Inspection on 13/08/07 for Sampson Avenue

This inspection was carried out on 13th August 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sampson Avenue 04/09/06

Sampson Avenue 08/12/05

Sampson Avenue 23/05/05

Sampson Avenue 04/01/05

Sampson Avenue 30/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Sampson Avenue 27 Barnet Hertfordshire EN5 2RN Lead Inspector James Pitts Key Unannounced Inspection 13th August 2007 11:00 Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sampson Avenue 27 Address Barnet Hertfordshire EN5 2RN 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) 020 8449 0142 F/P 020 8449 0142 www.pentahact.org.uk Adepta Miss Jacqueline Driscoll Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 6 adults who have a learning disability (LD) and who may also have a physical disability (PD). 4th September 2006 Date of last inspection Brief Description of the Service: 27 Sampson Avenue is a purpose built care home registered for six adults with learning and physical difficulties. The home was opened in 1993 and is run by Adepta, an organisation based in Finchley, North London and specialising in operating care homes and supported living projects for people with learning disabilities. Metropolitan Housing Association own the building and Metropolitan Housing Association and Adepta maintain it jointly. The home is a two storey detached property with a kitchen, laundry room, lounge, dining room, office, three bedrooms, one bathroom and one shower room to the ground floor. There are three bedrooms, a staff sleep-in room and one shower room to the first floor. There is a lift with access to both floors. The home is situated on a relatively new housing estate in Barnet. Shops and local amenities are a short walk away. The fees for residents living in the home range from £1,211.54 to £1,463.59 per week depending on their individual needs. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s key standards inspection and involved a tour of the premises, conversation with the home’s manager and other staff as well as examination of certain records that the home is required to keep. Most of the people who live here are not able to hold lengthy vocal conversations but all can make at least some of their needs known in other ways. It is encouraging to note that staff demonstrate a significant knowledge of the individual communication techniques that person employs and the specific ways in which each makes their needs known. All of the people who live here and five members of the permanent staff team were present during this visit. Limited conversation was held with one of the people who live here and observation of interactions was also used to assess this service. Conversations were also held with members of the staff team, the manager and specific records were examined. What the service does well: What has improved since the last inspection? What they could do better: Written confirmation must be provided to the Commission to show how many staff have completed the NVQ level 2 and how many have yet to do so. It is also necessary for Adepta to confirm the exact full time equivalent staffing complement for the home as no information is currently provided. A copy of the quality assurance audit and resulting annual development plan must be sent to the local Commission office once these are completed. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 7 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 Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The people who use this service have good outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standard 2 was assessed at this inspection. The people who use this service and other people are told what the home does and how it will do it. The service user guide is written in a clear way to maximise each person’s ability to understand it. The people who use the service can feel confident that the home will only care for people that the staff are trained and able to care for. EVIDENCE: The people who use this service, and others, are told what the home does and how it will do it, and the guide for service users is presented in a clear way. The people who live here can feel confident that the home will only care for people that the staff are trained and able to care for. The home is meant to provide long term accommodation for all of the people who live here. For this reason it will be unusual for anyone new to come to live here. The home has had no new service users admitted for quite some time and currently has no vacancies. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The people who use this service have good outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standards 6, 7, 8 & 9 were assessed at this inspection. The people who use this service can feel confident that staff know what they need. They can also be assured that the staff will make sure that each person who lives at the home is allowed to live the sort of life that they choose. EVIDENCE: All of the people who live here have a detailed care plan. This tells the staff in a lot of detail about the best ways to support each person. It also tells the staff about what each person likes to do each day, the things that they like and how the staff should do the best things to help in the right way. Each person also has an allocated key worker. This is a member of staff who especially makes sure that the individual is being supported in the right way. Each keyworker makes sure that the support plan is kept updated. It is noted that support plans are written in the first person, using phrases like “I do ………” , “I Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 10 like……….” and provides very clear information about each person’s unique personality, ways of communicating and recognises individual diversity, whether this is their racial, cultural, religious or linguistic heritage. As one example, a person who lives here is very familiar with phrases spoken in the first language of their family. As a result the staff have been taught to use particular words or phrases with this person that they became familiar with in their childhood. The staff are committed to making sure that all of the people who live here are allowed to make meaningful choices about how to live their life. Each person is asked about the things that they like, what they want and how they want things to happen. Those who live here all take part in helping to run the home, wherever meaningfully able to do so, and the staff are there to help whenever they need to. For anyone who has a difficulty with verbal communication there are clear guidelines in place about how each person makes their thoughts, wishes and feelings known. The people who live here also get involved in things like choosing what food to eat, arranging their social and leisure activities and taking part in decisions about how the home is run. The home writes a risk assessment for each of the people who use this service. A risk assessment tells the staff how to make sure that each of the people who live here is kept safe from anything that might harm them. The staff are still very good at doing this and they make sure that the risk assessments are looked at regularly to make sure that these are changed if they need to be. There are also risk assessments written about anything in the house or garden that might harm anyone if it is not taken care of. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The people who use this service have good outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standards 11, 12, 13, 14, 15, 16 & 17 were assessed at this inspection. The people who use this service can feel confident that the staff of the home will provide opportunities for everyone to develop their personal and social skills. This includes active support for each person to participate in the community both in terms of the activities of daily life and leisure interests. The opportunity for each to develop and maintain personal and family relations is also encouraged and is actively supported by the staff team. EVIDENCE: The people who come to live here stay for a very long time. Everyone is supported by the staff to be as independent as possible and to make as many choices as they knowingly can. The staff continue to be very good at helping each person to learn new things and to obtain new skills. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 12 Everyone has a detailed weekly activity plan; this includes college classes, using leisure facilities, music therapy amongst others. All make use of other things in the community such as the cinema, the pub and other places of interest. The staff help the people who live here to be a full part of the local community. There is an adapted vehicle that people can use to go out in and it is planned to replace this with a different adapted mini bus once the current vehicle lease expires. The staff are pro active with supporting each person to keep in contact with their families and friends. Family and Friends are made very welcome when they visit the home and some go to visit their families, often staying for weekends. There are not many rules at this home. The most important one is that no one is allowed to smoke in the house. All of the people who live here are allowed to use the entire house, except other people’s bedrooms or the office if a meeting is happening. Each person is allowed to make choices about what they want to eat. The staff are good at making sure that healthy food is always on offer. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The people who use this service have good outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 & 20 were assessed at this inspection. The people who use this service can feel confident that they will get the right support to take care of their personal and healthcare needs. Anyone who needs to take medicine regularly to help them stay well will get the proper support from staff to make sure that this happens. EVIDENCE: The staff demonstrated during this inspection that they are very aware of the needs of the people living here and they are sensitive about how they should meet those needs. Most of the people who live here need technical aids or equipment to help them to be independent. Everyone has a care plan that tells the staff in great detail the way that each person wants to be physically cared for and supported, this also includes details of personal preferences. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 14 All of the people who live at the home usually go to see a local GP if they are not feeling well. They can see any local GP but most see the same one that the staff know very well and get along with. The staff are still very good at writing down anything that happens if anyone becomes unwell. If any has an illness or something else is wrong with them then the staff do know what this is and how to help them to get the treatment that they need. There is an individual health action plan written that adds to the knowledge and understanding of staff about how each person is supported to remain healthy. Most of the people who live here need to take medicine every day and the staff are very good at making sure that this happens so that they can stay well. The staff are also good at making sure that no one can get hold of any medicine that they should not have and so they keep medicines locked away. Every time medicine is given two staff have to sign the chart to ensure that this is double checked and has happened properly. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The people who use this service have good outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standards 22 & 23 were assessed at this inspection. The people who use this service feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances. EVIDENCE: The people who use this service, and others, are given clear information about how to complain and what happens when they make a complaint. No complaints have been made by any of the people living here, or by anyone else who either visits or works at the home. No complaints have been made to the Commission. The home’s complaints procedure contains all of the necessary information and guidance, including the contact details of the local Commission area office. There is also clear written information for staff about what to do if they think that anyone who lives here is being hurt or abused by another person, or if an allegation is made. The home has not only Adepta’s own procedures, but also the multi agency procedures that are use by the geographical authority in which the home is located, in this the London Borough of Barnet. No concerns have been raised since the previous key standards inspection. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The people who use this service have good outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standards 24 & 30 were assessed at this inspection. The people who use this service can feel confident that they are living in an improvingly well maintained and clean home. EVIDENCE: The London Fire and Emergency Planning Authority (LFEPA), who visited the home last year made a recommendation that magnetic door releases should be fitted to the doors. A requirement was made that the registered persons ensure that all doors are fitted with a device that automatically closes in the event of the fire alarm sounding. This has now happened. The previous key standards inspection identified some maintenance issues in respect of the laundry room. This area is fit for its stated purpose although it would be useful to look at whether this could be remodelled in some way, not least to create some additional storage space. The remainder of the home is Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 17 well furnished, well decorated and provides a pleasant environment for the people who live here. The staff and part time cleaner make sure that the home is kept clean and free of unpleasant odour. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The people who use this service have adequate outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standards 32, 34 & 35 were assessed at this inspection. The people who use this service can feel confident that there is a committed staff team to meet their needs and that these staff are safe people to support them. EVIDENCE: It is necessary by law for half of the staff team to have a proper qualification to work with adults who need support in a care home. The name of this qualification is NVQ 2. The manager of the home stated that there is a system in place to ensure that staff are provided with the opportunity to obtain this qualification. However, written confirmation must be provided to the Commission to show how many staff have completed this and how many have yet to do so. It is also necessary for Adepta to confirm the exact full time equivalent staffing complement for the home as no information is provided. Adepta, as the managing company that owns the home, carries out checks to make sure that those who work here are safe people to work with the service Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 19 users. These checks include things like checking if a new member of staff has ever been found guilty of a crime (known as a CRB check), and asking people who used to employ them if their work was good and if they are the right sort of person to work with the service users and to support them. The home receives written confirmation from the organisation’s personnel department that these checks are complete for newly recruited staff. The home keeps records that say what training courses staff have done, and when they did them. These records show that staff training does occur on a cyclical basis and covers the necessary core skills that they require. Three new recruits are currently undertaking the organisations induction programme. It would, however, be timely to ensure that all staff attend up to date equalities and diversity training in order to ensure that they are aware of current legislation and good practise. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The people who use this service have good outcomes in the key standards that were examined. This judgement has been made using available evidence including a visit to this service. Standards 37, 39 & 42 were assessed at this inspection. The people who use this service can feel confident that they are living in a home that has good internal management. EVIDENCE: The registered manager has the necessary experience and skills to manage a residential care service. This person, during the course of this inspection, demonstrated the necessary degree of knowledge and understanding of the needs of the people who live here and about managing staff. She also said that she is still undertaking her (NVQ) level 4 as there had been a difficulty completing this earlier due to the unreliability of the distance learning organisation who were tasked to assess the qualification. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 21 A copy of the quality assurance audit and resulting annual development plan must be sent to the local Commission office once these are completed. A representative of the managing organisation carries out monthly visits to the home; reports are then written. The managing organisation should note that the monthly visits reports are now no longer required to be submitted to the Commission unless these are specifically requested. The London Fire and Emergency Planning Authority (LFEPA) visited the home on 28th February and 1st March 2006 and made five recommendations, which the home has now met. This was confirmed in writing by the LFEPA in a letter dated 23/04/07 after a subsequent visit was made. The following health and safety checks have been carried out within the last year: Fire Alarm System: 18/06/07 Fire Extinguishers: 27/04/07 Gas Safety Check: 15/06/07 Portable electrical appliances: 20/07/07 Electrical Installation: 31/08/06 Lift operation and safety check: 01/06/07 The home is good at making sure that the people who live and work here are kept safe from fire and other hazards. Fire alarms are sounded weekly and there are regular fire drills. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X X 3 x Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 23 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 YA32 Regulation 18 (1) (a) Requirement The registered provider must provide written confirmation to the Commission to show how many staff have completed the NVQ level 2 and how many have yet to do so. Timescale for action 13/10/07 2. YA32 18 (1) ( c ) (i) The registered provider must 13/10/07 confirm the exact full time equivalent staffing complement for the home as no information is currently provided. The registered provider must provide a copy of the quality assurance audit and resulting annual development plan to the local Commission office once these are completed. 13/11/07 3. YA39 24 (2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000010537.V345099.R01.S.doc Version 5.2 Page 24 Sampson Avenue 27 1. Standard YA35 It would be timely to ensure that all staff attend up to date equalities and diversity training in order to ensure that they are aware of current legislation and good practise. Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sampson Avenue 27 DS0000010537.V345099.R01.S.doc Version 5.2 Page 26 - 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!