Inspection on 27/09/06 for Orchard House

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard House 10/03/09

Orchard House 01/02/06

Orchard House 04/08/05

Orchard House 08/03/05

Orchard House 04/08/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Orchard House 401 Shoreham Street Sheffield South Yorkshire S2 4FB Lead Inspector Mrs Janis Robinson Key Unannounced Inspection 27th September 2006 08:30 Orchard House DS0000002995.V313535.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 Orchard House DS0000002995.V313535.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. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address 401 Shoreham Street Sheffield South Yorkshire S2 4FB 0114 249 4255 0114 249 4256 none 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) Orchard Care Ms Linda Margaret Anne Wake Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service can accommodate existing service users when they reach the age of 65 provided their care needs can be met. Date of last inspection Brief Description of the Service: Orchard House is a care home providing services for up to ten adults with a learning disability. It is based in an inner city area of Sheffield. The home was originally two terraced houses, which have been converted into one dwelling. Accommodation is provided on the ground and first floors. The second floor provides office and sleeping in space for staff. All of the ten bedrooms are single, six have en-suite facilities. A communal bathroom is provided on the ground and first floor. Communal space consists of two lounges, a dining room and kitchen. A small laundry is provided. There is a small garden to the front of the property. Current weekly fees range from £291 to £514. Written information about the home is provided to current and prospective residents and their representatives. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 6.5 hours from 8:30 am to 3pm. The inspector spoke with seven residents, individually and in small groups, about living at the home. Both staff on duty were spoken with, one member of care staff was formally interviewed, about working at the home. Discussions with the registered manager took place. An inspection of the environment was undertaken. Some records were examined, which included; staff rota, training and recruitment, residents care plans, medication, quality assurance, complaints and fire records. Written questionnaires about the home were provided for residents, staff and relatives to complete, in confidence, and return to the Commission for Social Care Inspection (CSCI), if they chose to do so. What the service does well: The interactions observed between residents and staff appeared respectful and caring. Residents said ‘it’s good living here’, ‘you can go out when you want, as long as you tell staff’, ‘the staff are good’, ‘we enjoy the food’. Assessments prior to admission were undertaken alongside planned visits to the home to ensure all assessed needs could be met. A care plan was in place for each resident to outline the staff action required to meet identified needs. Residents were supported to take risks and make decisions about their lives. Access to day care and work placements was supported to those residents who wished to access these. Whilst the majority of residents independently accessed facilities in the local community, staff supported some activities and trips out of the home. There was an open visiting policy, to encourage contact with relatives and friends. The routines at the home were flexible, to enable residents to have some control over their lives. The menu was varied, and individual preferences were respected. Residents’ health was monitored, and access to relevant health care professionals was available to ensure health was maintained. There was a complaints and adult protection policy in place to promote residents safety. On the day of the inspection the environment was clean and appeared comfortable. All of the residents asked said they were happy with their rooms. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 6 Agreed levels of staff were being maintained. Records were well organised and up to date. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard House DS0000002995.V313535.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 Orchard House DS0000002995.V313535.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments prior to admission were undertaken, to ensure the home could meet identified needs. Prospective residents, and their representatives, were able to visit the home to help them decide if they wanted to live there. EVIDENCE: Assessments of needs were undertaken prior to admission, to ensure the home could meet the needs of any prospective resident. The homes manager carried out the assessments. Copies of assessments were inspected, they contained the full range of information required, and provided sufficient information to assist in formulating a care plan. Copies of social workers assessments were contained in care plans. Information from other relevant professionals was obtained prior to admission, if available. Prospective residents, and their families and carers were encouraged to visit the home to meet staff, residents and have a look around the home before admission to inform their choices. Staff confirmed that this was normal practice. Discussions with the manager evidenced that introductions to the home were based on individual need, and could take several weeks. Two Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 9 residents had been admitted since the last inspection; staff confirmed that several visits to the home had taken place, over several weeks and including overnight stays, before a decision to move in was made. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident had a care plan, to ensure his or her opinions had been sought and their needs identified. Residents were supported to make decisions to enable them to have some control over their lives. Residents were supported to take risks to ensure they led full lives as safely as possible. There was a policy on confidentiality, to protect residents’ rights. EVIDENCE: Care plans were well set out and easy to read. Where they had chosen to do so, residents had signed the plans to evidence that they had been involved in the drawing up of the plan. Staff said that care plans were explained and discussed with residents in individual key worker meetings. The plans Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 11 contained a comprehensive range of information covering all aspects of personal, social and health care needs. The plans set out the staff action required to ensure identified needs were met. The care plans were in the process of being updated to include large, easy to read text, diagrams and pictures, to make the more accessible to residents. The plans had been regularly reviewed. Risk assessments were in place to ensure all identified risks were well managed whilst providing some independence to residents. Residents were encouraged and supported to make decisions. The inspector observed staff offering choices and discussing with residents their plans for the day. One resident chose to attend a local coffee morning and visit local shops, other residents attended day centres and work placements. The policy on confidentiality in place ensured information about residents was respected and kept safe. All of the residents spoken with said that they liked living at the home. They said that they had everything they needed. They could make decisions, and the routines at the home were flexible. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had opportunities to participate in activities, to enjoy leisure time. Some residents independently accessed facilities in the local community. Staff supported other residents to access these so that the same opportunities were available. Trips out of the home, and holidays, were provided to residents to improve choices offered. Contact with family and friends was encouraged and supported so that relationships could be maintained. Residents’ rights were promoted and responsibilities identified to support independence. A varied diet was provided to respect individual preferences and maintain health. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 13 EVIDENCE: Risk assessments had been undertaken and a minority of residents had been identified as needing staff support to access the local community to maintain safety. A range of activities was offered to residents. A weekly activities programme was on display, this included games in the home, trips to local pubs and shops. Residents said that they enjoyed the activities provided, and informed the inspector that they had just returned from a weeks holiday at Butlins, which they had really enjoyed. Staff and some residents confirmed that contact with family and friends were maintained. The home had an open visiting policy to encourage contact. Residents contributed to the running of the home, where able. Residents helped clear up after meals and were responsible for their own bedrooms. Some residents did their own laundry. Residents helped plan and shop for the weekly menu. All of the residents said that the food was good. The weekly menu was on display. Resident confirmed that they were provided with food that they liked, and could have different things to eat if they wanted them. Plentiful stocks of food were available at the home, including fresh fruit and vegetables. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents received personal support appropriate to their needs to support independence. Staff monitored residents’ emotional and physical health, to ensure this was maintained. The policies and procedures for medication in the home protected residents. EVIDENCE: The care plans examined contained information on residents personal care needs in detail. The plans set out the staff action required to ensure all identified needs were met. The recordings were specific and comprehensive. Staff had a clear understanding of the needs of residents, and the knowledge to ensure personal care needs were met respectfully. All of the residents were able to independently meet their personal care needs. The plans contained information on encouragement and advice. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 15 The care plans contained information on health care. Appointments and treatments with health care professionals were recorded. Access to specialist was supported. Staff responded to any health concerns promptly. Residents said that they could see their doctor when needed, and had contact with dentists and opticians when required. A policy on medication was in place. All staff administered medication and had been provided with in house training on the safe administration of medicines. All medication was stored securely. Medication administration records were fully recorded and up to date. A pharmacist audited the medication systems at the home. None of the residents self-administered medication, although systems were in place to accommodate this if residents were assessed as able to manage. Formal training on the safe administration of medicines had been organised for all staff, and was due to take place in October 2006. This training was being facilitated by a pharmacist. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear and accessible complaints procedure was in place, to ensure residents rights were protected and any concerns listened to and taken seriously. An adult protection procedure was in place to ensure residents’ safety was promoted. EVIDENCE: The complaints procedure was included in the information packs provided to residents. It included contact details of the local office of the CSCI. In addition, the contact details were provided in each bedroom. The staff were confident that any compliant received would be listened to and taken seriously. Those residents asked said that they could go to the manager if they were worried about anything. No complaints had been received by the home. There was an adult protection policy in place, which included the Department of Health guidance ‘No Secrets’. Staff undertook adult protection training as part of their national Vocational Qualifications (NVQ). The manager confirmed that all staff were undertaking, or had achieved, this award. The residents said that they felt very safe at the home. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained. Homely touches had been provided to create a comfortable environment. Communal areas appeared comfortable, and residents bedrooms were well personalised to reflect individual tastes. Sufficient bathing facilities were provided too enable residents’ choice. A rolling programme of redecoration was in place, to maintain the environment. EVIDENCE: A partial inspection of the environment was undertaken. The home was clean and well decorated. Communal areas were provided with pictures and ornaments. Furniture appeared in good condition. Three residents showed the inspector their bedroom. All were well decorated and reflected the individual Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 18 interests and personalities of the occupants. All of the residents said that they were very happy with their rooms. Six of the ten bedrooms were provided with en-suite showers. In addition, the first floor had a bath and shower, and the ground floor had a bathroom. These were clean and well maintained. The kitchen and laundries were well equipped. Since the last inspection the exterior brickwork had been painted. Four bedrooms had been redecorated and three bedroom carpets replaced. Two new washers and dryers had been purchased. The first floor bathroom had been refurbished. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Agreed levels of staff were being maintained to ensure sufficient staff were available to residents. Good relationships between staff and residents were observed. Access to NVQ training was provided to staff, to improve their skills. Whilst induction training took place, staff had not been provided with aspects of mandatory training to equip them with the skills required to carry out their duties well. A recruitment procedure was in operation, to uphold residents’ safety. Some gaps were evident in staff files. Staff were provided with regular supervision, for development and support. EVIDENCE: Staff had been provided with job descriptions, to inform them of their roles and responsibilities. There were clear lines of accountability within the home. The Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 20 staff had a positive attitude to their jobs. An on-call system was in operation; staff confirmed that the manager was available for advice if not on duty. The homes rota indicated that agreed levels of staff were being maintained. All of the staff and residents felt that enough staff were provided. Some training was provided to staff. Five staff had completed NVQ 2 or 3.All other staff were undertaking the award. Whilst structured induction training for new staff took place, aspects of mandatory training had not been kept up to date. Each member of staff had an individual training record. Two staff recruitment files were examined. These contained all of the required documentation, including; proof of identity, a photograph, criminal records bureau (CRB) check and references. However, the two application forms examined both had gaps in employment history that had not been explained. One application form had not been fully completed. All staff confirmed that they received one to one supervision regularly. Supervision records examined indicated that supervision was provided to all staff at the required frequency. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefited from the managers leadership style. A quality assurance system was in operation, to obtain the views of residents and their representatives. The results required publishing so they were available to interested parties. A range of up to date policies and procedures were available to staff to inform their practice. Health and safety systems were in place, to protect residents and staff. Equipment was checked and serviced. Some staff had not participated in a practice drill at the required frequency, and aspects of mandatory training were out of date, which did not maintain staff skills. Insufficient staff were trained in first aid to ensure a qualified person was on duty at all times. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered manager was qualified and experienced. Staff said the manager was approachable and supportive. The inspector observed positive interactions between the manager and residents. Residents said the manager was ‘good’, and ‘nice’. A survey had been undertaken with residents, their representatives and staff, as part of the quality assurance system. The results had been comprehensively audited. These required publishing so that the positive results were available to interested parties. A range of appropriate policies and procedures were in place. These were accessible to staff, and easy to read. Health and safety systems were checked and serviced. Weekly checks were undertaken on fire alarms and emergency lighting. All residents had participated in a practice drill, and records were kept of this. Staff had annual fire instruction. Fire drill records indicated that staff had not participated in a fire drill within the last six months. Staff required updates in aspects of mandatory training, such as food hygiene, infection control and health and safety. Insufficient staff were trained in first aid to ensure a qualified person was on duty at all times. Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 23 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 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 3 3 2 X Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 18 Requirement Staff recruitment files must contain evidence that gaps in employment history have been explored. (Previous timescale of 30/04/06 not met) Application forms must be fully completed. An audit of mandatory training must be carried out and training provided where gaps are identified. All staff must be up to date in moving and handling, food hygiene, infection control and health and safety training. (Previous timescale of 31/05/06 not met) 4 YA35 18 A written plan and timetable for all mandatory staff training must be developed. A copy must be forwarded to the CSCI. The results from the quality assurance audit must be published and made available to interested parties. Sufficient staff must be trained in first aid to ensure a trained DS0000002995.V313535.R01.S.doc Timescale for action 31/12/06 2 3 YA34 YA42 YA35 18 18 31/12/06 31/01/07 30/11/06 5 YA39 12 31/12/06 6 YA42 13 31/01/07 Orchard House Version 5.2 Page 25 person is on duty at all times. (Previous timescale of 31/05/06 not met) 7 YA42 18 All staff must participate in a practice drill at least every six months. 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Orchard House DS0000002995.V313535.R01.S.doc Version 5.2 Page 27 - 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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