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Inspection on 03/03/06 for Prince Alfred

Also see our care home review for Prince Alfred for more information

This inspection was carried out on 3rd March 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service even though large has a warm and friendly atmosphere. Service users are able to exercise a high level of choice in their day-to-day activities and generally are supported by a stable group many of whom have achieved their NVQ level 2 care qualification. The manager provides strong leadership to the staff team and has a good understanding and rapport with service users and staff.

What has improved since the last inspection?

Falls risk assessments have been introduced to promote the health and safety of service users. In addition, a new service user format and risk assessments have been introduced which are more detailed. The fire tests are being carried out at regular intervals as required since the last inspection.

What the care home could do better:

Where paintwork has been knocked, or stained it should be repainted to maintain the quality of the physical environment for service users. The registered person should ensure that there is always a carpet cleaner in the service which in good working condition to promote the quality of the environment of service users. The conservatory must be repaired and redecorated to ensure that service users have choice in where to sit in the communal areas. The service should have a dedicated activities budget to enable service users to access more community facilities. Also, the staffing hours set aside for a carer to provide activities should be separated so that it is not absorbed by the staffing hours providing support and personal care.The registered person must review the staffing level in the morning to promote the health and safety of service users because service users needs cannot be met given the dependency level of service users, the number of service users and the layout of the building.

CARE HOMES FOR OLDER PEOPLE Prince Alfred Prince Alfred Road Liverpool Merseyside L15 8HH Lead Inspector Leila Mavropoulou Unannounced Inspection 3rd March 2006 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Prince Alfred DS0000059310.V287646.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. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Prince Alfred Address Prince Alfred Road Liverpool Merseyside L15 8HH 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) 0151 734 2587 0151 734 5998 European Wellcare Homes Ltd Cheryl Marie Dobie Care Home 50 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (38), Physical disability over 65 years of age (9) Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 50 Nursing and 50 Personal Care in the overall total of 50. This service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection OP Old age - to include one named service user under the age of 65 years in an overall total of 50. One named service user over age 60 years old within the overall number of 50 older people over 65 years of age. 26th November 2005 Date of last inspection Brief Description of the Service: Prince Alfred is situated in the Wavertree area of Liverpool, within easy walking distance to Wavertree High Street and is close to local bus and rail routes, shops and amenities. The home has fifty single rooms, each with a hand-wash basin. The bedrooms are situated on the first and second floors. The first and second floors can be reached by stairs or by a passenger lift. Bathrooms are located on the first and second floors and toilet facilities are available on each of the three floors. Bathing aids are available. On the ground floor, there are two dining rooms, a conservatory and two lounges, one lounge being available for service users who wish to smoke. There is also a lounge on both the first and second floors. The home has a hydrotherapy pool and a hair salon. A garden with a seating area is provided. There is a car park at the front of the home. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted for five hours over two days. During which time some service users and staff files were inspected and other records that the service is required to keep and have available for inspection such as: fire, maintenance, building risk assessments records etc. What the service does well: What has improved since the last inspection? What they could do better: Where paintwork has been knocked, or stained it should be repainted to maintain the quality of the physical environment for service users. The registered person should ensure that there is always a carpet cleaner in the service which in good working condition to promote the quality of the environment of service users. The conservatory must be repaired and redecorated to ensure that service users have choice in where to sit in the communal areas. The service should have a dedicated activities budget to enable service users to access more community facilities. Also, the staffing hours set aside for a carer to provide activities should be separated so that it is not absorbed by the staffing hours providing support and personal care. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 6 The registered person must review the staffing level in the morning to promote the health and safety of service users because service users needs cannot be met given the dependency level of service users, the number of service users and the layout of the building. 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. Prince Alfred DS0000059310.V287646.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 Prince Alfred DS0000059310.V287646.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): 1,3,4,5 Prospective service users needs are assessed before they are admitted to Prince Alfred to ensure that the service is able to meet the assessed needs of the service user. EVIDENCE: The service has a detailed statement of purpose and service user guide. The information contained in both documents enables the service user to make a decision about the suitability of the service in meeting their needs. The statement of purpose should be reviewed to ensure that the information is up to date. Service users and their families are encouraged to have trial visits to the home to enable them to meet other service users and staff and to assess if they would like to live at Prince Alfred. Prince Alfred is registered to take service users that require nursing and personal care. However, for some years now the management of the service decided that only service users requiring personal care would be admitted to the care home and as such the staffing requirement has been adjusted accordingly i.e. the service does not have any qualified nursing staff on duty. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 9 Service users records seen showed that their needs were assessed before they were offered a place at Prince Alfred. The information obtained by staff from the pre-admission assessment is used to develop the initial service user plan and risk assessments in conjunction with the service user’s Care Management Assessment. The service user plan shows how the service user personal and health care, dietary needs medication needs are to b met and by whom. Observation of staff and discussion indicated that they have the necessary skills to meet the needs of the service users. This is promoted through staff receiving regular supervision and in-house training to ensure that they have the necessary skills and knowledge to meet service users needs at Prince Alfred. Prince Alfred DS0000059310.V287646.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): 7,8,9,10,11 The staff monitors the service user physical and emotional needs to ensure that their needs are met to promote their wellbeing. EVIDENCE: Service users files seen showed that detailed care plans and risk assessments have been developed to ensure staff know what the service users needs are and how their assessed needs would be met. Discussion with the manager show that service needs are assessed and where necessary appropriate support and advice would be sought. This was evidence by one service user being reassessed by a social worker to enable the service user to be move to more suitable accommodation where their needs could be met. Recently, a new corporate format of care planning has been implemented and the manager was transferring service users information onto the new format. Service user plans are reviewed regularly. Wherever possible the service user plan is developed with the service user or their representative. Observation of service users, discussion with staff and entries in the service users daily records show that their health needs are met through review of Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 11 their medication by their GP, visit by the District Nurse as required, continence need reviewed regularly by the Continence Adviser to promote service users dignity and health, as well as regular dental, optician and chiropodist visits. The service maintains a record of service users medication received into the care home, administered and returned to the pharmacist. Staff responsible for the administration of service users medication is provided with necessary training as evidenced in staff training records. Observation of staff providing care and support to service users showed that service user are treated with respect and dignity by the manner in which service users are spoken to, assisted with their meal and their mobility. Observation of service users showed that they were well presented and it would appear that they were dressed in a style that reflected their preference. Discussion with the manager indicated that the service users who are terminally ill or dying would be cared for at Prince Alfred as long as their care needs could be met with the assistance of other health professionals. Prince Alfred DS0000059310.V287646.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): 12,13,14,15 The service users social needs could improve by providing a specific activities budget and reviewing staff time dedicated to providing activities. EVIDENCE: The service users are able to exercise choice over activities of daily living such as: time of rising and going to bed, where to have their meals, where to spend the day and to see their visitors etc. Discussion with the service users and staff showed that the service users enjoy going out. The service has a minibus, which enables service users to be taken out without having to organise transport. Discussion with the manager and staff showed that there is no specific budget for entertainment/social activities for service users and that the staff have to fundraise to pay for the cost of taking service users out. The manager informed the inspector that petrol costs are met out of the service’s petty cash. The service has an unrestricted visiting policy and service users are able to choose where to see their visitors. Prince Alfred is close to the shops and some service users go out independently to the local shops. Observation during the inspection showed that that the home has a lot of visitors and that there was a good rapport between visitors and staff. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 13 The staff support service users to maintain their personal allowance and where monies are given to the management for safekeeping a record is kept of all incoming and outgoing payments via receipts. A secure place is provided for the storage of service users monies and valuables. Service users are encouraged to bring their furniture into the care home so that they can be surrounded with familiar items providing they comply with current fire regulations. The dining tables were well presented with condiments, serviettes, tablecloths etc. Menus are available in large print to promote service users independence and staff would tell service users the choice of meals available. Observation of service users at mealtime showed that mealtime is a social occasion and there is a lot of interaction between service users. Discussion with the manager confirmed that special diets would be catered for as well as dietary needs of service users from ethnic minority group. Currently, four service users required soft diet and three required feeding. The staffing level at mealtimes does not permit appropriate level of assistance to be provided to service users requiring assistance and to meet the needs of the more independent service users. Prince Alfred DS0000059310.V287646.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): 16,17,18 The service has various policies and procedures to protect service users from abuse. EVIDENCE: The service has a complaints procedure, which explains how complaints would be dealt with. The home has a copy of the Liverpool City Council’s guidance in relation to adult protection and its own whistle-blowing policy. Discussion with the manager indicated that any concerns family or service users may have are usually raised in the first instances informally with her. Concerns are usually addressed satisfactorily without having to use the formal complaints procedure. The manager should consider maintaining a record of all concerns raised by service users or their representative to show frequency, how it was addressed etc. which could be used to inform the service quality assurance. There is ongoing service users concern regarding the disrepair of conservatory. There has been no formal complaint at Prince Alfred in the past six months. The service has various policies and procedures to protect service users and staff from abuse. The deputy manager has devised training material on understanding abuse for all staff, which is discussed at supervision and staff meetings and forms part of the staff induction. Information on independent advocacy services is available and where necessary staff would access the service on behalf of service users. Service users are able to vote if they wish either through postal voting or staff would arrange for service users to be taken to the polling station. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The physical environment could be improved through routine maintenance/decorating to improve service users living environment. EVIDENCE: Prince Alfred is a purpose built home, which has the communal facilities on the ground floor. There is a separate smoking lounge the service users bedrooms are on the first and second floors. The home was clean and free from malodour and the service employs a number of domestic staff and domestic supervisor who check that tasks are carried out. The domestic supervisor is responsible for the ordering of cleaning material and to ensure that staff have the necessary cleaning products to maintain the cleanliness of the building. Observation during the inspection showed that the maintenance person carries out routine maintenance work to promote the safety of service users. The registered person must ensure that there is always one carpet cleaner in working order at the care home to promote the cleanliness of the building and to maintain the environment for service users. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 16 The paintwork to some bedroom doors are still damaged and requires repainting. The decoration to the first floor corridor is damaged in a number of areas and requires attention. The conservatory is still not in use and as such restricts the communal space provided to service users. The inspector is informed that work on replacing the conservatory is scheduled for the 10th April 2006 and that the decoration and flooring would start immediately after the building work is completed. The service has a number of assisted baths and toilets, which are situated close to service users bedrooms and the communal areas. There is a passenger lift that allows service users to access their bedrooms on the first and second floor easily. All bedrooms have a call point which service users and staff use to gain assistance. Aids are provided in the service to meet individual service users needs after the district nurse assesses the service user. Hoists are used to transfer service users to promote theirs and the staff safety. The hoists are serviced at regular intervals as required. All service users accommodation is provided in single bedrooms, which are generally well maintained. Service users are able to bring into the care home their own furniture if they wish. Electrical appliances brought into the care home by service users are PAT tested to ensure that the electrical wiring is safe. The service is centrally heated throughout and building risk assessments are carried out annually, which is followed up by monthly audit. The hot water is regularly tested for Legionella. It was done on the 1st September and the engineers were testing it during the inspection. The laundry is sited away from the food preparation area and policies and procedures are in place to minimise the spread of infection. The service has clinical waste contractor to collect soiled rubbish. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, The service must review the staffing level in the morning to promote the health and safety of service users. EVIDENCE: Currently, in the morning there are five carers plus the manager or senior carer on duty. Given the layout of the building, the number of service users and their dependency level the needs of the service users are not easily met within the existing staffing level in the morning. A number of hours have been dedicated to provide activities for service users. However, within the staffing rota this is not clear and as such these hours are easily absorbed into providing care and support to service users. Discussion with staff indicated that at time service users would not be observed in the communal areas, particularly when medication is being administered. The registered person must review the staffing level in the morning to promote service users safety, choice and to ensure that their health needs are met. Over 50 have completed their NVQ level 2 Care qualification and others are working towards achieving the award. Staff records seen showed that two written references are obtained and a Criminal Records Bureau check is obtained. European Wellcare Homes Ltd has a group of bank staff that cover vacancies at all of their care homes. Thus, Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 18 staff vacancies can be covered at short notice, as bank staff would have had all necessary checks and induction. Staff records showed that they are inducted into their role and receive a number of paid training days each year. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 Service users are in general, supported by the management and administrative systems at the home. EVIDENCE: The manager is currently working towards the NVQ level 4 care and management award. The manager is accessible to service users and staff as observed during the inspection. Regular staff and service users meetings are held to exchange information and to provide a forum where they are able to put forward ideas on how the delivery of the service could be improved. The manager receives regular supervision from the area manager of European Wellcare and she makes regular visits to the care home to provide information and support to the manager. However, reports of her monthly visits are not forwarded to the Commission as required. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 20 A current Public Liability Insurance was seen and discussion with the manager indicated that records are kept of all expenditure. It is anticipated that details in relation to the business and financial planning for the home would be made available to CSCI upon request. The health and safety of service users are promoted through regular checks and routine maintenance of equipment used at the care home. Regular fire checks are carried out as evidence in the service fire records and current gas and electric certificates were seen. The service maintains a record of all accidents/incidents to service users and staff and where necessary the Commission would be notified. Staff training in food hygiene, loads management, fire awareness and first aid are reviewed during their supervision to ensure that they are current. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16 Requirement The registered person must consult service users about the Programme and provide appropriate facilities and resources to promote this. The registered person must ensure that the building is maintained internally and externally. The paintwork where it is damaged on the first floor corridor and bedrooms are repainted. The conservatory must be repaired to provide appropriate level of communal space as required for the number of service users. The registered person must ensure that suitable staffing levels are provided to meet the assessed needs of service users. The registered person must ensure that the hours dedicated to provide activities to service users is not absorbed into the care and support hours. Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 23 Timescale for action 30/05/06 2 OP19 23 30/05/06 3. OP20 23 30/05/06 4 OP27 18 30/05/06 5 OP33 26 The registered person must ensure that a copy of her monthly visit report is forwarded to the Commission. 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP5 Good Practice Recommendations The registered person should review the service Statement of Purpose to reflect staffing qualification. The registered person should maintain a record of prospective service user or their representative visits to the care home, together with any additional information obtained or given. The registered person should maintain record of all concerns raised by service users or their representative to show frequency, how it was addressed etc. which could be used to inform the service quality assurance. The registered person must ensure that staff have the necessary equipment, which is good working condition to carry out their tasks. The registered person should ensure that the hours dedicated to providing activities are clearly recorded on the staffing rota. 3 OP16 4 OP27 5 OP27 Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Prince Alfred DS0000059310.V287646.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!