CARE HOME ADULTS 18-65
Rydal House 6 Spratslade Drive Dresden Stoke-on-Trent Staffordshire ST3 4DZ Lead Inspector
Rachel Davis Unannounced Inspection 15th September 2005 15:00 Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Rydal House Address 6 Spratslade Drive Dresden Stoke-on-Trent Staffordshire ST3 4DZ 01782 330854 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) Mr Alan John Bradshaw Mrs Joy Bradshaw Miss Gaynor Rowley Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th March 2005 Brief Description of the Service: Rydal House is a registered care home for up to eight adults with learning disabilities. It is one of three homes owned by Mr and Mrs Bradshaw. Gaynor Rowley is the care manager for this home. The level of need amongst the residents varies but generally the residents in this home are relatively independent and able to access local facilities with minimum support. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours. The methodologies used were: individual and group discussions with the residents, a meeting with one residents relative, and two further conversations with relatives over the telephone. Observations of the staff relating to the residents and informal dialogue also took place. Discussions were held with the manager and examination of care and staff records was carried out. A tour of the environment was also undertaken. What the service does well:
All of the residents said that they were happy at the home. “I like all of the staff.” “I am very happy”, were comments made that well reflected the relaxed atmosphere in the home. Relatives too were full of praise: “My relative is very settled, the staff are approachable, and I am always made to feel welcome.” “It’s super!” “I can’t fault them, the home is warm and welcoming, staff encourage the residents and I have seen good healthy food.” Staff support and encourage residents in their relationships with family members. Each resident’s health care needs were met that addresses both physical and mental needs, and any professional appointments required are followed up and acted upon. The plans held in the office hold all of the necessary information. Files are stored appropriately. It was pleasing to note the willingness of the manager to take other people’s views on board so readily and to help secure the safety of both residents and staff; the care manager promoted an open and inclusive atmosphere throughout the inspection. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
There are a number of things the home needs to do to make sure a consistent service is provided. Care planning is still in need of further development. A more informative plan of care is required. The home should now explore how they can further evidence the inclusion of residents making choices and decisions regarding daily living. Care plans must be fully reviewed twice yearly. The manager must ensure risk assessments are completed in all areas where a hazard has been identified, not doing so leaves both the service users and staff group at risk of injury. Medication training for the staff administering medication is required as a matter of urgency; not providing this training leaves staff and residents at risk. All training should be linked to staff appraisal and supervision. Training opportunities are not satisfactory; all staff must receive training in equal opportunities, disability equality training, race equality and anti discriminatory training and manual handling/movement of loads. There was no evidence to verify training has been provided that meets Skills Sector Council workforce training targets. Staff working in learning disability services should use Learning Disability Award Framework (LDAF) accredited training to provide underpinning knowledge. In the future it is hoped that there will be a rolling programme of training and development in specialist areas. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 7 Staff files do not contain all the necessary information. Future recruitment procedures must be tightened to meet requirements. Present staff must complete a medical declaration, a recent photograph, proof of identification and documentary evidence of any relevant qualifications of the person must also be evident. The home must develop and provide an appropriate Statement of Purpose and Service User Guide. The manager works full time but works as part of the staff team, the manager must be offered the time to fulfil her role and complete the tasks expected of her. 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. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The Home’s Statement of Purpose does not include all of the necessary information needed for prospective and existing residents to have a full understanding of what facilities the home is able to provide. A Service User Guide is not available. EVIDENCE: The homes Statement of Purpose is incomplete and therefore does not offer current and prospective residents and significant others the opportunity to make an informed choice about the services provided and whether the home can meet their needs. It was noted that all three homes owned by the proprietor were in receipt of the same Statement of Purpose. It is strongly recommended that these be separated to reflect differences The home does not offer a Service User Guide as required, this must include details of the homes main policies, complaints procedure, fees charged, a summary of the statement of purpose, description of the homes accommodation, residents views of the home and key contract terms covering admission, occupancy and termination. It was noted that a number of these documents were in place but they must be combined as a Service User Guide and in a format appropriate for those residing at Rydal. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 10 It is advised that the management team streamline some of their information to ensure that it is absolutely clear about what the home does and does not provide and what the residents may be expected to finance themselves. It is strongly advised that this be incorporated into individual contracts between the home and the resident. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. The manager and staff work well with each resident to find out what they want from life. Residents are encouraged to be independent however they are not supported by robust care planning and risk assessments. EVIDENCE: Three ladies and five gentlemen live at Rydal and have lived there for a few years. Discussions with residents confirmed that they were able to make decisions, offered opportunities to participate in the day-to-day running of the home and take reasonable risks. Personal files for all residents have been completed. One file was examined in detail. This file was not as comprehensive as needed and did not always provide a clear picture of the residents needs. It was not easy to ascertain the relevance of some of the information. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 12 There was no evidence to confirm if the care plan had been reviewed by Care Management, (social services) since 2/7/02. Leisure activities were in place and residents enthusiastically informed the inspector of their comings and goings. It was evident however that not all individual leisure needs were accommodated, this was discussed with the manager at the time of inspection. Some reviews by the home were in place but were not undertaken as regularly as needed. Some risk assessments were in place but not for all instances, assessments for behaviours that challenge and situations pertinent to individuals for example diabetes need to be included. Clear risk management strategies must also be in place. The care manager asked for direction in this field, the Health and Safety Executive guidance entitled Health and Safety in Care Homes has advice covering this area. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 and 16. Residents enjoy a varied lifestyle and take part in activities linked to their interests and abilities. They enjoy good relationships both within and outside the home. This lifestyle enables them to become full members of the local community. EVIDENCE: Three of the service users and their family members chatted about their lifestyles comments like: “There has been great progress, I know my relatives needs are being met.” “I have no concerns, I know my relative is being well cared for” were made. Residents also stated they could come and go as they please, friendships were evident both in and out of the home and opportunities to partake in various activities were offered. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 14 At the time of inspection four residents were out at three differing locations, one resident went out during the evening and a number of telephone calls were both made and received. Residents talked enthusiastically about a recent holiday and a visit to Alton Towers. Two residents independently access the local community and suitable documentation was in place, which had been planed and agreed with the individual. The way that the service users filled their day at this inspection visit supported all of the above. They were seen getting ready to go out, telling staff that they “were off”, and the comings and goings were the same as in any household. In discussion with the residents it also became evident that they all maintain contact with their families. Notes of family and friends contact was recorded in each individual plan under the daily records section, residents said that they enjoyed their lives. “I like the staff.” “I’m happy in my home”, were typical comments made. It is recommended that further evidence should be available within the activities plan, these were not always completed. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Personal care and health care needs are closely monitored and the results well recorded, medication procedures require strengthening to fully protect the residents. EVIDENCE: The plans examined and discussion with residents showed that requirements for support with personal care needs were individualised. A plan for each persons requirements regarding personal care support, bathing, night time routines etc, were in place. There was evidence that health care professionals are involved where necessary with information relating to health care issues within residents files. There were letters indicating that appointments were made with the relevant bodies to address health issues. Two of the service users at the home self medicate, suitable storage facilities were available. It is imperative that individual assessments are undertaken, agreed and signed by the resident to confirm their understanding of all the risks. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 16 Medication administration was checked during this inspection. It was revealed that not all staff administering medication had received the required training; this leaves both the staff and residents vulnerable. It was also recommended that a signature sheet should be in place against staff names. This would offer further evidence and accountability on whom had administered which medicines. It was pleasing to note that there weren’t any gaps being left on the medication administration records, controlled drugs were not being administered at the time of inspection. The manager confirmed that Homely Remedies are not available within this establishment. Policies, storage, and dispensing of medicines were not inspected on this visit. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The home has an appropriate complaints procedure in place. Staff have been offered some training in the protection of vulnerable adults. Residents and relatives are confident in raising any concerns with the home and felt that they would be listened to and dealt with in a timely manner. EVIDENCE: Residents and relatives were aware of the homes complaints procedure and who to speak to if they have concerns. The complaints procedure meets the requirements and is on display in the hall. This still refers to the National Care Standards Commission, (NCSC), rather than the Commission for Social Care Inspection. (CSCI) and should be amended. Staff files demonstrated an understanding of adult protection with an appreciation of potential indicators of abuse and what to do if they became aware of a potential abusive situation. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 27 The standard of the environment within this home is satisfactory providing service users with a homely place to live. Rydal provides a comfortable home for the residents, where each person is encouraged to take responsibility for maintaining the standard of cleanliness in the home. Bedrooms are personalised to reflect individual tastes and interests. EVIDENCE: A tour of the accommodation was made by the inspector with the support of one of the residents. The home has a satisfactory standard of decoration and fitments. The manager is fully aware that redecoration is required in some areas. There is one bathroom in this home that is looking rather ‘tired’ but is not unsafe. A toilet roll holder is required and toiletry products should not be stored communally, out of respect for individuals’ possessions. Issues relating to Control of Substances Hazardous to Health (COSHH) need to be considered. A shower cubicle has been installed on the first floor since the last inspection. Five residents rooms were visited during this inspection, the residents had personalised their rooms and were very happy with them. The communal areas
Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 19 of the home had a ‘homely’ feel and were comfortably furnished. The laundry was not seen on this occasion, the kitchen was not inspected. It was noted that radiators were not risk assessed, these must be individually assessed and guarded if necessary. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Future recruitment practices will need to be tightened thus ensuring suitable staff are employed. Staff have not received the mandatory training required to ensure that the individual and joint needs of the service users are appropriately met. EVIDENCE: There is a stable staff team within this home which gives residents confidence and ensures that everyone is aware of individuals needs. Residents confirmed that they knew everybody and were aware of who was, and who would be coming on duty. Relatives confirmed that staff were very well informed and that communication was “ excellent”. One family member stated that they feel very confident with the staff team and now don’t feel the need to rush over to the home if their relative is poorly as they have every confidence that the home will deal with everything efficiently and appropriately. Two staff files were seen on this visit. They did not contain all of the information required and this was discussed with the manager. Future recruitment procedures must be improved upon. Medical declarations are required to confirm that staff are both physically and mentally fit for the purpose of the work they are to perform, photographs of staff must also be on file. Supervision and training were discussed with the manager. There are still
Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 21 shortfalls in these areas. Staff require bi monthly supervision, training is needed in medication, moving and handling, equal opportunities and disability equality are required. Specialist training needs to be considered the manager should consider using a training matrix. Staff were discreetly observed throughout the visit talking to residents. They had a good understanding of each residents’ needs, and they showed the utmost respect to the residents both in their actions, i.e. knocking on doors, respecting their privacy and dignity, and in the various interactions with them. It was clear from observations that there was a good rapport between everyone. Staffing levels were suitable and residents and their relatives confirmed that they felt there were always enough staff on duty. During this visit, residents spoke highly of the staff team. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 39. The manager must be afforded the time to ensure the safe smooth running of the home for the residents and staff. EVIDENCE: The home is managed by Gaynor Rowley and supported by the proprietors. Staff supervision was apparent but this is not in place for everyone. It was revealed that it was dependant on how the shift patterns fell and who Gaynor tended to be on duty with. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 23 It was evident that the care manager did not have a lot of time to complete managerial tasks as she worked on shift as part of the staff team. The requirements relating to this report confirm that this shortfall in time is impacting on the paperwork, completion of care plans, risk assessments, training records, delivery of supervision etc, and is therefore a requirement of the inspection. It is important too that the care manager herself receive regular supervision. The residents are encouraged to voice their opinions either in ‘house meetings’ or by approaching staff or the management. Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 2 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 2 1 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Rydal House Score 3 3 1 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X X X DS0000029772.V249630.R01.S.doc Version 5.0 Page 25 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 YA1 Regulation 4 Requirement Timescale for action 31/10/05 2 YA1 3 YA6 4 YA9 5 YA9 6 YA20 The Statement of Purpose must be a current reflection of the service and include all items listed under schedule 1. 5 A Service User Guide must be produced and offered to all residents and /or their significant other. 24(1)(a)(b) The registered manager must establish a system to monitor and review the quality of care in particular care planning and residents access to leisure facilities. 13(4)(c) Risk assessments must be in place for all residents, a management plan of all identified risk must also be in place. These documents must be signed, dated and reviewed. 13(4)(c) Further risk assessements must be undertaken including, latex allergies if latex gloves are not replaced with latex free and Control of Substances Hazardous to Health.(COSHH), this list is not exhaustive. 18(1)(c)(i) Medication training must be provided to all staff administering medication.
DS0000029772.V249630.R01.S.doc 31/10/05 31/10/05 13/10/05 13/10/05 26/10/05 Rydal House Version 5.0 Page 26 7 YA20 12(1)(a) 8 9 10 YA24 YA27 YA34 13(4)(a) 23(2)(a) 19(1)(b)(i) 11 YA35 18(4) 12 13 YA35 YA36 18(1)(c)(i) 18(2) 14 YA37 8(1)(b)(iii) 10(a) Training must be booked within 10 days; the Commission accept that training cannot be offered within this timescale. There must be an assessment of residents who self medicate, which takes account of competence and risk. Radiators must be individually risk assessed and guarded where necessary. A toilet roll holder is required in the bathroom. The registered person shall not employ a person to work at the care home unless they have obtained all the documents and information specified in Schedule 2. Those in post require a photograph and medical declaration on file. All staff require a copy of the General social Care council Code of Conduct (Previous timescale not met.) Mandatory training must be offered to all staff. Staff must receive formal supervision a minimum of six times a year, one of which should be an annual appraisal. (Previous timescale not met.) The manager must be afforded the time to complete her managerial duties. 26/10/05 31/10/05 01/10/05 01/10/05 01/10/05 31/10/05 31/10/05 01/10/05 Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 27 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 Refer to Standard YA1 YA1 Good Practice Recommendations The registered person should consider providing three separate Statement of Purpose for each individual home owned by the proprietors, to avoid confusion. It is advised that the management team streamline some of their information to ensure that it is absolutely clear about what the home does and does not provide and what the residents may be expected to finance themselves The registered person should consider providing an activities/daily routine plan for all residents The registered person should consider introducing a signature sheet to offer accountability as to whom has administered the medication. The registered person should consider introducing a training matrix and supervision matrix for all staff. 3 4 5 YA16 YA20 YA35 Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Rydal House DS0000029772.V249630.R01.S.doc Version 5.0 Page 29 - 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!
