Inspection on 03/10/06 for Sandgate Manor

This inspection was carried out on 3rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Sandgate Manor 24/01/06

Sandgate Manor 12/05/05

Sandgate Manor 16/09/04

Sandgate Manor 16/09/04

Sandgate Manor 02/06/04

Sandgate Manor 02/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME ADULTS 18-65 Sandgate Manor 46 Military Road Sandgate Folkestone Kent CT20 3BH Lead Inspector Wendy Mills Unannounced Inspection 3rd October 2006 09:30 Sandgate Manor DS0000023523.V300634.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 Sandgate Manor DS0000023523.V300634.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. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandgate Manor Address 46 Military Road Sandgate Folkestone Kent CT20 3BH 01303 248313 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) leselle4@yahoo.com MNP Complete Care Group Mrs Lesley Ruth Rudd Care Home 25 Category(ies) of Physical disability (25) registration, with number of places Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One Service User with Physical disability whose date of birth is 26/07/1932 to reside in the home. 24th January 2006 Date of last inspection Brief Description of the Service: Sandgate Manor is part of the MNP Complete Care Group. The registered manager is Mrs Lesley Rudd. She also acts as lead manager for the company’s other homes in the vicinity. Sandgate Manor is a residential home providing care and support for people with a range of learning and physical disabilities. It is a large and wellmaintained manor house that has been adapted to be wheelchair accessible. The home is situated in Sandgate, about half a mile from the local shops and seafront. The house has spacious accommodation and large grounds. Recently three new lodges have been constructed within the grounds of the home and these will provide accommodation for people with disabilities who want a more independent way of living. The residents all lead busy lives and many attend colleges and adult education centres in nearby Folkestone. The fees for this home range between £750 and £1711 and depend on the assessed needs of the residents. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit began at 9.30am and took six hours. Mrs Lesley Rudd, the registered manager assisted throughout. During the course of the inspection ten residents were spoken to, some during the tour of the home and some in the privacy of their rooms. Four members of staff were spoken to in private and staff handover was observed. The responses to a pre-inspection questionnaire were considered. A tour of the home was made, documentation, including a sample of care plans was examined in detail. Both direct and indirect observations were made throughout the visit. The Home continues to meet, and sometimes exceed, the National Minimum Standards. The residents spoken to said that they are well cared and like living in the home. They are able to put their views forward and participate in the running of the home if they wish to and are able to do so. The residents, their supporters, the registered manager and her staff are all thanked for their assistance during this inspection and for the warm welcome they gave. What the service does well: The accommodation and grounds are spacious and allow for easy access and movement for all wheelchair users. The Home is well maintained and well decorated and provides an environment in which the residents are able to maximise their independence. Many residents have complex disabilities and require very specialised equipment. The Home is proactive in its approach to accessing the necessary specialist equipment, such as individually adapted wheelchairs and communication equipment. The home looks after the health of the residents very well. All have complex needs and the home ensures are all met. The residents participate in a wide range of activities. These activities are tailored to meet individual needs. In addition, it offers good support to relatives and friends who visit the Home. Staffing levels are good and staff training is very good indeed. The company own other homes in the area and have provided a training room at a sister home. Training policies and procedures are consistently good throughout the company. There is a rolling induction programme that ensures all staff reach the equivalent of NVQ level II within their first six months of employment. The staff then go on to formal training for the NVQ level III in Care. The internal long-term planning and quality assurance systems are excellent. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Sandgate Manor DS0000023523.V300634.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 Sandgate Manor DS0000023523.V300634.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 The quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit. The home provides the residents, their relatives and supporters, with the information they need in order to make a decision about moving into the home. The home makes appropriate pre-admission assessments prior to offering a place in the home. EVIDENCE: The statement of purpose and the service user guide are well written and enable residents to understand what to expect from the Home. Individual contracts are in place. Three new residents have been admitted since the last inspection. One was out on the day of inspection but it was good to be able to speak to the other two new residents and hear that they have settled in well. Individual needs and goals are reflected in the care plans and risk assessments are in place. Sandgate Manor DS0000023523.V300634.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 The quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit. The residents are able to make informed decisions about their lives and are supported to be as independent as possible. Appropriate records are kept and confidentiality is maintained. EVIDENCE: The residents said that they could talk easily to the registered manager or staff about any concerns they may have. They said they know that staff will only share information when it is important to do so. There is a key worker system and staff ensure that they support the needs and decision making of those residents who are unable to communicate those needs for themselves. Care plans are up-to-date and in order. They record decision-making and several residents have written much of their care plans themselves. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 10 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): 11, 12, 13, 14, 15, 16 & 17 The quality in this outcome area is excellent. This judgement is based on evidence gathered both before and during this visit. The home supports the residents to lead fulfilling lives and works to maximise their independence and minimise their disabilities. Nutrition is generally well managed in the home but more variety is recommended. Special diets are provided when indicated. EVIDENCE: Goals and aspirations are recorded in the care plans. Residents said that they have busy lives and can choose what to do. Everyone has enjoyed the good summer weather and there have been a lot of outings including the Chinese Circus and local places of interest. Some residents had been on a cruise to France and Portugal whilst others had just returned from a holiday in Yarmouth. All said that they had enjoyed themselves and were pleased to show off their photos of the trips. The home is very good at helping the residents to maintain family contact. A wide variety of communication methods are used from texting and e-mail to Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 11 telephone contact. Relatives said that they are made very welcome to the home and can visit at any reasonable time. Transport is provided for home visits when necessary. Nearly all the residents have very complex needs and many have communication difficulties. Staff were observed to be very good at establishing a rapport with the residents and understanding their needs and wishes. The home is good at finding out about all types of disability and at working with the local health and social care professionals to encourage each resident to maximise their independence. The home employs a physiotherapy assistant. This member of staff works under the direction of the local NHS physiotherapist who draws up physiotherapy programmes. The assistant then carries these programmes out routinely with the residents. This helps to maintain their mobility, circulation and general well-being. Nutrition at the home is generally good. Most food is purchased locally. Residents are consulted about the types of things they like to eat and there is always a choice. However on the day of inspection the lunchtime choice was limited to either pasty and salad or cold meat and salad. The manager said that this is because the cook does the grocery shopping on Tuesdays and therefore prepares a quick meal. More choice and a more seasonal meal would have been more appropriate. Some residents said that they would like more variety in the food they eat. Lunchtime on the day of inspection provided a good opportunity to sit and talk with the residents and to sample the meal. The food was well presented but rather bland. The dining area is pleasant and airy. Staff were indirectly observed to give assistance with meals in a discreet and unobtrusive way. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 12 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, 20 & 21 The quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit. The home gives personal support in a discrete and sensitive way that respects the privacy and dignity of the resident and looks after the health and wellbeing of the residents very well. EVIDENCE: Direct and indirect observation confirmed that the staff offer personal assistance and prompting in a discrete and sensitive way. On the day of inspection all but one of the residents were in very good health. Records show that all appropriate healthcare appointments are made and kept. Visiting professionals say that the home contacts them appropriately and works well with them. Since the last inspection two residents have sadly passed away and condolences are expressed to the staff and residents in their losses. Discussion with the manager showed that these events were handled in a sensitive and caring way. Relatives, residents and staff were given support to help them through this difficult time. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 13 Written policies and procedures for the management of medicines in the home are clear and comprehensive. Staff training in the administration of medicines is up-to date. Storage of medicines is safe and there are strict procedures for the ordering, receiving and returns of medicines. Two members of staff have specific responsibility for checking and recording medicines stocks. A member of staff was indirectly observed whilst administering medicines. She was noted to be competent and to make appropriate checks. MAR sheets were in order and we were informed that there have been no errors in the administration of medicine since the last inspection. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 14 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 & 23 The quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit. The home has sound policies and procedures of the handling of concerns and complaints, and for the protection of vulnerable adults. The staff are well aware of these and this protects the residents from harm. EVIDENCE: Residents said that they know they can talk to the staff or the manager if they have any concerns. There have been no formal complaints since the last inspection. The manager said that she deals immediately with any expressions of concerns and ensures that the residents are given the opportunity to make a formal complaint if they wish. There is a rolling, structured induction programme for all staff within the MNP group. This includes a module on the Protection of Vulnerable Adults. There are further training sessions to update staff. The staff interviewed were all clear about their responsibilities to report any concerns and said that they would not hesitate to do so. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 15 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, 27, 28, 29 & 30 The quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit. The standard of the environment in the home is very good. It provides the residents with an attractive and homely place to live. The layout and specialised equipment promotes the independence of the residents. EVIDENCE: Since the last inspection three new lodges have been constructed in the grounds. These are now registered with the CSCI. The accommodation is of a very high standard and will provide more independent living for people with severe disabilities who wish to take more control of their lives. The area surrounding the lodges has been landscaped. This has made it more accessible and attractive. The first resident to move into a lodge said he was very happy with it and was looking forward to putting some more pictures up on the walls. The lodge is very tastefully furnished and homely whilst still giving plenty of space in which to move around. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 16 The area at the front of the main house has also been landscaped and more parking spaces provided. A new entrance has been made and a barrier protects this entrance. Traffic is now one-way and slower. This has made the front of the home much safer. In the main house, all unoccupied rooms are redecorated prior to the admission of a new resident. One of the new residents said that she liked the colours. All rooms have individual colour and décor styles. Some residents said that they chosen their own soft furnishings and colour schemes and decided how to arrange their furniture. Some residents are unable to this but when this is the case, family and friends help to choose the décor and personalise the room. All rooms are reflect the personalities and interests of the residents and are well furnished. Due to the high dependency needs of the residents a significant amount of specialist, enabling equipment such as electric wheelchairs, specialist communication equipment and continence aids, is needed. All equipment is very well maintained. Specialist engineers visit regularly to service equipment. Despite the considerable amount of specialist equipment, it is arranged well and storage is discrete. This means that the home maintains a comfortable and spacious feel. All areas of the home were clean, tidy and free from offensive odours on the day of inspection. However, the kitchen should have been cleaner. The grill over the cooker hob needs a deep clean and staff should ensure that bins are not allowed to get so full that rubbish is touching the lid. The bin has a lid that needs to be lifted in order to put rubbish in. This could be an infection risk. The bin should be replaced with either a pedal or swing top bin. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 17 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): 31, 32, 33, 34, 35 & 36 The quality in this outcome area is good. This judgement is based on evidence gathered both before and during this visit. There is well-trained and enthusiastic workforce that positively promotes improvement in the quality of life of the residents. EVIDENCE: Staff said they love working in the home and that the management (both the company and the registered manager) are very supportive. They are clear about their roles and responsibilities and know how each resident likes their care provided. Staff spoke positively about their colleagues and said they “all care so much”. They said that training is “brilliant”. One member of staff said that she had “never seen so much training for care staff in any other home she had worked in. Staff said that they appreciate the amount of training. In addition to all mandatory training, the home achieves a very good level of specialist training. It accesses a number of organisations to provide this training as well as using in-house expertise. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 18 The home already has achieved a good level of staff holding level II and III NVQs. Five more members of staff are currently on the NVQ III course and one has just completed this and is awaiting her certificate. Regular staff meetings, annual appraisals and one-to-one supervision take place, Since the last inspection a training room has been provided on the top floor of a sister home. This has made it easier to arrange regular training sessions and to invite specialist trainers. Staff are able to attend the other home to train. This gives all staff in the group a chance to meet up with each other and exchange ideas. It also means that it is viable to run a rolling induction programme. An induction session is held every Tuesday afternoon. The registered managers in the group take it in turn to lead these sessions and one was in progress on the day of inspection. There is a very stable workforce and no agency staff has been needed as staff work together to cover annual leave. Sickness levels and staff turnover are low and staff moral is high. Examination of a sample of staff files showed that all appropriate preemployment checks have been made. Since the last inspection the company has completely revised its recruitment policies and procedures. The company has now centralised its recruitment procedures. This means that there is greater consistency throughout the homes in the group and that there are greater safeguards in place. An administrator carries out the initial checks. She ensures that the application form is completed correctly, makes requests for references and CRB checks and checks the references against information given on the application form. She then ensures that the candidate is available to work the required shifts. Once these initial checks are complete, the complete application pack is forwarded to the manager of the home. The manager then makes a decision about whether to interview the candidate and whether to offer employment. This means that the manager is freed from routine paperwork and can concentrate fully on the suitability of the candidate for the post. The final decision to appoint rests with manager or registered person. The company and the home are commended for this excellent recruitment practice that protects the residents from unsuitable staff. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 19 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): The quality in this outcome area is good. This judgement is based on evidence gained both before and during this visit. The home is well managed and is run in the best interests of the residents. EVIDENCE: Mrs Lesley Rudd, the registered manger has many years experience in working at all levels in care homes. She has managed the home for over two years. Prior to he appointment at Sandgate Manor she managed a sister home belonging to the same company. She knows the home and the residents very well indeed. She holds the NVQ IV in Management and Care and has maintained her continuing professional development. Conversation with Lesley showed that she has extensive knowledge of the specialist needs of the residents. She relates well to the residents, their supporters and her staff. She holds a budget for the home and is able to purchase day-to-day needs and general maintenance without having to get permission from the directors of the company. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 20 Staff said that they respect Lesley and can talk to her about any concerns they may have. Staff said that Lesley takes notice of their views and acts upon their concerns when appropriate. The registered providers submit regular reports about the running of the home to the CSCI, in accordance with regulation 26 of the Care Standards Act. They are commended for the high standard of these reports. Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 4 27 3 28 3 29 4 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 4 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 3 3 3 3 3 3 X Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 YA17 YA30 Good Practice Recommendations The home should review its menus to ensure they are varied and well balanced. The home should carry out an infection control audit in the kitchen to ensure that it is hygienic at all times Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sandgate Manor DS0000023523.V300634.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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