Inspection on 12/04/05 for Park Lodge Care Home

This inspection was carried out on 12th April 2005.

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

The inspector 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Park Lodge Care Home 15/09/08

Park Lodge Care Home 13/07/06

Park Lodge Care Home 27/09/05

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

CARE HOME ADULTS 18-65 Park Lodge Care Home 249-251 Victoria Park Road Hackney London E9 7BQ Lead Inspector Robert Sobotka Announced Inspection 12 April 2005 at 10:00am th 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 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 Stationary 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. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Park Lodge Care Home Address 249 - 251 Victoria Park Road, Hackney, London, E9 7BQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8533 2425 020 8533 3103 eileenharland@sanctuary-housing.co.uk Sanctuary Care Limited Ms Jean Hoyte Care Home 20 Category(ies) of Past or present alcohol dependence (20), Past or registration, with number present drug dependence (20), Mental Disorder, of places excluding learning disability or dementia - over 65 years of age (20), Physical disability (20) Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26 July 2004 Brief Description of the Service: Park Lodge is a residential home, which is registered to provide care up to 20 service users with past or present alcohol dependence, past or present drug dependence, mental disorder, excluding learning disability or dementia - over 65 years of age, and physical disability. The home is owned by Sanctuary Care Ltd, which is a non-for-profit organisation. The building has ground and two upper floors, and is divided into 20 self-contained flats. The communal areas consist of: a sitting room, a dining room, an entrance lobby, a small laundry room and a garden at the back of the house. Park Lodge is situated in Hackney, near Victoria Park. It can be accessed by a number of busses from various parts of East London. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Park Lodge Care Home was registered with the Commission for Social Care Inspection in September 2004. The home was previously registered and was managed by another care provider, which went into liquidation. The service was inspected in April and July in 2004 and a number of requirements and recommendations were made at the time. The aim of this announced inspection was to check the home’s progress towards full compliance with the legislation. The inspection took place over 1 day and included speaking to some of the service users, staff working in the home and the home’s manager. The inspector also conducted a tour of the premises, viewed various records and had lunch with those who use the service. A number of people living in the home, members of staff working there, as well as other health/care professionals have been asked to complete pre-inspection questionnaires, comments from which have been included in this report. What the service does well: The majority of those who use the service were satisfied with the home and said that they liked living there and that their needs were being met. They made positive comments about the home and staff in their discussions with the inspector. Those who use the service are consulted about the way the home should be run and they are invited to complete a six-monthly questionnaire. Members of staff belong to the National Staff Council. Service users were able to make complaints, which were being dealt with promptly and efficiently. All accidents/incidents were recorded and monitored by the manager. Visits from the responsible person were taking place on a monthly basis. Those who spoke to the inspector also said that they liked the food offered to them, staff were also supporting people who use the service in preparing individual meals. Special diets were also catered for. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 standard(s) 1, 2, 3, 4, 5. The home had a good assessment and admission system in place. Further work was required to improve the service user’s guide, so that prospective service users have all the information they need to make an informed choice about where they live. EVIDENCE: The home has now produced the new Statement of Purpose, which outlined the main principles of how the home is run and it’s aims and objectives. Further work was required to the Service Users Guide. There have been some new admissions to the home since the last inspection. The home manager carried out a thorough assessment to ensure that the home was able to meet the needs of prospective users. Apart from meeting with prospective users, she also liaised with other professionals involved in the person’s care. Prospective users were invited to visit the home to see the environment, meet other people who use the service and to meet staff working there. They could have a meal in the home. Overnight stays were organised. Each person has now been issued with the new contract/statement of terms and conditions. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 8, 9, 10. Care plans were generally well maintained, however they required further work. Those who use the service were encouraged to take part in making decisions relating to the care they needed. EVIDENCE: Each person living in the home had a care plan. Care plans viewed were generally well maintained and kept up-to-date, however, the quality of care plans viewed varied, depending on the experience of staff. This issue was discussed with the home manager, who acknowledged that more consistency was required and said that sessions for staff working in the home on how to be more consistent when writing up care plans were being organised. Each person living in the home had an allocated keyworker. Each keyworker was responsible for supporting and coordinating care for their service user. Keyworking sessions were organised, during which any individual goals, progress and areas that needed further support were discussed. Some people who used the service were sometimes refusing to attend those sessions and in some cases this was documented in individual care plan files. It was suggested by the inspector that this should be clearly recorded in individual care plans. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 10 There has been an improvement in risk assessments kept on each file. Care plans viewed showed that those who live in the home were involved in their reviews and care planning process. All confidential information was kept in the staff room, which was kept locked when not in use. Some information was kept on computer, which could only be accessed by people who were allowed to access this information. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17. Those who live in the home were encouraged to pursue their education and to seek paid and meaningful employment. Service users would benefit from higher level of activities. EVIDENCE: Some of those who spoke to the inspector said that they were attending colleges and were doing some paid or voluntary work. Comment cards from some service users and staff mentioned that more activities should be offered by the home. Those who live in the home can go out independently, however they are asked to inform staff when they are out of the building for health and safety reasons. Families and visitors are welcome to the home. One of the people who lived in the home received a visit from his brother on the day of the inspection. Visitors are required to sign the visitor’s book. Members of staff working in the home were respecting the service user’s rights. They spoke to service users kindly and were friendly. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 12 Those who lived in the home were invited to participate in weekly house meetings, during which they could make any suggestions about how the home should be run and what could be improved. Most of the people living in the home, who spoke to the inspector, said that they were very happy with the care and support offered to them. One person said that he did not like the home and would like to move to a more independent place. This issue was discussed with the home manager. Meals offered by the home can be eaten in the dining room with other service users. Some people chose to prepare their own food, staff working in the home offered support in preparing meals on individual basis. Meals for those who are vegan or eat Halal meat only are also provided. Kitchen premises were clean and hygienic. The home manager told the inspector that a new chef had been recruited and that all meals would be provided “in-house”. Those who spoke to the inspector said that the food was very nice and they complimented the chef on the food he cooked on the day of the inspection. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21. Service user’s physical and emotional health needs were being met. Medication systems were well managed. More work was required to establish wishes of those who use the service in relation to ageing, illness and dying. EVIDENCE: Care plans viewed showed that those who live in the service received appropriate care from the healthcare professionals. Comment cards received from Health and Social Care professionals indicated that the needs of those living in the home were met. One person who responded to the pre-inspection comment card said that not always there was a senior member of staff to confer with. Another person wrote that: “Park Lodge has made great efforts to turn itself around after a very difficult change of ownership/management. Morale has improved and staff seem happier and well supported now. Staff are caring but have little training in understanding of complex mental health issues. However, they are actively attempting to improve their knowledge and are receptive to advice”. Those who use the service received regular psychiatric reviews. Each person was registered with the General Practitioner and any other healthcare professional who would be beneficial to meeting his/her needs. Those who Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 14 required additional support from drug abuse service were promptly referred to appropriate agencies. There has been a big improvement in managing medication systems in the home. All medication was now signed for and there were clear records for any medication brought into the home and returned to the pharmacist. All staff have received medication training since the last inspection. Those who have been assessed as capable of administering their own medication were encouraged to do so. Further work was required to identify/establish the views of those who used to the service in relation to illness, death and dying. This is an outstanding requirement from the last inspection. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23. Those who use the service were free to make complaints, which were promptly and efficiently dealt with. They were also protected from abuse neglect and self-harm. EVIDENCE: Those people who spoke to the inspector said that they felt comfortable to complain and said their concerns were quickly dealt with. The complaints procedure was available for viewing in the main hall. Service users were also free to bring up any concerns during the home meetings. The home had an Adult Protection Procedure and a Whistleblowing Policy in place. Members of staff who spoke to the inspector were aware of adult protection issues. All accidents were clearly recorded and all records/ documentation were reviewed by the manager on a regular basis. The majority of people managed their own finances. Where it is felt that support or guidance in managing finances is needed by service users, this is readily available from members of staff. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30. Service users would benefit from a more homely environment. Individual flats required updating and new furniture. Some flats required cleaning. EVIDENCE: As previously mentioned, some of the people who were using the service and staff working in the home, felt that the home would benefit from updating and general renovation. This had already been identified and building works were due to commence within two months from the time of this inspection. People living in the home had been consulted and they have been asked to contribute to choosing colour schemes to be used throughout the building and in their individual flats. The home appeared to be uninviting and some areas (one flat in particular) required cleaning. Some of the furniture required updating. The home manager said that each flat would be redecorated, new carpets would be laid throughout the building and new furniture would be purchased. Some of those who used the service said that they would like to have television sets provided in their rooms, as opposed to just in the communal areas. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 17 At the time of the inspection the home did not provide accommodation for those requiring specialist mobility equipment, however all floors of the premises can be accessed by those who use wheelchairs. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36. Service users were supported by an effective staff team, which was appropriately selected, managed and supervised. Some additional training was required to improve the support to those who were using the service. EVIDENCE: As previously mentioned, there has been a great improvement in the staff morale, since the new manager has been appointed and the new organisation took over responsibility for managing the home. Staff felt well supported by the new manager, which improved the quality of care offered to those who use the service. Staff were courteous and worked well with those living in the home. They were aware of each person’s needs as well as their own roles and responsibilties. The home manager informed the inspector that all staff vacancies have been filled. Each new member of staff had received induction and their training needs were identified. Agency staff were only used in emergencies. Duty rosters showed that there were appropriate numbers of staff in the home at all times. Copy of the code of conduct was on display in the staff office. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 19 There has also been improvement in training offered to staff. The home manager said that out of 14 staff, 8 have achieved their National Vocational Qualification (3 people were still awaiting their certificates). Further training was also planned. The inspector felt that as the home is registered to care for people with past or present drug and alcohol dependence, training in those areas was required. Sound recruitment procedures were in place. Each person had received the required checks. Supervision sessions were in place, minutes from which were available for inspection. The home manager said that appraisal sessions were due to be introduced. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42. Those who live in the home benefited from a well-run service, which is managed by a competent manager. The health and safety records were up-todate, however some equipment required replacement. EVIDENCE: The home is run by the experienced manager who had been approved by the Commission for Social Care Inspection as fit to manage the service. She is a Registered Nurse and has recently completed the NVQ Registered Managers Award and was awaiting the certificate. Those who use the service, staff working in the home, as well as other professionals positively commented on her practices and management style. There were good monitoring and self-assessment practices in place and service users were consulted as to how things could be improved. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 21 Staff were aware of the organisation’s policies and procedures and were required to sign a document to confirm that they have read and understood policies and procedures practiced in the home. The majority of records kept in the home were well organised and kept up-todate. Health and safety records kept in the home were well maintained. Regular fire safety, hot water temperature and fridge/freezer temperature checks were being carried out. The home’s electrical wiring certificate issued in September 2004, which was valid for one year, stated that the wiring was unsatisfactory. This work was due to be rectified during the forthcoming building works to be undertaken in the home. Landlord’s Gas Safety Certificate was overdue. The home had appropriate insurance cover in place. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 Park Lodge Care Home Score 2 3 3 Standard No 22 23 Score 3 3 Version 1.20 Page 22 G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc 4 5 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 3 2 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 2 x Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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 17(2) Regulation YA41 Requirement Maintain records in the home as per Schedule 4 of the Care Homes Regulations 2001. (Previous timescales of 15/06/04 and 01/10/04 not met.) Ensure that all parts of the building, including service users flats, are kept clean. This might involve supervision and/or support provision to the service users. (Timescales of 15/05/04 and 01/10/04 not met.) The responsible person must ensure that the Service Users Guide in further developed and implemented. (Timescale of 15/09/04 not met.) The responsible person must consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities, including indoor activities. (Timescale of 01/10/04 not met.) The Registered Manager must ensure that each service user is consulted to establish their needs and wishes relating to ageing, illness and dying. (Timescale of 01/11/04 not Timescale for action 01 June 2005 2. 16(2)(j) YA30 01 June 2005 3. YA1 5 01 June 2005 4. YA14 16(2)(m) &(n) 15 June 2005 5. YA21 12(3) 01 July 2005 Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 24 met.) 6. YA32 18(1)c(i) The responsible person must arrange training for care staff in relation to drug and alcohol abuse awareness. The registered manager must esnure that each service user is provided with furniture and fittings sufficient and suitable to meet their needs and lifestyles. Any old/worn furniture must be replaced. The registered manager must obtain the Landlords Gas Safety Certificate without delay. The electrical wiring in the home must be rectified without delay. 15 July 2005 01 August 2005 7. YA26 23(2)c 8. 9. YA42 YA42 23(2)c 23(2)(b) 01 June 2005 01 August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA24 YA6 Good Practice Recommendations Explore and implement ways to provide a more homely atmosphere. It is recommended that any refusals from service users to participate in keyworking sessions are documented. Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 4th Floor, Gredley House 1-11 Broadway, Stratford London E15 4BQ 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 Park Lodge Care Home G56 G06 S61585 Park Lodge Care Home V211490 12130405 Stage 4.doc Version 1.20 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. 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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