Inspection on 08/11/06 for Oxberry Avenue, 25

This inspection was carried out on 8th November 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oxberry Avenue, 25 15/05/08

Oxberry Avenue, 25 23/07/07

Oxberry Avenue, 25 01/11/05

Oxberry Avenue, 25 11/04/05

Oxberry Avenue, 25 16/11/04

Oxberry Avenue, 25 10/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Oxberry Avenue, 25 Oxberry Avenue 25 Oxberry Avenue Fulham London SW6 5SP Lead Inspector Jacqueline Derbyshire Unannounced Inspection 8th November 2006 11:30 Oxberry Avenue, 25 DS0000019142.V317338.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 Oxberry Avenue, 25 DS0000019142.V317338.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. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oxberry Avenue, 25 Address Oxberry Avenue 25 Oxberry Avenue Fulham London SW6 5SP 020 7736 2427 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) info@yarrowhousing.org.uk Yarrow Housing Ms Georgina Frances Morgan Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: Oxberry Avenue is a registered care home providing accommodation and personal care for 5 women with a learning disability. The property is owned by the Threshold Housing Association and the care is provided by Yarrow Housing Limited, a voluntary organisation. The home opened in 1987 and is situated in a quiet residential street in Fulham, close to shops and public transport. Oxberry Avenue, 25 DS0000019142.V317338.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 on Wednesday 8th November 2006; the inspector spent 4.00 hours visiting the home. The Inspector spoke with 4 of the service users, the Deputy Care Services Manager and staff. The Inspector checked the care records of two service users; two of the service users finance records and medication records. All of the service users bedrooms were looked at and all communal parts of the home. The home provides an adequate standard of accommodation that was seen to be clean and tidy. 4 of the 6 requirements that were set 01/11/05 have been met; 12 new requirements have been made from this visit. There is an issue that staff are not attending mandatory training refresher courses in first aid and food hygiene, it is very important that all staff have an up to date training and development programme completed. The weekly placement cost is £1162.00. What the service does well: What has improved since the last inspection? What they could do better: The Manager to liaise with the local authorities placement team to make sure the relevant care package is being provided to one of the service users who has been living at the home for many years but has had no social worker attend reviews. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 6 The Manager to make sure all staff working at the home have got the relevant training specifically first aid and food hygiene as not having these could lead to health and welfare issues for of the service users. A training programme has to be produced by the Manager and a copy sent to the CSCI. The Manager to make sure any student placements have had the relevant recruitment checks with a CRB disclosure in place before them being placed at the home. The homes freezer needs to be defrosted and the Manager needs to make sure that any frozen food is safely stored. The Manager also needs to make sure dry foods are stored safely in containers. The homes boiler needs to have a new cover as it is falling apart; this needs to be replaced quickly as it is in the utility room that service users have access to. 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. Oxberry Avenue, 25 DS0000019142.V317338.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 Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is information in place that is up to date and informative for prospective service users. All service users have a contract in place. EVIDENCE: All five people living in the home have lived together for some years and original care needs assessments and other reports have been archived. The local authority monitors the care of 4 service users living in the home and the Placements Officer organises regular reviews, involving the service user, their relatives, staff and other significant people. As well as looking at how care needs are met, the review considers the overall suitability of the placement, as individual’s needs change. There is an issue that one of the service users does not have a placement officer and the Manager has to liaise with the local authority to make sure there is a named person for the service user who will attend a review meeting to make sure the relevant package of care is being provided. The Inspector looked at the records of the service user and was happy that the relevant care is being provided. All of the service users have an original contract in place, the two service user records the Inspector looked at had an up to date Residents Agreement that was signed and agreed by the mothers of both people. Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards of care planning and risk assessment are good. Staff involve service users in making decisions wherever possible. EVIDENCE: The Inspector looked at the records for two service users that were relevant and up to date. (PCP) Person Centred Planning records and review records have made excellent use of photographs of service users, significant people, places and events to make the information more accessible to people living in the home. The Inspector spoke with 3 staff and felt that they each had a good understanding of the care needs of each service user. One service was just getting ready for a late breakfast when the Inspector arrived in discussion with staff this was because the service user liked to have a lie in and choose what time she would get up. Service users were seen to be happy in the home and staff were interacting well with the service users not telling them what to do but allowing the service users to show them what they wanted with sign language and escorting staff to the kitchen for instance for a drink, staff were clear that part of their role is to promote choice and independence. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 10 The standard of risk assessment and risk management in the home is good. The Inspector looked at the risk assessments that have been completed for two service users that have been updated recently. Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 12,13,15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are well supported to take part in a range of activities in the home and the local community. EVIDENCE: The Inspector looked at the care plans for two people living in the home. Each plan included a variety of activities, including dance classes, movement and drama sessions. The staff rota is arranged to enable each person to be supported with an activity at least once each day. Staff also work late day shifts to support people with evenings out to the cinema or social clubs. One of the service users is taking part in work experience at a local business in the community. On the day of the Inspection one of the service users was away visiting her family the other four people all went out to participate in their planned activities. The two service user records looked at showed that they went on holiday, there were photographs of this holiday in both (PCP) Person Centred Planning review records. Risk assessments were completed on the service users before their holidays. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 12 Service users are also able to take part in leisure activities in the home, either in communal rooms or bedrooms, one service user was being assisted to look at photographs on a computer assisted by Yarrows multi-media expert and one service user was seen drawing and colouring pictures. Three service users have regular contact with their relatives, including one person who stays with their mother three nights each week. Other relatives visit service users in the home and staff said that they support contact by phone and in writing. In discussion with staff it was stated that one service user has links to an advocacy service in the community. The Inspector looked at the weekly menu for the home that is put in place at the weekly residents meetings on a Friday. The menu was varied with lots of choice; in discussion with staff they stated that they do cook a lot of different foods and the service users like this. Service users spoken with stated they liked the food and take turns assisting staff to prepare the meals. Fresh fruit was seen and the home had a sufficient amount of variety of service users. On the day of the Inspection lunch was a pasta dish that looked really good. The Manager has to make sure that all staff has the relevant food hygiene training that enables them to prepare and provide meals. Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 18,19, 20 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health care needs of people working in the home are well met and staff work well with other agencies. Medication procedures should be followed at all times, all staff should complete medication training. EVIDENCE: Service users’ health care needs are well recorded as part of their care plans. Staff said that all of the service users are assisted with their personal care needs, but two people require more physical assistance. Both people have asked to be supported with their personal care only by female staff. This is not an issue as the staff team is currently all female. The two service users records checked had a lot of information in place including medical appointments either at the home or hospitals. One of the service users has epilepsy there are detailed records in place to show staff the procedure to take when this occurs; all staff has been trained in this area. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 14 The Inspector checked the medication records (MAR) sheets and medicine cabinet there are issues that any bottles of medicine must have a date opened written on them. There is also an issue with the information on one of the service users dossett box that does not correspond with the information for administration on the MAR sheet; the Manager must liaise with the pharmacy to make sure the correct information is written. In discussion with staff the Inspector was informed that only 3 members of staff have completed the medication training. As written throughout this report the Manager must complete a training programme for all staff to make sure training has taken place. The policy for death and dying needs to be implemented for all service users and records should be kept in each service users care plan, in discussions with staff this has been implemented for one service user. Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure in an accessible format and service users are cared for safely. EVIDENCE: Yarrow had a complaints procedure, adult protection procedure and a separate ‘whistle blowing’ policy and procedures. Staff said that although all five people living in the home have little or no speech, each person can make their needs, likes and dislikes known to staff. The Deputy Manager confirmed that there have been no complaints or protection issues in the home. The Inspector saw in the two files looked at quality assurance questionnaires were the complaints procedure is mentioned both questionnaires show that the service user and family would know what to do if they had a complaint. The Inspector checked the finance records of two service users; one was seen to be correct with all relevant records and receipts in place. One of the service users financial transaction sheets for two months were not in place and hand written receipts were seen. The Manager must make sure the correct procedure is followed by all staff that shows all financial transactions and what balance of money should be left. Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 24,25,27,28 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 provides a good standard of private and shared accommodation. There is a need to complete the installation of the new shower. EVIDENCE: The Inspector had a full tour of the home that was seen to be well decorated and comfortable. All five-service users bedrooms were seen that were all individualised with personal items such as pictures, photographs and furniture all five bedrooms were well decorated and comfortable. A service user from another home managed by Yarrow works as a cleaner at Oxberry Avenue for 2 hours a day, 3 days a week, cleaning communal areas. People living in the home clean and tidy their own rooms, with support from staff. The home was clean and tidy in all areas. There is an ongoing issue with the shower in the home, a new shower has now been fitted there is still no power to it and in discussion with the Deputy Manager this is because they are awaiting the return of an electrician. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 17 Yarrow must ensure this work is completed urgently as one service user cannot have a bath and has to wait for a shower when she visits her family home this is impinging on health and welfare issues and must be not continue. Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 32,34, 35 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. All staff requires an up to date training and development programme to show they are competent in all relevant areas. All staff working at the home must have a CRB disclosure. EVIDENCE: The Inspector looked at the staff rota that showed sufficient staff is on duty at all times to meet the needs of the service users. In discussion with staff it was stated that only one member of staff is waiting to register for an NVQ qualification this is excellent. The Inspector looked at the training records of staff and in discussion with the Deputy Manager and staff it was evident that mandatory refresher training in first aid, food hygiene, moving and handling are not being provided. These training areas are extremely important and ensure that service users are protected under health safety and welfare issues. The Manager must do an internal audit on all staff and produce a programme of training ensuring all staff is up to date, a copy must be sent to the CSCI. The Manager must also make sure that a member of staff is on duty on all shifts that has a first aid qualification. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 19 There is a need for the Manager to make sure any student placements have all relevant checks completed as well as a CRB disclosure before the placement begins. The Deputy Manager told the Inspector that there are two vacancies in the home at present and that staff are working overtime or bank staff are used to sure up the vacancies. The Inspector checked the records of two staff and supervision and appraisal records were seen to be in place, staff stated that they have regular supervision. Oxberry Avenue, 25 DS0000019142.V317338.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): Standards 37,39,41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards of record keeping are good. There is a need to ensure that the correct procedures are followed for handling service users’ finances. The Manager must check the safe storage of food. EVIDENCE: The Manager was not on duty at the time of this inspection and the Inspector was unable to check certain areas of standards in this section. The Inspector looked questionnaires that had been completed by a service user and their mothers that show that there are no issues about the home and they are happy with the care provided. Yarrow does have an annual quality assurance document for all of their homes that is available to all service users, their families any stakeholders and the CSCI is sent a copy. Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 21 The Inspector checked all health and safety records including fire evacuations and tests, the records were all up to date with no issues. The Manager does need to check the safe storage of frozen food and dry food. The boiler needs to have a new cover, as it is unsafe as service users have access to the utility room where it is situated. Records looked at by the Inspector were well recorded and up to date, there is a need for some files to be archived, as there is a lot of old information in place. Oxberry Avenue, 25 DS0000019142.V317338.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 2 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 2 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 1 33 x 34 2 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 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 3 3 2 2 2 x 3 x 3 2 x Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 23 Yes 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 YA3 Regulation 15 Requirement The Manager to liaise with the senior placement officer, as one service user has not had any input from them to ensure care package is relevant. The Manager to liaise with the pharmacy to make sure that the information written on a service users dossett box corresponds with MAR sheet. All bottles of medicine to have date opened written on them. The Manager to make sure that the death and dying policy has been implemented and written information is in place for all service users. This is a repeat requirement. All records of financial transactions undertaken for a service user should be in place for staff to complete. A working shower must be provided for service users who choose not to use the bath. Original timescale of 30/06/05 not met. The Manager to make sure that any students doing a placement DS0000019142.V317338.R01.S.doc Timescale for action 31/12/06 2 YA20 13 30/11/06 3 4 YA20 YA21 13 15 30/11/06 31/12/06 5 YA23 13 30/11/06 6 YA27 23 30/11/06 7 YA34 19 17/11/06 Oxberry Avenue, 25 Version 5.2 Page 24 8 YA35 13 9 YA35 13 10 YA35 13 11 YA37 9 at the home has got a CRB disclosure. The Manager to make sure all staff working at the home are up to date in mandatory training including first aid, food hygiene, POVA and medication. The Manager to provide the CSCI with an up to date training and development programme for all staff. The Manager to make sure that the home has a member of staff on duty for all shifts that has completed first aid training. The manager must complete her NVQ Level 4 qualification training. All frozen food packages that have been opened must have a date opened and use by date written on them. The homes freezer must also be defrosted. Containers must be provided to keep dry foods that have been opened for safe storage. The cover on the boiler in the utility room to be replaced. 31/01/07 31/01/07 13/11/06 31/12/06 12 YA42 16 13/11/06 13 14 YA42 YA42 16 13 13/11/06 15/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA41 Good Practice Recommendations Old information in files to be archived for easy access to relevant up to date information, Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Oxberry Avenue, 25 DS0000019142.V317338.R01.S.doc Version 5.2 Page 26 - 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. 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