Inspection on 02/08/06 for Shenleybury House

This inspection was carried out on 2nd August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Shenleybury House 09/01/06

Shenleybury House 25/10/05

Shenleybury House 22/02/05

Shenleybury House 11/10/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Shenleybury House Black Lion Hill Shenley Hertfordshire WD7 9DE Lead Inspector Mrs Jan Sheppard Unannounced Inspection 9:00 2 August 2006 nd 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 Shenleybury House DS0000019523.V302720.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 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. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shenleybury House Address Black Lion Hill Shenley Hertfordshire WD7 9DE 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) 01923 859 238 01923 859 238 Shenleybury House Limited Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 9th January 2006 Brief Description of the Service: Shenleybury House is a residential care home offering accommodation to fifteen older people. It is a pleasant period building, in a rural setting within attractive grounds. The home is situated on the edge of Shenley village and neighbours the Roman Catholic church. The house is spacious, bright and holds many of its original features. Most of the service users are local people, which present the home as a pleasant community atmosphere. The home, which affords a safe and comfortable environment for its residents, is privately owned and currently charges fees, which range from £400 to £550 per week. Information about the home is Registration and Insurance Certificates along with copies of recent Inspection Reports and a book for Visitors Comments and Suggestions and the companies Complaints Procedure are displayed in the homes entrance hallway. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection for the inspection period commencing April 2006 and took place over one day when all the staff on duty and many of the residents were spoken with. A tour of the building was also undertaken. This report reflects the observations made in the home at the time of this inspection and also takes account of the information gathered from the pre inspection questionnaire recently completed by the homes manager and of other information periodically sent to the Commission from the home. Since the last inspection the Manager left her post in February 2006 and a new Manager, Mrs. Karen Cowen, commenced duties in April. She is well known to the home having previously worked there as the registered manager for some years prior to 2005. She is an experienced and qualified manager who appeared to have quickly settled back into her duties and following a period of assessment is now introducing a number of changes and improvements to the operations of the home. No concerns have been raised with the Commission by relatives or other health or social workers between inspections. The requirements and Recommendations made at the last inspection have with the exception of two been met or are in the process of being met. Seven requirements and one recommendation are made following this inspection. What the service does well: What has improved since the last inspection? Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 6 Since the last inspection and particularly since the change of manager residents and staff reported that the atmosphere in the home had improved. Staffing ratios have been increased so as to more adequately meet the residents requirements around the breakfast period. Staff reported that they now had better opportunities for training. The manager, in consultation with the residents, has introduced an Activities Programme and the variety of classes; activities and outings that are now regularly available are clearly appreciated by the residents. A refurbishment programme of redecoration and the provision of new equipment and soft furnishings is now well under way. 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. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 7 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 Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Standard 6 is not applicable to this home, as intermediate care is not offered. Information offered to prospective residents and their families is comprehensive and informative enabling an informed decision about admission to be made. All prospective residents and their families are given the opportunity to visit the home before admission arrangements are discussed. EVIDENCE: There have been no changes to the information given to prospective residents nor in the pre admission assessment procedures carried out by the home since the last inspection. Good information is available so that prospective residents can make an informed choice about whether the home is right for them. The Manager carries out a personalised needs assessment, which means that people’s diverse needs are identified and planned for before they move into the home. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 9 There has been one new resident admitted to the home since the last inspection. Case tracking evidenced that the manager visited this resident in their own home and consulted with their social worker and relatives as part of the assessment of their care needs and that the resident was able to visit the home, view the room and spend some time socializing with and sharing a meal with the other residents before making a decision about admission. The resident told the inspector that this admission process was not rushed and that everybody had been very kind and helpful. They said that they had a very nice room that they now felt settled and that Shenleybury was now their home. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Detailed care plans are maintained and these are regularly reviewed. The home has a robust medicines administration and storage policy and procedures. Care was seen to be being delivered by experienced and trained staff in a kindly unobtrusive manner enabling individual need to be met whilst maintaining dignity and respect for the residents. EVIDENCE: The new manager has reviewed all the care plans and has compiled a Quick View summary for each to assist staff in maintaining an up to date picture of the residents care needs with quick retrieval of information when needed. Good detail of each residents social history is included in the section called “This is your Life”, the care plans have a recent photograph, a missing persons profile and are signed by the resident or relatives where this is possible. Details of any care given by the district nursing service or help received from any hospital specialist are also recorded. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 11 The staff seen to be dealing with the medication demonstrated a good understanding of the homes medication policies and procedures and were found to be following the administration procedures correctly. The home uses an MDS, (monitored dosage system), and has good storage facilities including a Controlled drugs cupboard and a small medication fridge. One resident chooses to administer their own medication and the need to establish appropriate surveillance for this was discussed with the manager. Since the last inspection a number of long standing residents have died in the home all from natural causes. The records evidenced that the home accommodated their changing needs bringing in extra staff where required and enabling their relatives to assist with their care during their final days where they wished to do this. The manager has recently completed a training course, ‘Care for the Dying’. A number of appreciative letters from relatives and friends evidenced their appreciation of the sensitive manner in which this difficult time was dealt with by the home. The inspector was informed that the home planned a memorial service and dinner to take place shortly. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The recently introduced activities programme is very much appreciated by the residents. Regular consultation with the residents for their feedback and suggestions on all aspects of their care and the running of the home promotes their autonomy and ability to make choices and exercise control over their own lives. Visitors are always welcome in the home, which also has an active “Friends of Shenleybury” group. All the residents were complimentary about the food provided. EVIDENCE: Since the last inspection a regular budget has been allocated for the home to run an Activities Programme. A number of regular classes and group activities including bingo quizzes current affairs discussions and an exercise class have quickly become well established and are clearly much appreciated by the residents. One resident said “it makes life a lot more interesting to have things to do if you want to”. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 13 Several other residents spoke to the inspector about recent outings they had enjoyed, to a county pub for lunch, to a local garden centre and on the Sunday prior to this inspection a visit for all the residents to the local Stanborough Lakes followed by a surprise buffet supper in the home to which relatives and other friends of the home were invited. This event had clearly been very well received by all the residents several of whom mentioned it to the inspector. One said, “the food was wonderful we have got a very good chef and all the staff helped him as it was a Sunday”. Without exception all the residents spoken with were very complimentary about their food. The residents mostly eat together in the spacious and well appointed dining room with matching table linen crockery and fresh flowers on each table for lunch and supper times, but choose themselves whether or not to take breakfast in their rooms. The new manager serves breakfast to the residents herself as this enables her to meet them all on a daily basis. The chef also consults with the residents on a daily basis about their menu choices and a number of new dishes recently introduced were mentioned to the inspector has being delicious. The manager does the weekly food shopping and as she knows the individual residents preferences is able to buy particular brands at their request. Fresh meat and vegetables are purchased several times a week and fresh herbs are bought in by the chef and some carers from their gardens. Fresh fruit was seen to be freely available for the residents throughout the home. Staff who prepare food have completed Food Handling training and six staff have recently enrolled for the course, ‘Controlling Food Safety’ at Oaklands College. The home maintains good links with members of the local village community as well as with the relatives of residents. During this inspection several visitors were seen in the home, a local vicar held a short service for three residents and relatives who maintain some of the patio garden pots were also seen. The Friends of Shenleybury group are currently fund raising for more garden furniture. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a robust complaints procedure and follows the adult protection procedures as set out in Hertfordshire’s joint agency guidelines. EVIDENCE: The home has a comprehensive complaints procedure with a good system for recording any issues that arise. There have been no complaints made since the last inspection. Staff and residents spoken with said that they felt confident that their complaint or concern would be dealt with effectively. One resident said, “if I had any problems I would speak directly to the Manager”. A system for recording compliments is also in place and was seen to have been added to since the last inspection. Several very appreciative letters had been received from relatives following the recent deaths of residents in the home. Staff spoken with demonstrated a good awareness of the subject of Adult Protection and the homes records evidenced that all staff had attended refresher training on this subject during January 2006. Staff seemed confident that they would know what to do if any suspicions arose. The Hertfordshire County Council joint agency guidelines were seen to be displayed and available for all staff. Body charts recently introduced on the care plans were seen to be being used to record appropriately. Staff had an awareness of the whistleblowing procedures and seemed to understand their responsibility towards this. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 15 The open door policy of the manager encourages and empowers the staff and residents to make any complaints or concerns known and those spoken with said that they would be confident to do so. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home and its surroundings offer a pleasant comfortable and homely environment for its residents. The home generally meets the space and environmental requirements for this standard. EVIDENCE: On the day of this unannounced inspection the building appeared to be well maintained was comfortable and had with one minor exception no malodours. The manager was already aware of this exception and had put in place remedial measures. It is recommended that new carpeting is provided in this room. Since the last inspection a programme of redecoration and refurbishment has been commenced. New carpeting has been laid in the hallways and lounge dining areas as well as in some of the bedrooms. Areas of the ground floor communal facilities have been redecorated with new chairs and footstools chosen by the residents purchased for the lounges. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 17 The refurbishment programme, which is not yet fully completed, also includes redecoration new carpeting and the provision of new furniture in some of the bedrooms. The residents bedrooms were personalised with their own items of their choice and the residents consulted with all confirmed that they were happy with their rooms, “it meets my needs,” one said. Appropriate equipment hoists rails and frames are provided and call bells were seen to be accessible in all areas of the room. The records relating to hot water temperature evidenced that these were maintained within acceptable limits. A number of radiators were found not to be covered with low surface temperature covers; a requirement is made as this could put the residents at risk of accidental scalding. The home was found on the day of this unannounced inspection to be clean and tidy and a regular cleaning programme could be evidenced. Carpet cleaning is carried out regularly and the kitchen is now subject to a regular pattern of deep steam cleaning. Laundry facilities are sited so that soiled articles are not carried through any area where food is prepared. Hand washing facilities are provided throughout the building and staff are actively encouraged to maintain good hygiene practices gloves aprons and hand washing solution were seen to be readily available and staff confirmed that supplies of these are plentiful. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. On the day of this inspection the home had adequate staff on duty to meet the needs of the residents. Staff are experienced and undertake regular training. Robust staff recruitment procedures are in place to ensure the safety of the residents. EVIDENCE: The records relating to the two new staff recruited since the last inspection evidenced that the correct procedures and CRB checks had been carried out to ensure the residents safety. Since the last inspection the staffing duties had been rearranged to better accommodate the residents needs especially over the breakfast period and this rearrangement has amounted to an increase in staffing of care hours. The records evidenced that the staff all receive regular supervision and an annual appraisal. Improvements are needed to the records that accompany these meetings so that an annual plan can be evidenced. A similar requirement is made concerning staff training as although a number of training courses have been attended since the last inspection including food hygiene, adult protection and whistle blowing, medication administration and moving and handling, no individual staff training needs plans have been compiled Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 19 neither is there a plan outlining the training programme and costs for the forth coming year for the whole home. The home currently has eight carers two of whom have NVQ at level 2 and five more are near to completion of this course. The new Manager has the NVQ level 4 qualification, the Registered Managers Award and is qualified as an NVQ Assessor. The recently appointed deputy manager is very experienced but does not have any recognised NVQ qualification or formal supervision/appraisal training. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is managed by a qualified and experienced manager who is assisted by a stable and experienced staff group, many of whom have worked at the home for several years and who regularly undertake training. The residents interests and safety are generally supported by the good maintenance of the homes records and the following of procedures concerning risk and safety. Although some improvements needed have been highlighted EVIDENCE: The staff were observed to be working well together with good team working and told the inspector that the best interests of the residents was their priority. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 21 Staff confirmed that they receive regular supervision and are well supported by the homes manager. Without exception residents and staff expressed their pleasure that their old manager had returned to the home. The home does not retain any of the residents monies as they all have relatives, friends or legal guardians to help those who require assistance with this aspect. The manager explained to the inspector that since her return to the home she had concentrated on four areas; Team Building with the staff, The Development of an Activities Programme for the residents, Improving the Care Plans and Continuing with the Improvements being made to the Environment. Progress had clearly been made with all these areas although further improvements remain to be achieved; 1) Improvements are needed to the frequency of the programme of fire bell testing and evacuation practices this to ensure full safety for the residents and staff. 2) The proprietor or his representative must make monthly-unannounced visits to audit the home and a record of these visits must be kept in the home. This visit is required under Regulation 26 of the Care Standards Act. This requirement was also made at a previous inspection but remains unmet. 3) The home must establish a system for Quality Assurance and Quality monitoring based on seeking the views of residents relatives professionals and other stakeholders in the home. This requirement was made at a previous inspection but remains unmet. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 2 Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes 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 OP33 Regulation 24 Requirement Quality assurance service user questionnaires must be produced and circulated. This requirement is outstanding from the last inspection with a new timescale set. Enforcement action may be taken if this is not met within the new timescale. The proprietor must ensure that monthly visits are carried out and a report must be available in the home. This requirement is outstanding from the last inspection with a new timescale set. Enforcement action may be taken if this is not met within the new timescale. All radiators must be protected by low surface temperature covers. The frequency of Fire Bell testing and evacuation procedures must be increased. Timescale for action 31/01/07 2. OP33 26 30/09/06 3 4 OP19 OP38 13(4)(c) 23(4)(a) 31/10/06 30/09/06 Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 24 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. 3. 4. Refer to Standard OP26 OP30 OP30 OP36 OP30 Good Practice Recommendations The Malodour in the identified bedroom should be rectified. Individual staff training profiles should be compiled along with an annual training profile for the whole home. Evidence of a planned programme for staff supervision to be carried out by appropriately qualified supervisors is required for all the homes staff. The deputy manager should attend training on staff supervision and appraisal and also commence on an NVQ training programme. Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Shenleybury House DS0000019523.V302720.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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