Inspection on 05/04/07 for Miriam Kaplowitch House Care Home

This inspection was carried out on 5th April 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 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

Miriam Kaplowitch House Care Home 04/04/08

Miriam Kaplowitch House Care Home 31/01/06

Miriam Kaplowitch House Care Home 16/08/05

Miriam Kaplowitch House Care Home 21/03/05

Miriam Kaplowitch House Care Home 23/12/04

Similar services:

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Byars Care Home

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

CARE HOMES FOR OLDER PEOPLE Miriam Kaplowitch House Care Home 470 Mansfield Road Sherwood Nottingham NG5 2EL Lead Inspector Rob Cooper Key Unannounced Inspection 5th April 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Miriam Kaplowitch House Care Home Address 470 Mansfield Road Sherwood Nottingham NG5 2EL 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) 0115 962 2038 0115 969 2326 mkhouse@tiscali.co.uk Nottingham Jewish Housing Association Limited Maria Baddoo Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: 2. 3. Code OP One named service user may be admitted within the category DE(E) as named in application dated 10/10/05 The maximum number of service users who can be accommodated is 22 10th October 2006 Date of last inspection Brief Description of the Service: Miriam Kaplowitch House is situated in an adapted detached premises in a residential area in Sherwood. It is close to shopping areas, all amenities and public transport routes. Accommodation and care is offered to the older members of the Jewish community only. Bedrooms are on two floors with a lift to the upper floor level and a choice of communal areas is provided. There is a large well-maintained front garden area, which has some seating. All meals are prepared in the two Kosher kitchens, which are on the premises. Fees: £298.21 - £572 Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection – so that no one at Miriam Kaplowitch House knew that the inspection was going to take place. The inspection took approximately four hours through the middle of the day, with one inspector present. The method used to carry out the inspection was to send out a pre-inspection questionnaire, which asked questions about the service, to gather statistics, such as how many service users there are, the numbers of staff etc. We also sent out a number of surveys to residents and relatives, of which eleven were returned from residents, and ten were returned from relatives. This was followed with a visit to Miriam Kaplowitch House, where a method called case tracking was used; this involved identifying three residents and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was done by a partial tour of Miriam Kaplowitch House, looking at the activities on offer, and talking to staff and three residents. The registered manager – Maria Baddoo was present throughout the inspection and supplied much of the information provided for the inspection. What the service does well: What has improved since the last inspection? At the last key inspection seven requirements were set relating to: medication, risk assessments, producing a plan of care for each resident, introducing staff documentation in line with Care Homes Regulations, and keeping care plans under review. These have all been met. Miriam Kaplowitch House Care Home DS0000002212.V333860.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. The summary of this inspection report can be made available in other formats on request. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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 Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 13&6 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Prospective residents at Miriam Kaplowitch House have the information they need to make an informed choice about where to live. No resident moves into Miriam Kaplowitch House without having had their needs assessed, and been assured that these will be met. Miriam Kaplowitch House does not offer intermediate care EVIDENCE: The statement of purpose and service user guide for Miriam Kaplowitch House were both seen. Both documents contained all of the information, which Care Homes Regulations say that they should. Evidence from residents at Miriam Kaplowitch House showed that residents had a copy of the service user guide. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 9 As part of the case tracking process three resident’s files were seen. Each file contained an assessment of need, with one containing a Standard Community Care Assessment completed by the individual’s Social Worker, while the other two contained detailed in-house assessments carried out by Miriam Kaplowitch’s staff. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 & 11 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Resident’s health, personal and social needs are set out in an individual plan of care at Miriam Kaplowitch House. Resident’s health care needs are fully met. Residents at Miriam Kaplowitch House where appropriate are responsible for their own medication, and are protected by the policies and procedures in place for dealing with medicines. Residents at Miriam Kaplowitch House feel they are treated with respect and their right to privacy is respected. Residents are assured that at the time of their death, staff at Miriam Kaplowitch House will treat them and their family with care, sensitivity and respect. EVIDENCE: The three resident’s files seen all contained an individual plan of care, and details of health, personal and social care. Evidence was seen that the care plans are being redeveloped, with a more logical and easier to follow format. All three files contained all of the basic and key information that should be within them. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 11 Each of the three files contained care plans relating to the resident’s health. The care plans contained sufficient detail for staff to be able to monitor the progress of health related issues, while recording all relevant information. Miriam Kaplowitch House have a monitored dosage system (medication dispensed into dossette boxes by the pharmacist), which is run through the local chemists. Inspection of the storage and record keeping – including administration records showed that there were no errors or omissions, and there is a clear audit trail for medication within the building. Some residents do self-medicate – usually creams, and there are care plans and risk assessments in place for those individuals. At the last key inspection a requirement was set relating to the storage of eye drops, and them being dated when opened. This requirement has now been met. During the inspection a number of staff to resident interactions were observed. These were always polite and respectful, and residents were seen to be treated with care. Staff were seen knocking on doors before entering, and there was a relaxed atmosphere throughout the home. All three residents who were spoken with said that they thought the staff were very good, and treated them with respect. This was also reflected in the resident questionnaires, which were returned. Each of the resident’s files had a specific care plan dealing with death and the wishes of the individual resident at the time of their death. The Jewish faith have many rituals associated with death and dying, and there was a great deal of evidence to show that any resident’s death would be dealt with in accordance with the customs and wishes of their faith. A rabbi was visiting the home during the inspection to spend time with a resident whose health was failing, and to offer spiritual support. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 Quality in this outcome area is excellent; this judgement has been made using available evidence including a visit to this service. Residents find that the lifestyle experienced at Miriam Kaplowitch House matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Residents at Miriam Kaplowitch House maintain contact with family/ friends and representatives and the local community as they wish. Residents are helped to exercise choice and control over their lives. EVIDENCE: Miriam Kaplowitch House caters for the needs of Jewish residents, although the staff are not of the Jewish faith. Staff were found to be knowledgeable about the Jewish faith and traditions, and the inspection took place during the festival of Passover. Staff were observed to be supporting residents during the festival, and engaging in activities that were associated with the festival. There is a weekly programme of events on display, and during the inspection a session of Bingo was underway. Talking with one resident who has passed their 100th birthday showed that they go by taxi every week to play cards at a Bridge club. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 13 All of the residents who were spoken with said that they had good family contact, and that their families could come whenever they wanted to. Some relatives were attending Passover events at the home, and all of the residents who were spoken with said that they felt Miriam Kaplowitch went some distance to include relatives in events and activities. Each of the residents spoken with said they thought there was a great deal of choice at Miriam Kaplowitch House, and gave examples. The choices ranged from the food on offer in the menu, activities, and daily living. Records relating to choices made over food were seen. Food plays a very important part in the Jewish faith, and all of the food prepared at Miriam Kaplowitch House is kosher. The staff working in the kitchen, explained the principals of kosher food, and showed me how the kitchen was divided into a dairy kitchen and a meat kitchen. Discussions with three residents indicated how important they thought this was. As it was Passover, a new menu had been introduced for the duration of the festival, and there were obvious signs of great care being taken over the ordering and preparation of the food. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon at Miriam Kaplowitch House. Residents at Miriam Kaplowitch House are potentially at risk of abuse. EVIDENCE: Miriam Kaplowitch House have received one complaint since the last key inspection, a review of the complaints record showed that the complaint had been dealt with in line with Miriam Kaplowitch’s complaints procedure. All three residents who were spoken with said they knew how to complain and who to complain too, but they felt quite happy, and had never made a complaint. This was also borne out by the resident’s and relative’s questionnaires, which also indicated people, knew how to complain, but had never felt the need. Discussions with three staff members indicated that two had received training in safeguarding adults however this was over two years ago, and they had received no update training, while the third member of staff said that they had not received any training in safeguarding adults. A review of staff training records showed that mandatory training was, and specifically safeguarding adults training needed to be tightened up, so that all staff receive the necessary training and have annual updates to ensure they are aware of the latest policy and best practice. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 & 26 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents at Miriam Kaplowitch House live in a safe, well-maintained environment. Residents have access to safe and comfortable indoor and outdoor communal facilities. Miriam Kaplowitch House is clean, pleasant and hygienic. EVIDENCE: A partial tour of Miriam Kaplowitch House showed it to be well maintained, and comfortable. During the tour the maintenance man was decorating a bedroom, and discussions with him indicated that this was being done in a way that would cause the minimum of disruption to the residents. Evidence was seen that minor repairs are dealt with swiftly, and that procedures are in place for dealing with bigger maintenance issues. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 16 All three residents who were spoken with said they thought that the building was very comfortable, and they were very happy with the decorating and the fixtures. Outside the garden is spacious, fairly private and is landscaped, with a mixture of lawns and flowerbeds, with trees and shrubs to provide shade and privacy. There are also ramps and handrails to enable those residents with restricted mobility to access the gardens. Throughout the inspection the house was found to be clean and tidy, with cleaning staff seen to be hoovering and cleaning. Discussions with cleaning staff indicated that there were cleaning routines in place, and that the staff thought they had enough cleaning materials to be able to do their job properly. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff at Miriam Kaplowitch House meets the residents’ needs. Residents at Miriam Kaplowitch House are in safe hands at all times. Residents are supported and protected by Miriam Kaplowitch House’s recruitment policy and practices. Staff at Miriam Kaplowitch House need to be better trained so that they are competent to do their job. EVIDENCE: The staffing rota for Miriam Kaplowitch House was seen, and this indicated that there was enough staff on duty to meet the resident’s needs. The rota showed that the staff team had a structure, with some staff, more senior to others and able to take decisions and organise the work. Three members of staff who were asked all said that they thought that the staffing levels were sufficient, as did the three resident residents who were spoken with. The recommended standard training course for staff working in care is the National Vocational Qualification (NVQ) level II. Of the twenty-four staff members on the team, one person has their NVQ level II, four are currently studying for the qualification, while four more are about to start. In addition two members of staff are starting their NVQ level III course. Ideally there should be 50 of the staff team qualified to a minimum of NVQ level II. The indication is that while this 50 has not yet been achieved Miriam Kaplowitch Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 18 is working towards achieving it. Miriam Kaplowitch House also employs two qualified nurses to work on the night shift. Three staff files were seen, and each one contained all of the necessary documentation to indicate that staff had been recruited in a manner, which would protect residents – this would include: written applications, formal interviews, two written references, and a criminal records bureau check. Each of the three members of staff who were spoken with said that they had been through a formal recruitment process, and had supplied references, and been criminal records bureau checked. A review of the staff training records showed that Miriam Kaplowitch House does have a training plan for it’s staff, and that some areas are well covered, for example a number of staff had recently received first aid training, and the majority of staff had also received moving and handling training. However records indicated that the last training on fire safety was in 2005, and as already identified not all members of staff had received training in safeguarding adults. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 & 38 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents at Miriam Kaplowitch House 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 her responsibilities fully. Miriam Kaplowitch House is not necessarily run in the best interests of its residents. Resident’s financial interests are safeguarded. Staff at Miriam Kaplowitch House are appropriately supervised. The health, safety and welfare of residents and staff at Miriam Kaplowitch House are promoted and protected. EVIDENCE: Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 20 The registered manager has been through the Commission fort Social Care Inspection’s ‘fit person’ process, and has been judged to be fit to manage a residential care home. Miriam Kaplowitch House has a quality assurance system based on questionnaires being sent out, and the comments received analysed. The current quality audit questionnaires have just been sent out, and the manager is awaiting their return. Currently resident’s meetings do not take place at Miriam Kaplowitch House, and these should be introduced to ensure that residents have a formal voice, and the opportunity to comment on the quality of care they are receiving. Resident’s at Miriam Kaplowitch House have a small cash needs system for their cash needs. This is operated on their behalf by the staff, and four resident’s finances were sampled at random and checked. All cash balances tallied with the records, and receipts were kept, which enabled a clear audit trail of resident’s expenditure. The manager said that a system of formal staff supervision was being devised, and implemented, but that as yet it is not in place. Three staff members when asked said that they were not receiving formal supervision, although they felt they could approach the manager if they had any ‘issues.’ A range of health & safety records were seen, including fire records, Control of Substances Hazardous to Health records, and water temperature checks, and these were all found to be correct and complete, and indicate that both residents and staff at Miriam Kaplowitch House are kept safe by the policies and procedures in place. Miriam Kaplowitch House Care Home DS0000002212.V333860.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 4 X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 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 OP18 Regulation Requirement Timescale for action 31/10/07 2. OP30 3. OP36 Regulation All members of staff must 18 receive training in safeguarding adults, and receive an annual update, so that they aware of the latest policies, and best practice. Regulation All members of staff must 18 receive all of the mandatory training and have an annual update. Fire training for all staff should be made a priority. Regulation All members of staff should 18 receive regular formal supervision, to enable their work and development is monitored. 31/07/07 30/06/07 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 OP33 Good Practice Recommendations Formal residents meetings should be introduced to give residents the opportunity to express their views, and to comment on the care they are receiving. DS0000002212.V333860.R01.S.doc Version 5.2 Page 23 Miriam Kaplowitch House Care Home 2. OP36 All staff members should receive formal supervision a minimum of six times a year. Miriam Kaplowitch House Care Home DS0000002212.V333860.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Miriam Kaplowitch House Care Home DS0000002212.V333860.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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