Inspection on 09/05/06 for Philiphaugh

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Philiphaugh 06/07/09

Philiphaugh 29/08/07

Philiphaugh 10/10/06

Philiphaugh 24/11/05

Philiphaugh 11/05/05

Philiphaugh 10/11/04

Philiphaugh 06/07/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Philiphaugh Station Road St Columb Major Cornwall TR9 6BX Lead Inspector Elaine Bruce and Michael Dennis Key Unannounced Inspection 09:00 9th and 10th May 2006 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 Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Philiphaugh Address Station Road St Columb Major Cornwall TR9 6BX 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) 01637 880520 01637 880520 Mr Stephen Michael Hendy Care Home 32 Category(ies) of Dementia - over 65 years of age (19), Learning registration, with number disability over 65 years of age (6), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (19), Old age, not falling within any other category (12) Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Service users to include up to 12 adults of old age (OP) Service users to include up to 6 adults aged over 65 with a learning disability (LD(E)) Service users to include up to 19 adults aged over 65 with a mental illness (MD(E)) Service users to include up to 19 adults aged over 65 with dementia (DE(E)) Total number of service users not to exceed a maximum of 32 Date of last inspection 24th November 2005 Brief Description of the Service: Philiphaugh provides care for up to thirty two service users in need of care by reason of old age, dementia, mental disorder and a learning disability. Respite care is available at the home in addition to long stay care (when a bed is available). The home also provides a day care service. The home is situated close to the town of St Columb Major enabling the more mobile service user to visit the shops and facilities independently. The home is set in attractive grounds and is a listed building. Car parking is available in the grounds of the home. The building has been extended with two wings. There are several communal rooms including an activities room and a smoking lounge. Access to the first floor in the main house is by a staircase, which is provided with a stair lift. Bedrooms are available on the ground and first floor of the home. Many of the bedrooms have en suite facilities. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 9th and 10th May 2006. The inspection was carried out as a key unannounced inspection with two inspectors. Case tracking of particular service users took place as did conversations with them and other service users. Staff files were inspected and staff members on duty were spoken to. Some policies and procedures were inspected as were the standards of the meals and medication administration. A brief tour of the premises took place and it is noted that improvements could be made to communal areas in particular. Some of the service users who were able to give an opinion expressed positive comments on the standard of the care that they are receiving at the home. In particular they expressed very positive comments on the standard of the meals at the home. The registered provider was present during the course of the inspection as was the new acting manager. The home now has a management team and structure in place which should allow staff to undertake their specific duties and roles and move the home forward. The following paragraph gives an explanation of the comments under the management section of the report: The legal proceedings in relation to cancellation of registration proceedings have been currently adjourned to allow improvements to be made to the home over a six month period. The present agreement in place relates to the registered provider agreeing not to admit any service users into the home other that in the category of old age (OP). The registered provider would be allowed to admit service users within the dementia (DE) category, in addition to the OP category in the future once the CSCI are satisfied that staff members are appropriately trained in dementia/mental disorder to allow further service users in this category to be admitted. The agreement also limits the registered provider’s service users at the home to 28 as opposed to the registered number of 32 until the home is sufficiently improved and that the registered provider agreed to appoint a deputy manager. The registered provider recently breached the agreement by admitting service users other than the old age (OP) category. This is viewed seriously by the CSCI. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 6 What the service does well: 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. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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 Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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): 1,2,3,4 and 5 It is recommended that important documentation to include the statement of purpose is brought up to date to ensure that potential service users are fully aware of the services that the home offers. A pre admission assessment document must be developed to ensure that service users are admitted to the home appropriately. EVIDENCE: It is not clear whether the service user guide and statement of purpose are one document or two. When this decision is made the documentation should be brought up to date to ensure that all potential service users have the correct information about the services that the home offers. Each service user has been provided with a contract of care document that details the terms and conditions of their placement. It is recommended that some further information be included in this document on the notice period should a service user wish to leave the home. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 9 The acting manager will be assessing all service users prior to admission to the home. At this time there is no pre admission assessment document in place. This must be developed to ensure that service users are admitted appropriately to the home. The registered provider is reminded of the importance of the above paragraph following further investigations. The CSCI investigations have concluded that two inappropriate admissions having taken place at the home. These admissions have been inappropriate as the staff have not had the training to meet their care needs and they are not in the category of old age which is in breach of a recent agreement made by the CSCI and agreed by the registered provider. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Documentation is in place to evidence that the staff have information on the care needs of the service users. It was though noted that some essential information had not been transferred into care planning and that the system is time consuming for the carers and could be improved. Medication is being administered correctly to the service users. Observation of the care staff during the course of the inspection indicates that they are working well as a team under the direction of the new acting manager. EVIDENCE: Each service user has in place a problem based plan of care which is supported by daily day and night recording. In addition separate documentation is held on any visits to the service users by a health care professional. Monthly review documentation is also held separately as is a hand over diary. The system of care planning was discussed in detail with the acting manager who has already recognised that the system is very time consuming for the Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 11 care staff to access and could be improved. She has plans to address this with the help of her deputy manager. It was noted that some essential information on a particular service user had not been transferred into the care plan. This was also discussed in detail with the acting manager. It is also recommended that more evidence is provided where a service user is able to participate in the care planning process. The medication policy and procedure is fully up to date to guide staff in safe administration. Medication administration records were found to be completed appropriately. It is recommended that separate entries are made on a particular controlled drug medication as discussed at the time of the inspection. It is also recommended (and discussed at the time of the inspection) that the senior staff members attend accredited medication training as soon as possible to reduce to requirement for the acting manager to cover extra hours for medication administration. The policy and procedure on death and dying includes important information on religion but needs a lot more information on pain control and the involvement of the family for instance. It is also recommended that some reference is made to this area of care in the statement of purpose. Observation of the care staff during the course of the inspection indicated that they are working well as a team. The staff also expressed positive comments about the new acting manager at the home. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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 Consideration has been given to meeting the social care needs of the service users. It is though recommended that more information be included in care planning on individual needs. The service users are receiving wholesome appealing diet but at this time there is no flexibility in the times of the meals at the home. The service users spoken to during the course of the day expressed very positive comments on the standard of the meals. EVIDENCE: The daily records held at the home evidence that the service users are involved in a number of activities to include for example weekly bingo, skittles and a trip out. The home has it’s own transport. It is recommended that more information is included in care planning on the social care needs of each service user. Daily records also evidence when a service user has received a visitor. Some of the service users in the home chose and are able to be independent and exercise this choice by going to the shops to collect a paper for example. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 13 For those service users who are unable to express a choice it is important that information is included in care planning about decisions that have been reached and how they have been reached and that they are in their best interests. Service users who were able expressed very positive comments on the standard of the meals that the home provides. The meal of the day is displayed on a board in the communal sitting/activity room. The cook is knowledgeable about the likes and dislikes of the service users and all records as required by legislation are in place. There is always an alternative choice to the main meals of the day. Staff in the afternoon ask the service users what they would like for their tea. The menu rotates over a four week period and is mainly traditional to include two roasts in the week and fish and chips on a Friday. It is noted that there would appear to be no flexibility in the timings of the meals for example: breakfast commences at 8.00am and is finished at 8.45 when the staff have their breakfast break. Generally in a care home breakfast will take place over half the morning to suit the need of the service users. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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): 16,17 and 18 The home has a complaints policy and procedure to guide the service users should they or their representative wish to complain. Statutory requirements for adult protection have yet again not been met and are included again in this inspection report. EVIDENCE: The statutory requirement (in the inspection report dated the 11th and 12th May 2005) has been addressed and the complaints policy and procedure has been updated. When the telephone number of the CSCI is added to this documentation the policy and procedure will be complete. As identified in the inspection report of the 11th and 12th May 2005 (and the follow up inspection report) amendments to the adult protection policy and procedure were required. This yet again has not been addressed. There appears to be a number of policies and procedures in the home on adult protection. These should be brought into one robust policy and procedure and the staff then given the opportunity to read this very important documentation. This recommendation was included in the inspection report of the 6th July 2004. Staff have received adult protection training from a member of the Cornwall County Council care management team. During discussions with the staff it was though apparent that they were unaware of some instances of abuse. This is of a concern to the CSCI considering the acting manager has covered adult protection in her supervision to some of the staff. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 15 The acting manager is involved in discussions with the adult social care department to ensure that some of the service users have their legal rights protected particularly in relation to finances. Service users can be involved in the legal process re voting should they so wish. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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 and 21 The environment at Philiphaugh could be improved by some day to day maintenance especially in communal areas. EVIDENCE: Philiphaugh is well placed for service users to access St Columb Major and all it’s facilities. Grounds are spacious and seating is provided for the service users. It is noted that some day to day maintenance could improve in particular the communal areas of the home. The dining room is looking shabby and would benefit from a coat of paint, new table clothes would also improve the general appearance. It is accepted that the ceiling in the dining room is to be repaired and is presently drying out. This should be attended to as soon as is possible. Odour control is variable throughout the home. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 17 It was noted during the course of the inspection that a bathroom in the older part of the home is out of use and there would appear to be a lack of hoists in some of the bathrooms. This situation should be reviewed to ensure that the care needs of the service users for bathing are being met, especially those with mobility problems. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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 Staffing levels are appropriate to meet the needs of the service users. Recruitment procedures for the employment of staff are satisfactory. Staff employed must receive further dementia training, mental disorder and learning disability training as well as induction training to ensure that they can meet the care needs of all the service users in the home. EVIDENCE: The home employs four care staff on duty in the morning and afternoon (0730 to 1700) and then two care staff are employed between 1700 and 2200. The acting manager is also on duty during the week and her deputy manager. It is recommended that they are identified on the rota to show the hours that they have worked. Two waking night staff are employed by the home. In addition to the care staff, housekeeping, cleaning and maintenance staff are employed. The total number of care staff employed is fourteen with six of these care staff having achieved an NVQ 2 qualification in care. There are times when the home has to use agency staff but this is generally at night and with the aim of using the same staff members. Staff contracts and job descriptions are presently under review. Recruitment procedures for the employment of staff were found to be satisfactory. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 19 Induction training must be improved along with the good practice guidance in The National Minimum Standards. It is recognised that staff members have received basic training in dementia care but it is recommended that this is now expanded to also include training on mental health. There are service users in the home who have specific mental health problems which the staff require guidance and training to ensure that their care needs are met at all times. Although fire drill training is taking place in discussions with staff it is apparent that they require further information/training. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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): 31,32,33,34,35,36,37 and 38 Significant management changes have taken place at Philiphaugh since the last inspection. A new acting manager has been employed. She has a difficult job to do at this time due to legal proceedings that are ongoing with the registered provider and the CSCI about the future of the home. EVIDENCE: The acting manager appears to be well regarded by the staff and registered provider. Her application is to be progressed (when received by the CSCI) to formally register her as the manager at Philiphaugh. She has commenced at the home at a difficult time. A recent legal agreement that had been agreed by the CSCI and the registered provider has been breached. In addition protection of vulnerable adults procedures are not in place despite statutory requirements to that effect. The acting manager is given a great deal of responsibility by the registered provider. It is understood Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 21 by the CSCI that the registered provider is in the home every day but his role and responsibilities have never been fully established by the CSCI. A detailed discussion took place with the acting manager and registered provider around the management system that has been set up at the home. There is a deputy manager now in place at the home and two senior care staff members. It is suggested that these senior staff members are given more responsibilities to allow the manager to do her job effectively. In addition the registered provider was advised to support his new manager as much as he can. This could include for example undertaking some tasks in relation to The National Minimum Standards that are not met at this time. The registered provider for example could undertake a quality assurance/monitoring of the home to involve the service users and other stakeholders with the aim of meeting standard 33 of The National Minimum Standards. Records are in place to evidence the incoming and outgoing of the personal finances of the service users and an audit trail can be carried out for the majority of the service users. The Adult Social Care department are involved in legal procedures for the Court of Protection for two service users and this is unfortunately taking a considerable amount of time to become concluded. The acting manger was advised to communicate regularly with the department to ensure that the legal rights of these service users are protected as soon as is possible. In addition an unsatisfactory state of affairs exists with the appointee arrangements for some of the service users. The previously employed registered manager had taken on appointee status which has not yet been relinquished. This has resulted in the particular service users accounts been frozen at the post office. The registered provider was reminded of the importance of chasing this situation up to protect these particular service users financially. The acting manger has commenced supervision with the staff at the home. She is to undertake all the supervision duties herself which is ambitious but she is confident that she can meet the requirements of the standard. To meet the requirements of standard 37 and 38 all the home’s policies and procedure should now be reviewed. It was recommended that more information be recorded in relation to any incidents in the home and records should be kept on any accidents that the staff have during the course of their duties. Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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 2 2 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 2 x 2 x x x x x STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 2 2 2 2 Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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 OP18 Regulation 13(6) Requirement The registered provider must make arrangements, by training staff to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (The original timescale of the 31/12/05 was not met. An extended date has been given for compliance). The registered provider shall ensure that the premises are kept in a good state of repair externally and internally. (This standard was not assessed at this inspection. An extended date has been given for compliance). The registered provider shall ensure that the staff employed receive training appropriate to the work they are to perform. (The original timescale of the 31/03/06 was not met. An extended date has been given for compliance). Timescale for action 31/07/06 2. OP19 23(2) 31/07/06 3. OP30 18(1) 31/07/06 Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 24 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. 3. 4. Refer to Standard OP1 OP2 OP3 OP7 Good Practice Recommendations To update the statement of purpose and clarify if this document is to include the service user guide. To update the contract of care document. To develop a pre admission assessment document. To review the care planning system to make it less time consuming for the care staff to access. To involve and evidence where possible service users in care planning. To ensure that the financial interests of the service users are safeguarded. To review the policy and procedure on death and dying and include some new information on pain control for example. For the senior care staff to undertake accredited medication training. To establish that the home is being run with daily routines that are the choices of the service users. To review the time of breakfast (in particular) at the home to ensure that all service users are happy having this meal at 8.00am. To review all the policies and procedures at the home. To show on the rota the manager and her deputy ref the hours that they have worked. 5. 6. OP35 OP11 7. 8. 9. OP9 OP14 OP15 10. 11 OP37 OP27 Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Philiphaugh DS0000009249.V293562.R01.S.doc Version 5.1 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!