Inspection on 19/07/05 for Rosedale Manor Care Centre

This inspection was carried out on 19th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosedale Manor Care Centre 23/04/08

Rosedale Manor Care Centre 23/04/07

Rosedale Manor Care Centre 23/05/06

Rosedale Manor Care Centre 06/01/06

Rosedale Manor Care Centre 23/02/05

Rosedale Manor Care Centre 18/05/04

Rosedale Manor Care Centre 02/03/04

Rosedale Manor Care Centre 03/09/03

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

CARE HOMES FOR OLDER PEOPLE Rosedale Manor Sherbourne Road Crewe Cheshire CW1 4LB Lead Inspector Wendy Smith Unannounced Inspection 19 July 2005 09:30 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 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. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rosedale Manor Address Sherbourne Road Crewe Cheshire CW1 4LB 01270-259630 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Better Care 2000 Limited Judith Barton Care Home 80 Category(ies) of OP - Old Age (56) registration, with number DE(E) - Dementia over 65 (24) of places PD - Physical Disability (10) DE - Dementia (1) MD(E) - Mental Disorder over 65 (1) Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered for a maximum of 80 service users to include: * Up to 56 service users in the category OP (old age not falling within any other category) may be accommodated. * Within the 56, 10 service users in the PD (physical disability) category may be accommodated. * Within the 56, 1 named service user in the MD(E) (mental disorder over 65 years of age) category may be accommodated. * Up to 24 service users in the category DE(E) (dementia over 65 years of age) on the Woodlands Unit. 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 3 Date of last inspection 23 February 2005 Brief Description of the Service: Rosedale Manor Nursing Home is a detached two-storey purpose-built home which is set in its own grounds. The home is in a residential area approximately one mile from Crewe town centre. It is close to local shops and other facilities and is convenient for bus and rail services. The home is divided into three discrete living units. On the ground floor, Willows unit provides accommodation and nursing care for ten younger adults with a physical disability, and Woodlands unit provides accommodation and nursing care for 24 people with dementia. Meadow Unit, on the first floor of the home, provides nursing and personal care for a maximum of 46 older people. 12 of these places are contracted with South Cheshire PCT to provide intermediate care. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted this announced inspection on 19th July 2005 over a period of seven hours. 76 residents were living at the home, 24 on Woodlands unit, nine on Willows unit, and 43 on Meadow unit. 12 of the people on Meadow unit were having a short stay at the home. Eight residents were receiving personal care and the others were receiving nursing care. The inspection was carried out using a process of cross referencing the documentation of identified residents following discussion with them, and following the delivery of care and support to them. A tour of the building, including communal areas and some bedrooms, was completed. A sample of records was inspected. Time was spent in conversation with the home manager and with other members of staff. Ten residents were also spoken with. The home has recently changed ownership and is now part of the Four Seasons Healthcare group. What the service does well: What has improved since the last inspection? A number of bedrooms on the Woodlands unit have been re-decorated. The lounges on Woodlands unit have been decorated and generally improved. The main dining room on the first floor was tidier and had been improved by the addition of new tablecloths. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 6 A profiling bed had been purchased for a resident on Willows unit. All bed rails were fitted to a satisfactory standard. The manager has been registered with the Commission for Social Care Inspection and a deputy manager has been appointed. More staff have been recruited. 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. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 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 standard(s) 3, 5 and 6. Residents are assessed before admission is agreed to ensure that their needs can be met at Rosedale Manor. The home does not provide all the facilities recommended for people receiving intermediate care. EVIDENCE: The manager, deputy, or one of the unit managers assesses prospective residents, before admission is agreed. Evidence of this was contained in the care plans. On Woodlands unit a pre admission assessment had been completed for the resident who had most recently moved into the home. The pre admission assessment was detailed and referred to a diagnosis of dementia. A detailed care plan had been written form the information obtained in the pre admission assessment. The supporting information on discharged from hospital did not refer to a diagnosis of dementia. The manager confirmed in writing that the resident did have a diagnosis of dementia as requested at the inspection. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 9 In conversation with the resident who had recently moved into Woodlands unit, the resident said that ‘It’s called Rosedale Manor; I have been here about two months. I have settled in very well. My brother and sister in law came in and looked around and I looked at it from the outside. I like it here, the staff are very good and very patient. I shout and scream a lot in the morning, as I get very anxious and worries and they calm me down. I have got to know them and they me. The other people in here are very confused and you cannot have a conversation so I spend a lot of time in my bedroom and watch TV or read. I am not well at the moment but want to get well so I can go out with my family. I like the meals but would like to see a menu, I am not a fussy eater but would like to see a menu to choose from a staff just bring it to you. I like being on the unit and trust the staff, as they know my moods’. See recommendation The home has 12 rooms for people receiving intermediate care, but this arrangement will be discontinued within the next few months. The home does not provide facilities for people receiving intermediate care to practise independent living skills, however as the arrangement will be ending soon it would not be cost effective to develop the facilities. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Each resident has a care plan. Residents’ healthcare needs are met. On Woodlands unit the procedures for managing medication had deteriorated and service users’ health is at risk from them not receiving prescribed medication or the use of covert administration of medication without suitable policies, procedures and guidance. Residents’ dignity is not always upheld. EVIDENCE: Each resident has a care that identifies their needs and how they should be met. A sample of care plans was inspected on Meadows unit and they were found to be of a satisfactory standard. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 11 On Woodlands unit care plans were found to be generally satisfactory with some exceptions. A resident was identified as being a risk to herself due to an enduring mental health problem and previous attempt to harm her health. There were no details on the circumstances to inform staff on why the resident had previously attempted to harm herself other than the method used. The action plan to manage the need stated staff were to be aware of the method used and monitor this. In addition a decision had been made to remove the nurse call lead on the assumption the resident may attempt strangulation, when there was no information so support this decision. In addition the assessment for the prevention of developing a pressure ulcer indicated that the resident had a grade 1 pressure ulcer, which the manager confirmed as being incorrect. Another resident’s file contained written consent for the use of physical intervention, with the ‘minimum amount of force to be used to prevent staff being hit’. This had been agreed in writing with the resident’s relative. This was agreed for staff to use when assisting the resident with personal care. Evaluation of the care plans in place recorded ‘no aggressive behaviour during intervention from staff’. The nurse in charge on Woodlands unit was unaware of the agreement and said that physical intervention was not used with the resident and the risk assessment detailing this needed changing. The nursing homes doctor visits twice a week. See requirement. Examination of medicine storage, administration and recording on Woodlands unit found that a medicine had been signed as being administered and was still in the blister pack. Two other administrations of medicine did not have a signature to verify that the medicine had been administered. In examining residents’ care plans it was noted that residents were being administered medicines by covert means in either food, drinks or chocolate. There was written agreement from the relatives of the residents, and for one of the residents the pharmacist had been consulted. There was no evidence that the residents’ general practitioners or social workers had been consulted, or if the pharmacist had been contacted for advice on two of the residents. There was no guidance from the home to confirm if this was in keeping with company policy and procedure, or if guidance from the Nursing and Midwifery Council was being used. See requirement. Pressure relieving mattresses were in use for all residents who had been identified as being at risk of developing pressure sores. One inflatable mattress seemed to be very hard, although it was not on a high setting, and the resident whose bed it was on was a small lady. Another mattress felt very soft although it was on the highest setting. They need to be checked to ensure that they are working correctly. See recommendation. Where bedrails were in use they had protective covers. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 12 Adjustable beds were provided for residents with a high level of care needs, and two residents on the Willows unit had profiling beds. Staff going about their work were pleasant and polite to residents and the residents spoken with said that the staff were kind and caring. Residents had been assessed by the continence advisor and were receiving appropriate aids. Continence pads are kept in each person’s bedroom to ensure that they are used for the right person. Unfortunately they were not stored discretely to protect the dignity of residents. See recommendation. Notices pinned up in dining rooms referred to some residents as ‘feeders’ and displayed personal information about their needs. This information should be kept more sensitively so that it is available to staff as they need it, and the term ‘feeders’ needs to be considered as an inappropriate from of address. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 12 and 15. Residents’ social needs are met. Residents receive a nutritious diet. EVIDENCE: The home has a full time and a part time activities organiser. They keep records of activities and trips out, and individual records for each resident. Activities are organised for groups and for individuals. Records showed that a good range of social opportunities are provided for residents. The home has use of a minibus for two weeks out of six. Musical entertainment is organised monthly and there is a monthly religious service. Two residents on Willows unit are assisted to access daytime activities outside of the home. Residents spoken with were satisfied with the meals provided. There is always a choice of meal. Each unit of the home has a dining room and most residents choose to have their meals in the dining room. See recommendation. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Complaints are dealt with appropriately. Staff awareness and training of how to manage challenging and aggressive behaviour needs to improve to ensure service users are protected from abuse. EVIDENCE: The home has a complaints procedure that meets the required standard. Six complaints had been recorded this year. Complaints records were inspected and showed that all complaints had been fully investigated. They were well recorded, and action had been taken where necessary. A resident’s file contained written consent for the use of physical intervention, with the ‘minimum amount of force to be used to prevent staff being hit’. This had been agreed in writing with the resident’s relative. This was agreed for staff to use when assisting the resident with personal care. Evaluation of the care plans in place recorded ‘no aggressive behaviour during intervention from staff’. The nurse in charge on Woodlands unit was unaware of the agreement and said that physical intervention was not used with the resident and the risk assessment detailing this needed changing. In discussion on the use of whether physical intervention was used with the resident a senior carer said it was not longer used as the resident was now’ meek and mild’ and did not get aggressive. She was unaware of the consent to use physical intervention of the resident and said ‘we were told we could hold her hands, but there is no clear policy on the use of restraint, I am not sure as with some residents we may have to hold their hands, for example when having a shave so we don’t get hit and that is restraint. We have not had any training so it’s not clear’. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 15 Another care assistant said that the resident in question was no longer aggressive and had not hit out at her while she had worked with her. We talked about the use of physical intervention and she said ‘we have been told not to use restraint it’s abuse’. She was asked if she would act to stop one resident hitting another or attempting to injure them self. She said ‘I’m not sure, I don’t think anyone on here is clear about the use of restraint, we haven’t had training and I have been here two years’. See requirement. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 16 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 standard(s) 19 and 26. The interior of the home is maintained to a good standard but the exterior is not. The home is clean and hygienic. EVIDENCE: The home is set in extensive grounds. The grounds have not been maintained in good order and there were large areas of overgrown grass and weeds. This not only presents a poor appearance from the outside, but also for residents looking out through their windows. The home has a new maintenance person who was working in the garden on the day of the inspection. However due to the size of the task, the registered person should consider whether additional support is needed in order to clear the weeds and maintain the grounds to a satisfactory standard. The lawn-mower was broken at the time of this inspection. See requirement. Some windows were noticed to be in need of re-painting and, in some cases, repair. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 17 See requirement. The Woodlands unit does not have a safe outdoor area for residents. This is an outstanding requirement from the last inspection. See requirement. A number of bedrooms on Woodlands unit had been decorated and were much improved in appearance. The corridors had also been painted and the lighting improved. The large lounge on Woodlands unit had been decorated and reorganised to provide a pleasant and comfortable sitting and dining area for residents. The small lounge had also been decorated and provides an alternative sitting area for residents who prefer to be in quiet surroundings. Paintwork in the corridor on Willows unit has been marked by wheelchairs, hoists and other equipment, and the carpet is stained in places. See recommendation. Many bedrooms were personalised with residents’ own belongings. The manager said that a continuing programme of decorating bedrooms was being followed. A visit in February by the environmental health officer identified some maintenance and cleaning requirements, and these have been addressed. There has been no recent visit by a fire officer. All parts of the home were found to be clean and there were no unpleasant odours in communal areas or in bedrooms. Laundry and sluicing facilities are provided to meet the required standard. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. The home provides nurses and care assistants in sufficient numbers to meet the needs of residents, but there are no registered mental nurses employed on the dementia care unit. EVIDENCE: Each part of the home has its own staffing rota. Examination of the rotas showed that nurses and care staff are provided to meet the staffing notice that was previously agreed with the health authority. Unfortunately the home has not been able to recruit any registered mental nurses for the Woodlands unit. A deputy manager has been appointed. He is available to provide nurse cover on any of the units as needed and to assist the manager with management tasks. The home has a new maintenance person. Cleaning and catering services are currently contracted out and are provided by an outside agency, however the manager said that this will be changing in the near future and all services will be provided by employees of the home. Problems of sickness/absenteeism are being addressed by the manager. Five new care staff and one nurse have been recruited. The manager said that they would be coming into the home for induction training before they take up post. Moving and handling training is provided every Friday afternoon for new staff and for staff who need an update. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31. The home has a suitably qualified and experienced manager. EVIDENCE: The manager is a registered nurse who has previous management experience. She has completed the registration process with the Commission for Social Care Inspection. She has almost finished the Registered Managers Award. The manager said that she hoped that the deputy manager would have the opportunity to commence working towards a management qualification in the near future. An area manager provides support. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x x x x Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 21 Yes 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 OP7 Regulation 15 Requirement Care plans must be completed accurately and reviewed regularly to ensure that the information they contain is up to date. Medicines must be managed and administered safely, and clear policies and procedures governing covert administration of medicines must be put in place and issued to all staff. Staff must have suitable guidance and training on the use of physical interventions. The grounds of the home must be maintained in good order. External woodwork must be painted and repaired as needed. A safe garden are must be provided for residents to use. Timescale for action 31/8/05 2. OP9 13 30/9/05 3. 4. 5. 6. OP18 OP19 OP19 OP19 13 23 23 23 31/10/05 30/9/05 30/9/05 30/9/05 Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 22 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. Refer to Standard OP8 OP10 OP15 OP19 Good Practice Recommendations Pressure relieving mattresses should be checked by a competent person to ensure that they are working properly. Continence pads should be stored discretely. Residents living on Woodlands unit should have access to menus. The corridor on Willows unit should be improved. Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Lane Gadbrook Park Northwich Cheshire, CW9 7LT 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 Rosedale Manor F51 F01 S18738 rosedale Manor V237961 190705 Stage 4.doc Version 1.40 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. 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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