Inspection on 10/01/06 for Monmouth Court Nursing Home

This inspection was carried out on 10th 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

Monmouth Court Nursing Home 19/06/07

Monmouth Court Nursing Home 07/06/05

Monmouth Court Nursing Home 27/10/04

Monmouth Court Nursing Home 02/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Monmouth Court Nursing Home Monmouth Close Off Montgomery Road Ipswich Suffolk IP2 8RS Lead Inspector Jane Higham Unannounced Inspection 10th January 2006 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 Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 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. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Monmouth Court Nursing Home Address Monmouth Close Off Montgomery Road Ipswich Suffolk IP2 8RS 01473 685594 01473 680785 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Claudette Yvonne Lyons Care Home 120 Category(ies) of Old age, not falling within any other category registration, with number (120), Physical disability (3), Terminally ill (120) of places Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. General Medical Physically Disabled aged from 50 years Terminal Chronic Sick Palliative Care - 3 patients - Cilgerran House Date of last inspection 7th June 2005 Physically Disabled aged from 50 years Brief Description of the Service: Monmouth Court was built in 1993 and purchased by BUPA Care Homes in 1998. The home is situated next to a pleasant park in the residential Maidenhall area of Ipswich, about two miles from the town centre. It is on a local bus route to and from Ipswich town centre and near a local parade of shops. There is ample parking to the front of the building. Monmouth Court is a modern purpose built care home and consists of four houses (Raglan House, Powys House, Cilgarren House and Harlech House), each accommodating up to 30 residents. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection of Monmouth Court, a 120 bedded nursing home for older people and people suffering from a terminal illness. The home is owned and administered by BUPA and sited within a residential area of Ipswich. This was the second inspection in the inspection year 2005/2006. The inspection was carried out by two regulation inspectors on 10 January 2006 over a period of four and a half hours. All core standards have been assessed over the two inspections and this document should be read in conjunction with the report of the Announced Inspection dated 7/8 June 2005. The home was inspected against the National Minimum Standards: Care Homes for Older People and the Care Standards Act 2000. The National Minimum Standards and Care Homes Regulations 2001 are referred to throughout this report and any non compliance identified. The Registered manager of the home was present during the inspection. On this occasion, core standards not assessed as part of the previous inspection were examined and requirements made at that time were re-assessed. During the course of the inspection, the inspectors visited Powys and Raglan Houses. One of the inspectors focused on the provision of individual care plans and feedback from service users and their families. The other inspector spent some time on both houses gaining feedback from a random selection of staff members. Additionally procedures for the safekeeping and administration of medication and resident finances were assessed as was training provision for staff. What the service does well: The service provides a good standard of accommodation both communal and private and despite its large size has managed to create a homely atmosphere within each house. The home is to be commended on the level of cleanliness and hygiene which it continues to maintain. The home continues to place a strong emphasis on the provision of meaningful activity for residents. As observed in previous inspections, activity sessions are carried out in a warm and light hearted manner and it was clear that these sessions were very much enjoyed by all the participants. The home ensures that residents are offered support and care by a level of staffing which is appropriate and which ensures Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 6 that their individual needs will be met. Staff receive the training that they require in order to ensure that they are able to carry out their roles and responsibilities in a competent manner. The home is professionally and competently administered by a knowledgeable and experienced staff team who offer support and guidance to family members in relation to the placement of the prospective service user. 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. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 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 Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 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): 2, 3 and 6 Residents coming to live at the home can expect to be provided with a placement contract and a copy of the terms and conditions of residence. Prior to moving into the home, all prospective residents can expect the home to carry out a full assessment of their individual needs. EVIDENCE: On the day of the inspection, the home was able to evidence that it provides all privately placed residents with a written copy of the terms and conditions of placement. A copy of this document is held in the resident’s room so that it can be referred to should a query arise. The terms and conditions document also includes the contract for privately placed residents. Although residents placed via the local authority are not provided with this same document, the home ensures that they are provided with a detailed information sheet which provides information on the terms of placement and the services available. Since the previous inspection, the home has ensured that no residents are considered for placement without a core needs assessment being completed. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 9 The home no longer offers an intermediate care service. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 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 and 9 Residents living at the home can expect to be provided with a detailed plan of care which gives a clear outline of how their individual assessed needs are to be met. Residents are protected by the home’s procedures for the administration and safe storage of medication, apart from one minor shortfall. EVIDENCE: On the day of the inspection, the systems used for the administration and safe keeping of medication were examined on two of the four houses. All resident medication is administered by qualified nursing staff and is stored securely in “fit for purpose” trolleys. In general, on both houses, the medication administration records (MARS charts) were completed accurately and there were no gaps in the recording. It was noted however, in the case of one resident, the staff member responsible for the administration of medication, entered their signature to confirm that a certain medication had been administered, before it had been taken to the resident. Medication records must not be completed until it can be confirmed that the prescribed dose has been administered. It was also noted that in several instances, where the Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 11 MARS sheet indicated a dosage of one or two tablets, as in the administration of paracetamol, the exact amount administered was not recorded. A selection of resident care plans were examined on both Powys and Raglan House. All plans seen were detailed in their content and gave a clear picture of the assessed individual care needs of each person. Care plans included a falls risk assessment, an eating and drinking assessment which included individual preferences in relation to food and a moving and handling assessment. A separate care plan was produced for each person in relation to the provision of personal care. In the case of one resident where a break in the skin’s surface had occurred, a short term care plan for its treatment had been produced. In general care plans were detailed, providing a clear outline to staff of the individual assessed needs of each resident and the interventions required to meet those needs. All care plans examined had been reviewed on a monthly basis and a record of reviews was maintained. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 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): 12, 13 and 15 Residents living at the home can expect to be provided with a range of activities which are appropriate to their needs and abilities. Residents can also expect that, if it is their wish, their family members will be kept informed of their well-being by staff. Residents can be assured that they will be provided with a menu of meals which are both nutritious and varied and that their dietary needs and preferences will be catered for. EVIDENCE: Whilst the above standards were assessed as part of the previous inspection, on this occasion, activity sessions provided for residents were again observed. Each house is provided with an activities co-ordinator whose responsibility it is to provide meaningful activity to residents which is appropriate for both their needs and abilities. On the day of the inspection, residents on Raglan House enjoyed a game of carpet bowls, a “knock-out” competition with a trophy awarded to the winner. This was followed by a quiz. Residents appeared to enjoy both activities and participated in a light-hearted and pro-active manner. Residents living on Powys House reported that they had enjoyed a quiz during the morning and were looking forward to taking part in a games session in the afternoon. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 13 During the inspection, several visitors arrived to see their relatives. One family member spoken to reported that their relative was very well looked after, that levels of personal care provided were of a good standard and that they were kept informed by staff of any concerns that may arise. The provision of resident meals was assessed as part of the previous inspection. On this occasion a selection of residents were spoken to following the mid-day meal. Feedback in relation to the quality of meals was very positive. A small group of residents reported that they had chosen egg and chips for lunch which they had thoroughly enjoyed. Meals were served to residents in an organised manner by the hostess whose responsibility it is to ensure that residents receive their preferred option. Staff provided assistance to residents who found it difficult to eat their meals independently. One resident reported that they preferred one specific meal every lunchtime. This preference was recorded on the resident’s care plan and was provided by the kitchen staff. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 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 and 18 Residents and family members can expect to be provided with sufficient information to enable them to raise any concerns or complaints they may have around the quality of the service provided. Residents can expect to be protected by the home’s procedures on the recognition and reporting of abuse, although a shortfall in the provision of staff training in this area was highlighted. EVIDENCE: During the inspection, the home was able to evidence that a copy of the Complaints Procedure is displayed on each house and therefore accessible to all residents, staff and any visitors. Since the previous inspection, the Commission has received one complaint on 16 November 2005. An investigation of the complaint was carried out by the allocated inspector on 29 November 2005 and neither of the two elements of the complaint were found to be upheld. As part of this inspection, the procedures employed for the protection of vulnerable adults were assessed. The home was able to evidence that it complies with the joint Protection of Vulnerable Adults Procedure, produced jointly by Suffolk health and social services. An up to date version of this procedure was available to all staff. Discussions with staff members confirmed that training on the recognition and reporting of abuse is included as part of the home’s induction training package and thereafter through supervision Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 15 sessions. It was identified through examination of staff training records that one staff member, on duty during the night, had not received this training. Whilst the Commission is aware that the provision of training for night staff can at times be problematic, due to the limited supervision and support available at night, it is even more imperative that staff receive this training. Through discussions with staff it appeared that ongoing training for staff on the protection of vulnerable adults was somewhat informal. Some long –standing staff spoken to could not remember receiving this training, although others confirmed that they had received a training booklet and watched a video. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Residents can expect to be provided with a high standard of both private and communal accommodation which is appropriate to their needs and abilities. Residents can be assured that the environment in which they live will be maintained to a good standard of cleanliness and hygiene. EVIDENCE: The home consists of four separate houses, each with thirty single bedrooms, a large centrally sited communal lounge, with dining area and a conservatory and communal bath and toilet facilities. On the day of the inspection, accommodation provided to residents was assessed on both Powys and Raglan House. Resident bedrooms were maintained to a good standard of decorative order and repair and in many cases had been made to look very homely with the addition of personal belongings such as photographs, ornaments and paintings. Good use had been made of attractive soft furnishings and furniture provided was of a good standard and appropriate to the needs of each person. Each bedroom has a Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 17 fitted wash handbasin and although there are no ensuite facilities, each house is provided with four communal bathrooms equipped with both assisted baths and showers. All residents spoken to at the time of the inspection expressed satisfaction with the accommodation provided. All accommodation provided is suitable for wheelchair users. Each house has a large central, communal lounge which also incorporates a dining area. These areas are very spacious, furnished to a good standard and provide an ideal area for residents to either relax, enjoy communal meals or take part in organised activities. Each lounge also includes a nurses office and a very pleasant conservatory area which is pleasantly furnished and provides very good natural light. Minor requirements were made during the previous inspection in relation to some repairs which needed to be carried out. The home was able to evidence during this inspection that all these areas had been addressed. All areas of the home seen at the time of the inspection were maintained to a high standard of cleanliness and hygiene and no unpleasant odours were detected. Domestic staff are commended on their efforts in maintaining such a clean environment. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Residents residing at the home can expect to be supported and cared for by a level of staffing which ensures that their individual care needs will be met. Residents can also expect to be supported and cared for by staff who are well trained and competent to carry out their roles and responsibilities. EVIDENCE: As found in previous inspections, the home provides a staffing level which is appropriate to meet the individual needs of residents. During the day each house is staffed by two registered nurses, supported by four care staff in the morning and two in the afternoon. During the night period each house is staffed by one qualified nurse who is supported by two members of the care staff. These staffing levels are in addition to the attendance of a hostess who is responsible for ensuring the provision of meals to all residents and an activities co-ordinator. Staff training records seen at the time of the inspection, evidenced that appropriate training is provided to all staff to enable them to competently carry out their roles and responsibilities. The home was able to evidence that in addition to an in-house induction training programme, the owning organisation provides all care staff with an Induction training package which complies and is cross referenced with the NTO workforce training targets. Records seen evidenced that staff are provided with all areas of mandatory training such as moving and handling, health and safety, fire safety and food hygiene. It was identified however that one member of staff who was rostered to work during Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 19 the night had not received any training in the Protection of Vulnerable Adults. Moving and handling training is provided to staff by the owning organisation’s own trainers. The home uses several training mediums and some training is delivered via distance learning training packs. Since the previous inspection, four qualified nurses had undertaken tissue viability training. In general, staff spoken to at the time of the inspection indicated that they received sufficient levels of training to enable them to carry out their roles competently. When asked, the majority of staff indicated that the current staffing levels were sufficient to meet the individual care needs of residents. Staff indicated that they felt comfortable in raising any concerns that they may have with the house managers. During the inspection, staff carried out their responsibilities in a professional and competent manner. Residents spoken to made very positive comments about the quality of the staffing. Two residents spoken to in the communal lounge commented that they had no complaints about the home and that the staff were really “super”. One visitor commented that the levels of personal care provided to their family member who was bedridden was very good. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36 Residents can expect to benefit from the open leadership and management approach of the home and can be assured that the systems used for the administration of their finances are secure and accountable. Residents can expect to be supported and cared for by staff who are appropriately supervised. EVIDENCE: During the inspection, discussions with staff members indicated that in general they felt able to raise their concerns and questions with the senior members of staff and with the house manager. One staff member reported that if staff, for example, were not comfortable using a certain piece of equipment, then they could go directly to the house manager who would show them how to use it. Staff confirmed that they considered residents were well cared for and that the Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 21 management of the home was very open to suggestions for improving practice. Several staff members reported that they really enjoyed their work. Although staff members were able to confirm that they received formal supervision sessions, some indicated that these had been less frequent of late. Staff confirmed that supervision sessions were often used to address training needs. During the inspection, the procedures and systems used for the administration of resident finances were examined. The home does not in fact hold any monies for residents but ensures that a petty cash float is maintained in order that any service user can access cash if required. Any expenditure or transaction carried out is invoiced against the resident’s personal monies account which is set up with a well known bank. All transactions carried out by residents or on their behalf are receipted and recorded on the home’s computer system. The residents’ personal monies account attracts interest which is apportioned dependent on the amount of money which has accrued. Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 4 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x x 3 3 x x Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Timescale for action 10/01/06 2 OP9 13(2) 3 OP18 13(6) The Registered Persons must ensure that medication administration records are not signed by the responsible staff member until such time as they can confirm that individual resident medication has been administered. The Registered Persons must 10/01/06 ensure that where a medication administration record indicates a dosage of one or two tablets; the exact amount administered must be recorded. The Registered Persons must 10/01/06 ensure that all staff members receive training on the recognition and reporting of the abuse of vulnerable adults. u RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000024449.V276665.R01.S.doc Version 5.1 Page 24 Monmouth Court Nursing Home N/A Standard N/A N/A Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Monmouth Court Nursing Home DS0000024449.V276665.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!