Inspection on 18/04/07 for Ravensworth Lodge

This inspection was carried out on 18th April 2007.

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

Ravensworth Lodge 28/12/05

Ravensworth Lodge 03/05/05

Ravensworth Lodge 02/02/05

Ravensworth Lodge 18/08/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Braeburn House - North Yorkshire County Council

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

CARE HOMES FOR OLDER PEOPLE Ravensworth Lodge 3 Belgrave Crescent Scarborough North Yorkshire YO11 1UB Lead Inspector Mrs Rosalind Sanderson Key Unannounced Inspection 18th April 2007 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 Ravensworth Lodge DS0000007668.V335035.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 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. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravensworth Lodge Address 3 Belgrave Crescent Scarborough North Yorkshire YO11 1UB 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) 01723 362361 01723 375867 www.ravensworth.org.uk Yorkshire Friends Housing Society Limited Mrs Suzanne Elizabeth Sellers Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th December 2005 Brief Description of the Service: Ravensworth Lodge is registered to accommodate up to 24 older people and is situated in the Falsgrave area of Scarborough, North Yorkshire. It is a short distance from all local shops and amenities and a short walk away from the town centre. Resident accommodation is arranged over 4 floors from the basement to the 2nd upper floor and has been operating as a care home since 1947. The home is maintained by the Yorkshire Friends Housing Society Ltd. All the equipment and systems required of a modern care home are made available for residents and staff. There are 24 single rooms, 16 of which are ensuite. There is a passenger lift to all floors. However 5 bedrooms are accessible from the lift via a few stairs. A paved garden area and garden summerhouse to the rear of the property affords level access to people accommodated and visitors to the home. Disc parking is available near the home and is restricted to 2 hours. However staff are provided with parking permits and visitors can request a ‘scratch card’ that enables them to park all day. Whilst the home adheres to Quaker principles, admissions are not restricted to any religious denomination. Information about what services are available at Ravensworth Lodge is provided to service users and potential service users in the form of a brochure. The most recent Commission for Social Care Inspection report is also made available to service users and those looking at the home at the same time. The range of fees charged per week is £320-£350. The Registered Manager provided this information on 5/3/07. Additional variable charges are made for hairdressing, chiropody, newspapers, toiletries and clothing. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on a pre inspection questionnaire; Comment cards returned from 5 service users, 6 relatives and 1 GP. A visit to the home carried out by one inspector that lasted for four hours. During the visit to the home seven service users, five staff and one visitor were spoken with. Records relating to four service users, four staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Ravensworth Lodge for the people living there. A senior care assistant was available to assist throughout the visit and the registered manager and administrator were available for feedback at the close. What the service does well: People like living at Ravensworth Lodge. They can be assured that their care and social needs will be met. They receive care that has been agreed with them and that is delivered in a way that promotes their dignity and respects them as individuals. The manager and staff liaise with a wide variety of health care professionals to ensure that service users receive the best possible care. Service users comments include, ‘The staff are marvellous, they seem to know how much help you need without asking’ ‘The care is excellent, I get very well looked after’ ‘Staff assist me with bathing, I really appreciate their considerate care’ A relative stated, ‘The staff give generous support to the various needs of those in their care whilst providing a warm, home like atmosphere.’ Service users are encouraged to remain as independent as possible for as long as possible and staff are encouraged to promote independence. The food is much appreciated by all spoken with. Mealtimes are seen as social events and staff are available to assist when needed. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 6 Service users enjoy the activities on offer at the home and enjoy the well kept grounds. Many commented they were looking forward to the summer months. People said, ‘There is plenty to do here, they seem to do a good job of pleasing most of the people most of the time!’ ‘I enjoy the dominoes afternoons’ ‘I don’t always want to join in activities and that’s fine, you’re not made to feel uncomfortable about it’ A relative said, ‘It is just like a five star hotel’ Service users relatives and health care professionals feel that their opinions matter and that they are considered. One comment received from a healthcare professional stated, ‘This is the best home in Scarborough that I have visited. There is a lovely atmosphere.’ The staff at the home are well trained and this ensures that the service users receive the best possible care. Relatives surveyed by the Commission for Social Care Inspection had commented, ‘Ravensworth Lodge is wonderful. The staff are lovely, kind and caring’. 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. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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 Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. 6 is not applicable. People who use the service experience good quality outcomes in this area. Service users can be assured that their assessed need will be met. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: The records showed that a thorough pre admission assessment is carried out for all prospective service users. Information about service user’s needs is gathered from varying sources. This includes GP’s, healthcare professionals involved in the individual care of the service user and, where appropriate, social services. Service users take a full and active part in the assessment and are encouraged to sign to indicate their agreement with it. Where possible, all service users are visited prior to their admission and they are encouraged to visit the home as well. This gives the service user an opportunity to get to know key members of staff prior to their admission and be greeted by a familiar face when they arrive at the home. All information that is gathered about the health and social needs of service users is used to formulate the plans of care for each service user. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 9 The records of a service user admitted for a repeat period of respite were unclear whether the assessment had been updated to ensure their current needs were addressed. However staff spoken with were very clear about the needs and wishes of the service user and the service user felt that their needs were well understood by staff. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience excellent quality outcomes in this area. Service users receive health and personal care in a safe way that respects their privacy and promotes dignity and independence. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: All service users have a written care plan that details how their health and social care will be delivered. The plans are based on information received during the pre admission assessment and reviewed and updated as needed. All activities that the service user may be involved in have been the subject of risk assessment and this ensures that service users are cared for safely whilst maintaining their independence and choice. All staff are aware of the care plans and were seen referring to them during the course of their duties. Staff were seen speaking respectfully to service users and giving them the opportunity to express their wishes and receive care in a way that they have chosen. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 11 At each shift change all staff receive current and up to date information about the needs and wishes of service users. Staff are able to contribute to discussions about service user’s care. The records showed that all service user’s healthcare needs are kept under regular review and where indicated relevant healthcare professionals are involved as well as the service user and their families. Service users comments include, ‘The staff are marvellous, they seem to know how much help you need without asking’ ‘The care is excellent, I get very well looked after’ ‘Staff assist me with bathing, I really appreciate their considerate care’ A relative stated, ‘The staff give generous support to the various needs of those in their care whilst providing a warm, home like atmosphere.’ The registered manager arranges for all staff to receive training vital to their role and to enable them to care for service user’s specific care needs. A staff member confirmed that they receive sufficient training and are able to approach the manager if they feel they require more specific training. This is always provided. Policies and procedures relating to the administration of medication ensure that service users receive their medications promptly and in a safe way. Medication records that were looked at showed that this was the case. All controlled drugs were recorded and stored correctly. Service users are encouraged to look after their own medication if they wish following an assessment of the risk. They are provided with lockable facilities in their rooms to ensure that they can store these safely Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience excellent quality outcomes in this area. Service users are able to lead fulfilling lives and are provided with a nutritionally sound diet. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: Activities provided at the home have been devised following consultation with service users so ensuring that they meet their wishes and preferences. Recent activities include trips out, craft afternoons and music afternoons. All service user’s are encouraged to participate but their wishes respected if they choose not to. Comments received include, ‘There is plenty to do here, they seem to do a good job of pleasing most of the people most of the time!’ ‘I enjoy the dominoes afternoons’ ‘I don’t always want to join in activities and that’s fine, you’re not made to feel uncomfortable about it’ A relative said, ‘It is just like a five star hotel’ Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 13 Church services are held in the home and ministers from different denominations visit on a regular basis. Service users who wish to, continue to attend church with assistance from families, friends of the church, or staff from the home. Service users are free to spend time alone in their rooms if they wish. Each room has the service users name on the door and a ‘Please Knock’ sign. Staff were seen to show respect by carrying this out and waiting for a reply before entering. Forthcoming activities and summaries of recent activities are published in the newsletter that is provided by the ‘Friends of Ravensworth Lodge’. This gives information to service users and relatives. The newsletter also gives information about what has been happening at the home and encourages people to put their views forward. One relative commented, ‘I am on the mailing list for forthcoming events’ The well-kept gardens are much appreciated by all service users as is the summer house. The call bell system can be used in this area by the use of pendant call bells. This means that service users are able to enjoy the gardens independently while still having access to staff should they need it. Raised flower beds are provided so that service users of all abilities can enjoy them. Careful consideration is given to the dietary needs of service users. There is a menu provided that is kept under review. There is a choice at each mealtime and alternatives are always readily available. Special diets such as diabetics and vegetarians can be catered for. Any special diets are recorded in the individual care plans. Consideration is given to providing ‘enriched’ diets for those service users that require this. Staff are made aware of any dietary issues for service users during the handover period. Staff were observed assisting service users at mealtimes. This was done in a respectful and dignified way. Service users and relatives commented favourably about the meals provided. A selection of these comments include, ‘First class chef providing excellent meals’ ‘We have been fortunate in acquiring an excellent chef’ ‘I am always offered appetising food even when I am under the weather’ ‘There is always a choice of meals and ….can take them in their room if they wish’ Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience excellent quality outcomes in this area. Service users are listened to and their best interests are protected. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: Service users and their representatives are aware of the complaints policy in the home and know whom to approach should they have a complaint. They feel confident that any complaint will be taken seriously and acted upon. Information about the complaint policy is contained within the brochure and displayed in the entrance hall. There have been no complaints received by the home or the Commission for Social Care Inspection since the last inspection. A service user said, ‘I have never had to complain all my needs are anticipated. I feel if there was a problem then it would be swiftly dealt with’ The adult protection policy and procedure ensures that service users are fully protected. Staff are aware of the whistle blowing policy and their responsibilities. Staff were very clear about reporting procedures following any disclosure. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People who use the service experience excellent quality outcomes in this area. Service users benefit from a clean, safe and homely environment that is able to meet individual and collective needs. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: The well-kept grounds are accessible by ramp access. Service users particularly enjoy the grounds and the summerhouse and were looking forward to the summer. One commented, ‘I love sitting out in the gardens it is so peaceful, the flower beds are at eye level and you can see them more clearly’ There is a programme of renewal and redecoration in order that the home continues to be decorated to a high standard. An additional toilet has been Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 16 provided on the ground floor that has been adapted to accommodate people using wheelchairs or those that need additional room. All equipment used for the care of service users is used in a way that promotes service user safety. Service users that require the use of a wheelchair have them fitted for their individual use, these are checked on a regular basis to ensure they continue to be safe for use. All necessary fire checks are carried out and staff receive regular training. All fire doors to service users bedrooms are fitted with door guard devices to enable them to be held open. These doors will close automatically should the fire alarm sound. Doors in communal areas also have this facility. Laundry facilities are on site and the equipment is suitable for its purpose. Staff are provided with personal protective equipment and are fully aware of their responsibilities for infection control. A relative commented, ‘……..always looks smart as do all the residents here.’ A service user said, ‘The laundry service is exceptional, you always get it back the following day and I’ve never lost anything’ Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area. Safe and well-trained staff care for service users. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: Staff rotas provided show that there are sufficient numbers of staff on duty at all times and the skill mix on each shift is good so that service users are well cared for. There is a core group of staff that have worked at the home for a long period of time. Additional staff are provided at busy periods to ensure that service users needs are attended to promptly. All staff receive an induction when they join the home. The induction covers all the ‘Skills for Care’ requirements and goes further to provide staff with the specific skills they need to meet the needs of the service users in a way that promotes dignity and respect. 50 of staff have achieved qualifications at NVQ levels 2 or 3. Staff were observed having time to spend with service users and spending time helping service users at lunchtime. This was done in an appropriate way and a way that promotes service users dignity and respect. Staff files showed that the manager follows robust recruitment procedures and this contributes to protecting service users. The manager had recruited a Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 18 member of staff who was under the age of eighteen to work as a carer providing personal care. Staff over the age of eighteen have gained life experiences and had the opportunity to develop their caring skills to provide dignity to people that they care for. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People who use the service experience excellent quality outcomes in this area. This home is well managed We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: The manager is competent and qualified to manage the home. She has completed her NVQ level 4 in management and care. Observation on the day of the visit showed she has an open door policy. Staff confirmed this by saying how they would feel free to approach her at anytime. Staff receive supervision on a regular basis when their individual performance is discussed and training needs identified. Written records of these meetings Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 20 are kept. Staff stated that they found this useful. Regular team meetings are held. Service users are encouraged to manage their own finances. The manager does not look after any personal monies for service users. Quality assurance within the service is carried out on a regular basis. The results of these surveys are analysed and discussed in the regular residents meetings, informing them of any actions taken. This reassures service users that their views are taken into account and acted upon. Areas that are included in the surveys include admission procedures, food provided, activities, and the physical environment. Surveys are also sent to healthcare professionals and people who visit the home. One comment received from a healthcare professional stated, ‘This is the best home in Scarborough that I have visited. There is a lovely atmosphere.’ Relatives surveyed by the Commission for Social Care Inspection had commented, ‘Ravensworth Lodge is wonderful. The staff are lovely, kind and caring’. The manager ensures the health, safety and welfare of service users and staff within the home. This is achieved by making sure all health and safety requirements are met and risk assessments that are in place are reviewed regularly. Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 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 OP3 Regulation 14(1) Requirement For service users requiring respite care an assessment of their needs must be undertaken for each separate stay at the home. This will ensure current needs and wishes are met. Staff under the age of eighteen must not be employed to give personal care to service users. This will enable the staff to gain life experiences and develop their caring skills to provide dignity to people that they care for. Timescale for action 28/04/07 2. OP27 18(1) 28/04/07 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 Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 23 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 Ravensworth Lodge DS0000007668.V335035.R01.S.doc Version 5.2 Page 24 - 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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