Inspection on 15/11/06 for Preceptory Lodge

This inspection was carried out on 15th November 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Preceptory Lodge 23/10/08

Preceptory Lodge 06/03/06

Preceptory Lodge 13/09/05

Preceptory Lodge 01/03/05

Preceptory Lodge 14/09/04

Preceptory Lodge 04/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Preceptory Lodge Preceptory Lodge Temple Hirst Selby North Yorkshire YO8 8QN Lead Inspector David White Unannounced Inspection 15th November 2006 09:00 Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 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 Preceptory Lodge DS0000038302.V317109.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 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. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Preceptory Lodge Address Preceptory Lodge Temple Hirst Selby North Yorkshire YO8 8QN 01757 270095 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) Mr Donald Smith Miss Gillian Stacey Prior Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: Preceptory Lodge provides personal care and accommodation for four service users with Autism in a domestic environment. The home is situated in the private grounds of Preceptory Farm. Preceptory Lodge is registered for four adults, currently there are three service users living in the home. The home is located between Selby and Doncaster and transport is provided for access local amenities and leisure activities. The home was first registered in March 2003 and is privately owned by Mr D Smith. The current weekly fees at the time of the site visit ranged from £1441.29 to £1765 per week and do not include costs for chiropody, entrance fees for activities and toiletries. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on 15 November 2006. This visit was carried out by one Regulation Inspector and took 6 hours with 4 hours preparation time. Since the previous inspection visit an application has been successfully made to vary the home’s registration and this means that the home is now registered to accommodate up to four service users, having been previously registered for up to two service users. The home was able to return the requested information before this site visit. The report includes information from the Regulation Inspector’s inspection record, which details the history of the home and relevant information about what has been happening in the home since the previous inspection visit. The site visit included an inspection of the premises. The visit involved looking at three service users’ care records, including service users’ assessments, care plans and medication records. Staff rotas and health and safety documentation were inspected. Two service users, two members of care staff and the manager talked about their experiences in the home and time was spent observing the interaction between service users and staff. The focus of the inspection was on a number of key standards and inspecting the case records of a number of service users to establish whether they corresponded with their experiences of life in the home. The manager was available throughout the inspection and the findings were discussed at the end of the inspection. What the service does well: The home encourages the service users to make their own choices in how they live their lives and this helps to encourage their independence. A good care planning system helps provide staff with easy to follow guidance to make sure that service users’ needs are met safely. Service users enjoy a range of activities both in and outside of the home and have involvement with the local community. Service users live in well-maintained, attractive, and comfortable surroundings and in an environment that is homely and this promotes service users’ comfort and safety. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 6 The staff team are committed towards providing good standards of care for service users and are well trained to give them the skills and knowledge to meet service users’ needs. The home is managed well and this means that concerns are addressed, service user interests are safeguarded and good standards of care are maintained. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 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 Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Proper pre-admission procedures ensure that people moving into the home know what the home has to offer and can feel confident that their needs will be met. EVIDENCE: Existing and prospective service users and their representatives receive a range of information explaining the care and services available at the home. Part of this information includes the home’s statement of purpose and service user guide that has recently been updated so that people are aware that the home has been extended to accommodate another two service users. The manager carries out pre-admission assessments which include an assessment of the prospective service user’s needs. Information is obtained from other sources such as GPs and social services to help the home to decide if someone is suitable and people are invited for informal visits to the home before making any decisions about moving there. A service user who has only recently moved into the home said that he was able to visit the home on a number of occasions before his admission. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 9 Each service user has an individual contract and a statement of terms and conditions so that they are aware of their rights and copies of these are kept in their personal files. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home encourages service users to live as independently as possible and to make their own choices and good care planning systems provide staff with the information to meet service users’ needs safely. EVIDENCE: The care plans give clear information about the specific needs of the service users and how these are to be met. The home has a very good, well-organised care planning system in place which provides a range of information about each service user. The care plans contain a “pen picture” of each person detailing their life history and likes and dislikes. Information gathered from the assessment of the service user prior to their admission to the home is reflected in the service user’s care plan and states how assessed needs are to be met. The care plans are detailed and consider the social aspects of each person’s needs as well as their physical, personal and emotional needs. Staff said that the care plans are easy to follow and are particularly useful in explaining how Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 11 to deal with difficult situations that may arise with a service user. Each service user has a key worker and this encourages service users to have one to one input from staff and service users said that they regularly met with their key worker to talk about their care. The care records include information about service users’ preferences about daily routines and how they wish to receive support from the staff team. Due to the needs of the service users some of the daily routines are very structured and the care plans provide clear instruction to staff on such things as when to prompt service users to get up in a morning. However, there was no written evidence in the care records to show that service users or people acting on their behalf were in agreement with the actions being taken. Within each care record there are a number of risk assessments to promote the independence and safety of each service user and these take into account the potential gains to the service user from taking risks. All risks to the service users are assessed and preventative measures needed to minimise risks are recorded. There is also a range of strategies to manage difficult and inappropriate behaviours. A service user has recently been physically threatening towards a member of staff and measures were in place to minimise risks from the behaviour. All incidents of this kind are analysed afterwards to look at the possible reasons for the behaviour and any lessons, which could be learned from the incident, and this is good practice. Daily records are kept up to date and well maintained and these reflected the care being given. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a wide range of activities both in and outside of the home and have involvement with the local community. EVIDENCE: In each service user’s care records there is information about their social interests and hobbies. Service users said that they enjoy the activities on offer at the home and some attend a local social club where they are able to meet their friends. Some service users have involvement with a day centre and a service user said that he likes using the computers in the centre. On occasions service users enjoy going swimming to the local baths and they make regular visits to the nearby pub where they are developing good relationships with members of the local community. The manager is trying to establish links with a horticultural Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 13 learning centre and the possibility of therapeutic work programmes for service users wishing to get involved in this. The home is located away from the centre of Selby and Doncaster, however has a minibus to provide transport to enable service users to have access to the local amenities. The minibus is also used to take service users on day outings and one service user has recently enjoyed a visit to Dublin with the support of staff. Service users said that they could see their family and friends whenever they want and staff provided support with this. Menu planning takes place with the service users who have the responsibility of doing the grocery shopping and staff assist service users with food preparation. Service users have choices at mealtimes and feel that the quality of the meals is “good” and mealtimes are flexible, unhurried and relaxed. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good personal and healthcare support with good access available to specialist services when needed. EVIDENCE: The care records indicate how service users want to receive support from staff and service users feel that staff are “kind and helpful” towards them. Staff offer support in a sensitive manner and through observing and speaking to staff it was clearly evident that they act in the best interests of the service users and respect their rights. Each service user is registered with a General Practitioner and a dentist and where appropriate receive input from external services such as mental health services. One service user receives visits from a private psychiatrist and this service is being funded by the home. The service user welcomes the input being offered and said that as a result of a change in his medication he was now “sleeping a lot better”. The home encourages service users to have physical exercise and there are visits to the local swimming baths and one Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 15 service user has an exercise bike to help him keep fit. The menu planning also considers healthy food options for service users. Input from healthcare services is well documented within the care records. In the care records there are a number of risk assessments to support service users with their independence and if there is any restriction on choice for the service user this is clearly recorded as to why. The medication systems are satisfactory and all medication is stored safely and the records are up to date. The home has an audit system to carry out daily stock checks and a random check of the medication stock tallied with the records. All the staff who administer medication at the home receive some basic medication training, and two of them have had accredited medication training. The manager has made arrangements for all the other staff to receive this accredited training. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and adult protection policies and procedures are in place to safeguard service users from harm. EVIDENCE: The home has a complaints procedure that clearly details how complaints are to be dealt with in given timescales. A summary of the complaints procedure is available within the service user guide which is given to all the service users and their representatives. Service users said that they would raise concerns with the manager if they had any concerns and staff had good relationships with the service users and said that they would know from the service user’s behaviour if there were any problems and would act on this. The home has policies and procedures in place to safeguard their service users from harm. These reflect the local multi-agency policies and procedures that detail clearly what actions are to be taken in the event of suspected or incidents of abuse. All the staff receive abuse awareness training and a Protection of Vulnerable Adults (POVA) employees guidance booklet explaining the types of abuse and how to respond to it. Service users have support from staff or their family in managing their monies. Two service users have their own bank account and cash card. The home stores only small amounts of spending money for each service user and satisfactory systems are in place for the recording of incoming and outgoing Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 17 monies. A random check of a service user’s money tallied with the records. Service users have access to their monies at all times. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, pleasant and safe environment that is well maintained. EVIDENCE: Since the previous inspection visit the home has been extended to accommodate another two service users. This means that the accommodation is now over two floors, which is accessible by stairs. The two new bedrooms are decorated to a high standard and have en-suite facilities. The home is located away from the main road and the owner of the home provides transport so that service users can access the local amenities. There are extensive gardens to the home with a paved patio area to the rear of the building. Within the grounds there is a day service facility to enable service users to take part in activities and service users also have access to a swimming pool and pool table which are located on site. There is ramped Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 19 access enabling people visiting the home with mobility problems to have access to and from the home. The home has a welcoming atmosphere and service users said they like living at the home and one made a comment that “everyone got on well together”. Each bedroom is decorated to suit the service user’s personal tastes and these are personalised. Communal areas in the home are bright and spacious and there are toilets and bathrooms that are easily accessible for the service users. A toilet seat in a downstairs toilet was cracked and this was brought to the attention of the manager who dealt with the matter at the time of the site visit to prevent any possible risk of injury or harm to service users. The home has a maintenance programme and all the required safety checks are carried out. A recommendation made from a recent environmental health visit has been dealt with and all the equipment is tested and updated as required. The home has a fire risk assessment and follows procedures to promote fire safety. The home is clean and well looked after and there are separate laundry facilities to attend to service users’ personal clothing. All dangerous substances are stored securely. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive a very good standard of care from a well-motivated and enthusiastic staff team, however one aspect of the recruitment procedures needs to improve to make sure service users are safeguarded from any risk of harm. EVIDENCE: The home has good staffing levels with at least two members of staff on duty at all times through the day. On a night there is one member of staff who sleeps on the premises. Staff feel that staffing levels are good and service users said staff are always available for support. Staff morale at the home is good and a staff member said that the home “is a good place to work”. The home has recruitment procedures in place and in general these are followed. However in one instance a new member of staff started working at the home before the completion of the required CRB and POVA checks and this practice needs addressing in order to safeguard service users from possible harm. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 21 All the staff receive a range of training to equip them in meeting the needs of the service user group. This includes training on autism and non-violent crisis intervention and this also forms part of the induction training for new staff. Staff feel that the training programme is good and helpful in enabling them to have a better understanding of people’s needs. The home has an ongoing commitment to NVQ training and a number of staff are currently undergoing the training programme. Staff have regular individual supervision and this is recorded so that support is given to staff and management are aware of any staffing issues. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in the best interests of the service users and overall proper attention is given to ensuring their health and safety. EVIDENCE: Since the previous inspection visit the manager of the home has successfully applied to become the registered manager of the home with the Commission for Social Care Inspection (CSCI). The manager is very experienced and has the Registered Manager’s Award. She is well respected by the service users and staff who describe her as “very supportive and approachable”. The manager has a deputy who helps with the leadership of the home. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 23 The home has systems in place to seek the views of service users, relatives and others who are in contact with the home. Questionnaires are sent out and information from these is used to look at ways of improving the care and services at the home. Staff and service user meetings are held and encourage the views of everyone to improve standards within the home. A recently appointed staff member made comments that she is encouraged to give her opinions. The owner of the home visits the home regularly and produces a report of his findings. The home has proper arrangements in place to make sure that health and safety practices promote a safe environment for service users, relatives and visitors to the home. The required health and safety certificates are up to date and satisfactory and hot water temperature tests are undertaken on a regular basis. All staff receive health and safety training and accidents are clearly recorded in the home’s accident book to safeguard the interests of service users. The manager needs to make sure that proper pre-employment checks are done for all new members of staff before they start work at the home in order to protect service users from possible harm. Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 YA7 Regulation 15 Requirement The registered person must make arrangements to show that the service user or a person acting on their behalf has agreed actions being taken within each service user’s care plan. The registered person must make sure that all staff who are responsible for administering medications in the home receive accredited medication training. The registered person must make sure that as a minimum requirement, a Protection of Vulnerable Adult (POVA) First check is completed on all staff prior to them starting work at the home. Timescale for action 15/12/06 2 YA20 13, 18 15/02/07 3 YA34 19 15/11/06 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 Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 26 Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Preceptory Lodge DS0000038302.V317109.R01.S.doc Version 5.2 Page 28 - 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!