Inspection on 30/10/06 for Pexton Grange

This inspection was carried out on 30th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 02/04/07

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 30th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gleneagles Nursing Home DS0000021780.V313964.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.V313964.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.V313964.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. 15th May 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. The previous inspection report was made available to service users and their families, details of this was on the homes notice board. The weekly fees are: £429 to £475 this information was provided on the 15th May 2006. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Gleneagles Nursing Home DS0000021780.V313964.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 that took place from 9:30 am to 16:30 pm. The reason for the inspection was to check out issues of concern noted in previous inspection visits and to check out issues of concerns raised by one complainant in a complaint made to the Commission for Social Care Inspection. As part of the inspection process, four relatives, four service users, two directors, four staff, and the manager were spoken to. A number of records were examined and several areas of the building were inspected. The inspectors were pleased to note that throughout the inspection staff interacted positively and sensitively with each service user. Since the last inspection the Commission for Social Care Inspection have received one complaint from a relative about, the cleanliness of some parts of the building, the physical care of one service user, that some equipment and lights were broken. The complaint has been fully investigated by the provider and found to be partially upheld and action was taken against some staff under the homes disciplinary procedures. In the last three months the two serious incident meetings have been held about issues related to the care provided at this home. Following theses meetings the providers made a number of changes, these were reviews of several policy documents and more efficient monitoring systems were introduced. The inspectors would like to thank service users, the relatives, the providers, the managers and staff for their commitment to the inspection process. What the service does well: Over the last few weeks the staff, the providers and the manager have worked hard to improve the quality of the service provided. Some improvements have been made to the, food provided, recording systems and the medication system, but further improvements are still necessary. Several meetings have been held with other agencies and the providers have strived to improve concerns raised by them they include the review of several policy documents more stringent monitoring systems and training sessions for staff. The inspectors would like to commend the managers and provider for their commitment to acknowledging and accepting that the care provided at this home must be improved. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gleneagles Nursing Home DS0000021780.V313964.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.V313964.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is: good. This judgement has been made using available written evidence, discussion with four service users, four relatives and a visit to the home. No service user moves into the home without having his or her needs assessed, but the information in one of the assessments was not adequate to ensure that the care needs of the service user could be met. Service users were able to have informal introductory visits to the home at the time of their admission. The relatives confirmed that this helped the service users to get to know everyone at the home, which made them feel less anxious. This home does provide intermediate care services in a dedicated area of the building. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 9 EVIDENCE: Needs assessments had been completed by the referring social worker for all service users admitted to the home. The information in one needs assessments was not detailed enough to allow staff to meet the service users total needs. Relatives spoken to said at the time of the service users admission they were able to have informal introductory visits to the home. Records checked did not show that service users families had been involved in decisions regarding the arrangements. Relatives and service users did know how they could obtain a copy of the most recent inspection report. An up to date contract/statement of terms and conditions had been provided to service users. These clearly detailed the fees, including any extra charges, and the services and facilities provided by the home. The home provides intermediate care in a dedicated area of the building. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is: adequate. This judgement has been made using available written evidence, discussion with four service users, four relatives and observations made by the inspectors at the visit to the home. Service users said they received individual personal support that promoted their privacy, dignity and independence. Some care plans had not been fully completed and the information in one care plan was found to be incorrect. Procedures were not in place to closely monitor all the health, safety and personal care of each service user. This does not protect the service user from harm. Medication recording sheets had not always been signed to show whether medication had been given or not and one service user was out of her prescribed medication. This does not promote the health and wellbeing of service users. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 11 EVIDENCE: The case files of three service users were checked. The care plans did not contain details of the leisure, social and religious needs of the service users. It was also stated in one care plan that the service user did not eat pig meat but this was incorrect. The staff gave examples of how on a daily basis they respected service users right to privacy and dignity. There was a system in place for the booking in of medication and for the recording and administration of medication. Medication recording charts were not always signed to show whether medication was given or not and one service user was out of her prescribed medication. A pharmacist had checked the home’s medication systems earlier this year. Some issues of concern were raised by the manager were being monitored by her. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is: adequate. This judgement has been made using available written evidence, discussions with four service users, four relatives, four staff and a visit to the home. Service users care plans did not detail what leisure activities service users would wish to participate in. This does not allow the service users individual choices and preferences to be met. The service users spoken to said they sometimes got bored and would welcome more activities and outings. The relatives said they were always welcome at the home. Which creates a home that people want to visit. A choice of food was being offered to service users at lunchtime and three service users from an ethnic background said they were being offered special diets on a regular basis. This promotes the rights of service users. The tables were poorly set no condiments were offered in one dining room and the condiment tray in another dining room was dirty and looked disgusting. This could impose on the health of service users. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 13 EVIDENCE: Service users said that the sometimes get bored and would welcome more outings, they said that staff supported them with discovering how to enjoy some social situations and activities but they needed more stimulation. The inspectors observed lunch, the meals served looked good and a choice of food was available. However the tables were poorly set no condiments were offered in one dining room and the condiment tray in another dining room was dirty and looked disgusting. Several service users were being offered special diets. Special cutlery and crockery were not provided for those service users who had difficulty using knives and forks. Service users were supported with maintaining and developing contact with their family and friends, the relatives said they were always welcome at the home. Which creates a home that people want to visit. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made after discussion with four service users, four relatives, four staff members and using available written evidence including a visit to the home. The homes complaints procedure was clear, accessible and contained the necessary information. The Commission for Social Care Inspection have received one complaint since the last inspection. In the last three months there have been a number of concerns investigated by the providers about the attitude of the some staff at this home. This should protect the service users from harm. The staff interviewed had received adult abuse training. This is good management practice. EVIDENCE: Details of how to make a complaint was provided to service users and their relatives, and displayed in the home. Records were kept of all complaints made at the home. Since the last inspection the Commission for Social Care Inspection have received one complaint about the home, the complaint was about the cleanliness of some parts of the building, the physical care of one service user, that some equipment and lights were broken. This complaint has been fully investigated by the provider and found to be partially upheld. In the last three months the service providers have investigated a number of concerns raised about the attitude of some staff at this home, this has resulted in the providers taking action against some staff under the homes disciplinary Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 15 procedures. Multi disciplinary meetings are still being held with the providers to look at ways the service at this home can be further improved. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. Quality in this outcome area is: adequate. This judgement has been made after discussion with four service users, four relatives and using available evidence including a visit to the home. On the day of the inspection the home was dirty in parts and some areas had damaged/stained decoration and easy chairs. This made the home look shabby in parts. Two bathrooms were being used to store equipment in; this could impose on the staff and service users safety. The bedroom doors were fitted with locks. This promotes the privacy of service users. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 17 EVIDENCE: Service users said they could choose where they wished to spend their time and that they had enough room to do the things they wanted. Some areas around the home were dirty and some had damaged decoration and easy chairs. The bedroom doors were fitted with suitable door locks and lockable facilities were provided in all the bedrooms. Each floor had a number of toilets and bathrooms, assisted baths and showers were provided for those service users with mobility problems. However some bathrooms and shower rooms were being used as storerooms. Toilets were easily accessible as they were close to lounge and dining areas. All the toilets had been adapted for service users with physical disabilities. The hot water in some rooms exceeded 43c and in other rooms the hot water was cold. Several refuse bins did not have their lids in situ and the string light cords in some rooms were dirty. Some lights were not working. 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. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is: good. This judgement has been made after discussion with four service users, four relatives, four staff and using available evidence including a visit to the home. Care staff had a range of skills and experience, which effectively supported the service users. This will ultimately benefit the health and welfare of the service users. The home had a training and development plan and all staff had completed a range of training relevant to their role, but further training is required. Staff said that they had not had any training on caring for people with physical disabilities. This does not allow the staff to ensure they meet the individual assessed needs of service users. Staff were not being formally supervised at the frequency required this does not fully ensure individual staff development and the development of care practices. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 19 EVIDENCE: The service users and relatives said that there was always enough staff on duty. They added that staff worked very hard and described them as “very caring, kind and understanding” they added that staff treated them like human beings they were not intrusive and that you could have a joke with them. Staff were approachable and sensitive to the needs of service users and were able to communicate effectively with each person. Three staff files were checked; the files demonstrated that a thorough recruitment processes had been followed as required by the Care Homes Regulations. Criminal Record checks had been done and two references. 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. Staff files checked and discussions with four staff and the manager confirmed that all staff had completed detailed induction training. Staff had completed training on NVQ in care and this had ensured that more than 50 of the staff team were qualified to level 2. Staff said that they still had not had any training on caring for people with physical disabilities. Staff were not being formally supervised at the frequency required to fully ensure individual staff development and the monitoring of care practices Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is: adequate. This judgement has been made after discussion with the manager, four staff and using available written evidence including a visit to the home. The homes record keeping, policies and procedures do not safeguard service users rights and best interests as they had not been followed and have placed some service users at risk of harm. The service users health and safety had not been promoted and protected in several areas as hazardous substances were insecurely stored. The current management arrangements were not organised. There was little evidence of direction. This is affecting the quality of the service provided. Staff are not receiving regular individual supervision. This is bad management practice. Service users case files were noted to be insecurely stored. This imposes on the confidentially of service users. Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager is a registered nurse but she has not a lot of previous management experience in a nursing home settings. The manager has not yet completed her NVQ level 4 training. The current management arrangements were not organised. There was little evidence of direction. The manager was co-operative with inspectors and responded to all requests for information and investigations in a professional manner. There was evidence from recent investigation and this inspection that the home is not running at an acceptable level at present. The care given to some service users meets some basic primary needs, but does not meet the full range of care needs. At present the home is not meeting the service users needs in an acceptable manner. Staff are not receiving regular individual supervision. The nature of incidents and complaints at the home are very concerning, the fact that some procedures and polices have not been followed. The responsible individual had been visiting the home at regular intervals put his monthly reports show he has not pick up on the poor quality of service provided at this home. The safe administration of medication is not being managed appropriately and the general levels of record keeping in many areas are wholly inadequate. Hazardous substances were insecurely stored. Service users case files were noted to be insecurely stored in the nurse stations. Gleneagles Nursing Home DS0000021780.V313964.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 2 X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 2 2 1 Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14. Requirement The service users assessment of need must include full details of the service users identified needs and what action the staff need to take to meet the needs. Service users care plans must detail the service religious, cultural and social/leisure care needs. Information in care plans must be correct. Service users and their relatives must be invited to care planning meetings and reviews. This has been outstanding since 01/10/06. Timescale for action 01/01/07 2. OP7 15 01/01/07 3. OP8 14 01/01/07 4. OP9 13 Medication administration records must be signed to show whether medication has been given or not. Service users must never be left without a supply of their prescribed medication. 30/10/06 Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 24 5. 6. 7. OP14 OP15 OP18 16 12 13 8. OP19 23 Service users must be offered more stimulating activities and more outings. The tables at meal times must be correctly set with condiments in clean containers. The providers and the manager must be vigilant at all times to ensure they protect the well being of the service users. The damaged easy chairs must be repaired or replaced. The areas with stained damaged decoration must be redecorated. 01/01/07 01/01/07 30/10/06 01/01/07 9. OP22 23 Suitable provision must be made for the storage of aids and equipment. This has been outstanding since 12/05/2004. Bathrooms and shower rooms must not used as storerooms. All areas at the home must be kept clean at all times, as should all the equipment. All the lights must be functional at all times. Refuse bins must be fitted with secure lids. The dirty string light cords must be cleaned or replaced. 05/05/07 10. OP26 23 01/12/06 11. OP30 18 12. OP31 OP32 9 Staff must be offered training for caring for service users with disabilities. This has been outstanding since 2004. Improvements must be made in how the home is run, therefore the manager must :Be trained to NVQ level 4. This as been outstanding since DS0000021780.V313964.R01.S.doc 01/05/07 01/08/07 Gleneagles Nursing Home Version 5.2 Page 25 1/12/06 13. OP33 26 The responsible individual must ensure that a thorough check is made of all aspects of the service provision following his monthly monitoring visits to the home. Staff must be offered formal supervision at least 6 times a year. Service users records must be kept in s secure place at all times. Hazardous substances must be kept securely stored. The hot water temperatures must be regulated at the required temperature. 12/01/07 14. 15. 16. 17. OP36 OP37 OP38 OP38 19 17 12 12 01/01/07 30/10/06 30/10/06 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gleneagles Nursing Home DS0000021780.V313964.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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