Inspection on 27/07/05 for Russettings

This inspection was carried out on 27th July 2005.

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 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

Russettings 02/04/09

Russettings 03/04/08

Russettings 22/11/07

Russettings 23/05/06

Russettings 08/11/05

Russettings 28/02/05

Russettings 20/11/04

Russettings 29/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Russettings Mill Lane Balcombe West Sussex RH17 6NP Lead Inspector Mrs L Driver Announced 27th July 2005 V229274 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. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Russettings Address Mill Lane, Balcombe, West Sussex, RH17 6NP 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) 01444 811630 Alpha Health Care Limited Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (OP) - 45 Both of places Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1, Up to 45 male and/or female service users in the category of Old Age, not falling within any other category may be admitted/accommodated. 2, Only service users over the age of 65 years may be admitted. Date of last inspection 28th February 2005 Brief Description of the Service: Russettings is a care home with nursing registered to provide accommodation for forty-five service users within the category OP (Old age, not falling within any other category). The home is located in Balcombe village, close to local shops. The village is situated between Haywards Heath and Crawley town centres. The home consists of three floors, two of which provide service user accommodation and communal space. Both floors are accessible by passenger lift. The establishment was registered with the current provider in January 2003. Alpha Health Care owns Russettings and the Responsible Individual is Mrs Sian Sobti. There is a new manager in place, Mrs Theodora Verner, who is to apply for registration with CSCI in the near future. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day in the presence of the newly appointed manager, Mrs Theodora Verner. The inspector carried out a tour of the home, had discussions with service users, staff, one relative and viewed documents and records. All requirements and recommendations from the previous inspection had been addressed and met. A pre inspection questionnaire was received prior to the inspection. Three relatives responded to questionnaires and all comments were addressed during the inspection and reported on in this report. What the service does well: What has improved since the last inspection? The home has addressed all the requirements and recommendations resulting from the last inspection. The appointment of a very experienced manager, Mrs T Verner. The addition of a new laundry room has provided good laundry provision for service users. Appointment of gardener and maintenance persons. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 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 Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 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) 1,2,3,6 The home provides appropriate information for prospective service users and their families/relatives to enable them to make an informed choice. Service users are assessed pre admission to ensure the home can meet their needs. Contracts are in place for service users. EVIDENCE: The home has a Statement of Purpose and Service Users guide in place that have recently been updated. ( July 2005). This provides service users, both current and prospective, with recommended information about the home. Sample records showed service users have contracts in place so they know what services are covered in the fees. Records viewed show service users had pre admission assessments carried out that provides the home with information to enable service users needs to be met. Service users have individual records in place. This information is carried forward onto individual care plans. The home does not cater for Intermediate care. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Health and welfare needs of service users are identified and met. Medication administration is in general satisfactory but the home needs to ensure all medicines are given and that stocks do not run out. Privacy and dignity is respected at the home although needs to be revisited with staff on a regular basis. EVIDENCE: All service users have individual care plans in place that meet with the recommendations of the National Minimum Standards for Older People. The home has systems in place to ensure they are reviewed regularly and updated as needed. The inspector viewed four care plans and found them all to be satisfactory. Care plans seen indicate that all health care needs are met. The newly appointed manager stated she is to review all service users care plans over the coming weeks with either the service user themselves or a family/relative representative. This is a positive move forward and will enable service users and /or their families to be well informed of the care needed/provided. The manager has also commenced new systems to ensure continuity of care between shifts, by reinstating the afternoon handover session for staff. The manager also has handover with staff at 2.15pm every day. Other handover times are 8am and 8pm. A night report book has been Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 10 commenced together with a communications book that staff are accessing for up to date information about service users and any change in care. Feedback from relatives indicate that call bells are not answered as quickly as they should be which could result in service users needs not being met at times. The manager stated she was aware of this concern and was rectifying the issue. The inspector sat in on the afternoon handover session and noted when a call bell went off the manager asked a member of staff to leave the meeting and answer the bell immediately. The manager needs to monitor the situation and ensure bells continue to be answered as quickly as possible. The home has policies and procedures in place for administration of medication. The newly appointed manager stated she is currently looking at the Pharmacy provision to ensure the best service possible. This she stated should prevent omissions of medication that was commented on by relatives in feedback to CSCI. The manager stated she had identified this area and was to act on it. In general the systems in place are efficient despite the few omissions that occur. This will be looked at again at the next inspection. The new requirement regarding disposal of medication, which came in place in July 2005, is currently being addressed at head office. The Responsible Individual confirmed this during a phone conversation at the end of the inspection. Currently there is one service user who self medicates and a risk assessment has been completed. The service user has a lockable storage area for medication in their bedroom. Medication administration records are well maintained. All feedback stated that privacy is respected, and that on the whole staff treat service users with dignity and respect. There was some feedback from a relative regarding staff attitude when speaking with service users, and this is an area that the manager needs to revisit with staff to ensure all service users are treated with respect. A service user stated staff are respectful and being at Russettings “was just the tonic she needed.” Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Social activities are plentiful and well organised. Social, cultural and religious needs are met. There is an organised catering department which provides nutritious, balanced and varied meals. EVIDENCE: Social, cultural, interests and religious preferences are identified in pre admission assessments and are recorded in care plans. A sample of care plans viewed showed individual needs are met. The home has a very active “activities co-ordinator” who provides a variety of activities during mornings and afternoons, Mondays to Fridays. On the day of the inspection many service users were seen to be joining in and enjoying themselves. Activities on offer include, arts and crafts, quizzes, floor games, fit and active, videos, plus trips out to garden centres, the South of England Show and shopping. Church services are held regularly at the home. The homes own newsletter gives much information about forthcoming events on offer. It is produced monthly and provides a comprehensive list of all activities on offer each morning and afternoon. There is also a designated hairdresser who has her own hairdressing room for service users to access. Costs are clearly stated on a poster in the room. On the day of the inspection many service users were seen to be visiting the hairdresser. The home did have a mini bus however this has now gone and local transport is used, generally Taxis or a hire mini bus. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 12 Family and friends have open access to visit. Both relatives and service users voiced no concerns about this. The home has a signing in and out book situated in the entrance of the home that ensures safety and protection of service users. The inspector spoke with The Catering Manager during the inspection who evidenced a well organised team of catering staff. He stated he could work happily within the budget provided for food provision and menus showed a good variety of nutritious meals on offer with choices. All catering staff are designated solely to the catering provision and care staff do not work in the department. The catering manager informed the inspector that the last Environmental Health inspection was in May 2004 with no outstanding requirements. All catering staff have certificates for handling food and hygiene. Special diets are catered for and current ones include, Diabetics, Low fat, and pureed. Birthdays are celebrated by the provision of wine at lunch and a birthday cake. The catering manager confirmed he and his staff had attended fire training. The dining room is divided into two areas, one off the lounge and a separate area in the conservatory. All tables were very laid nicely and the atmosphere was pleasant and welcoming. The inspector viewed, for a short time, lunch taking place and saw it as a social event where many service users were communicating with each other and with staff who were on hand to offer assistance. Staff were seen to be providing appropriate assistance at a leisurely pace. The home provides two further kitchens around the house for relatives/friends and service users to access. On the day of the inspection the inspector viewed the kitchens and found them to be sufficiently clean. Feedback from some service users was very complimentary about the food they received. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) People who use this service are protected from abuse ensuring a safe environment to be cared in. A complaints procedure is in place for service users and their relatives/friends to access ensuring any concerns are dealt with. EVIDENCE: The home is in possession of The West Sussex Adult Protection document together with their own policy. Staff receive training around adult abuse which was last had in June 2004. The manager stated further training is due later this year. Staff interviewed were well informed of abuse areas and what to do if an allegation is made or abuse witnessed. There are no current adult protection investigations. The home has a copy of their complaints procedure on display in the entrance of the home. The new manager inherited two complaints since starting her job. Records show that the manager has dealt with the complaints within the recommended time scales. Action taken in the home as a result of the complaints investigation has taken place. The manager stated she is committed to ensuring all complaints are dealt with quickly and efficiently. Records seen are in good order. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 14 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) 19,20,21,23,24,26 People who use this service live in a reasonably maintained environment that is safe and clean providing a pleasant living environment for residents. The lack of radiator covers in some corridors make some areas of the home less safe for service users. Access to the outdoor areas has been improved by the recent installation of a ramp. Service users are able to furnish their rooms to their own needs with personal items and possessions from home enabling them to maintain contact with memories of their lives. EVIDENCE: Prior to a tour of the home the newly appointed manager pointed out areas she has already identified for work to be carried out. This is a positive move forward and she stated the provider is fully supportive of her requests. The home presents as a pleasant environment with service users accessing all areas as they wish. The manager stated the exterior of the house needs re painting and has sought quotes for this. She has also requested that new and suitable chairs be brought for service users, 30 over the next year. The home has recently employed a gardener who will visit regularly. The garden was Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 15 seen to be requiring some attention. A ramp for easy access into the garden has been installed since the managers arrival enabling all service users to enjoy the grounds. The bathing and toilet provision meets with the amended National Minimum Standards for Older people. All rooms have a toilet and hand basin. The manager has identified carpets that need replacing in the near future. The lighting in the home causes problems for service users, as in some areas it is rather poor. The manager stated she is aware of this and looking at ways to rectify the situation. The home was clean and free from offensive odours on the day of the inspection. Rooms showed service users are able to bring in their own possessions. Furnishings and fittings provided by the home are of a good standard. The home has employed a new maintenance person who is due to commence work the week following the inspection. The manager has identified and prioritised work for him to do. The manager needs to ensure that all radiators currently with no covers in place are done so in the very near future, to provide maximum safety for service users. The current staff toilet is on the third floor and in practice is not best located for staff to use. Consideration needs to be given to locating a staff toilet on the ground or first floor for easier access. The home has a new laundry room in place with sufficient washers and dryers. There is a designated laundry person in place. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 16 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) 27,29,30 People who use this service are cared for by a staffing team that is led by a newly appointed and very experienced manager. She is supported by a friendly team of care staff. Reviewing of staffing numbers takes place by the manager. EVIDENCE: Since her appointment the manager has met with many staff at the home to gain an understanding of the staffing levels and their needs. She has also sat in on a residents meeting held the week prior to the inspection. The next staff meeting is due in August 2005. Records of meetings were seen to be kept. The manager is aware of the need to review dependency levels of service users and provide staffing levels to meet the needs of service users. She is to meet with all service users and their relatives over the next few weeks to review their care plans. She stated she will then be able to review staffing levels. The newly appointed manager has much experience in assessing staffing levels and showed a clear commitment to ensuring the needs of service users are met. There are many examples of areas she has identified and addressed/addressing in this report, staffing levels being one. The inspector was impressed at the amount of information she had gained in only two weeks at the home. Her practice of communicating with service users and all staff over the first few weeks of her appointment is a clear indication of her commitment to getting it right for service users. On the day of the inspection there was one trained member of staff on duty and six care staff, together with an activities co-ordinator, three cleaners, two catering staff and a receptionist. Feedback form relatives stated they had concerns about staffing numbers at times, this was discussed with the manager who stated she was assessing the Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 17 situation as evidenced above. Current dependency levels and staffing hours provided meet the recommendations of The Residential Forum staffing guidance document. Staff receive training provided by the company. There is a training officer who visits the home to carry out training sessions. The next training sessions are to take place over two days in August 2005 where Adult protection, manual handling infection control and first aid will be covered. New staff undergo an induction programme that is comprehensive. The newly appointed manager has a separate induction programme in place specifically related to her role. Staff receive supervision on a regular basis and the manager stated she is to implement appraisals in the near future. Staff undertake NVQ training. Currently 37 of care staff have NVQ level 2 or above. A sample of staff records were viewed and showed a robust recruitment procedure in place. All staff records are stored safely and securely. The manager needs to submit her application to CSCI for Registration. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 18 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) 31,35,36,38 Service users who use this home are cared for by a newly appointed experienced manager who has been in post for two weeks. She has many years experience in caring for the elderly. Service users will benefit from her good leadership skills. Service users are encouraged to manage their own financial procedures. Staff are appropriately supervised to enable them to provide good levels of care. Health and safety of service users is promoted. EVIDENCE: The home has been without a manager since February 2005. The deputy manager has been covering and has worked hard to ensure requirements and recommendations resulting for the last inspection have been addressed and that the run ran smoothly. Mrs Theodora Verner has been appointed as the manager and had been in post for two weeks when the inspection took place. The inspector saw both the manager and deputy working well together. Mrs Verner is a very experienced qualified nurse with much experience in caring for Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 19 the elderly. She has worked hard in the two weeks she has been in the home to gain an indepth view of the home and its workings. The home does not manage service users monies but currently looks after pocket money for one service user. Storage and records for this service users pocket money was viewed and all was in order. Currently 3 service users handle their own finances and 36 are subject to Power of Attorney. Staff receive regular supervision and the manager stated she is to supervise all qualifies staff and qualified staff are to manage care staff. The manager stated she is to implement an internal audit over the next few months, once she has settled in. This will provide information that she can act on for the benefit of the service users and staff. The manager has reviewed all the homes policies and procedures since her appointment to ensure they are up to date and applicable to the home. Both staff and service users stated that Mrs Sobti ( provider and Responsible Individual) regularly visits the home. The inspector saw records that showed all testing of equipment and fire checks having been done on a regular basis. Risk assessments are in place for the building, individual rooms and fire assessment. Apart from some radiators not being covered the home posed no health or safety concerns on the day of inspection. The home carries out its duty regarding health and safety effectively. All records are well maintained, organised, up to date and stored safely and securely. The management structure in the home is sound with the new appointment of Mrs Verner and the support she is receiving from head office and her staff at the home. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x 3 3 x 3 Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 21 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 9 Regulation Requirement Medication stocks are to be sufficient so that no omissions of medication administration takes place. All remaining radiators are to be covered. Timescale for action 30th August 2005. 30th September 2005 2. 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 8 10 15 25 21 Good Practice Recommendations It is recommended that the manager continues to monitor the response time for staff answering call bells It is recommended that staff revisit the homes policy on dignity and respect. It is recommended that the kitchens for use by service users and their relatives are kept clean at all times. It is receommended that plans to replace furnishings and fittings continue. Also that minor maintenamce work takes place regularly. Consideration should be given to relocating the staff toilet. Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY 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 Russettings H60-H11 S37746 Russettings V229274 270705 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!