Inspection on 26/04/07 for Oak Tree House

This inspection was carried out on 26th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Tree House 20/02/06

Oak Tree House 01/09/05

Oak Tree House 09/02/05

Oak Tree House 12/07/04

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 Oaktree House The Vicarage Paddock Barnhay Bampton Tiverton Devon EX16 9NB Lead Inspector Teresa Anderson Key Inspection 26th April 2007 13:00 Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaktree House Address 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) The Vicarage Paddock Barnhay Bampton Tiverton Devon EX16 9NB 01398 331446 F/P 01398 331446 www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Vacant at present Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2006 Brief Description of the Service: Oaktree House is a purpose built care home providing accommodation and personal care for up to seven adults who have learning disabilities and are over 18 years of age. The home is owned by CARE (Cottage and Rural Enterprises) Ltd, and operates as a satellite of the CARE home in Blackerton, Devon. As such the people who live at Oak Tree House have access to all the facilities offered at CARE Blackerton. Oaktree House is situated in the village of Bampton and is within walking distance of the shops and amenities. The closest town is Tiverton. Communal areas are made up of a large kitchen/dining room and a lounge. All bedrooms are singles and are situated on the first floor, accessible by stairs. The home does not have any adaptations or aids for those people with physical disabilities as all the service users are able bodied. The home operates as a family home where the service users share household tasks such as cleaning and cooking. Staffing levels are minimal and staff support is aimed at helping service users to develop their skills so that they can be independent. The home has its own transport and has some parking. The fee charged for staying here is £406.65 per week. This includes some costs towards an annual one-week holiday (with staff support) but does not include personal items, taxi fares or external activities or shows. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as part of the normal programme of inspection. One day’s notice of the inspection was given as the service users living here are very busy and are often out. They were out when we tried to carry out an inspection the first time. During the site visit we spoke with six of the seven service users (one was away) and with the manager and one member of care staff. We were shown around the home by a service user and saw two bedrooms (with the occupants permission). We also looked at records in relation to service user assessment, care planning, medication, staff recruitment and service users monies. Prior to the site visit surveys were sent to all the service users and all were returned; to seven staff and five were returned and to health and social care staff and none were returned. Comments given are included in this report. In addition the manager completed a questionnaire giving details about the management of the home. What the service does well: Oak Tree House is a busy family home that is clean and fresh, and like any other busy home, can by untidy and ‘lived in’. People like living here because of that and because they can be very independent. There are minimal staffing levels and staff only do what each person wants them to do so that they can be as independent as possible. If people were considering coming to live here they will have enough information about the home in the guide to the home. Staff will get to know them well before they move in to make sure that their needs can be met and that the home will suit them. Each person who lives here has a comprehensive plan of care that is aimed at ensuring that their wishes, aspirations and full potential are met. In this way people are helped to build on skills, develop new ones and to build their confidence. This involves being supported to take risks such as travelling and going out alone. As part of the home’s ethos of promoting independence, people are supported to manage their own money, their own medication and to plan and prepare meals to a degree that suits them. People also like living here because they do lots of things. This includes having jobs, going to college, going shopping in the village and local towns, going to football and cricket matches, going to local clubs and being able to participate in the activities and workshops offered at CARE (a much larger sister home). The home has its own transport so getting out and about is relatively easy. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 6 People who live here can also receive and entertain visitors in the home (although there are no facilities for them to stay overnight). The healthcare needs of the people who live here are well met through local healthcare services and through specialist services where needed. All of the people who live here are encouraged to have an annual health check, but if they decide not to do this, staff respect this decision. People who live here are able to make complaints and feel these are taken seriously. The home has dealt with four complaints made by people, to the satisfaction of those who made the complaint. People living here feel safe and secure. Many checks are made on staff before they are allowed to work here, including police checks, to ensure that they are suitable to work with people with learning disabilities. Staff receive training in safeguarding adults and demonstrate a good understanding of this. Staff also receive other training to make sure they have the skills they need to support the people living here. This includes 1st Aid training, fire training, food hygiene training and total communication. 75 of the staff team have a National Vocational Qualification (NVQ) in care to level 2. The manager of this home has worked here for about six months. She is well liked and respected and demonstrates a good understanding of the needs of this client group. She makes sure that the home is kept safe and is well maintained. The quality of the services provided at this home are monitored through the home’s own surveys and from other sources of feedback. What has improved since the last inspection? What they could do better: The guide to the home needs to be reviewed and updated to ensure that current and prospective service users have the information they need. Much work has been done to support people to have and to manage their own bank accounts. This work should continue so that the account where some people’s monies are pooled can be closed to help prevent the risk of financial abuse. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 7 Staff have a good knowledge of what abuse is but are not familiar with the actions they should take if an allegation were made or if abuse were suspected. This might result in the people who live here being at risk of harm. The manager has not yet registered with the commission. She should do this so that the people who live here can be assured that their home is being managed by a person competent to do so. 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. Oaktree House DS0000021994.V331283.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 Oaktree House DS0000021994.V331283.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 and 2. Quality in this outcome area is good. There are rarely vacancies at this home but if there were there would be sufficient information about the home on which prospective service users could base their decision to live here. People who decide they want to live here can be assured that staff would work hard to get to know their needs so that they could be sure they could meet them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people who live at Oak Tree House tend to come here having previously lived at the sister home CARE Blackerton. As such they know a lot about this home, the staff, the other people who live here and how the home operates. There are rarely vacancies. Each person is assessed prior to coming to live here to ensure that the home can meet their needs. This assessment is comprehensive. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 10 In surveys the people who live here say they were asked about whether or not they wanted to live here and had enough information about the home on which to base their choice. In conversation they had an excellent understanding of the ethos of the home and how it operates to help each person develop life skills. However, the guide to the home, whilst containing some very important information, has not been reviewed or updated since 2005. Oaktree House DS0000021994.V331283.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 and 9. Quality in this outcome area is excellent. The people who live here have a plan of care that is all about them, what they want to do and how they might do it. This includes being supported to develop the skills which them to take risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person who lives at Oak Tree House has an individual plan of care. These are kept locked in individual lockers belonging to the service user. Each person has their own key to their locker and there is a master key for emergencies. Two of the people who live here showed their plans to us. These demonstrate exceptionally well thought out person centred and goal orientated care. Each person, with the help of their key worker, thinks about what they would like to achieve and works out what they need to do to achieve this. This may include learning new skills or building on old skills. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 12 Part of this care planning process is about taking risks. Some staff are exceptionally skilled at working out what the risks might be and how to work with the service user towards overcoming them. They work exceptionally hard to ensure that obstacles are overcome and goals are achieved and to avoid failure. In this way service users confidence has grown and developed, as has their quality of life. Since the last inspection each person has been helped to open their own bank account and they are particularly proud of this. Some now manage their monies with little support whilst others still need more support. For that reason the home still operates a combined account system, although they are working towards closing this or managing it in a different way. Oaktree House DS0000021994.V331283.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): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. People who live here have their quality of life enhanced by the opportunities and activities available to them. They benefit from a healthy diet which they plan and cook themselves. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Oak Tree House is a busy family home. As such routines are kept to a minimum and are only there to make sure that the home runs smoothly so that each person living there has the opportunity to be able to live their life as they choose. The people who live here say that staff are there to give them support when they need it and that staff don’t do anything that they haven’t asked them to do. This suits the service users as they wish to be as independent as possible. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 14 Some people living here attend college or are employed. Those spoken with are very proud of this and of their achievements. Two people are very involved in People First – a training group which is managed and operated by people with learning difficulties. Each plays an important role in that organisation and is building on and developing their skills. Other activities include attending the local Gateway club, going to CARE Blackerton workshops, Causeway and going to the cinema and the local pubs. Some residents visit the local towns for shopping trips and some attend local football and cricket matches. People are as involved in village life as they want to be, using the local shops and pubs. One is holding a coffee morning in the village hall to raise awareness for the Downs Syndrome Association. Each person has their own TV, music centre and some have SKY television. Each has their favourite pastimes which they get on with as they wish. Friends and relatives are free to come and visit and might stay for tea or a meal. Some of the people who live here go and visit and stay with their family on occasion. Meals are planned and prepared by the service users. Dinner is usually a cooked meal, prepared by one person on a rotational basis and is eaten in the kitchen/diner. This is not applied rigidly and those that wish to do something different can do so. Discussions with the people who liver here clearly demonstrate that they choose what they eat. Information is provided on healthy eating and people are encouraged to eat fruit and vegetables. Oaktree House DS0000021994.V331283.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 and 20. Quality in this outcome area is excellent. People who live here benefit from proactive healthcare management. They manage their own medications to a degree that suits them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live here need minimal help with their personal care. Discussions with staff and with service users demonstrate that individual choices about personal care are respected. People are helped to access specialist services and to attend specialist appointments when needed. The manager reports that all the people who live here are offered an annual health check. Service users are supported to manage their own medications to a degree that suits them based upon a risk assessment. Some people completely manage their own medications, including ordering repeat prescriptions, whilst others need more support. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 16 The medication system in use was checked and found to be in order. One service user showed us the system they use and this was safe and suitable. Oaktree House DS0000021994.V331283.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 and 23. Quality in this outcome area is good. Complaints are encouraged as a way of helping to build service users confidence and as part of quality control procedures. Service users are protected from abuse although some minor additions to the information available to staff would further enhance this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys all the people who live here say that they know how to make a complaint; that staff always or sometimes treat them well and that staff always or sometimes listen and act on what they say. During discussions with service users they said that if they did not like what someone was doing that they would tell their key worker who would sort it out. They said they feel safe and secure in their home. Four people have made complaints at the home and these have been dealt with to their satisfaction. The commission has not received any complaints about this home. The manager talked of encouraging people to make complaints as a way of helping them to have more control over their lives and their home and as a way of increasing their confidence. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 18 Staff demonstrate a good understanding of what abuse is and a zero tolerance to it. They have received appropriate training, but were not completely clear about the procedures to be followed if an allegation of abuse is made. They did however say they would report this to the person on call, if the manager were not available. When spoken with, the senior manager (who might be on call) gave a clear account of the procedures to be followed, which agencies to involve and when this should happen, ensuring that service users are fully protected. She also said that this is not as clear as it might be in the ‘on-call pack’ and would give priority to reviewing and amending this. Oaktree House DS0000021994.V331283.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): 24 and 30. Quality in this outcome area is good. The people who live here have a home that suits their needs and is safe and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys the majority of the people who live here say the home is sometimes fresh and clean. During this visit it was found to be clean and to have a ‘lived in’ appearance. Service users explained that they are responsible for cleaning their own bedrooms and for working together to keep communal areas clean and tidy. Some are keener than others to do this. People care for their own clothes and do their own laundry. There are facilities in the home for them to do this. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 20 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 and 35. Quality in this outcome area is excellent. People who live here benefit from a small staff team who, through appropriate recruitment, training and support, can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are usually two members of staff working with the people who live here until mid or late afternoon and one in the evening. At night there is a member of staff who sleeps at the home. People who live here say that this is enough because they are very independent. The home uses it’s own staff to cover sickness and holidays ensuring that people are supported by a staff group who fully understand them and their needs. In surveys staff say they know who to contact in an emergency and that they get the support they need. During discussions with the inspector staff Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 21 demonstrate an excellent understanding of the client group, their right to equality and a real commitment to best practice and care. The manager reports in the preinspection questionnaire that staff receive a variety of training including total communication, dementia care, team building and safeguarding adults. She also reports that 75 of staff hold a National Vocational Qualification in care to level 2 and it is planned that level 3 training is planned. Two staff recruitment files were inspected and contained all the checks necessary to ensure the protection of residents. This includes police checks and two references. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 22 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 and 42. Quality in this outcome area is good. People live in a home that is well managed, is safe and is run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager has worked at Oak Tree House for approximately six months. Whilst she has not yet applied to become the Registered Manager, she does intend to do this. Staff and the people who live here are very supportive of her and of the aim of this home to treat each person as an individual supported in their own home. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 23 In the pre-inspection questionnaire the manager reports that appropriate maintenance checks and contracts are in place for systems such as heating and electrics. Appropriate fire checks take place and staff demonstrate a good understanding of this. Quality of the services provided is monitored and measured through the homes own surveys and from using feedback from varied sources such as healthcare professionals and the people who live here. Fire drills take place and service users told the inspector what they do when this happens and how often they happen. Staff demonstrate a good understanding of some peoples’ lack of understanding around fire drills and have taken action and know what to do to compensate for this. All staff receive mandatory training including 1st Aid, food hygiene and health and safety. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 24 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 2 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 3 23 3 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 4 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 x x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 x 3 x 3 x x 3 x Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 5 (1) Requirement The guide to the home should be updated to ensure that the people who live here, or consider coming to live here, have up to date information about the home and the services offered here. To further protect the people who live here from financial abuse, the work ongoing to ensure that people do not have their monies pooled in one account should continue. An application to become the Registered Manager should be submitted to the commission to ensure that a competent manager supports the people who live here. Timescale for action 31/08/07 2. YA7 20 (1) (a) 30/11/07 3. YA37 8 (a) 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 OP23 Good Practice Recommendations In order to fully protect service users from harm the onDS0000021994.V331283.R01.S.doc Version 5.2 Page 26 Oaktree House call pack should include information about the procedures to be followed if an allegation of abuse were made, or if there were suspicion of abuse. Oaktree House DS0000021994.V331283.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Oaktree House DS0000021994.V331283.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. 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!