Inspection on 21/09/05 for Pinetrees

This inspection was carried out on 21st September 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pinetrees 11/09/07

Pinetrees 03/10/06

Pinetrees 01/03/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Pinetrees 36 Kensington Road Selly Park Birmingham B29 7LW Lead Inspector Kerry Coulter Unannounced Inspection 21st September 2005 11:50 Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 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 Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Pinetrees Address 36 Kensington Road Selly Park Birmingham B29 7LW 0121 471 4399 0121 472 4639 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) autism. west midlands Mrs Jacqueline Thronicker Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care and accommodation to four persons under 65 with a learning disability. N/A Date of last inspection Brief Description of the Service: Pinetrees was previously registered jointly with another of autism.west midlands homes but separated into a single registration in 2005. This is Pinetrees first inspection since separation. The home offers accommodation to 4 people with autism spectrum disorder. The home is situated in a pleasant tree lined road; it has modern internal features and a large rear garden. All bedrooms are single rooms. There is sufficient off road parking for three vehicles. The home is not equipped to provide services for people with physical disabilities Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted by one Inspector. The Inspector had the opportunity to meet and talk with all service users who live at the home. A tour of parts of the building and garden was made. Service user care plans and risk assessments were inspected. Staff recruitment procedures were examined, and a number of Health and Safety records were inspected. The Inspector had the opportunity to talk with the Manager and informally members of staff. During this visit the Inspector did not have opportunity to speak with relatives and other professionals. What the service does well: What has improved since the last inspection? The home has had a new laundry built. This is an improvement on infection control as previously the washing machine was located in the kitchen. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 6 Autism.west midlands are moving towards updating the care planning documentation with the intention of standardising documents across its care homes. 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. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The Service User Guide and Statement of Purpose do not provide all the information for prospective service users to be clear about the services the home provides to meet their needs. EVIDENCE: The service user guide and statement of purpose have been updated since Pinetrees has become a separate registration. These documents were observed to be available in the hallway, the Manager said that service users also had a copy of the guide in their bedroom. Some amendments are needed to the statement of purpose as it referred to ‘Oakfield’ and not ‘Pinetrees’ on one page, room dimensions also need to be included. The service user guide needs amendment regarding guidance on making a complaint as it gives the impression that a complainant can only contact the CSCI with their complaint if they are not satisfied with the response of the autism.west midlands. The CSCI can in fact be contacted at any stage. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 There is generally a clear and consistent care planning system in place to provide staff with information they need to meet service user needs but the information is not always regularly reviewed. Service users are generally supported to take responsible risks, but some work needs to be done on how this information links in with the care plans and reviews are done regularly. The systems for service user consultation in this home are good with a variety of evidence that indicates that service users’ views are both sought and acted upon. EVIDENCE: Two service user care records were sampled. The Manager said that autism.west midlands have introduced new corporate records and that she is in the process of introducing them. Care plans were well constructed with clear information about service users routines, preferences and assessed needs. It was pleasing to note that individual plans included input from the service user about their personal goals. However not all plans had evidence of review in the last six months. The Manager also needs to ensure that behaviour management strategies are available for identified behaviours. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 10 There was lots of evidence of service users being consulted and having opportunities to make decisions about their lives. The home holds a yearly review with each service user having the opportunity to attend. Regular ‘peoples meetings’ are held in the home. The service users agree the agenda in advance. A peoples meeting took place during the inspection. A service user chaired the meeting with staff assisting with taking minutes. The meeting was service user led and staff did not dictate the topics discussed. Service users were able to say what they wanted and discussed things that were important to them. Service users risk assessments were sampled and noted to be detailed including the action to be taken by staff in response to identified hazards. Some service users travel independently and risk assessments were seen to be in place to support this practice. Service users at Pinetrees were observed to be involved in a number of independent living tasks such as cooking and assessments had been completed. However not all risk assessments had been reviewed in the last six months, this will need to be done to ensure risk is appropriately managed. Some improvement is needed to the presentation of the risk assessments, each risk assessment should be directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. One of the outcomes for completing risk assessments and care plans should be that the finished article is a simple and effective working document, in which essential information can be easily found. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 16 and 17 A range of activities is offered in order to promote personal development, participation in the life of the local community and enjoyable leisure time. Service users enjoy a healthy and nutritious diet and exercise choice about what they eat. EVIDENCE: Service users are provided with opportunities to develop independent living skills. During the inspection service users were observed to participate in ironing, making lunch and drinks. Service users also have a rota for domestic tasks, discussion with one service user indicates that he was consulted on the implementation of this rota. Service users have opportunities to attend a variety of activities in the community, this includes swimming, drama and Greek lessons. One service user has a work placement at a horticultural charity once a week. A day trip to Alton Towers has been planned for the end of September. Service users’ leisure activities within the home include use of a play station, computer, television and DVD/video facilities. Staff on duty informed the inspector that service users are also supported to undertake leisure activities including days out, shopping, using the cinema, and eating out. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 12 One service user said that he was going on holiday to Pontins soon. He had a holiday brochure that he said he been to the travel agent to collect so he could decide where he wanted to go. One service user said that food shopping is done by service users with support from staff. Plentiful supplies of food to include fresh food were observed in the kitchen. The records for one service user evidenced that staff had encouraged healthy eating and also arranged for input from a Nutrionalist. Records of people’s meetings show that service users are consulted on the menu. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 The health needs of service users are generally met. The systems for the administration of medication are generally good with clear and comprehensive arrangements being in place to ensure service users receive the medication they need. EVIDENCE: A sample inspection of service users’ health records indicates that service users are receiving routine access to general health services, such as well person’s checks, dentist, eye tests and chiropodist. Referrals are made to other health professionals as required to include the Nutrionlist. Sampled accident records indicated a low level of minor accidents to service users occurring. Service users do not have individual health action plans. This is something that the Government paper, ‘Valuing People’ recommended that each person with a learning disability had by 2005. This is to ensure individuals receive all the care they need to stay healthy. It may be that this is an opportune time to engage with the local Community Nurse (Learning Disability) Service in order to move this forward. The system for the administration of medication is satisfactory. Medicines were seen to be stored appropriately in a secure location. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 14 A random audit of stocks held revealed no discrepancies, and there were no gaps on the administration record. Service users are assisted to self medicate within a safe framework supported by staff. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The complaints procedure is generally satisfactory with some evidence that service users feel that their views are listened to and acted upon. EVIDENCE: One service user spoken with said the he did not have any complaints but that if he did he would bring them to the attention of staff. The Manager stated that no complaints had been received since the last inspection. As stated earlier in Standard 1, amendment is required to the complaints procedure to ensure it makes clear that a complainant can contact the CSCI at any stage of a complaint. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Some replacement of fixtures and fittings is required to ensure the home continues to present as a homely and comfortable environment for service users. EVIDENCE: The home is situated close to the Pershore Road and a number of shops, pubs and places of worship. Public transport is within walking distance and it was reported that some service users access public transport as part of their daily routines. The home was clean, warm and free from unpleasant odour on the date of inspection. Service user bedrooms were not observed. The kitchen is quite worn in appearance and the organisation will need to consider allocating funding to redecorate and refurbish the units in the near future. The carpet in the lounge was observed to be quite stained, staff meeting minutes recorded that one service user bedroom carpet was also stained although this room was not observed at the inspection. The Manager will need to audit the carpets in the home and plan a schedule for replacement of carpets as needed. Infection control procedures were satisfactory. Records were available to evidence that food in the fridge is stored at safe temperatures. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 17 This ensures infection control and reduces the risk of services users getting food poisoning. Liquid soap and paper towels were available for staff and service users to hygienically wash and dry their hands. The home has had a new laundry built. Whilst laundry still has to be carried through the kitchen this is an improvement as previously the washing machine was located in the kitchen. An infection control procedure for carrying washing through the kitchen was observed to be in place. The Environmental Health Officer visited the home in July 2005, the report of the visit did not raise any concerns regarding practice in the home. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 34 Staffing levels are appropriate to ensure service users are supported by sufficient numbers of staff to meet their needs. Recruitment practices need to improve to ensure all the required checks are carried out and service users are not put at risk. EVIDENCE: It was noted that both staff and service users appear comfortable in each other’s company and enjoy a good general rapport. They give support with warmth, friendliness and patience and treat people respectfully. The home benefits from having a core group of permanent staff. The Manager said there is 28 vacant hours but that these are easily covered as the home benefits from having several relief staff who regularly work at the home. This ensures that service users are supported by staff who know them well and are aware of their needs. Staffing levels at the time of the inspection were satisfactory to meet service user needs. The numbers of staff on duty each day are variable. The Manager explained that often some service users go and stay with their relatives and so staffing levels reduce accordingly. On some days when there are more 1:1 activities planned, then staffing levels increase. Discussion with the Manager and sampling of records show that staff meetings are held on a regular basis. This gives the Manager the opportunity to update staff on important issues and seek their feedback. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 19 Recruitment records were sampled for a new member of staff on her second day at the home. An application form, proof of identity and two written references had been obtained before the staff started work in the home. The Manager stated that a Criminal Record Bureau check had been applied for but had not yet been received so she had completed a risk assessment. Unfortunately the Manager had been unaware of the requirement to complete a POVA first check before the staff started work in the home. This is a check that will inform the home if an individual is on the Protection of Vulnerable Adults list that means they are not suitable to work with vulnerable adults. The Manager immediately made arrangements for this to be done and within a few days of the inspection it was confirmed that the staff was not on the POVA list. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The manager has a good understanding of the areas in which the home needs to improve but has inadequate time designated for management tasks. Some improvements are needed to ensure the health, safety and welfare of the service users is adequately promoted and protected. EVIDENCE: The Manager of the home has been in post for several years but has only recently become the registered manager since the home has changed its registration status. The Manager has completed an NVQ 4 and the Registered Managers Award. Discussions with the Manager and outcomes for service users indicate that she is working hard towards the home meeting all of the National Minimum Standards. However some records in the home require review to include care plans and risk assessments. The rota shows that the Manager has little time designated for administrative work and is often part of the care staff numbers. This needs review to ensure the Manager has enough time off direct care to undertake her role effectively. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 21 It is the responsibility of the organisation to ensure that their representative visits the home on a monthly basis. However since January 2005 only reports for three visits were available in the home. The Manager said that more visits had occurred but that the reports had not been received. It is essential that the Manager receives the reports of the visit so that she is clear on their outcome and identified action is completed. The home had a visit from the West Midlands Fire Service Officer in September. The fire risk assessment for the home has not been reviewed since August 2004, this needs review to reflect the discussions with the WMFSO and the installation of the new laundry. Refresher fire training has been arranged for staff in October. Fire records indicated that the fire equipment had been regularly tested by staff and one service user and serviced by an engineer. Regular fire drills are carried out but the Manager must record the names of all participants, this is to ensure that all staff and service users have the opportunity to participate. In April 2005 the gas engineer found that the gas fire did not meet safety standards. Evidence was observed that the Manager had taken immediate action and had the fire disconnected. There is no formal system in place for monitoring water temperatures in the home to ensure that water is maintained at a safe temperature to reduce the risk of scalding to service users. The Manager provided evidence that this matter had been recently discussed at a Managers meeting in September and that a system to implement water temperature monitoring was under consideration. Often staff work alone in the home. The Manager needs to complete a risk assessment for this practice to ensure it is safe for both staff and service users. Risks such as fire, accidents, illness and potential of challenging behaviour would need to be considered as part of the assessment. Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pinetrees Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 X DS0000064232.V253504.R01.S.doc Version 5.0 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4(1) & Schedule 1 15 13(4) & 15 Requirement Amendments are required to the statement of purpose to ensure it refers to Pinetrees and not Oakfield House. Room dimensions also need to be included Care plans need to evidence that they have been reviewed at least six monthly. Service user risk assessments must be kept under regular review, six monthly or after a critical incident has occurred. Risk assessments must cross reference to care plans and vice versa. The Manager must consider how Health action plans can be introduced for all service users in line with the Government paper Valuing People. Amendment is required to the complaints procedure to ensure it makes clear that a complainant can contact the CSCI at any stage of a complaint. The Manager will need to audit the carpets in the home and plan DS0000064232.V253504.R01.S.doc Timescale for action 30/11/05 2 3 YA6 YA9 30/11/05 30/11/05 4 YA19 12(1) & 13(1) 30/12/05 5 YA22 22 30/11/05 6 YA24 23(2) 30/11/05 Pinetrees Version 5.0 Page 24 a schedule for replacement of carpets as needed. 7 YA35 19(1) The provider must ensure that staff do not commence work in the home without a satisfactory POVA check. (POVA check now completed for new member of staff who commenced in September) The provider needs to review the amount of time the Manager has designated for administration and management tasks to ensure it is adequate. The provider must ensure that visits to the home which comply with regulation 26 are carried out on a monthly basis. Reports of the visit must be available in the home. Outstanding from inspection in December 2004. The fire risk assessment requires review. Ensure all risk assessments for premises, food and staff are regularly reviewed. A risk assessment for the lone working of staff needs to be completed. A system to monitor the water temperatures must be introduced to ensure that water is delivered at a safe temperature not exceeding 43°C at baths and showers. 20/10/05 8 YA37 10(1) 30/11/05 9 YA39 26 30/11/05 10 11 YA42 YA42 13(4) & 23 13(4) 21/10/05 21/10/05 12 YA43 13(4) 30/11/05 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 Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 25 Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Pinetrees DS0000064232.V253504.R01.S.doc Version 5.0 Page 27 - 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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