Inspection on 19/06/08 for Sea View Lodge

This inspection was carried out on 19th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sea View Lodge 04/08/09

Sea View Lodge 18/05/09

Sea View Lodge 26/06/07

Sea View Lodge 22/11/06

Sea View Lodge 23/06/06

Sea View Lodge 02/03/06

Sea View Lodge 31/05/05

Sea View Lodge 14/12/04

Sea View Lodge 30/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Sea View Lodge 116 Central Parade Herne Bay Kent CT6 5JN Lead Inspector Joseph Harris Unannounced Inspection 19th June 2008 09:30 Sea View Lodge DS0000023424.V365544.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 Sea View Lodge DS0000023424.V365544.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. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sea View Lodge Address 116 Central Parade Herne Bay Kent CT6 5JN 01227 375253 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) seaviewlodge@aol.com Mr Shahid Sheikh Mrs Nelofar Sheikh Manager post vacant Care Home 10 Category(ies) of Learning disability (0) registration, with number of places Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only – (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) The maximum number of service users to be accommodated is 10. Date of last inspection 26th June 2007 Brief Description of the Service: Sea View Lodge is a 10-bedded home for people with learning disabilities in the town of Herne Bay. The house is located on the seafront close to the pier and a short distance from the centre of town with a good range of amenities and facilities. There are reasonable public transport from the town including bus routes and a train station. The home is set out over two floors. The ground floor mainly comprising of communal space with two bedrooms and the first floor consisting of bedrooms and toilets/bathing facilities. There is adequate communal space throughout the home with more space available following refurbishment. There is a small, enclosed courtyard to the rear of the home and a larger paved area with parking space to the front of the home. The current fees for the service at the time of the visit range from £398 to £560. Information on the home services and the CSCI reports for prospective service users will be detailed in the statement of purpose and service user guide. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection process culminated in a site visit to the home on 19th June 2008. The site visit commenced at approximately 9.30am and concluded at 2.30pm, lasting for around 5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the owner/manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: What has improved since the last inspection? The home has improved the level of information contained within individual service user plans. The care plans are now written clearly and contain clear action for staff to meet needs. They also reflect the changing needs of service users. Similarly the risk management processes have also improved. The level of activities in the home have increased and daily sessions are organised by staff. The owner/manager stated his intention to continue to investigate opportunities for all service users. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 6 All records relating to staff personnel and health, safety and welfare were available for inspection and systems have been introduced to ensure this remains the case when the owner/manager is not on site. 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. The summary of this inspection report can be made available in other formats on request. Sea View Lodge DS0000023424.V365544.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 Sea View Lodge DS0000023424.V365544.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): 2. Quality in this outcome area is adequate. The needs of service users are assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 2 service user files were examined including pre-admission assessments. In one case detailed and comprehensive information had been gathered. Copies of care management assessments and Care Programme Approach (CPA) documentation were on file. The owner/manager had also completed in-house assessment forms showing evidence of information collated from the care team, family and service user. The assessment of needs and expectations linked in with support plans and the meeting of individual needs. A second file was also examined for another recently admitted service user, however there was limited information in place. The owner/manager was able to produce copies of care management assessments and CPA care plans and risk assessments. He stated that in the initial weeks of the placement the home worked to these documents in meeting needs. He also stated that additional information was not on file because it was in the process of being typed up. The home is advised to ensure that key information is retained on file at all times following admission to ensure that key needs can be Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 9 communicated and met. Refer to recommendation 1. Care staff were, however, able to demonstrate a good understanding of the care and support needs of all service users. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 10 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): 6, 7 and 9. Quality in this outcome area is adequate. Service user’s assessed needs are reflected in individual plans. Residents can make decisions about their lives and are supported to take risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner/manager has improved the level of information and format of individual service user plans. Two service user files were examined for recently admitted residents. In one case well-developed support plans were in place including a pen portrait, assessment of needs, and clearly formulated care plans and risk assessments. A second individual file was examined, which related to a resident who had moved into the home approximately 3 weeks prior to the inspection. There was not an individual service user plan in place, however the owner/manager was able to provide some records and stated that he was currently typing the information up at his own home. It is essential that Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 11 key care planning information, ensuring any staff entering the home would be able to meet the needs of the individual, is available at all times. Refer to recommendation 2. All residents present in the home were spoken to during the course of the site visit. Every person stated that they enjoy living in the home and that staff are both courteous and helpful. Service users said that they are able to spend their time in the home as they wish and that they are able to make decisions affecting their lives. The owner/manager does act as an appointee for some of the service users and maintains records of all transactions. The home has improved the risk management processes, which now more clearly identify perceived risks and the actions required by staff to minimise these risks. Two service user’s risk assessments were examined. One contained the new documentation and had been developed consistently. The second file did not contain any risk assessments, but these had been removed from the home to be typed and printed according to the owner/manager. A discussion was held with the manager to underline the importance of retaining key documentation in the home at all times. Refer to recommendation 3. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 12 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): 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users have a lifestyle that meets their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussions were held with service users throughout the day. All that expressed an opinion said that they enjoy life in the home. One service user said, “I like to knit in the morning, see my friend at lunchtime and then I go and do puzzles and games in the lounge in the afternoon.” She went on to say that she does not like to go out much anymore, but staff do take her in a wheelchair when she wants. Another resident said, “I haven’t lived here long, but I feel like part of the furniture. It’s great.” The owner/manager said that the home has tried to expand the activities available and there is an activities group at 3pm every day. He has employed an additional member of staff so it is easier to support residents in the Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 13 community. 5 residents regularly attend a day centre from 1-5 days per week and two other residents have been referred recently. The home is also exploring voluntary work and college course opportunities for some residents. It was reported by service users that their visitors and relatives are welcomed into the home and there is additional space available if people wish to meet in private. Menu records are maintained and staff have completed food hygiene training. The home was adequately stocked with necessary food and available fresh fruit. Some service assist with aspects of food and meal preparation from setting tables, to preparing vegetables and cooking full meals with support on occasions. All of the service users said that they are happy with the quality of food and choices available. There is a reasonably sized dining room and residents enjoy their meals in a relaxed and unhurried environment. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 14 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): 18, 19 and 20. Quality in this outcome area is good. Service user’s health and personal needs are catered for. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users independently stated that the care staff in the home are friendly, helpful and caring in their manners. Everyone said that where they require support with personal care needs from staff that they are supported in a sensitive and respectful way and that their needs are met. Discussions were held with the owner/manager and care staff. It was evident from these conversations that the staff spoken to have a good awareness of the needs and preferences of the residents. Individual service user plans provide suitable guidance for staff to enable personal care needs to be met. The home retains records of healthcare professionals involvement with each service user. These records summarise the reason for consultation and any outcomes and actions arising from the appointment. The home liaises with Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 15 community nursing teams and one service user receives regular support from the District Nursing team. There is evidence that when healthcare issues have arisen they have been appropriately referred to the relevant specialists. One service user has a history of unstable diabetes and the home maintains clear records and has helped in stabilising the condition. Service users are registered with local GPs and receive regular input. The home also receives support from local community learning disability teams. Complimentary healthcare issues are maintained such as chiropody, dentistry and optician appointments. The home maintains clear medication records and storage facilities are suitable for the needs of the home following previous advice from a Commission for Social Care Inspection pharmacist. The home has also purchased a separate refrigerator for medication purposes. This is stored away from the main part of the home, but should be fitted with a lock to ensure safety. Refer to recommendation 4. Medication administration records were examined and well-maintained. The home has suitable policies and procedures in place relating to medication issues and staff complete medication training prior to administration responsibilities. At the current time no service users are selfmedicating, although the owner/manager stated that this is an area he wishes to improve over the coming months. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 16 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): 22 and 23. Quality in this outcome area is good. Service user’s views are listened to and they are protected from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints process in place, which is displayed and given to new and prospective residents. All of the service users spoken to said that they felt comfortable in raising any issues with the owner/manager and staff. One resident said, “If I have a problem I tell Mr Sheikh. He’s very helpful.” Another person said, “I don’t have any complaints, we all get on, this is my home.” No complaints have been received by the Commission for Social Care Inspection regarding the home since the last inspection. Policies and procedures are in place relating to issues of abuse and adult protection. The owner/manager has completed a train the trainer course in Adult Protection and all care staff attend training on this topic. In discussion, staff demonstrated a reasonable working knowledge of the reporting and recording of any allegations of abuse. One adult protection alert was raised in respect of the home in the last 12 months. This was investigated by the Safeguarding Vulnerable Adults team and was closed without any further action. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 17 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): 24 and 30. Quality in this outcome area is good. The home is suitable for the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sea View Lodge provides a comfortable and homely environment for up to 10 service users. The owner/manager has systematically redecorated and refurbished the home including new carpets, bedroom furniture and colour schemes chosen by residents. There is a good-sized extension to the rear of the home and there are plans to convert this providing a much needed additional toilet/shower downstairs, further communal space and an office. The home is located on the seafront in Herne Bay and enjoys an excellent position close to shops and other amenities. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 18 There is a large lounge/dining room that constitutes the main communal space, but additional rooms are available to greet visitors in private or for a little quiet time. There is one toilet and bath downstairs, which is used by only two of the residents as it adjoins one of their bedrooms. There are further toilets and bathing facilities on the other two floors of the home. All of the bedrooms are single rooms and service users are able to bring in their own furniture and have a say in the colour schemes. All of the residents spoken to said that they are happy with their accommodation and find the house to be comfortable. The home was clean and hygienic on inspection, bright and airy. The laundry facilities are sited off the kitchen and a risk assessment has been completed minimising the risk of cross-infection. The kitchen and laundry facilities are suitable for the needs of the home. It was reported that home meets the requirements of environmental health and fire safety legislation. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 19 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): 32, 34 and 35. Quality in this outcome area is adequate. Service users are supported by a competent staff team who have been given appropriate training. The recruitment process needs to be robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of care staff have been recruited through an overseas recruitment agency from China. These staff members have nursing qualifications gained in their country of origin. Two newly appointed staff members have been recruited from other care homes in England after moving from China. The owner/manager has provided all mandatory training for care staff and has appropriate courses booked for those staff who have been employed for less than 6 months. All staff work through an induction process that includes the Skills for Care Common Induction Standards. Staff also attend a two-day course covering learning disability issues as part of the induction package. The owner/manager has attended train the trainer courses in Adult Protection and Fire Safety. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 20 Discussions were held with staff members on duty who demonstrated a good understanding of the needs of each service users and displayed a caring and positive attitude towards working with the residents. The owner/manager has also developed an open and friendly relationship with the service users. 2 staff personnel files were examined, which highlighted some areas for improvement. Recruitment policies and procedures are in place and in one case had been closely followed. However a second file revealed a number of gaps, containing only one reference. A CRB disclosure had been applied for, but no POVAfirst check had been completed. The owner/manager stated that new staff members do not work unsupervised until all checks have been completed. Refer to requirement 1. The application for employment form requests the previous two employers and should be amended to include a full employment history. Refer to recommendation 5. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 21 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): 37, 39 and 42. Quality in this outcome area is good. The home is well run and in the best interests of the service users. Resident’s health, safety and welfare is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner/manager has been in post for a number of years. He has attained all the required qualifications and has continued to expand his own education having recently completed train the trainer courses in Adult Protection and Fire safety. Through observation it is evident that he has developed positive relationships with staff and service users. Privately some residents commented that he is helpful, friendly and ‘always willing to listen’. Care staff stated that Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 22 they feel supported by him and that there is a positive atmosphere in the home. Over the past number of years Mr Sheikh has shown a willingness to address shortfalls highlighted through the inspection process and has continued to look to make further improvements in the service provision. There is evidence available that the owner/manager monitors the quality of the service. This is done through resident meetings, both in group and individual settings, staff meetings and other forms of consultation. Service user surveys were completed just over 12 months ago to test satisfaction with the home. This should be an annual exercise and the results collated into an annual report showing outcomes and actions to address any issues raised. Refer to recommendation 6. The owner/manager keeps the Commission for Social Care Inspection informed of events and notifications on a regular basis. All health and safety records and documentation examined including fire safety logs, accident records and service certificates were up to date and in place. There are systems of safe working practices in place and staff receive all mandatory training within the first six months of employment. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 23 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 2 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 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 24 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 YA34 Regulation 19(1)b; schedule 2 Requirement To ensure that all recruitment checks are fully completed prior to employment. 19- (1) The registered person shall not employ a person to work at the care home unless – (b) subject to paragraph (6), he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 6 of Schedule 2; Timescale for action 01/08/08 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 YA2 YA6 Good Practice Recommendations To ensure that key assessment information is retained in service user’s individual files at all times. To ensure that care planning information is retained on file for all service users at all times. DS0000023424.V365544.R01.S.doc Version 5.2 Page 25 Sea View Lodge 3. 4. 5. 6. YA9 YA20 YA34 YA39 To ensure that risk management plans are retained on file at all times. To fit a suitable lock on the drug fridge. To ensure a full employment history including gaps from employment is requested prior to the appointment of new staff. To complete an annual quality report including the results of service user’s surveys. Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sea View Lodge DS0000023424.V365544.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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