Inspection on 24/11/05 for Quarry Mount Residential Care Home

This inspection was carried out on 24th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Quarry Mount Residential Care... 02/12/08

Quarry Mount Residential Care... 10/10/08

Quarry Mount Residential Care... 12/12/07

Quarry Mount Residential Care... 25/10/06

Quarry Mount Residential Care... 14/06/05

Quarry Mount Residential Care... 18/01/05

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The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Quarry Mount Residential Care Home 83 Bath Road Swindon Wiltshire SN1 4AX Lead Inspector Pauline Lintern Unannounced Inspection 24th November 2005 10:00 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 Quarry Mount Residential Care Home DS0000062385.V266636.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 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. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Quarry Mount Residential Care Home Address 83 Bath Road Swindon Wiltshire SN1 4AX 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) 01793 527715 01793 616130 Quarry Mount Care Ltd Mrs Karen Meadowcroft Care Home 32 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (4) Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 32 No more than 25 service users aged 65 years and over with dementia may be accommodated at any one time No more than 4 service users aged 65 years and over with a physical disability may be accommodated at any one time 14th June 2005 Date of last inspection Brief Description of the Service: Quarry Mount is a large detached house in the Old Town area of Swindon offering accommodation and care to 32 older persons, some of whom have dementia. The home is a short walk from local shops, post offices, bus stops and churches. The home is arranged on three floors. The communal space is arranged on the ground floor and consists of a large lounge, dining room and a further lounge and dining room. There is also some seating accommodation in the hallway. There are two semi-detached bungalows in the rear garden accommodating four residents. A large garden at the rear with seats and tables is provided in the summer so that residents can sit out. A people carrier is provided for outings and shopping. The accommodation is appointed to a high standard. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over five and a half hours. The inspectors met with approximately 10 service users and with six staff members. The manager was present throughout the inspection. One new service user was admitted during the day of the inspection. The inspectors toured the building and the two bungalows, which are located in the grounds. During the inspection health and safety files, staff recruitment, complaints, activities, meals and care plans were observed. What the service does well: What has improved since the last inspection? There have been no specific improvements since the last inspection other than general up keeping of decoration and maintenance. The staff aim to maintain the standard met at the last inspection. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 6 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. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 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 Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 All new service users are assessed to ensure that the home can meet their needs. EVIDENCE: The inspector observed the placement enquiry form of a service user that had recently moved into the home. The assessment showed information on the person’s medical needs, diet, personal care supervision, mobility, continence, possible risks and also any allergies. A member of the service users family had also completed a comprehensive assessment that identified the individuals needs. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 9 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, 9 and 10 All service users have a care plan, which is regularly reviewed. Systems are in place to ensure the safe handling of medication, however some of the storage arrangements are unsatisfactory. Staff were observed treating the service users respectfully and allowing them plenty of time to complete tasks. Privacy needs to be addressed with regard to locking toilet and bathroom doors. Clear protocols need to be in place with regard to assistance with personal care. EVIDENCE: During the inspection four service users care plans were observed. They include information on dietary needs, requirements for personal care, mental health needs, communication, pressure sore assessments, mobility, risk assessments, (including a falls assessment) and medical information. One service user is diabetic and the care plan informs the reader of a guide to meals for diabetics and also identifies ‘bad’ food that has high sugar content. The care plans need to include an inventory of the service users assessed needs and requirements with regard to holding keys to bedroom doors. Each service user should have an assessment to determine whether they require being able to lock their bedroom door from the inside. It is a requirement that Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 10 all existing mortice locks are removed from bedroom doors and replaced with alternatives that are underpinned with a risk assessment. The manager must provide suitable locks to the bathroom and toilet doors to provide privacy for service users, whilst ensuring that staff can access the room in an emergency. Service users that spoke with the inspectors confirmed that staff treat them well and have a warm and friendly approach. During the inspection staff were observed spending time with individuals reassuring them and treating them with dignity. The home needs to adopt clear protocols for providing assistance with personal care. Where cross gender assistance is provided this needs to be clearly documented in the care plan and agreed with the service user/family and advocate. One service user confirmed that she had been asked if she was happy with this arrangement and she confirmed that she is. Service users report that they had been involved in their care planning and knew the contents of the plan. One service users care plan listed her current medication, the manager confirmed that this had been reviewed however there was no documentation to support this. After discussion with the manager a new format for recording medication requirements was agreed and a new form was developed before the end of the inspection. Two of the service users who live in the bungalows located in the grounds told the inspectors that they had their own telephones. Service users who live in the main building have access to a pay phone in the hallway of the home. Medication is stored securely and appropriate records are maintained. The home maintains good contact with the pharmacy. Trained members of staff according to the home’s procedure carry out the administration of medication. Two aspects of the storage should be given further consideration. The fridge temperature should be monitored regularly to ensure that it falls between 2c and 8c, no medicines were held in the fridge at the time of the inspection. Controlled drug storage must be removed from the trolley. Written additions to the printed medication administration record should be signed, dated and checked by two members of staff. Information is kept on the use of some ‘as required’ medication; this must be updated so that staff have clear guidelines for when it is appropriate to administer prescribed medication on a ‘as required’ basis Other areas discussed with the manager included the use of ‘bulk’ prescriptions for some items and the ability to break tablets, which have score lines and the equipment available to aid this process. Further recommendations were made regarding the use of photographs and information being kept in a file with the administration records, and the use of patient information leaflets as a resource. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 11 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 and 15 Opportunities are given for service users to access recreational activities both inside and outside the house. Meals provided are well balanced and varied. EVIDENCE: A feature of this service is that there is a wide range of appropriate leisure and recreational activities provided. Service users confirmed that they had visited the local shops for Christmas shopping and on the day of the inspection outside entertainment was in the house. There is a calendar of social events, which have been planned. These include musicians, pantomime visits, ‘Name that tune’ competitions, bingo and sing-along. The residents have access to gentle exercise and movement sessions, which include ball games, beanbags and armchair hockey. The inspector observed part of this session and observed many service users taking part. Service users told the inspector that they had really enjoyed the fish and chip supper they had had the night before. One service user said that she really liked the Christmas tree and decorations, which staff had put up. Some service users told the inspector that they had made some biscuits the day before the inspection, which they had enjoyed. The service users living in the bungalows confirmed that staff inform them of any events or entertainment that are planned. They confirmed that although they are away Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 12 from the main house, they do not feel excluded and that they choose if they wish to participate. There is evidence that the local clergy visits the home on a regular basis. Discussion with service users confirmed that meals provided at the home are tasty and well prepared. Service users commented that ”meals are good” however when asked what was for lunch no service user knew and they stated that they “ never know it just comes”. Service users said that they would like to know what was for lunch. The inspector did find a four week menu on display close to one of the lounges, however it was not clear which of the four menus were being used. Discussion with the chef highlighted that service users likes and dislikes are known and where service users do not like a meal an alternative would be offered. The chef was recording changes to the menu on a sheet, which is used for recording cooking temperatures. It is a requirement that all records of alternative meals given to service users are recorded. Service users living in the bungalows confirmed that all their meals were hot on arrival although they did not know what they would be having. The chef has a City and Guilds qualification. Mealtimes are suited to the needs of the service users. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home ensures that complaints are taken seriously. EVIDENCE: The home has a comprehensive complaints policy and procedure that specifies complaints would be responded to within a 28-day period. The complaints procedure is on display on the notice board at the entrance to the main lounge and dining room. The complaints procedure includes the name and address and telephone numbers of the CSCI office in Chippenham. Discussion with service users confirmed they would feel confident in raising any concerns with the manager or staff. One service user said she felt “in safe hands”. The manager confirmed that there had been no complaints since the last inspection. The inspectors did meet with two service users who had recently expressed concerns to the manager regarding staff changes. These concerns had not been recorded as a complaint and it is recommended that the home provide ways of recording concerns to ensure service users views are being listened too. Discussion took place with the manager with regard to house meetings, which would provide a good forum for raising concerns and reassuring service users if they had any worries. One service user commented that they would like to attend a house meeting if they had the opportunity. Discussion with the manager confirmed that the majority of staff has received abuse awareness training. Policies and procedures are in place to safeguard residents where possible. Discussion with staff members demonstrated a clear understanding of what action they would take if they were concerned about the welfare of a service Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 14 user. The home has a ‘whistle blowing policy in place to support staff in raising concerns. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 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, 21, 23 and 26 The home is maintained to a high standard. The furnishings and furniture are in keeping with the building and all bedrooms are suited to the needs of the service users. Although there are sufficient toilets and bathrooms there needs to be more consideration given to privacy. The home is clean and hygienic. EVIDENCE: The home has a part time maintenance worker; this ensures that any repairs and redecoration are dealt with swiftly. The décor throughout the home is of a high standard. When the inspectors arrived the home was being cleaned and all the rooms were tidy and hygienic with no unpleasant odours. All windows have restrictors on them and all radiators are covered. The bedrooms are decorated to suit the age group of the service users, with matching soft furnishings. Service users had personalised their rooms with photographs, pictures and personal items. All rooms have access to a call system, although the manager reported that some service users are unable to use them. There is a requirement to remove all mortice locks from the doors and replace them with an alternative, that enables people to lock their door from inside whilst still allowing staff to access in the event of an emergency. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 16 The inspectors found that the bathroom and toilet doors had disabled locks on them, which prevented service users locking the doors for privacy. This needs to be addressed and suitable locks should be fitted. The manager reported that they would assess each persons needs with regard to locking doors and the access to the bedrooms. At the moment keys to bedrooms are hung outside each door. To empower service users, the registered manager should encourage individuals to hold their own keys where appropriate, underpinned with a risk assessment. It is recommended that all care plans include an inventory of service users needs and requirements with regard to their bedrooms. The home has two commercial washers and a drier. Sluice facilities are located near to the laundry room. It is recommended that the home purchase red alginate bags for infection control when handling soiled laundry. Staff confirmed that the home provides protective clothing. Each service user has a small lockable cupboard in their bedrooms for keeping small personal items in. The two bungalows, which are located in the grounds, are of the same high standard as the main house. One service user said that they were happy living in the bungalow and that she had a new electric fire this year. Both bungalows had a very nice homely feel to them. The home has eight shared bedrooms throughout the building. The manager reported that all service users were happy with this arrangement. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 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 and 29 At the time of the inspection the home had a full compliment of staff. Recruitment records show that service users are protected by the homes policies and procedures where possible. EVIDENCE: The inspectors met with several staff members during the inspection. Staff confirmed that they received induction training when they began working at the home. Staff files indicated that recruitment practice was satisfactory and that the required documentation is in place. The manager commented that one new member of staff was shadowing a more experienced staff member and that a POVA first check had been carried out on her. The rota was inspected and showed an acceptable level of staff on duty. The manager said the home now has a full compliment of care staff, which has reduced the overtime burden; the home has not used any agency staff in recent years. The home has an on-call system, which supports staff if needed. The training records confirm that staff are given the opportunity to learn and attend training courses. Staff reported that they have the opportunity to do their NVQ’s. There is evidence that staff receive training in basic food hygiene, manual handling, health and safety, first aid, challenging behaviour and fire procedures. Staff commented that they receive regular supervision and that they feel supported by the manager. Comments made to the inspectors indicate that staff are well liked and service users are generally happy with the service that is provided. One service user Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 18 commented that “the staff are good, very friendly” and that it is “ a lovely home”. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 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): 35 and 38 The home safeguards service users’ financial interests. The health, safety and welfare of service users and staff are protected as much as possible. EVIDENCE: Two service users living in the bungalows hold their own money and make their own purchases for items they require. One service user confirmed that she pays for her daily newspaper and her phone bill. The manager confirmed that all other service users’ money is held by relatives or appointees, and none is held by the home. Records of transactions where the home purchases items or services for service users are kept at the home’s head office for invoicing purposes. Each service user has the facility to lock away any small valuables and personal items within their bedrooms. Health and safety records were inspected and showed that the required checks have been completed. There is a record of fire alarm tests; the last one was Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 20 on 20/11/05, emergency lighting tests, fire fighting equipment checks and fire instruction for new staff. It is recommended that when new staff have received fire instruction it is recorded using their name and not ‘new staff’. There is a generic fire risk assessment in place although there is no evidence that this has been reviewed. The manager confirmed that staff receive training in infection control. Staff were observed wearing protective clothing during the inspection. Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X 2 X 2 X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 22 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 OP10 Regulation 12(2) Requirement The registered manager must ensure the arrangements for providing personal care enable service users’ or their representative to agree to cross gender assistance and this is recorded in their care plan. Controlled drug storage must be in a fixed cupboard not on the trolley. The registered person shall ensure that all complaints and concerns are recorded, detailing investigation, action and outcome. The registered manager must ensure that assessments are carried out to identify whether the locks on service user’s bedroom doors are suited to the service users’ capabilities and the outcome should be recorded in the care plan. The registered manager must ensure that service users’ privacy is upheld with regard to the bathroom and toilet doors. Timescale for action 24/11/05 2 3 OP9 OP16 13(2) 22 Schedule 4.11 12(4)(a) 24/11/05 24/11/05 4 OP10 24/12/05 5 OP10 12(4)(a) 24/12/05 Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 Refer to Standard OP15 OP15 OP38 OP38 OP26 OP33 OP9 OP9 Good Practice Recommendations When alternative meals are given to service users’ this needs to be recorded. The menus displayed on the notice board should show only the meals for that particular week. The generic fire risk assessment needs to be reviewed and dated. The recording of fire drills needs to be more specific. The registered person should provide red alginate bags to reduce the risk of infection when handling soiled laundry. Service user meetings could provide the opportunity for group discussion and sharing information. Consideration should be given to the storage of medicines in the fridge; this must be between 2c and 8c. Photographs and relevant information kept with the administration records aid accurate administration. This should be regularly updated to include information about new medications, particularly when prescribed ‘as required’. Written additions to the medication administration record should be signed, dated and checked by two members of staff. 9 OP9 Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Quarry Mount Residential Care Home DS0000062385.V266636.R01.S.doc Version 5.0 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. 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