Inspection on 17/08/06 for Osborn Manor

This inspection was carried out on 17th August 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 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

Osborn Manor 09/11/05

Osborn Manor 29/04/05

Osborn Manor 09/12/04

Osborn Manor 05/05/04

Osborn Manor 22/05/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Osborn Manor 38 Osborn Road Fareham Hampshire PO16 7DS Lead Inspector Mrs Michelle Presdee Unannounced Inspection 17th August 2006 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 Osborn Manor DS0000011768.V305499.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 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. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Osborn Manor Address 38 Osborn Road Fareham Hampshire PO16 7DS 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) 01329 823216 osbornmanor@tiscali.co.uk Mr J Allen Mrs Jean-Anne Allen, Ms M Josephs, Mr D Smith Mrs Jean-Anne Allen Care Home 14 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (14), Old age, not falling within any other of places category (14) Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 All service users must be at least 55 years of age. Date of last inspection 9th November 2005 Brief Description of the Service: Osborn Manor is situated on the outskirts of Fareham town centre, opposite Fernham Hall. The home benefits from being on a main bus route, and is directly opposite a variety of shops, library and a local medical practice. Set in immaculately kept grounds of nearly three quarters of an acre, the home is well screened from the road, and provides accommodation over three floors, within single and double rooms. Communal areas are well maintained, homely and comfortable, and provide a large, comfortable sitting room, a conservatory providing views over the gardens, a dining room and kitchen. Osborn Manor is registered to provide accommodation to fourteen older people, including those with dementia. Two residents may be admitted with dementia over the age of 55. The current charges range from £410.00 to £450.00 per week. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours. During this time the inspector was assisted by the deputy manager and all service user in the home were spoken with and all staff were spoken with. One visitor to the home was spoken with. Six service user comments were received, all were positive except one, which had ticked they like the food sometimes. Two comment cards were received from relative/visitors, which made very positive comments. During the inspection the inspector looked at relevant paper work, records, policies and procedures. All comments received from service users were of a positive nature. Service users enjoyed living in the home and felt the home matched their expectations. Some service users enjoyed going out on their own to the nearby shopping centre, library and one gentleman enjoyed going to the barbers. Service users felt they were treated with respect and had choices in their activities of daily living. What the service does well: What has improved since the last inspection? The home is continually improving the environment of the home. Since the last inspection three bedrooms have been re-decorated, as have the hallway, landing and stairs. Handrails have been fitted on the stairwells, and in the hallway. Grab rails have been to the exterior of the property. Service user meetings have been introduced on a regular basis, which service users enjoy. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 6 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. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 7 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 Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Assessments give a clear picture of a service users needs, ensuring their needs are met. Service users are given the opportunity to come and spend time in the come before moving in, ensuring it is the correct home for them. EVIDENCE: The files of three service users were sampled. Two service users had been in the home for over a year and the third service user had been in the home for under a year. It was noted pre-admission assessments had been completed and information had been gained from hospitals and care managers. The inspector was advised the service user would always where possible be invited to come and spend some time in the home before moving in. If possible a member of staff would visit the service user before moving into the home. Assessments seen did give a clear picture of a service users needs. Discussions were held on the presentation of the information; for the service user who had been in the home for less than a year the information was easy to find and Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 9 gave clear picture. For the service users who had been in the home for a longer period the information was presented in a less comprehensive manner and it was harder to find all the information, although when searching the file information was available. It was agreed it would be more useful to present the information in a manner, which made it easy to access and read in one record. Two service users spoken to stated they could remember coming to look around the home before they moved into the home. The home does not provide intermediate care. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 10 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, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Care plans provide adequate information, but further detail is needed on the care plan to ensure care staff have all information to meet a service users needs. Health care needs are well documented with a range of services available to meet service users needs. Medication is well managed in the home and offers appropriate protection for service users. EVIDENCE: Three care plans were sampled. It was found care plans did record some good information and it was clear to see service users overall health and social needs were being met. Clear information is recorded on all a service users needs and all health visits are recorded in the service users file. Evidence was seen that service users have access to doctors, district nurses, community psychiatric nurses, dentists, opticians and chiropodists. The inspector was advised service users generally go to the health centre for appointments, which is close to the home. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 11 Care plans did give good information but more detailed information was needed in how care should be given. For example when the care plan stated a service user needed assistance with bathing, the care plan should state how assistance is needed and what the carer has to do. Care plans had not always been updated with service users changing needs. The inspector was advised one service user had recently detiorated and the family had been asked to look for a nursing home, however this was not recorded on the care plan. Daily and nightly notes were maintained, which the inspector was advised is where most information is recorded. Daily notes did give lots of information, it was agreed on a monthly basis these should be summarised and added to the care plan where it reflects changes to the care and the service users needs. The home uses a monitored dosage system in line with the homes policies and procedures. All medication is kept in the locked drugs trolley, which is chained to the wall. The senior on duty holds the key, but the inspector was advised all staff are involved in the administration of medication. All staff have received training on the administration of medication and the manager and deputy have received training in Care of Medicines. Medication records and stock held on the day were all accurate. No service users currently take any controlled medication but staff were aware how this should be stored and how it should be recorded. The pharmacist who signs a record for the medication returned collects all excess medication. The inspector watched a member of staff dispense the medication and noted the correct procedure was followed. None of the current service users are selfmedicating. It was clear from observations and discussions on the day service users are treated with respect and their right to privacy is upheld by care practices. A visitor to the home stated she always got to see her friend in private. Care staff knocked on all doors before entering and service user were spoken to in a respectful manner. Most service users had keys to their rooms; which some users choose to use, whilst others felt there was no need to keep their doors locked. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 12 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, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a variety of social activities in and out of the home, giving service users the choice to join in when they wish. Visitors are made welcome to the home and can see service users in private. A varied menu with a choice and good quality food is served to service users. EVIDENCE: All service users spoken to felt the home had matched their expectations before moving in. All service users felt the home offered a range of social activities in and out of the house, which met their needs. Some service users enjoy accessing the local amenities on their own. Other service users spoke of staff members taking them to the local shopping centre. On the notice board there was photographs of staff and service users enjoying a trip to bluebell wood, which service users had enjoyed. The home also arranges activities in the home including representatives from a local day centre calling once a week and organising an activity, manicures, cards, bingo and a selection of board games. Several service users attend church on a weekly basis. Service users Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 13 reported their visitors are made welcome and can visit at any time. One visitor stated they were always made welcome and can visit at any time. Some service users enjoy visiting the local library and books were available in the home. It was clear service users exercise choice in their daily lives. One service user had decorated their room by covering all wall space with pictures of a female celebrity. This service user also had lots of photography equipment in their room. One service user spoke of their choice to move from a double room to a single room. Another service user stated how they liked having a shared room and kept photographs of their roommate. The home has a pleasant dining room, where meals are served. The dining room had four tables, which are laid at meal times. A bowl of fresh fruit was available. The dining room had a large clock, which also tells the date, month and year. The menu is displayed in the dining room on a daily basis, on the day of the inspection roast pork, roast potatoes, cauliflower and broccoli was served. When the inspector arrived in the morning and sat in the dining room many service users came to check the date and the menu. The home has a rotating four-week menu, which demonstrated a varied and balanced diet is provided. All service users spoken to felt the meals were of a good quality and a choice was available. Menus had just been changed due to requests made at the residents meeting, which had recently taken place. One of the six comment cards received had stated the food was only enjoyed sometimes; on the day of the inspection all comments about the food were good. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 14 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive complaints procedure is available, which service users and visitors felt able to use. Staff have knowledge on abuse, which offers protection for service users. EVIDENCE: The home has a complaints procedure, which details all the necessary information. The home has received no complaints since the last inspection. Service user and visitor comment cards received all stated they would know how and who to complain to. Service users spoken to on the day stated they would speak to the manager if they were unhappy and all felt their complaint would be dealt with. The home has relevant paperwork to assist staff with knowledge on abuse and adult protection and the appropriate procedures. No formal training has taken place, but care staff had knowledge of the different types of abuse and what to do if abuse was suspected in the home. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 15 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, 20, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean, safe, pleasant and well-maintained environment for the enjoyment of service users. EVIDENCE: All areas of the home were clean and well decorated. The home provides a relaxed and friendly atmosphere. The home is clean, safe, pleasant and well maintained. Service users spoken to loved the home and seemed proud of the decoration and their rooms. One service user showed the inspector her room and stated how pleased she was to be to bring her own furniture into the home. All rooms were seen and decorated to a good standard and had been personalised by each service user. The home has a pleasantly decorated lounge, which leads onto a conservatory, both look out over the large gardens. New garden furniture has been Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 16 purchased and service users spoke of their enjoyment of sitting outside and having lunch outside on occasions. One service user whose room had been damaged by the storm last year was pleased she had been able to choose the colour scheme and furniture for her room. Service users felt the home was safe and suitable for their purposes. One service user felt the new handrails on the basement staircase and on the corridors on the ground floor had been very useful. Risk assessments have been completed on the building, each room and for each service user. The alarm call system had recently been damaged by a storm. Service users spoken to were aware of this and stated it had not caused them any problems. One service user stated she had asked staff to stop checking her in the night as it was waking her up. A risk assessment had been completed and measures put in place to ensure service users were not put at risk. The inspector was advised quotes for a new system are currently been gathered. The laundry room is on the basement; the inspector was advised all laundry is brought down in covered linen baskets. The laundry is equipped with 2 domestic washing machines. The inspector was advised night staff are responsible for the laundry and ironing. Whilst walking around the home it was noted pots of cream had been left out in service users bedrooms. It was agreed if these are going to be kept in service users bedrooms they must be kept in a locked cupboard. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 17 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, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff on duty meets service users needs, but consistent staffing levels would benefit staff and service users further. Training records should demonstrate what training has taken place in the last twelve months and who has up-to-date training in the core areas. The lack of good recruitment records could put service users at risk. EVIDENCE: The home employs 11 care staff and two domestic staff. Most staff have worked in the home for a lengthy period and have a good knowledge of the service users needs. The inspector was advised nine members of staff have a National Vocational Qualification (NVQ) Level 2 and one member of staff has started a Registered Managers Award. Staff spoken to could remember undertaking an induction period and felt they receive adequate training to equip them to do their job. Training records were not available but the inspector was advised 7 members of staff have current first aid certificates. Other training recently undertaken includes moving and handling, fire training and oral hygiene. Future training includes dementia awareness, parkinsons disease and fist aid at work. It was unclear as records were unavailable to demonstrate when staff had last received training in basic food hygiene, health and safety and abuse. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 18 Duty rotas indicated there was adequate staff on duty to meet the needs of service users. Service users spoken to confirmed there was always someone available and they never waited long if they needed assistance. All staff on duty were spoken with who felt the staff team were supportative of one another. One staff member did report during the school holidays staff were put under pressure due to the third staff member in the mornings who works from 10-2 and who is responsible for cooking being on leave, aswel as the administrator. This member of staff also reported when the home is busy staff could work an 8 hour shift and not get a designated break; at times she stated she had to eat lunch whilst still working in the kitchen. The staff member reported she had discussed these concerns with the manager but no changes had been made. The staff member whist having these concerns still felt it was a good home to work in. Staffing records were not available, but the manager had made her own records demonstrating she had interviewed staff, taken up two references seen all relevant documents and made the appropriate checks. No records could be found at all for one member of staff. All records relating to staff as identified in schedule 2 should be available at all times. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 19 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, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Service user and visitors views contribute in the development of the home. Service users finances are protected and the health and safety procedures in the home ensure service users are protected. EVIDENCE: Mrs Allen was not present on the day of the inspection but all staff and service users stated they felt well supported by the manager. Mrs Allen has been the manager since 1980, as well as being one of the registered providers. It was clear from discussions with service users and staff the home is run in the best interests of service users. Monthly residents meetings take place, which are well attended and give service user the opportunity to discuss any Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 20 concerns or ideas they have. The minutes are taken each meeting and put on the notice board. Service users are taken out for lunch on their birthday; one service user recently went up the Spinnaker Tower on his birthday. Advocates have been found for those service users who have no visitor, which one service user was very pleased with and looked forward to the visit. Staff meetings are held on a regular basis and the minutes are taken. The home manages the personal allowance for several service users, but does not become involved in the larger sums of money. The records held for three service users personal allowance were checked and found to be accurate, with all in-goings and outgoings recorded and receipts maintained. The deputy manager carries out supervision with all staff members. A minimum of six sessions is carried out in a twelve-month period. A record is maintained of each supervision session, which is signed by both parties. Whilst touring the building it was noted all hazardous substances such as cleaning fluids were stored securely. The kitchen was kept clean. Food was being stored appropriately and there was a good selection of fresh vegetables. The temperatures of the fridge and freezers were being recorded daily. All alternative meals were being recorded. At the present time no special diets were being catered for. Records demonstrated staff receive adequate sessions on fire training in a twelve-month period. Necessary checks are carried out on the fire equipment and are recorded on a weekly basis. The fire officer visited in July 2006 and the manager has confirmed she is working on the recommendations made at that time. Service records for checks on equipment were not available on the day of the inspection. The inspector was advised the gas boiler was serviced on 3.8.06. The homes star lift was being serviced on the day of the inspection. The accident book was seen, which demonstrated all accidents are recorded and dealt with appropriately. Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 21 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 X 18 3 3 2 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 (1) Requirement Care plans must be up-to-date and give clear concise information in a chronological order, which allows staff to care for service users. The alarm call system must be replaced as soon as possible. Records as identified in Schedule 2 paragraphs 1-7 must be available at all times. Training must be provided in the home to ensure all core areas are covered in a twelve-month period. Timescale for action 01/11/06 2 3 4 OP21 OP29 OP30 23 (2) (c) 19 (1) 18 (c) (1) 01/12/06 01/11/06 01/12/06 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 Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Osborn Manor DS0000011768.V305499.R01.S.doc Version 5.2 Page 24 - 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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