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Inspection on 26/01/09 for Shadon House

Also see our care home review for Shadon House for more information

This inspection was carried out on 26th January 2009.

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

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides a good range of information to people thinking of coming to the home, so they can make an informed decision. The service makes a full assessment of a person`s needs before deciding if it can meet all those needs. The service draws up plans to meet the care needs of its service users.Service users health care needs are also fully assessed and properly met. The service stores medicines safely, and administers them correctly and safely. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome. Service users are also encouraged to take as much control over their own lives, as they are able, and make their own decisions. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The environment is kept clean and hygienic and free from odours. The service has enough staff to meet the needs of service users. The service is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the home`s policies and accounting systems. The health and safety of the service users and of the staff are protected by appropriate policies and systems.

What has improved since the last inspection?

The service continues to provide high standards of care. It is successful at helping people to return to their own homes, or finding alternative accommodation that suits each individuals needs.

What the care home could do better:

To promote health and hygiene in the kitchen, all the windows should be fitted with fly screens.To enable easier access to the care plan evaluations, repetitive daily comments should be discouraged, for example: Service user able to express her needs today, or slept well. Whole pages were filled with the same repetitive comments. Statutory training for staff must always be up to date, however the senior officer was able to demonstrate that the training needs of staff had been identified and planned.

CARE HOMES FOR OLDER PEOPLE Shadon House Northumberland Place Barley Mow Birtley Tyne and Wear DH3 2AP Lead Inspector Jim Lamb Key Unannounced Inspection 26th January 2009 09:30 X10015.doc Version 1.40 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 Shadon House DS0000038099.V373917.R02.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shadon House Address Northumberland Place Barley Mow Birtley Tyne and Wear DH3 2AP 0191 410 2816 0191 411 1209 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) Gateshead Council Manager post vacant Care Home 23 Category(ies) of Dementia (23), Mental disorder, excluding registration, with number learning disability or dementia (5), Physical of places disability (5) Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places 23 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 5 The maximum number of service users who can be accommodated is: 23 11th December 2008 2. Date of last inspection Brief Description of the Service: Shadon House is a Local Authority owned home which can provide personal care for up to 23 people who have dementia, 5 of whom may have mental health needs, and 5 of whom may have a physical disability. The home provides accommodation for some permanent service users, whilst the other beds are available to people who wish to stay in the home for a short break or for an assessment. Nursing care cannot be provided but District Nursing services can be accessed as required. Accommodation comprises of 23 single bedrooms on the ground floor level, all with en-suite facilities and located along three corridors. Assisted bathing and shower facilities are located along two of the corridors and in addition to the three communal lounges, conservatory and spacious dining area; service users have access to a multi-sensory room in which a range of equipment such as fibre optic lighting, soothing music and pleasant aromas are provided. There are two separate hairdressing facilities, kitchen, laundry and a range of staff rooms, including a sleep-in room, the latter being available on the first floor of the home. There is a spacious enclosed garden, fully accessible to service users, and separate car parking facilities are available. Local shops, places of worship and Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 5 other community facilities are located a short distance from the home. Fees range from a minimum of £79.92 per week for short-term care to up to £882.80 for those receiving long-term care. Details of all charges are available in the home and terms of residency are explained to individuals. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run. The providers view of how well they care for people, and the views of people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, relatives, staff, the manager and visitors, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable, and checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well: The service provides a good range of information to people thinking of coming to the home, so they can make an informed decision. The service makes a full assessment of a persons needs before deciding if it can meet all those needs. The service draws up plans to meet the care needs of its service users. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 7 Service users health care needs are also fully assessed and properly met. The service stores medicines safely, and administers them correctly and safely. Service users say that staff treat them well and treat them with respect. The staff are working hard to provide a stimulating atmosphere in the home, with appropriate social activities for service users. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome. Service users are also encouraged to take as much control over their own lives, as they are able, and make their own decisions. Service users were very complimentary about the food, and there is a balanced diet, with service users choice included. Complaints and concerns are taken seriously and are responded to properly. The environment is kept clean and hygienic and free from odours. The service has enough staff to meet the needs of service users. The service is very careful as to how it recruits new staff, and runs all the necessary checks on them to protect its service users. The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the homes policies and accounting systems. The health and safety of the service users and of the staff are protected by appropriate policies and systems. What has improved since the last inspection? What they could do better: To promote health and hygiene in the kitchen, all the windows should be fitted with fly screens. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 8 To enable easier access to the care plan evaluations, repetitive daily comments should be discouraged, for example: Service user able to express her needs today, or slept well. Whole pages were filled with the same repetitive comments. Statutory training for staff must always be up to date, however the senior officer was able to demonstrate that the training needs of staff had been identified and planned. 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. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with enough information about the service to enable them to make a choice about where to spend their short breaks, receive treatment/assessment. EVIDENCE: The care records for three service users were examined. These showed that the service makes sure that a full assessment of a new service users needs is carried out by the persons social worker before they come into the home. The service also carries pre admission assessment, to be doubly sure that they can meet all of the new persons needs. More detailed assessments are carried out once the new service user has been admitted. These include assessments of risk, of nutritional needs, social needs, moving and handling needs and of behavioural needs. A dependency rating scale is also completed. Skin care assessments are also carried for those at risk of developing pressure sores. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 11 As a result of all these levels of assessment, the service can clearly demonstrate that all the service users are in a place that can give them the care and ongoing assessment that they need. All of these assessments are important, and they help staff and care managers to determine what is best for each individual’s future care needs. The service users guide is available, and information will is available in large print, compact disc, and in Braille. All are provided with a contract explaining the terms and conditions of the service, and fees. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system is clear enough to ensure that staff have the information they need to meet the assessed needs of the service users. EVIDENCE: People using the service are given sensitive personal support by the staff, who promotes each individuals independence, dignity, privacy and choice. Each person has an individual assessment of his or her personal needs, and has a care plan in place to meet those needs. Plans are person-centred, sensitive and thoughtful. They stress the strengths of the individual, and are positive in terms of seeking to develop the skills and abilities of the person. Privacy is given a high priority. Plans are reviewed/evaluated every two weeks, and amended as necessary, to reflect the progress made by the individual. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 13 Some of the daily comments in the care plans were very repetitive and unnecessary, and these made it a little difficult to locate the evaluation reports. The assistant line manager for the home said she would address this issue. Each person has his or her own personal health information file. This contains professional health assessments, correspondence, and records of contacts with health professionals. It demonstrated that all aspects of a person’s physical and mental health are taken seriously and are properly met. Medicines are delivered in blister packs. This is said to be working well, and to minimise any risk of a medication error. The Medication Administration Records were checked. These were completed to a good standard, with no gaps, and the codes used properly. Medicines are safely stored. All staff has had training on how to use the medication system. They have also had external Safe Handling of Medicines training. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users are offered a good quality lifestyle, which includes varied social contact and activities. EVIDENCE: Each service user has a social skills assessment carried out. All service users and their representatives participate in this process. The completion of the skills assessment assists staff to implement more detailed social care plans. There are daily activities available, and entertainers frequently visit the home. The activities programme is based on service users’ interests and choice. Activities include, reminiscence sessions, drama groups, dance, storytelling, reflexology, chair exercise, cooking sessions, arts and crafts, and board games. The service also has a multi-sensory (snoezellen) room. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 15 Emphasis is given to achieving the highest level of cognitive functioning for each person, and enhancing their social skills and self esteem. All service users are supported to maintain very close links with their families. They can choose who they want to see and when. The menus are based on the known likes and dislikes of the service users. At least two hot meals are provided each day. The menus are varied and well balanced. The chef had good knowledge of the service users’ dietary needs. Special diets are provided when necessary. All those spoken to said that the meals were very good and that they were always offered a choice. A religious service that is open to all denominations is held every two weeks. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using the service can feel confident that their complaints or concerns will be listened to, taken seriously and acted upon. EVIDENCE: There is a complaints procedure. The procedure is written in a way that ensures service users fully understand its contents. Two service users said that they had been given a copy of the procedure and that staff always listened to any concerns and always dealt with them fairly. The service keeps a record of complaints. The service has a Whistle Blowing policy, its own Local Authorities Vulnerable Adults procedures, and a copy of the Department of Healths document, NO SECRETS. Staff confirmed that are aware of these procedures and have easy access to them. Since the last inspection visit, there have been four complaints received, three of these were investigated and resolved. One is currently being investigated. Safeguarding adults training is ongoing for all staff. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 17 Service users can deposit cash for safe keeping in the homes safe and records are kept of accounts. A sample of personal finances records was examined. Transactions were appropriately recorded and had two signatures for each entry. There was plenty of evidence of personal spending. Receipts are obtained for purchases and numbered to cross-reference to the transaction. Weekly checks of balances and cash are carried out. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service provides a safe and comfortable place for those staying there. EVIDENCE: The premises maintain a pleasant and homely atmosphere. The home is set out into a variety of communal areas, all of which are accessible by service users. All parts of the building seen were clean, suitably equipped and have good quality decoration and furnishings. There is an ongoing programme of decoration and refurbishment. The grounds are well maintained and are used regularly by service users. There is a sensory designed garden in progress, and this will be completed by April. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 19 A number of service users spoke positively about their bedrooms and the accommodation in general. All bedrooms are single and have en-suite facilities. The Service has policies and procedures on hygiene and control of infection. Staff have received infection control training. There is suitable hand washing facilities throughout the building. Disposable gloves and aprons are provided for staff use. Arrangements are in place to dispose of clinical waste. The kitchen was clean, and well organised. The stock levels were good. Appropriate checks are maintained for fridges, freezers and food temperatures. The laundry facilities are well organised and the washing machines have a disinfection control cycle. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and supervised. EVIDENCE: Staff levels on the day of the inspection met the agreed level for the number of service users. On the day of the inspection there were 17 service users. In addition to the manager, the required numbers of staff were on duty: 1 senior and 4 staff between 8am and 10pm with 2 staff between 10pm and 8am. A stand-by on-call system also operates during the night. All staff are over 18 years of age and those left in charge were at least 21. The training needs of the staff are identified in supervision and appraisal sessions. The home’s training programme meets the National Training Organisation requirements for the first six months. Staff receive at least three days paid training each year. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 21 The service has a rigorous staff recruitment and selection process to ensure that all appropriate checks and references are in place prior to employment. The service has a good staff training and development programme in place. Some statutory training has lapsed, however there are plans in place to bring this back up to date. All of the staff team has completed NVQ level 2/3, this includes domestic staff. Four staff were interviewed, they confirmed that the training they had received in the past was first class, and described training and development opportunities within the service as excellent. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager is supported by the organisation in providing good leadership throughout the service, with staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The manager had obtained relevant qualifications, including the Registered Managers Award. There was evidence that the staff team work hard to improve the lives of the people using the service. Staff and service users felt that the managers style of leadership was fair, supportive and understanding. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 23 Staff also said they were clear about the standards of care which they were expected to achieve. The majority of service users had requested that the home take on day-to-day responsibility for overseeing their money during their stay. A safe was available to ensure that their money could be kept secure. Staff signatures had been obtained for all money spent on behalf of service users and receipts had been obtained and attached to their financial balance sheets. Financial records showed evidence of regular audits. The service was not acting as an appointee for any of the service users. A quality assurance system had been developed to monitor the quality of care provided. For example, quality surveys had been sent to people using the service and their relatives. The assistant line manager confirmed that professionals visiting the home are also sent surveys. There are also regular performance audits carried out, and there is a detailed annual development plan completed. All staff working at the home had received supervision at least six times during the last 12 months. Supervision sessions are used to provide staff with feedback on their performance, and training needs. A range of health and safety records were examined and these were found to be up to date. A tour of the premises identified no health and safety concerns. An audit of the fire records confirmed that the required fire prevention checks had been completed. For example, the home’s emergency lighting and fire extinguishers had received monthly visual checks. An up to date fire risk assessment was in place. The home’s accident records contained the required details. The hoisting equipment had been serviced. All gas and electrical appliances had been subject to the required safety checks. A range of workplace risk assessments had been completed. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 4 18 4 3 4 4 4 4 4 4 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 25 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 OP7 OP19 Good Practice Recommendations Devise a system that will help to access care plan evaluations more easily. Fly screens must be fitted to the kitchen windows. Shadon House DS0000038099.V373917.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Shadon House DS0000038099.V373917.R02.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. 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