Inspection on 06/02/07 for Oak Bank Residential Home

This inspection was carried out on 6th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak Bank Residential Home 28/07/09

Oak Bank Residential Home 01/07/08

Oak Bank Residential Home 10/07/07

Oak Bank Residential Home 10/07/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Oak Bank Residential Home 31 South Road Weston Super Mare BS23 2HD Lead Inspector Paul Grey Unannounced Inspection 6th February 2007 09:30 Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 1 Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 2 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 Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 3 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. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Name of service Oak Bank Residential Home Address 31 South Road Weston Super Mare BS23 2HD 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) 01934 647670 Oak Bank Residential Home Limited Alison Davis (pending registration) Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 5 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 6 service users who have a learning disability. Date of last inspection 11/10/06 Brief Description of the Service: Oak Bank provides care for service users with learning disabilities and a range of complex needs. Oak Bank provides varying care packages with fees varying between £1600 and £1900 a week. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted this unannounced inspection in the presence of the manager and one director. The inspection took place over a five-hour period. During this time the Inspectors observed care, spoke with staff and the manager, conducted a tour of the premises and reviewed documentation of care at the home. Since the last inspection, Alison Davis has been appointed to the post of manager at Oak Bank. Her application to become the registered manager of the service was approved by CSCI on 28th February 2007. James Liscombe is now the Responsible Individual for the company. Generally, standards at the home have improved greatly. There are still significant shortfalls, particularly regarding screening and recruitment of staff. This is explored later in the report and is subject to requirement. The Inspector noted that the manager, directors and staff team have made great efforts to improve both the standard of care, delivery of care and staff skill base at the home. In particular, the inspectors noted improvements in the assessment of service users needs, care planning, delivery of care, risk assessments and the use of meaningful day-care activities. The inspector observed that the manager’s effort to improve overall standards have made a significant difference to the lives of the service user group. What the service does well: What has improved since the last inspection? The single most significant change in this service is the experience of people living in the home. Service users appeared brighter, more engaged in their environment and more relaxed. The manager has reviewed and improved much of the documentation of care, assessment of needs and delivery of care to service users. The manager has Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 7 attempted to prioritise which areas were most in need of improvement and has made significant positive change. 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. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 8 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 Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 9 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): 1, 2 Quality in this outcome area is good The home understands the importance of having sufficient information when choosing a Care Home. The home provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a Service user Guide. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the statement of purpose for the Home. This has been completely re written by the new manager. The new statement of purpose clearly outlined the aims and objectives of the home. The statement of purpose contained a detailed outline of services offered by the home along with a clear description of facilities offered at the service. The previous admission and assessment documentation has been discarded and replaced with a new person centred approach to assessing service users’ needs and aspirations. The inspector reviewed 3 assessments. These contained a detailed assessment of the personal needs of the individual and was written from the perspective of the service user. Assessments were particularly useful for the staff team as they gave the reader a clear understanding of needs Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 10 varying from diet to social and communication needs. This is a significant improvement on previous documentation. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 11 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, 9 Quality in this outcome area is good Care plans are developed following person centred planning principles. It is written in plain language, is easy to understand and considers all areas of the individual’s life including health; specialist treatments, personal and social care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection the inspector noted care planning and risk assessment processes have been rewritten to come into line with current good practice. The inspector reviewed 3 care files. The home has moved to a person centred format which reflects the objectives laid out in the statement of purpose. The care plans reviewed were based on the assessment of the needs of the individual and clearly documented. Care files sampled contained an outline of needs and aspirations of the service user along with a plan for delivering care. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 12 The individual plans of care detailed any specialist needs of the service user. One service user had specialist needs around their epilepsy. This was clearly assessed and incorporated in the plan of care. Care planning was a highly individualised and comprehensive process. The plan of care is drawn up with the involvement of any relevant parties. Unfortunately, service users at the home are and able to participate in designing their plans of care due to the extent of their disability. One Inspector observed care whilst the other reviewed documentation and spoke with the manager. Observation, documentation and staff statement indicate that the home supports the service user group to make decisions about their own life. Given the needs of the service user group, some service user rights need to be restricted for health and safety reasons. For example, service users would not be able to leave the premises unescorted. The Inspector noted that where restrictions on an individual were in place, these were reasonable, in the interests of the service user and clearly care planned . Service users rights were not unreasonably restricted. The service user group is supported to take risks as part of a normal lifestyle by staff at the home. The Inspector reviewed risk assessments by the home, both the service users and the environment. The Inspector found that risk assessments had been rewritten to comply with national minimum standards. The Inspector noted evidence of the identification of risk and action on behalf of the staff team to reduce it. For example, one service user was at risk of getting trapped in the bathroom, the staff team had identified this as a risk and care planned to reduce this risk. Risk assessments at the home were comprehensive and up-to-date. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 13 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): 13,16 Quality in this outcome area is good Residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capability; they have been fully involved in the planning of their lifestyle and quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspectors reviewed the program of activities. The day-care activity programme has been heavily revised. The current programme is based around a range of meaningful activities based on the needs and aspirations of the service user group. During inspection, two service users were engaged in activities off the premises. One service user had been taken on an escorted walk, the other was off on a trip with a staff member. The manager informed the Inspector that the service users were trying a range of activities to see Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 14 what they prefer to do with their time. When this process has been completed a formalised individual plan will be drawn up. Service users are now being supported to access local facilities. At the time of writing service users are starting to access activities in Weston-super-Mare including visits to local shops, a cafe and walks at a range of beauty spots in the area. The manager has also applied for bus passes for the service user group. This should enable the group to use public transport and access more community facilities. The establishment of a more skilled and experienced staff team has resulted in a more flexible approach for activities and involvement in the local community. Whilst this is still in its infancy this is good practice. No Service Users are currently attending any courses at the local college or educational establishment. Observation, documentation and staff statement indicates that the house is run and flexibly and in the interests of the service users. Service users are able to choose what time they go to bed, (within reasonable hours), and are allowed to have privacy in their own bedrooms. During the inspection, staff addressed service users respectfully and by the individual’s preferred name. The staff team interact well with the service user group and did not exclude them from conversation. Service users have unrestricted access to the home with the exception of the areas that could pose a risk to health and safety, such as the kitchen all the stairs down to the cellar area. Service users are able to go in and out of the building into a contained rear garden. Service users are unable to leave the garden for reasons of health and safety. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate The health needs of residents are monitored and appropriate action and intervention taken. There are gaps in recording how medication has been stored or administered. Where medication systems have been seen to be weak and in need of action the registered person has responded and is working towards improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector reviewed daily records, medication records and spoke with the manager and staff. The manager has reviewed the documentation outlining the way care is provided. The Inspector saw that the service had identified the preferences of the people in their care. The Inspector was able to sample how service users preferred to be supported to attend to their own personal hygiene, or choose what clothes to wear. This is a great improvement on the previous documentation. There was evidence that people living at the home were Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 16 supported sensitively and treated with dignity and respect. The service user group are supported to choose their own clothing, hairstyles and express their personality via their choice of appearance. Service users have a designated key worker and notes regarding their preferred routine at the home. The Inspector was also able to track service users likes and dislikes through the care files. Some service users had specialist physical or health needs. The inspectors were able to find evidence that the manager and staff team had been proactive in meeting these specialist needs. One service user had needs around their epilepsy. The Inspector found evidence that the manager had identified training needs and obtained external support to provide a good standard of care for this individual. The home also received specialist medical support from a local consultant. The consultant was responsible for the service user’s general medical needs, in addition to specialist behavioural issues and reviewing medication. This is a significant improvement on what was previously available to the service user group. The Inspector also noted that service users’ health needs are assessed and documented in their care files. This allows the staff team to identify any issues of concern. An Inspector reviewed medication administration at the home. The home uses a monitored dosage system. Staff on the premises had been trained to administer medication. The Inspector and the manager reviewed the stock against the medication administration records. The Inspector and manager found an a discrepancy between medication in stock and that marked as administered. The manager will investigate this matter further. This is subject to requirement later in the report. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 17 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, 23 Quality in this outcome area is poor The service has a simplistic complaints procedure, which has shortfalls in its content. This needs to be reviewed. The policies relating to the protection of service users are simple generic documents that do not meet national minimum standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the complaints procedure for the home. This was a generic complaints procedure referring to the National Care Standards Commission and did not meet national minimum standards. The inspector spoke with the manager concerning this. The manager was in the process of updating policies and procedures and had scheduled the complaints procedure for review. The complaints procedure is subject to requirement. Previously the inspector noted the policies and procedures fall short of the national minimum standards. The manager spoke with the inspector concerning this and explained that she had not been able to update the policies in their entirety. This was largely due to the lack of meaningful documentation in the home prior to the manager taking up post. The inspector recognises the improvement in care and overall documentation, however currently the home fails to meet these standards. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 18 Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good The home provides a physical environment that is appropriate to the specific needs of the residents who live there. The home is a very pleasant, safe place to live the bedrooms and communal rooms exceed the National Minimum Standards. The home is well lit, clean and tidy and smells fresh. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally, the premises are suitable for the purpose of caring for the service user group. Potentially, the environment is outstanding with large rooms and pleasant spacious surroundings for service users. The general environment was very pleasant, however the Inspector noted several small environmental issues that required attention. For example the fitting of door stops, removal of door wedges, and replacement of a toilet seat. The premises were clean and hygienic. During the inspection some toilets could have done with a little attention but this may have been as the result of recent Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 20 use. There were hand washing facilities located in appropriate areas and laundry facilities were sited so that soiled articles were not carried through areas where food was prepared. The washing machines and laundry were capable of washing clothing at a minimum of 65°. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 21 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, 34,36 Quality in this outcome area is poor The service ensures that all staff within its organisation receive relevant training that is targeted and focussed on improving outcomes for residents. The service has a poor recruitment procedure with shortfalls which may place service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has recruited new staff with a broad range of training and experience within the learning disabilities field. The staff on duty were observed to interact well with the service user group and demonstrated a clear understanding of the specialist needs of those in their care. This was reflected in how staff interacted with the service users and staff documentation. Staff have under gone ‘Positive Response’ training in order to understand and manage aggressive behaviour. In excess of 50 of staff employed have NVQ 2 or equivalent. The inspector sampled 4 staff files. There was an improvement in general recruitment procedures and practices. The selection process was more robust Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 22 than previously. Staff had documentation that was generally in order and references were more frequently present than previously. However, the home had failed to meet it’s own policies and procedures regarding obtaining a Protection of Vulnerable Adults check, a police check and 2 references. The inspector also found a contract of employment that was vague and not fit for purpose. At the time of inspection this caused a difficulty for the home manager regarding the employment of an inappropriate person. This situation would have been prevented had references and appropriate checks had been made prior to employment. The home did not safeguard the service user group. This remains subject to requirement and may be subject to action by the Commission unless remedied. The inspector reviewed staff supervision with the manager. The manager was able to demonstrate good practice in supervision; both in the frequency of staff supervision and the constructive use of the supervision process to support staff deliver the home’s philosophy of care into practice. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 23 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, 42 Quality in this outcome area is Adequate The Manager has the required qualifications and experience to run the home. She is working to improve services. A range of policies and procedures have yet to be reviewed by the new manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has been recently employed to address a range of shortfalls in the service. The manager has appropriate management and supervisory experience and holds the Registered Managers Award. The manager has implemented a range of improvements in both practice and administration in the home. At the time of inspection these changes were Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 24 beginning to take effect. There are however still significant areas of weakness. . At the time of inspection there had been no change in or implementation of, the home’s generic quality assurance policy. This brief document did not relate to the home and needs to be reviewed and updated. There was no evidence of continuous self-monitoring on the part of the service or an objective and verifiable method of quality assurance. The policies and procedures are general policies obtained elsewhere. These have not been reviewed, were not always appropriate to the home and were out of date. The manager will review and replace these policies. The manager has addressed shortfalls in health and safety training and fire safety that concerned inspectors previously. The health and welfare of service users are protected. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 1 34 x 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 2 2 x 3 x Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 26 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 YA34 Regulation 19 (5) a 19 (1) b Requirement Two written references and a CRB disclosure or POVA first check must be obtained before staff start work in the home. The service must maintain an accurate record of all medication administered used in the home The home must review its complaints procedure in line with National Minimum Standards. Timescale for action 06/02/07 2. 3. YA20 17 (1) a Sch 3 (1) 22 (1) 22 (4) 22 (6) 11/03/07 30/06/07 YA22 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 YA24 Good Practice Recommendations The thickness of the glass in the side of the staircase leading from the main hall to the basement should be checked to ensure it complies with Building Regulations. Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Oak Bank Residential Home DS0000066474.V329318.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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