Inspection on 02/04/07 for Pexton Grange

This inspection was carried out on 2nd April 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Pexton Grange 30/10/06

Pexton Grange 15/05/06

Pexton Grange 20/09/05

Pexton Grange 21/04/05

Pexton Grange 02/02/05

Pexton Grange 30/04/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Gleneagles Nursing Home Pexton Road Sheffield South Yorkshire S4 7DA Lead Inspector Janice Griffin Key Unannounced Inspection 2nd April 2007 07:00 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 Gleneagles Nursing Home DS0000021780.V330421.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. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gleneagles Nursing Home Address Pexton Road Sheffield South Yorkshire S4 7DA 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) 0114 244 1223 0114 244 1224 maureenparr@sheffieldcare.com www.shefieldcare.co.uk Gleneagles (Yorkshire) Limited Mrs Maureen Parr Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability (56) of places Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 18 Service Users can be admitted for intermediate care. The intermediate care service can only be provided in the unit dedicated to intermediate care. 30th October 2006 Date of last inspection Brief Description of the Service: Gleneagles is a purpose built home providing accommodation on three floors; all floors are serviced by a lift. The home is sited in a residential area in the North of Sheffield, close to local shops and a bus route to the city centre. Parking is located at the front of the building. The garden which has level access is attractive, well maintained and is situated to the rear of the building. Details of the services provided at the home were available in the foyer and copies of the last Commission For Social care inspection report were also available for service users and their families to read. The weekly fees are: £429 to £475 this information was provided on the 30th October 2006. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out from 7.00 am to 14.15 p.m. Eight people who use the service, two professional visitors, one relative, six staff, including two managers, were spoken to as part of the inspection process. Comment cards were sent to people who use the service, one was returned and the person made positive comments on all aspects of the service provided. A number of records were examined and several areas of the building were inspected. The inspector was pleased to note that throughout the inspection staff interacted positively and sensitively with the people who use the service who were obviously comfortable and at ease in the company of staff. The inspector would like to thank the people who use the service, the managers, the professional visitors, the relative and staff for their commitment to the inspection process. The Commission for Social Care Inspection carried out a random inspection at the home on 6Th February 2007. The visit looked at medication systems and some previous requirements. No complaints have been made about this service since the last random inspection undertaken on the 6th February 2007. What the service does well: There was good evidence that the manager and staff had worked hard to make improvements at the home. This has followed the previous key and random inspections. This showed that the staff and manager are committed to the care of the people who use the service and the improvements at the home have benefited the welfare and safety of those people. The people who use the service said that they generally felt well cared for by the staff and they were treated with respect and kindness. There was a relaxed atmosphere in the home; the staff had taken care to ensure that the people who use the service were helped with all aspects of their personal care; the people who use the service were clean and well dressed, they thought that the food was ‘very good’ and there was plenty of choice available. The relative and professional visitors said the care provided at this home was good. Routines appeared to be relaxed, the people who use the service said that they could get up when they wished and go to bed at a time that suited them. They also confirmed that they were able to talk to the manager and staff whenever they wished if they had any ideas or concerns. Assessments had been made of the people prior to them coming into the home to ensure that their needs could be met. Healthcare records and contacts with outside professionals were Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 6 documented in the care plans. The home was clean, tidy and the staff had endeavoured to ensure that all areas were fresh smelling. There was an established programme of staff training and more than fifty percent of the staff team had obtained their NVQ Level 2. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gleneagles Nursing Home DS0000021780.V330421.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 Gleneagles Nursing Home DS0000021780.V330421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are fully assessed prior to moving into the home to ensure their needs can be met. They are able to have informal introductory visits to the home at the time of their admission; this makes them feel less anxious. The people who receive an intermediate care service receive the care in a dedicated area. This allows staff to provide rehabilitation in one area. EVIDENCE: Detailed full needs assessments had been completed by the referring social worker before a person is admitted to the home. Families had been involved in the assessment process as appropriate. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 9 People who use the service said at the time of their admission they were able to have informal introductory visits to the home and they had been provided with a contract containing the relevant information. Records checked and discussion with eight people who use the service and one relative confirmed that their families had been involved in decisions regarding the arrangements. The people who receive an intermediate care service receive the care in a dedicated area and they are helped to maximise their independence. An up to date contract/statement of terms and conditions had been provided to the people who use the service and signed copies were retained on individual files. These clearly detailed the services and facilities provided by the home. Gleneagles Nursing Home DS0000021780.V330421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive care and support to meet their physical and emotional needs, this allows them to achieve their individual preferences and personal goals. The care plans had not been reviewed on a monthly basis. This does not allow staff to meet the changing needs of the people who use the service. All of the easy chairs in the lower ground lounge had incontinent pads on the seats. This does not promote the dignity of those people who use the service. The systems for the safe administration of medication were satisfactory; this protects the best interests of people living at the home Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 11 EVIDENCE: The inspector observed staff interacting in a friendly and positive way towards the people who use the service. Bathroom, toilet and bedroom doors were noted to be closed if people were receiving personal care and staff knocked on doors before entering peoples bedrooms or the bathrooms. Three peoples plans of care were checked. Each set out individual needs and the action required and taken by staff to ensure the needs were met. Discussion with four staff and two professional visitors identified that a range of health professionals visited the home to assist in maintaining health care needs. The people who use the service were being weighed on a regular basis. A range of aids to assist them with mobility problems was provided; these included lifting hoists, assisted baths, walking frames and wheelchairs. The care plans had not been reviewed on a monthly basis. All care plans detailed the gender of staff that the person wished to support them with their personal care; they also contained details of their religious and cultural needs. People who use the service and their relatives have been involved with production of the care plans. All of the easy chairs in the lower ground lounge had incontinent pads on the seats; the staff said this was to protect the chairs. There were systems in place for the safe custody and administration of medication; the containers were all clearly labelled, with prescription information fully legible. All items were for named individuals. There were medication administration (MAR) sheets for each service user; these recorded the type of medication, the dosage and how it was to be administered. There were reasonable stock levels of medication kept in the home. Controlled drugs were safely stored and there were two signatories for the administration of controlled drugs. Gleneagles Nursing Home DS0000021780.V330421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good range of activities from which people who use the service may choose, for their particular lifestyles. This promotes the wellbeing of service users. People who use the service were supported with maintaining and developing contact with their family and friends, and they said that visitors were always welcome at the home. Which creates a home that people want to visit. A good choice of food was offered at breakfast and lunchtime. Some of the people who use the service were being offered special diets on a regular basis. This promotes their rights. The people who use the service in the lower ground lounge were kept waiting for a long period before breakfast was served. This is not promoting their wellbeing. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 13 EVIDENCE: The aims and objectives of this home reinforced the importance of treating people with respect. The people who use the service and one relative confirmed that staff were extremely supportive and always encouraged them to become integrated into the local community, when they felt able to do this and with the appropriate staff support provided. Staff confirmed that they were encouraged to support the people who use the service with discovering how to enjoy social situations and activities. All the people spoken with said that they could have visitors whenever they wished. There are a number of lounges and small quiet sitting areas if the people who use the service wish to see their visitors outside of their rooms. The files contained information about any special dietary needs and the people who use the service had been weighed on a regular basis if this was felt to be necessary. Those people, who were able to say, said that the food was good. The inspector observed breakfast and lunch the food provided was of good quality, well presented and a good choice of food was offered. Three people were receiving special diets. It was noted in one dining room that some people who use the service were kept waiting for their breakfast for over one hour. Special cutlery and crockery was provided for those service users who had difficulty using knives and forks. Gleneagles Nursing Home DS0000021780.V330421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and relatives are confident that their views are listened to and acted upon. Policies, procedures and staff training are in place to protect people who use the service from abuse and harm. EVIDENCE: The complaints procedure was available for people who use the service, visitor, relatives and staff. The manager confirmed that this would be available in alternative formats and languages should this be requested. The people who use the service and one relative spoken to said that they knew that they could complain if they were not happy about anything and that they felt able to discuss any issues or concerns that they may have with the manager and staff. They also said that staff were always available and that they were encouraged to talk about anything that troubled them or caused them anxiety. Since the last random inspection no complaints have been made about this home. The staff had received training on recognising and dealing with abuse. Staff had been made aware of the action to take in dealing with third party information. Gleneagles Nursing Home DS0000021780.V330421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service live in a spacious, clean and comfortable home with furniture and equipment available, both communally and individually, to meet their needs. This creates a home that people like to live in. The new owners are currently refurbishing parts of the home. This should improve the quality of the environment for the people who use the service. EVIDENCE: All the people interviewed said that the rooms were very clean. At least three bedrooms were checked, all were very homely, highly personalised and contained a range of furniture, including chairs, bedside tables and suitable storage. Most had photos and ornaments. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 16 The lounge areas were spacious and there was a quiet lounge for those who preferred not to sit in the area with the TV on. There were other areas around the home where people who use the service could sit or take visitors if they did not wish to use their rooms. Each floor had a number of toilets and bathrooms and assisted baths were provided for those people with mobility problems. Toilets were easily accessible as they were close to lounge and dining areas. All the toilets had been adapted for people who use the service with physical disabilities and a good supply of equipment was also available for those people. The appropriate seating had been provided in the garden for those wishing to sit outdoors whenever the weather permitted. The home had a proactive infection control policy and they work closely with external specialists, e.g. the Health Authority, Environmental Health and their own staff to ensure infections are minimised. Clinical waste is properly managed and stored. Staff confirmed that they were provided with protective clothing if they needed it and that all the equipment was in good working order and that it had been serviced as required. The well maintained outside areas were easily accessible for people in wheelchairs and there was garden furniture for them to use. Gleneagles Nursing Home DS0000021780.V330421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team were experienced with a good knowledge of the needs of the people who use the service, enabling them to support the people in maintaining their independence. Staff and the people who use the service said that the staffing levels were always good. Appropriate checks had been made on all the staff; this ensures that vulnerable people are protected. The home had a training and development plan and all staff had completed a range of training relevant to their role. Some staff had not yet completed training on caring for people with physical disabilities. This doe not allow the staff to ensure they meet the special needs of those people who have physical disabilities. 50 of the staff are trained to NVQ level 2. This shows the providers commitment to staff development. EVIDENCE: All the people who use the service who were able to clearly express themselves said that they felt that they were well looked after by the staff and that there were ‘usually’ enough people on duty. They said that the staff worked very hard and described them as “very caring, kind and understanding”. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 18 Staff were approachable and sensitive to the needs of the people who use the service and were able to communicate effectively with each person. Three staff files were checked; the files demonstrated that the recruitment processes had been followed as required by the Care Homes Regulations. Criminal record checks had been done for all three staff. Two references had been obtained and no gaps were noted in staff’s employment history. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control, however some staff have still not had training on caring for people with physical disabilities. Staff files checked and discussions with four staff and the manager confirmed that all staff had completed detailed induction training. 50 of the staff team were qualified to NVQ level 2. Staff were being formally supervised at the frequency required to fully ensure individual staff development and the monitoring of care practices Gleneagles Nursing Home DS0000021780.V330421.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience a good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has effective quality assurance systems. These include health and safety, and finance. This promotes the best interests of the people who use the service. The manager has not yet completed her NVQ level 4 training. Completion of this training will allow the manager to be more effective. The CSCI has not been notified of all incident required. This is not good management practice. The staff handles money on behalf of some service users but a second individual does not always witness all transactions. This does not protect the people who use the service from financial abuse. All records were available for inspection up to date and securely stored. A safe environment was provided in all parts of the home. This protects the health and welfare of the people who use the service. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager does not yet have the required management qualification but she is half way through her NVQ level 4 training. She has worked hard recently to improve the service and provide an increased quality of life for the people who use the service. She has a job description that clearly defines her roles and responsibilities and staff were aware of her role. Staff said she was committed to ensuring that the home provides a high standards of care, she completes regular internal audits on all aspects of the service provided by the home. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control. There was a quality assurance system, which sought the views of of the people who use the service and relatives. The responsible individual visits the home on a regular basis. No fire exits were blocked and hazardous substances were securely stored. The CSCI had not been notified of all incident as required by Regulation 37 of The Care Home Regulations. The staff handle money on behalf of some service users, account sheets were kept, receipts were available for all transactions but a second individual does not always witness financial transactions. All records were available for inspection up to date and securely stored Gleneagles Nursing Home DS0000021780.V330421.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 3 3 X X 3 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(b) Requirement Care plans must be reviewed monthly to ensure the people who use the service receive the appropriate care. The damaged decoration and carpets must be replaced to make sure that the people who use the service live in a well maintained home. The staff that work with people that have been assessed has having physical disabilities should be appropriately trained, to ensure the people who use the service receive appropriate care. The manager must be trained to NVQ level 4 to ensure she has the necessary training appropriate to her work. This as been outstanding since 1/12/06 Timescale for action 01/07/07 2 OP19 23 (2) (b) (d). 01/09/07 3 OP30 19 (5) (b) 01/08/07 4. OP31 9 (2) (i) 01/08/07 Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 23 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 OP10 Good Practice Recommendations 1. 2 3 OP15 OP35 The practice of putting incontinence pads on chairs should be reviewed to ensure the dignity is protected of the people who use the service. The arrangements at breakfast time should be reviewed to ensure the people who use the service are not kept waiting for long periods. Two staff should witness all financial transactions undertaken on behalf of service users to ensure their financial assets are protected. Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Gleneagles Nursing Home DS0000021780.V330421.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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