Inspection on 13/10/05 for Oaken Terrace

This inspection was carried out on 13th October 2005.

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

Oaken Terrace 23/02/09

Oaken Terrace 06/01/09

Oaken Terrace 24/08/07

Oaken Terrace 10/01/07

Oaken Terrace 17/02/06

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

CARE HOMES FOR OLDER PEOPLE Oaken Terrace Hollybush Lane Oaken Codsall Wolverhampton West Midlands WV8 2AT Lead Inspector Mrs Joanna Wooller Announced Inspection 13th October 2005 09:30 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 Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 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. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Oaken Terrace Address Hollybush Lane Oaken Codsall Wolverhampton West Midlands WV8 2AT 01902 847575 01902 846974 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) Interhaze Limited Mrs Flora Gumede Care Home 90 Category(ies) of Dementia (50), Dementia - over 65 years of age registration, with number (50), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (50), Physical disability (40), Physical disability over 65 years of age (40) Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 Physical Disability (PD) - Minimum age 60 years on admission 50 Dementia (DE) - Minimum age 60 years on admission Date of last inspection Brief Description of the Service: Oaken Terrace is located on an elevated area on the edge of the villages of Codsall and Oaken, approximately four miles from the City of Wolverhampton and stands in its own spacious grounds with spectacular views overlooking the countryside. Oaken Terrace transferred registered provider status to Interhaze Ltd on the 7/02/05, recognising Mr R. Patel as registered person and Mrs Linda Parker as Group Care Director. The previous deputy manager Mrs Florah Gumede has been recently registered as the care manager. The home has four units Henderson (20 elderly physically disabled), Cavell (33 Elderly Mentally Ill), Norton (19 elderly physically disabled) and Nightingale (17 residential EMI). Oaken Terrace is an 89 bedded Care Home offering nursing and residential care. The Home is currently registered to admit 33 Elderly Mentally Ill, 17 residential Elderly Mentally Ill and 39 Elderly service users. The home is set in a rural location with good road links and nearby rail and bus services and is comprised of mainly single rooms but there are eleven double rooms available. All areas of the home have access via stairs and a passenger lift. There are adequate parking facilities with easy access to each unit. Each of the units is run as separate operations, with an overall management and support services presence. There is an ongoing upgrade programme in progress. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine announced visit was made on the 13th October 2005 @ 09.15hrs. The inspection was undertaken using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including pre and fieldwork, amounted to 14hrs. The registered Care Manager Florah Gumede was in the home accompanied by Linda Parker the Care Director. Each unit had one trained nurse on duty 24hr a day except Nightingale where the deputy manager worked daytime only. The care staff on duty were all in sufficient numbers to meet the needs of the residents. Ancillary staff on duty included two cooks, 2 catering assistants, five domestics and two laundry persons. The home employs three maintenance persons whose responsibilities include the gardens also. One administrator was also in the home. These staffing levels were adequate to meet the needs of current 88 residents in the home. The inspection included the following elements; a tour of each of the units, observation and inspection of records relating to provision of care, discussions with many residents and their relatives, discussions with the staff members on duty, observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, quality assurance and health & safety. Since the last inspection on 21st February 2005 no additional visits had been necessitated. It was evident that aspects of care had been addressed well, with residents able to choose the home following an assessment and invitation to visit the home. Although major plans are organised for the care records to be altered the residents plans had been well written, some being based on the community care plans completed by social workers. Health, personal and social care needs had been met and well documented. Privacy, dignity and choice aspects for residents were being upheld and relatives spoken to confirmed this to the inspector. The home was found to be fit for purpose and provided a safe environment for the residents and staff. A very homely atmosphere had been created, and the premises were clean and tidy. Adequate areas for residents were provided including; communal space, dining/activity space, bathing/toilet facilities, and bedrooms. Services and facilities, including catering and laundry, were adequately provided. Health and safety aspects had been given a high priority and no shortfalls were noted. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 6 Recruitment and retention of staff aspects were good with little staff turnover. Staff training had been given a high priority, with induction training being followed by NVQ training, and staff had received regular supervision. The home appeared to be managed well by a qualified and competent care manager. General management aspects were good with quality assurance taking place. Records had been correctly filed and stored. Assurances were given regarding the positive financial viability of the home, and that suitable accounting/business procedures are adopted. The home is in the process of a major upgrade, which has included the refurbishment of bedrooms and lounges throughout all the units. Requirements or recommendations made, including the few remaining environmental items, are identified below. It was pleasing to note that their was strong evidence of the home being well managed and that the upgrade of the environment although on going was being completed to a high standard. What the service does well: What has improved since the last inspection? The management of the home have really moved the home on positively. Staffing, training and environment concerns have been well addressed allowing the home to raise its overall standards and appearance. The strong leadership has been reflected in the staff retention and morale within the home. Relatives spoken to have really noticed the changes and felt reassured that their loved ones were well cared for in a safe environment. Further refurbishment is to continue and will be monitored on the next visit. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 7 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. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 8 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 Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 9 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): 3 and 5 Individual health, personal and social cares needs had been established through preadmission assessments and individual needs were being met by staff, which individually and collectively had the necessary skills and experience. EVIDENCE: The documentation seen by the inspectors, and following discussions with the residents/representatives, it was evident that residents had been assessed prior to admission and they had been enabled to make a choice about the home. All those involved had the opportunity to visit the home prior to choosing to stay. Those residents spoken to had visited the home, and had a meal prior to deciding to stay, and this was seen documented within the care plans. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 10 The community care plans provided by the social worker, as part of the individual needs assessment process, were seen within the service user plans. Residents asked confirmed that they had been fully involved and were in agreement with the assessments. The records seen and a discussion with the staff evidenced that care staff, individually and collectively, had the necessary experience and skills to meet the assessed needs of the current service users. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 11 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 to 11 The assessed health and personal care needs of residents had been well documented and were being met, with good standards of care being delivered. There was a safe system for the receipt, storage, administration and disposal of medicines. Residents were treated with respect, privacy and dignity, during the caring process. Assurances were given that at the time of death residents would be treated with respect. EVIDENCE: Many residents and several relatives spoken to all commented positively about the care being provided. The residents plans and associated documentation was well written, meaningful and reflected the current condition of residents. The documentation seen and a discussion with both residents and staff members evidenced that health and personal care needs were being well met. NHS facilities and professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded. A local GP practice and a local Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 12 pharmacist service the home, and there is a good working relationship with them. Records of their visits and outcomes were seen documented. The medicines within the home, medication administration records, controlled drugs book and drugs returned book, were all checked and no errors were noted. It was observed that a safe system was in place, and that the comprehensive medicines policy documentation seen was being complied with. Certified training had been completed for the senior care staff involved with the administration of medicines. No resident was ‘self medicating’, but locked facilities were available. During the inspection it was observed that privacy and dignity were being afforded to residents, and there was very good interaction with staff. Care staff were seen knocking on doors before entering. Doors knockers had been fitted to bedroom doors. Many residents told the inspector that they were treated with respect, and that the staff were very kind and good. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 13 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 to 15 Residents were satisfied with their lifestyle in the home, and they had been able to exercise choice and influence decisions affecting them. Contact had been maintained with relatives and friends of residents. Opportunities to partake in activities and to access the local community had been made available. Catering aspects were good with balanced nutritious meals being served, along with resident consultation and choice. All of the above had contributed to the high level of satisfaction expressed by service users during the inspection. EVIDENCE: Several residents told the inspector that their views had been listened to, and that they had been able to influence some aspects of the running of the home e.g. mealtimes, menus. These comments had been documented along with the feed back from the resident/relatives questionnaires, and they had been acted upon. Contacts had been maintained, where possible, with relatives and friends and this was seen documented. Residents spoke of their visitors and their involvement with the home. Visitors attending the home during this inspection, told the inspector of the good links and communication with them. Trips out to the community had previously been organised and transport provided. A designated person is employed as activities organiser and the Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 14 activities and entertainment provided was seen recorded. The local clergy attend the home regularly, the local church facilities are used, and several residents go out from the home with relatives on a weekly basis. It was noted that no summer fair had taken place this year, although Christmas activities and fund raising was well in hand. Several residents spoke of their satisfaction with the meals and choices offered. The menus and catering records were examined and evidenced that the dietary requirements of residents were met. The records evidenced that residents’ needs with diabetes, and special diets, had been met. The cook when asked said that fresh good quality food from local suppliers was delivered on a weekly basis, the records seen confirmed this. Adequate supplies of fresh vegetables and fruit were also seen. The mid day meal seen was well presented and met all nutritional requirements. The care staff spoke with each resident on a daily basis to establish his or her choice of food for the day, and this was seen documented. The inspector sampled the mid day meal and it was very good, meeting all requirements. Several residents were unable to make a decision regarding choice of meal, due to their current condition, and the inspector saw them being assisted by staff who were knowledgeable of their likes and dislikes. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 15 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 to 18 Complaints or grumbles are listened to and resolved. No complaints had been received by the home or CSCI, since the last inspection. The home policies, procedures and staff training, protected residents from aspects of abuse. Service users legal rights were protected. EVIDENCE: An examination of the complaints record, the relevant policy and procedure documentation, and a discussion with staff and residents, evidenced that complaints and grumbles were listened to and dealt with. Since the last inspection two complaints had been recorded or brought to the attention of this commission. Both of these complaints had not been upheld. Many ‘thank you’ and complimentary cards were seen from appreciative relatives. No incidents of neglect or abuse of any kind has been reported. The policy documentation seen, and a discussion with staff confirmed that residents are protected from all forms of abuse. Documentation seen evidenced that the above issues had been discussed at length during staff induction, training and on-going supervision. A discussion with the staff and residents evidenced that all residents had been afforded the opportunity to exercise their vote in past elections. The manager confirmed that an advocate would be facilitated if required by a resident. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 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): 19,23,26 The home was fit for purpose and provided a safe environment for residents. The home was clean, warm and tidy, and had a comfortable atmosphere. The buildings were adequately maintained, but grounds and gardens required some attention. Increased single bedroom occupancy is being constructed. The above has contributed to the satisfaction of the premises as expressed by the residents and their relatives. EVIDENCE: A tour of the building, and a check on the maintenance documentation, verified that the premises were fit for purpose, clean warm and tidy, and were being well maintained. It is understood that in the long term an increase in single bedroom occupancy is being considered. Two new single bedrooms were seen being constructed, as previously agreed with CSCI. The duty rosters evidenced that adequate ancillary staff were employed. Staff when asked told the inspector of their knowledge on infection control, and showed him the relevant documentation. Adequate hand washing facilities, Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 17 including hand gel, were available throughout the home. The laundry and sluice facilities were seen to be fully compliant. A tour of the premises identified that there is a need for the ongoing redecoration to continue. The walls, ceiling and floors in the laundry area must be made good and redecorated, as agreed. The ceiling in the main kitchen must be cleaned and repainted with an impervious finish. The grounds and gardens were seen as requiring some work to remove weeds from beds and to cut the grass, all as identified during the inspection. It was understood that other work had taken priority and that additional hours would now be allocated for this work. The bedrooms seen were comfortable and residents had personalised them. It is understood that bedroom furniture is being renewed on a rolling programme. Residents and relatives expressed satisfaction with their rooms. Hot water temperature checks, and emergency lighting/fire alarm tests were seen up to date and correct. There are no outstanding issues known from the Environmental Health department. The EHO previously reported items in the main kitchen had been addressed. The fire prevention officer and building control officer will need to inspect the premises on completion of the bedroom work currently in progress. CSCI must be informed when this area is completed prior to occupancy, when checks on satisfactory completion/documentation will be carried out. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 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 to 30 The assessed needs of service users had been met by an adequate number of suitably trained staff. Recruitment procedures had been correctly addressed which had contributed to the protection of service users. No agency staff is being used at present. Staff training had been given a high priority. EVIDENCE: The duty rosters seen, and a discussion with the care manager and the staff, evidenced that adequate numbers of staff had been on duty to meet the needs of the existing service users. Staffing rosters were checked and were in order. In addition to the manager there is a full time deputy manager and three trained nurses on duty on an early shift supported by 13 carers throughout the units. On the afternoon shift there is three trained nurse and ten carers in duty and on the night shift there is three trained nurses and six care staff. Adequate ancillary staff had been provided each week. Several residents when asked stated that staff were available when they wanted them, and that the staff were very kind and helpful. The records seen evidenced that in addition to the manager the home employed 16 nurses and 36 care assistants, of which 18 (50 ) were trained to NVQ level 2 or above. Twenty ancillary staff were also employed at the home. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 19 The homes recruitment policy, procedures and documentation were examined and recruitment issues had been handled correctly. Staff had been subject to POVA/CRB comprehensive checks, and these were seen recorded. Staff asked stated that they had job descriptions and contracts of employment. Training had been given a high priority and the training records of individuals were seen. The records evidenced that care assistants had benefited from ‘in house’ and external training which had covered the needs of the registered client group. Staff told the inspector that they had been afforded the time off and encouraged to study. Training had been provided for staff in the awareness and management of dementia related conditions, and staff outlined this to the inspector. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 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): 31, 33, 35 and 38. The home appeared to be well managed and quality assurance was in place. Financial aspects were correctly addressed and recorded with safeguards to residents. Health and safety issues had been given a high priority and managed well. EVIDENCE: From observations made, discussion with service users, and discussions with the manager and staff, it was evident that the home was being run in the interests of service users. Quality assurance, including feedback from residents and their representatives, was seen documented. Documentation seen evidenced that the views of visiting professionals had also been established, and included in the review process. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 21 A check on the records and a discussion with both residents and representatives evidenced that all service users had the opportunity to handle their own finances and all residents and families had chosen to do so. Day to day monies of residents were checked and money held reconciled with the ledger. Inventories of valuables and belongings brought into the home were seen recorded. No health and safety issues were noted during this inspection, including a tour of the home. The documentation seen for checks and examination of plant and equipment was all correct and up to date. The manager and staff spoken to confirmed that health and safety issues are given a high priority. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 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 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 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 OP19 Regulation 23(2)(d) Requirement Redecoration must continue, with particular attention to the main kitchen ceiling and laundry area, as agreed. Timescale for action 13/12/05 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 2 Refer to Standard OP19 OP19 Good Practice Recommendations The grounds and gardens maintenance should be improved, as discussed. On completion of the new bedroom work all required documentation should be forwarded to CSCI, prior to occupation, as agreed. Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Oaken Terrace DS0000063270.V253471.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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