The assessment recognised the person’s increasing care needs and the manager confirmed that it is being used by staff in the home to develop a person-centred care plan. Other records in the care plan files showed that people have some involvement with relevant clinicians from the local multi-disciplinary Learning Disability Team and front-line health services, including GP’s and dentists. The home uses a monitored dosage system for all prescribed medication. Medication is delivered in blister packs each month and is administered by staff in the home. Staff told the Inspector that none of the current residents managed his own medication. All prescribed medication is securely stored in a lockable cabinet in the main office. During this visit the Inspector checked the Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 13 Medication Administration Record (MAR) sheets for all four residents. There is a need to improve the management and recording of prescribed and requirements and recommendations are made in this report to make sure that residents’ medication is managed safely. Since the last inspection, one resident has died after a long illness. The Inspector felt that Yarrow Housing and managers and staff from the home had dealt with this sensitively and other residents were kept fully informed and supported to attend the funeral, if they wished. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. EVIDENCE: During this visit the Inspector saw that the home has a complaints procedure that has been produced using pictures and photographs to make the information more accessible to some people living in the home. The procedure includes contact details for the Commission’s local office and has been circulated to all residents and their relatives / representatives, following a requirement made at the last inspection. The manager confirmed that there have been no formal complaints since the last inspection. Staff who spoke with the Inspector were aware of the local safeguarding adults procedures and were able to say what actions they would take if they thought a resident was in need of protection from abuse or neglect. The Inspector also checked the finance records for all four people living in the home. Records were generally well maintained and receipts were in place for all transactions. To make sure that residents’ money is used appropriately, the manager must clarify that all money is used in line with the organisation’s policies and procedures. In particular, the use of a resident’s personal money to pay for staff ferry tickets and bus fares when on holiday must be reviewed. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of the fixtures and fittings need replacing and some of the décor requires upgrading. The quality of life for people using the service is being made worse by the environment in which they are living. EVIDENCE: 35 Minford Gardens is a terraced house suitable for use as a registered care home providing personal care and accommodation for people with a learning disability. Notting Hill Housing Trust owns the property and the care is provided by Yarrow Housing Limited, a voluntary organisation. The home is close to the shops and transport links of Shepherds’ Bush and Hammersmith. During this visit the Inspector saw all communal parts of the home and all four residents’ bedrooms. All parts of the home were clean and tidy. The bedrooms were well decorated and furnished and very individual. Staff had provided excellent support to individuals to personalise their rooms to reflect their interests and personalities. The home had a selection of communal areas, including the lounge, kitchen / dining room and garden. The lounge and kitchen / dining room were comfortable, well furnished and well equipped. The manager said that staff Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 16 and residents were working to clear the garden and provide a patio area for residents’ use. While the home had a sufficient number of bathrooms and toilets for residents’ use, the condition of these areas is very poor and detracts significantly from the overall standard of accommodation provided for residents. In the bathroom, the window frame was rotten, wall tiles were missing, the flooring was in poor condition, the toilet seat was broken and the bath was in a very poor condition. The shower room had mould on the walls and ceilings and was in a very poor condition overall. The manager said that a surveyor from the housing association had visited, but there was no project plan or agreement what works were needed, with timescales for completion. It is a requirement of this report that refurbishment works to the bathroom and shower room are completed by the end of January 2008. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. Staff meetings take place regularly. Supervision sessions are regular and staff find them helpful. Notes are taken of meetings and sessions. EVIDENCE: During this visit, the Inspector spoke with residents and staff on duty. When the Inspector arrived, the home’s Manager and deputy Manager were both working with 2 Residential Support Workers (RSW) also on duty. Three other RSW’s were also on duty later in the day. Staff training arranged for the day had been cancelled as three staff were sick. The Inspector felt that the levels of staffing in the morning and afternoon / evening were sufficient to meet the care needs of people living in the home. The Manager confirmed that 3 staff have completed their National Vocational Qualification (NVQ) training. 5 other staff are also currently completing their NVQ training and the Inspector was satisfied the home is on target to meet the required standard for 50 NVQ qualified staff. The Inspector also checked other staff training records and saw that staff are due to attend a range of appropriate courses. These included fire safety, challenging needs, risk assessment and equal opportunities / diversity. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 18 The Manager confirmed that Criminal Records Bureau (CRB) checks are carried out on each member of staff before they start work in the home. The Inspector was shown a list of CRB Disclosure numbers for all staff that showed they are suitable to work with vulnerable adults. The Manager and deputy Manager shared responsibility for supervising staff working in the home. Staff said that supervision was regular and they were given a written record after each supervision session. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 and 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the Home. There is a continuing need to improve the quality of support and auditing of care from the provider organisation. EVIDENCE: The home’s Manager confirmed that she worked as a deputy Manager in a home for people with a learning disability for 10 years before transferring to Minford gardens as the Manager in June 2007. She completed the Registered Manager’s Award (NVQ Level 4) in 2003 and has applied to the Commission for registration. Information provided by the Manager before this inspection is evidence that the organisation has developed all of the required policies and procedures. Standards of record keeping in the home are generally good. One health and safety issue was noted during this visit and staff must make sure that opening restrictors are fitted to all windows above ground floor level. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 20 Fridge and freezer temperatures were recorded regularly and door holders have been fitted on two doors, following a requirement made at the last inspection. The home has a current gas safety certificate, insurance cover is adequate and fire safety equipment is serviced regularly. The organisation is failing to make sure that monthly monitoring visits are made to the home and reports sent to the home and the Commission after each visit. The Inspector saw copies of reports written following visits in July and September 2007, but copies of reports for visits between March and June 2007 were not available. The Inspector was satisfied that the new Manager has made sure that visits now take place each month, but the provider must confirm that all visits have taken place and provide the Commission with copies of reports. Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 21 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 X 2 3 3 X 4 X 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 1 25 3 26 3 27 1 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 3 3 2 2 Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13 Requirement To make sure that residents take their medication safely, the manager must clarify if paracetamol prescribed for one person is ‘as required’ or to be take daily. To make sure that accurate records are kept of medication given to residents, where records say ‘take one or two,’ staff must make sure that they record the amount of medication given on each occasion. Prescribed medication that is unused or past it’s ‘use by’ date must be returned to the pharmacist for disposal. To make sure that residents’ money is used appropriately, the manager must clarify that all money is used in line with the organisation’s policies and procedures. In particular, the use of a resident’s personal money to pay for staff ferry tickets and bus fares when on holiday must be reviewed. Yarrow managers must make sure that monthly monitoring visits take place and a written DS0000019138.V350879.R01.S.doc Timescale for action 31/10/07 2. YA20 13 31/10/07 3. YA20 13 31/10/07 4. YA23 13 31/10/07 5. YA43 26 30/10/07 Minford Gardens, 35 Version 5.2 Page 23 6. YA27 23 7. YA42 23 8. YA43 26 report must be sent to the home and the Commission after each visit. Repeat Requirement. Original timescale of 31/03/06 not met. Refurbishment works to the bathroom and shower room must be completed by the end of January 2008. Staff must make sure that opening restrictors are fitted to all windows above ground floor level. Yarrow must confirm that monthly monitoring visits were carried out in March, April, may and June 2007. If visits have been carried out, copies of reports must be sent to the Commission. 31/01/08 30/10/07 30/10/07 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 YA9 Good Practice Recommendations The manager should make sure that, as part of the development of one resident’s person-centred plan, that risk assessments are reviewed and adapted to acknowledge the person’s current care needs. Staff must make sure that they record the date of opening on tubes and tubs of medicinal creams. 2. YA20 Minford Gardens, 35 DS0000019138.V350879.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Minford Gardens, 35 DS0000019138.V350879.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. 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