Inspection on 24/05/07 for Oaklands

This inspection was carried out on 24th May 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oaklands 01/05/08

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

CARE HOME ADULTS 18-65 Oaklands 87 Burton Road Derby Derbyshire DE1 1TJ Lead Inspector Tony Barker Unannounced Inspection 24th May 2007 09:10 Oaklands DS0000069564.V337295.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 Oaklands DS0000069564.V337295.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. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaklands Address 87 Burton Road Derby Derbyshire DE1 1TJ 01332 242770 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) Parkcare Homes (No2) Ltd Ms Debora Armes Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Parkcare Homes (No 2) Ltd is registered to provide personal care for service users of both sexes whose primary needs fall within the category mental disorder MD. The maximum number of service users to be accommodated is 9. Date of last inspection Brief Description of the Service: Oaklands is a large detached house, situated within walking distance of Derby City Centre, shops and facilities. The Home provides assessment and rehabilitation for up to 9 people with mental health needs aged 18 to 65 years. People are supported to develop daily living and social skills and move towards more independent living. The Home has 7 single and 1 shared bedroom on the ground and first floor - access to the first floor is by stairs. There is a small garden area at the front of the premises. Parkcare Homes (No2) Ltd became the registered provider of Oaklands on 19 February 2007. The current weekly fees for this Home range from £821 to £1219. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The time spent on this inspection was 8 hours and was a key unannounced inspection. It was the first inspection since the change of registered provider. Survey forms were posted to the service users but none of these had been returned at the time of this inspection. The Deputy Manager, four support workers and five service users were spoken to and records were inspected. There was also a tour of the premises. Two service users were case tracked so as to determine the quality of service from their perspective. This inspection focussed on all the key standards. The PIQ was reviewed prior to this inspection. What the service does well: What has improved since the last inspection? What they could do better: The Manager must complete an NVQ Level 4 in management in order to maintain a high standard of management within the Home. Some records and Health & Safety matters could be improved. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 6 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. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 7 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 Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual written needs assessments were in place before people were admitted to the Home so that their diverse needs were identified and planned for. EVIDENCE: Two service users were case tracked – one being the most recently admitted person. This service user’s file contained a number of comprehensive reports including a full assessment of need, risk assessments and care plan. It was clear that people were not admitted without a full assessment being undertaken. One service user spoken to said, “I’d recommend this place to anyone”. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 9 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): 6,7,8 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users had an individual plan of care which indicated that they were treated as individuals and supported to make decisions about their lives. EVIDENCE: A good range of appropriate and comprehensive care plans were seen on the two case tracked service users’ files. There was evidence from the content of the Care Plan Evaluation sheets, and by the signatures, that service users were fully involved in the monthly review of their care plans. Individual log books were being completed by staff twice a day, in relation to each service user. These entries explicitly addressed each care plan topic, with extra entries if necessary. There was also evidence of periodic Care Programme Approach (CPA) multi-professional meetings regarding these service users. The Home is commended on the comprehensive way that service users’ needs were being constantly reviewed. One support worker explained that the majority of service users were accommodated on a two-year rehabilitation programme at the Home. However, two were being accommodated on a long term basis and one of Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 10 these people spoke with pleasure about the opportunity to purchase bedroom furniture soon and had already chosen items to buy. One case tracked service user spoken to said that although there were expectations that the daily programme is kept to between 9am and 5pm Monday to Friday they could decide what to do with their time on evenings and weekends. There were restrictions on using alcohol at the Home and these were considered reasonable: the service user accepting the breath tests, given whenever they returned to the Home after an unaccompanied visit out, as being fair. This person also said that they felt respected by staff and other service users. All the service users had been involved in tidying up a garden area in front of the Home’s premises in 2005, staff informed the Inspector, with five actually physically involved in creating the new pond there. The service users were proud of this achievement. Participation of service users in all aspects of life in the Home was also noted through the minutes of Residents’ Meetings and Community Meetings. Recently updated risk assessments were in place. There was plenty of evidence that a central principle of the Home was in supported service users to take risks as part of an increasingly independent lifestyle - in order to take control of their own lives. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 11 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home provided activities and services that were appropriate to service users’ needs, valued by them and promoted their independence. EVIDENCE: Activities carried out by the service users were recorded on care plans and Activities Programmes. The latter indicated a wide range of vocational, educational and leisure interests being followed by the current service user group. One service user proudly drew the Inspector’s attention to drawings on the dining room wall that this person had drawn. Staff said that a student social worker had run an art class at the Home recently. Both case tracked service users spoke positively about the voluntary work they undertake in the local community. Two ex-service users of the Home were supported, in their own accommodation, by staff from the Home. They had retained links with the Home - visiting for meals at weekends and joined service users from Oaklands Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 12 for some leisure activities in the local community, such as swimming and snooker. One case tracked service user stated that, “I get on with everyone here”. This person spoke of a “good atmosphere” at the Home and of peers: “We help each other out”. Records indicated ongoing relationships with friends in the community and staff spoke about examples of service users’ relationships with their families being “rebuilt”. Staff said that rising times at weekends were flexible and service users confirmed this. All service users were involved in domestic tasks each day and these provided structure to their days, especially weekdays, and skills that they would take back to the community within more independent accommodation. Food stocks were at a satisfactory level and included fresh fruit and vegetables. The menu indicated that service users were being provided with a nutritious and varied diet. Lunch, on the day of the inspection, was a relaxed, communal occasion with staff sitting down with service users. Staff said that service users are encouraged to help prepare main meals for the group and are all involved in the setting and clearing of tables and in food shopping. One case tracked service user said that “Once a week I cook for myself, from a budget of £3, and I can decide what to cook”. This service user spoke of receiving advice from staff about dietary matters, such as not cooking a ‘fry up’ every week. Another case tracked service user said the food is “really good”. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 13 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 excellent. This judgement has been made using available evidence including a visit to this service. The Home was providing service users with personal support in the way they preferred and required and was meeting their health needs in an individualised way. EVIDENCE: There was evidence, on service users’ care plans, of staff supporting people to maximise control over their lives. One case tracked service user confirmed that they were listened to by staff who would act on requests if possible but added that, “just talking helps”. This service user felt staff to be supportive when “feeling down” and that ”there was always someone on hand”. The other case tracked service user also felt staff to be “very supportive...and approachable” and told the Inspector that though they are “strict” they are reasonable too. This person spoke of having more independence now in the ‘run up’ to a move from the Home into more independent accommodation. One support worker was asked about how staff meet service users’ need for privacy and respect. She said that staff knock on service users’ bedroom doors, wait for a answer and call out if no reply. She spoke of how satisfying it was to see service users progressing. There was a payphone for service users’ use in the entrance hall. The Home is commended on the level of personal support provided to service users. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 14 Care plans showed clear evidence of service users’ health needs being met and of a range of health professionals being involved in their lives. The service user who was due to leave the Home in the near future was selfadministrating all personal medication. There was a ‘Self Custody of Medication’ form on their personal file. There was a ‘Monthly Self-Medication Assessment Sheet’ for this person to complete, which indicated their awareness of their medicines - for example what they were for and their side effects. This was particularly good practice. Handwritten items of medication on Medication Administration Record (MAR) sheets had signatures, countersignatures and dates recorded. Medicines for use ‘as and when’ (prn) were being appropriately recorded and there was a written policy on their use. However, staff were not aware of the need to complete written protocols for the administration of prn medication to individual service users - although the maximum dose of prn medicines was recorded on MAR sheets. There was a template for such protocols on the Home’s Policies and Procedures file. The only prn medication in use at the Home, at the time of this inspection, was paracetamol. Photographs of service users and specimen staff signatures were also seen with MAR sheets. The Deputy Manager said that most staff had been provided with training in the safe use of medicines. The Home is commended on its high standard medicine management. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. There was a robust complaints procedure and good staff awareness regarding safeguarding adults so that service users felt safe and were protected from abuse. EVIDENCE: There was a well-worded Complaints Procedure displayed in the entrance hall. The Home’s complaints record was examined which confirmed there had been no complaints received since the previous inspection. Both case tracked service users said they would feel able to speak to any staff member if they had a problem or complaint. The Deputy Manager spoke of an incident two years previously when service users complained to the Company’s Regional Manager about restrictions on the use of tea and coffee in the Home – brought about through unhealthily heavy usage by the service user group at the time. She gave this as a good example of service users feeling empowered. The Home had a detailed ‘Safeguarding Adults’ policy & procedure and their ‘whistle blowing’ policy was displayed in the entrance hall. The minutes of the most recent staff meeting made reference to this ‘whistle blowing’ policy being available to staff. One support worker spoken to showed good awareness of this policy. There was documentary evidence of all staff having attended training on ‘Safeguarding Adults’ – also of five staff attending ‘Non-Violent Crisis Intervention’ training. Both case tracked service users confirmed they felt safe living at the Home. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were living in a comfortable, hygienic and well-maintained environment, which was furnished and decorated to a good standard. EVIDENCE: The Home was well decorated and furnished and was comfortable. One service user’s bedroom was viewed and this was nicely personalised. All bedrooms had door locks for service users’ privacy. However, the privacy lock on the first floor female toilet door was not functioning. The exterior of the building was well maintained. There was a small garden area at the front of the premises, which included a small pond. There was a fault on the Home’s emergency call bell system that was being dealt with by the electrician. Also, there was no emergency call point in the first floor female toilet. A member of staff said that the current group of service users did not use the system. Other aspects of Standard 29 were not assessed on this occasion. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 17 The Home was clean and free from odours. The service users were all involved in the cleaning rota for the communal areas, and their own rooms, as well as having responsibility for handling their own laundry. Two time slots each day were available for individuals to wash their own clothes, with support as necessary. A support worker said there were plans for one of the Home’s two washing machines to be made available for the independent use of service users. The Home’s Infection Control policy was examined and the Deputy Manager said all staff had been provided with Infection Control training. One case tracked service user confirmed that the Home was clean and fresh “at all times” and added that, “I am good at keeping the Home clean” and that, “personal hygiene is encouraged”. The Home did not employ any domestic staff. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 18 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): 32,33,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home had a stable group of well-trained staff to ensure that service users’ needs were appropriately met. EVIDENCE: Four of the eight care staff had achieved a National Vocational Qualification (NVQ) to level 2 or above – three of these to NVQ level 3. This met the National Minimum Standard to maintain a staff group with at least 50 qualified staff. Additionally, two staff were still undertaking this qualification. Information from the PIQ indicated that the Home was providing numbers of staff on duty in excess of the standards laid out by the Residential Forum. Additionally, evidence from observations on the day of the inspection, and from staff and service users, showed that staffing levels were providing good levels of individual support to the service users. There was a stable staff group, with no one leaving since the previous inspection. Any gaps in the duty rota were being covered from within the staff team and agency staff were not being used. Staff meetings were being held and minuted. The file of the support worker most recently appointed was examined. It contained all of the elements, required by current Regulations, regarding staff Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 19 recruitment practices. All staff had been given copies of the code of conduct issued by the General Social Care Council. From examination of the PIQ, staff training records and discussion with the Deputy Manager, it was clear that staff had been provided with all mandatory training. The availability of an ’at a glance’ training matrix would have been of value. There was documentary evidence of new staff following induction and foundation training that meets the specifications laid down by ‘Skills for Care’. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 20 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): 37,39,41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home was well managed so that service users were protected and their best interests were promoted by the systems in place. EVIDENCE: The Deputy Manager confirmed that the Manager was still in the process of completing a course leading to the Registered Manager’s Award at National Vocational Qualification (NVQ) level 4 and had worked with people with poor mental health for 27 years. Records of the monthly, unannounced audit visits to the Home, undertaken on behalf of the registered provider, were examined and found to be satisfactory. The Deputy Manager stated that the Company had an Annual Plan although this could not be found on the day of the inspection. The Deputy Manager said that satisfaction questionnaires are sent to service users and their relatives. These are returned to the Company’s headquarters and a summary of the Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 21 collated responses sent on to the Manager. Residents Meetings and Community Meetings were being held regularly and the responsibility of chairing and minute taking was held by service users on a rota’d basis. The minutes of a recent residents meeting included entries such as, “Everyone is happy with the food” and “Everyone enjoyed the West Midlands Safari Park”. All required records were in place. The Employers’ Liability Certificate, Statement of Purpose and Registration Certificate were all displayed in the entrance hall. The Deputy Manager said she was planning to display a notice informing service users, staff and visitors where the last inspection report is available. Cleaning materials were being safely stored in locked cupboards and Product Information Sheets were available – although not near the first floor store. The pre-inspection questionnaire showed that equipment was being checked and maintained appropriately. Up to date Portable Appliance Test, electrical wiring and emergency lighting test certificates were examined. Good food hygiene practices were being followed and at the last visit of the Environmental Health Officer he stated, ”Standards of food hygiene were found to be very good”. The Home was following up on the one requirement left by the Fire Officer from his visit in February 2007. Six monthly Health & Safety Audits were being undertaken. All staff had been provided with Health and Safety training. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 22 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 X 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 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 X 2 X 3 X 3 3 X Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 23 N/A 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 YA37 Regulation 9(2)(b)(i) Requirement The registered manager must complete an NVQ Level 4 in management in order to maintain a high standard of management within the Home. Timescale for action 01/11/07 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. 2. 3. 4. 5. Refer to Standard YA20 YA24 YA29 YA35 YA42 Good Practice Recommendations Written protocols, for the administration of prn medication to individual service users, should be completed when necessary. The privacy lock on the first floor female toilet door should be repaired. The Home’s emergency call bell system should be operative in all rooms used by service users. An ’at a glance’ training matrix should be developed. Cleaning material Product Information Sheets should be kept near to the first floor store. Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oaklands DS0000069564.V337295.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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