Inspection on 09/01/07 for Redwood House

This inspection was carried out on 9th January 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Redwood House 16/12/05

Redwood House 16/08/05

Redwood House 14/02/05

Redwood House 16/11/04

Redwood House 09/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Redwood House 54 Sharpenhoe Road Barton-le-clay Bedfordshire MK45 4SD Lead Inspector Mrs Louise Trainor Unannounced Inspection 9th January 2007 10:00 Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redwood House Address 54 Sharpenhoe Road Barton-le-clay Bedfordshire MK45 4SD 01582 881325 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) Complete Care Services Limited Mr Stephen Ofosu Koranteng Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th December 2005 Brief Description of the Service: Redwood House was situated on the outskirts of Barton-Le-Clay approximately midway between Luton and Bedford with good road access to both towns. The registered owners are Complete Care Services Ltd who have operated the home since it opened in 2000. The manager had been registered in March of this year but had been in post for several months prior to this. The service was registered to provide care for up to seven younger adults with a learning disability. The home was within walking distance of the village centre and local amenities. The building had been converted and extended from its original use as a family home. It was set in generous grounds. All the bedrooms were for single occupancy, two rooms had en-suite facilities and the garage had been converted to provide a meeting room and when required an activity/day care area. The fees for this home range from £1300.00 to 1500.00 per week. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first Key Inspection for this service. It was an unannounced visit and was carried out on the 9th of January 2007 by Lead Inspector Louise Trainor between the hours of 13:30 hours and 17:30 hours. The manager of the home was present to assist throughout the inspection and guided the inspector on a full tour of the premises. During the inspection There are presently seven service users living at Redwood House. The inspector met all the service users, though some rather briefly, and spoke to two in more depth. These two particular service users were picked at random by the inspector for tracking. This would usually involve viewing all the documentation relating to their care, visiting them in their personal bedroom areas and chatting with them informally. But on this occasion one declined to allow entry into their personal room Documentation relating to medication administration, service users’ finances, staff personal files (including supervision and training records), quality assurance and business planning were also made available for inspection. This home has a small workforce of twelve including the manager, however the inspector only had the opportunity of interviewing one on this visit. The inspector would like to thank everyone involved for their assistance and support during this inspection. What the service does well: This is a well run home with strong leadership from the manager and deputy manager, providing both support and guidance for the team. The service users best interests are safeguarded and protected by the policies and procedures that are in place. New referrals to this service are thoroughly assessed to ensure their needs can be fully met and that they are compatible with the other service users. Individual care plans identify changing needs and personal goals, and all activities are clearly risk assessed so that service users independence is promoted to its full potential. This service promotes the service users personal development. Interaction in the local community is encouraged through participation in age and peer appropriate leisure activities of the individuals’ choice. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 6 Documentation and observations of care practices indicate that service users receive personal support, appropriate to the individual to ensure that their physical and emotional health needs are fully met. There is an effective recruitment policy in place so that service users are protected and staff are well supported and supervised in their roles within this home. Service users and their representatives are encouraged to offer their views and opinions on all aspects of their life, and are protected from abuse, neglect and self harm by the policies and procedures that are in place. This service provides a safe and comfortable environment for its service users, their individual bedrooms promote independence, and are decorated and furnished to reflect individuality and to suit their individuals’ needs and lifestyles. What has improved since the last inspection? What they could do better: Some system should be implemented to ensure that all home office paperwork for overseas staff is accurate. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 7 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. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New referrals to this service are thoroughly assessed to ensure their needs can be fully met and that they are compatible with the other service users. EVIDENCE: Discussions with the manager revealed that this home has not had a new service user for approximately two years. However he was able to discuss in depth the protocols that are in place. Prior to any admissions being considered they are first fully assessed to ensure that all the individuals’ needs and goals will be successfully addressed and met within this environment. Prospective service users are then invited to visit the home, and overnight/weekend stays are arranged. This enables the team to assess how compatible an individual would be with the rest of the service users. Only then is a permanent placement considered, involving input from: the service user, the family and representatives of the service user, social workers and other specific professionals as appropriate. All placements are then reviewed on a regular basis to ensure the placement is successful. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 10 Service user files that were inspected contained contracts / agreements with the home, and had been signed by the service user and the home manager. Fees were included on this document. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans identify changing needs and personal goals, and all activities are clearly risk assessed so that service users independence is promoted to its full potential. EVIDENCE: All service users have a very detailed file that contains in depth information relating to their needs, their personal goals, and the level of the support they require to achieve them. These were all updated on a regular basis. One file that was examined contained the following documentation, and much more besides: A fully completed contract, signed and dated, documentation relating to the service users right to vote, a form specifically related wishes regarding illness, death and old age, personal goals and aspirations for 2006, identification of the allocated Key Worker for this particular service user, care plans relating to various needs from moods and mobility to recreational pursuits, a full medical Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 12 history, psychology reports, a crisis management report and a weekly budget sheet that was presented in picture form to ensure easy understanding. All care plans had corresponding risk assessments completed and had been regularly reviewed. There is a monthly residents meeting held in the home, where service users are encouraged to voice their opinions and contribute their own ideas about daily life. It is through this meeting that menus and holidays are planned, and activities / outings are arranged. The staff also use this meeting as an opportunity to educate service users to learn to listen and respect others’ opinions. Looking through the minutes it identified that one of the service users that the inspector tracked, rarely attended these meetings. This individual confirmed their lack of attendance, and personal reasons for it, and clearly has a tendency to ‘do their own thing’ most of the time, with some assistance in decision making from staff. All service users are encouraged to assist with the preparation of shopping lists, daily shopping trips and general day- to- day household chores. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service promotes the service users personal development. Interaction in the local community is encouraged through participation in age and peer appropriate leisure activities of the individuals’ choice. EVIDENCE: All the service users at this home, with the exception of one, whose issues are being clearly addressed and documented, appeared happy and at ease in the company of the staff and fellow residents, and generally well cared for. All the service users have an individual weekly programme. This includes visits to college or day centres for part of their week and time spent in Redwood House focusing on individual personal development, which may include shopping, laundry or other daily living tasks. One the day of the inspection one service user returned to the home late afternoon. She had been into the town with her Key Worker, and was keen to Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 14 talk about her trip to the library, and her new found knowledge about Sir Walter Raleigh and his friendship with the queen. When service users return from work at approximately 16:30 hours, they are free to pursue any activities they wish. This may include activities within the home, visits to evening clubs based in the local area or other external activities accompanied by staff. On return from work in the evenings, service users also prepare their own ‘packed lunch’ for the following day, and are sometimes involves in the preparation of the evening meal. All service users have an annual holiday, and are very much involved in the planning. Last year one of the service users went to France, whilst the rest went to Great Yarmouth. This year, Spain and Cornwall are on the agenda. Two of the service users in this home are from ethnic backgrounds, and both have a weekly trip to a local ethnic community, where they may have a meal in a restaurant or do shopping. Neither of these service users have a wish to follow religious beliefs, however they have been encouraged to attend local worship ceremonies. All the service users maintain some level of contact with their families; some go for weekends and some just for day visits. One service user regularly goes for a two-week periods. Service users are involved in the menu planning, and minutes from service user meetings revealed service user opinions and requests for different meals to be added or removed from the menu. They are all encouraged to participate in the evening meal, however one service user in particular was keen to inform the inspector that they would ‘sort out something for themselves separately’. On the evening of the inspection there did not appear to be any one particular service user assisting staff with the evening meal. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Documentation and observations of care practices indicate that service users receive personal support, appropriate to the individual to ensure that their physical and emotional health needs are fully met. EVIDENCE: There is an in depth policy for the administration of medications in place. It includes a section on ‘household remedies’, listing the medications that are under this category. It also includes a section regarding ‘covert medication’, a monthly audit, and certificates for all staff that have completed appropriate training enabling them to administer medication. There were nine staff certificates present in the file. There is a risk assessment for each service user regarding ‘self medication’, and at present no service user has been assessed as safe to carry out this level of independence. However one service user does check their own blood sugar levels daily with minimal supervision, and also administers their own insulin, again with supervision. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 16 All medication is dispensed in the NOMAD cassette system by a local pharmacy, and all records and stocks reconciled correctly. The service users in this home are of varying independence levels, and support is given accordingly. Physical and emotional needs are all addressed within the individual care plans, and addition visits, appointments and treatments with GP’s, Consultant, Psychologists and any other involved disciplines, are recorded on a separate document. Each service user file also contained a form relating solely to Standard 21:’The ageing, illness and death of a service user are handled with respect and as the individual would wish’. In each case this was completed, signed and dated by the service user and a representative of the home. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives are encouraged to offer their views and opinions on all aspects of their life, and are protected from abuse, neglect and self harm by the policies and procedures that are in place. EVIDENCE: Since the last inspection there had not been any formal complaints to this home. There had been one POVA referral made, following an incident involving two service users. This was over a year ago and had been satisfactorily resolved. Observations of the interactions between staff and service users gave an impression of trust and mutually respectful friendships. Service users are involved in monthly meetings in order to capture their views and opinions on all aspects of life in the home. There is also evidence to indicate that service users are involved in the planning of their own care with consideration being given to their personal goals and aspirations. Training is in place for the Protection of Vulnerable Adults, and all staff have attended these sessions. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service provides a safe and comfortable environment for its service users, Their individual bedrooms promote independence, and are decorated and furnished to reflect individuality and to suit their individuals’ needs and lifestyles. EVIDENCE: This home is clean, comfortable and well maintained, and provides a safe environment for its’ residents, although it did appeared rather bare in places. The communal area is comprised of a good sized lounge- dining room, the kitchen and a smaller dining area, a laundry room, drug room and one bedroom with an en suite shower room. On the first floor are six more single bedrooms, one of which has an en suite bathroom. There is also a bathroom and a shower room on this floor. There is a small annex on the ground floor level; this has an office, and an activity room that doubles up as a sleep in room for the ‘waking night staff’. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 19 The service users bedrooms were decorated very individually, and interior furnishings varied, depending on the service users needs, choices and safety. One service user had a variety of ornaments, photographs and other personal belongings in her room, which was wall to wall with pop star posters. However another service user’s room was very sparsely furnished, this was due to the fact that too much furniture may impede interventions that maybe required for a medical condition. All individuals’ rooms had a locking facility in place. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an effective recruitment policy in place so that service users are protected. Staff are well trained, supported and supervised in their roles within this home. EVIDENCE: The work force in this home is made up of a manager, a deputy manager, one senior support worker and nine support workers. This is a well- established team, many of which have been in post since the home first opened in 2000. There is a shift system in place, which places three staff on a day shift from 07:45 hours – 20:15 hours, plus the manager, and two staff on a night shift from 20:00 hours – 08:00 hours, one waking and one sleeping. There is a full training programme in place for the staff in this home. Training is provided by an outside agency as well as ‘in-house’ courses. This includes leadership skills training for the more senior staff, and a variety of courses, both mandatory and more specialist subjects, available for all staff. The inspector examined three staffs’ personal files, and all contained numerous certificates for training courses that they had attended. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 21 Other documentation in these files included, full employment histories, appropriate references, CRB certificates, photograph identification and supervision records that identified all staff receive supervision from either the manager or the deputy every other month. The manager also receives supervision from a senior company representative on a regular basis, and stated that he also benefits from peer supervision from the managers of the company’s’ other three homes. The majority of staff in this home, are from overseas, and appropriate Home Office paperwork / passports were available in all files that were seen, with the exception of one, whose ‘leave to remain’ expired on the 30th of September 2005. This was an oversight and is presently with the Home Office awaiting renewal. Confirmation has been obtained from the Home Office that an extension until June 2007 has been granted. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 40, 41, 42, 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well run home with strong leadership from the manager and deputy manager, providing both support and guidance for the team. The service users best interests are safeguarded and protected by the policies and procedures that are in place. EVIDENCE: The manager of this home has been in post for several years, and has many years care and management experience prior to this post. He is service user focused, ensuring that service users health, safety and welfare is a priority. He monitors the quality of care through; service user meetings, internal audits, questionnaires to service users and their representatives and the Area Managers’ monthly visits. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 23 Policies and procedures are closely adhered to ensuring that service users rights are safeguarded at all times. The manager of this home is not appointee for any of the service users, however they all have a pocket –money account that is in a locked cupboard. Two individuals’ accounts were inspected. All transactions were clearly documented, dated and signed by two staff, and receipts were present to correspond with all transactions, this included receipts for purchases from shops and also for cash withdrawals. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 3 3 3 3 Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19(1)(b)(i) Requirement The registered person shall not allow a person to work at the care home unless he has obtained in respect of that person the information and documentation specified in paragraphs 1 to 7 of schedule 2. Timescale for action 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA34 Good Practice Recommendations The registered person should consider auditing staff records at regular intervals, and taking appropriate action in anticipation of expiry dates on documents. Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Redwood House DS0000014951.V321981.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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