Inspection on 22/06/06 for Shila House

This inspection was carried out on 22nd June 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shila House 13/10/08

Shila House 17/09/07

Shila House 16/02/06

Shila House 13/07/05

Shila House 08/11/04

Shila House 28/04/04

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

CARE HOME ADULTS 18-65 Shila House 49-53 Main Avenue & 1 Poynter Road Enfield Middlesex EN1 1DS Lead Inspector Mr Teferi Degeneh Key Unannounced Inspection 22th June 2006 10:00 Shila House DS0000010620.V295945.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 Shila House DS0000010620.V295945.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. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shila House Address 49-53 Main Avenue & 1 Poynter Road Enfield Middlesex EN1 1DS 020 8367 8774 020 8350 5361 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) Simiks Care Limited Mr Delroy Watson Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 11 people with mental health needs of either gender at 49-53 Main Avenue and 3 people at 1 Poynter Road. 16th February 2006 Date of last inspection Brief Description of the Service: Shila House is a home registered to provide care to fourteen people with a mental disorder, excluding learning disability or dementia. The home is located at Main Avenue in Enfield and the annexe is over the road at Poynter Road. There are eleven places at Main Avenue and three at Poynter Road. Both homes are managed by Simiks Care Limited. Many of the service users have enduring mental health issues and have periods of time in hospital. The home was first registered in 1994.The main house was built partly above and behind a parade of shops. Poynter Road is a small end of terrace house. Next to the homes are a range of local shops and public transport. There are other leisure amenities in the local area. The annexe at Poynter Road is a semi-independent service where service users do their own cooking and other domestic chores. All the service users have their own bedrooms and at Shila House there is a wash basin and shower in each room. Shila House has two communal lounges and dining room areas. There are also two kitchens, one of which is for the service users to cook their own food if they wish. The home does not have a garden but does have a yard at the back of the home where service users can sit. The home has staff available 24 hours a day. Most of the service users spend their time doing domestic activities in the home or going out in the local area. Some attend a local day service one or two days a week. All the service users have access to a GP, psychiatrist and care manager. Some have input from a community psychiatric nurse. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection is based on information obtained from the observation of the people who use the service and discussions with them about their experiences of living at the home. The files relating to care plans and risk assessments of the service users were inspected as part of this inspection. Other documents examined included the staff files, the rotas, and records relating to service users’ finances, visitors’ book and the home’s diary. The deputy manager, Ms Joanne Day, and the registered manager, Mr Delroy Watson, were present during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The hygiene of the fridge/freezer in the small kitchen needs to be improved. It is of great concern that the home keeps loaves of bread and fruits which have past their expire dates. The practice of decanting medicines and keeping them in containers not labelled by a pharmacist has put service users’ health and safety at risk. Even though the procedures of recruitment of the home are satisfactory, these have not been fully implemented. All staff who work at the home must a satisfactory CRB check. The registered person must ensure that the recommendations made by the environmental health officer in respect of pest control, refuse containers overflowing and risk assessment are complied with. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Shila House DS0000010620.V295945.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 Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users are confident that their admission to the home is dependent on the outcome of their needs assessment and the ability of the home to meet their needs. EVIDENCE: No new service users have been admitted since the last inspection. The registered person said a new service user has been referred to the home and their needs are being assessed. It was evident from discussions with the registered person and the records that the home has attended a review meeting of the prospective service user and has completed an assessment for them. Completed assessments and information about the service user have also been received from the placing authority. It was clear from discussions that the prospective service user is an ex-resident of the home. The home has an admissions’ procedure and all new service users are admitted on the basis of the outcome of their assessments and the ability of the home to meet their needs. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home have benefited from the home’s processes of care plans and risk assessments. EVIDENCE: Five service users’ files were examined. All these files contained evidence of care plans and risk assessments. Four service users, who were spoken to, confirmed that they were involved in the review of their care plans. They also said that their key workers regularly talked to them. The risk assessments are detailed with information of possible risks to service users and how to manage them. A number of people who live at the home said that they could travel independently to shops and health centres. The home has a kitchen where people can make drinks and light meals. The staff spoken to demonstrated good knowledge and experience of providing support, which enables people to take responsible risks and to realise their potential of independent living. A service user’s files indicted that the home and a social worker were looking into how they could support a service user to move to a self-contained accommodation with a minimum support. It was also evident from the files Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 10 that the home has supported a service user to access community based facilities through the use of a voluntary worker. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are adequately engaged. However, the standard of the fridge/freezer and food storage are poor. These have put service users health and safety at risk. EVIDENCE: Discussions with four people who live at the home and three care staff showed that people are engaged in various activities. A service user was observed making snacks and three others were seen sitting in the lounge and watching television programmes. Service users have full access to all communal areas. There is a pool table in the lounge on the ground floor. A service user said they save their money and travel to the Enfield Town for shopping. Two of the people who live at the home manage their finances while the others are supported by the home to look after their money. Five service users’ cash tins, which were checked, were correct on the day of the inspection. However, it was noticed that a large sum of money was kept in some cash tins in cash for some service users. Records and discussions with the registered person showed that the home has liaised with social workers and arranged a voluntary worker for a service user. As required at the last inspection, the registered Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 12 person has ensured that keys are available for service users to access the kitchen. However, the inspection of the small kitchen showed that the fridge/freezer has not been regularly checked and cleaned resulting in out-ofdate food being kept in it. There was offensive smell coming from the fridge. Further inspection of both kitchens revealed that loaves of bread with past expiry dates have been kept for consumption. The registered person explained that the loaves of bread have been stored in the freezers. There was no evidence to show the dates or time when the bread was taken out from the freezers on the day of the inspection. During the tour of the premises it was observed that the fruits in the bowl in the sitting room have shrunk due to being left for a number of days. There were no fresh fruits in the home at the time of the visit. A number of people who live at the home and who were spoken to said they liked the food provided. Some of the people were able to go out and buy meals occasionally from shops or cafés. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Even though the staff improvements have been made in respect of staff training and medication administration recorded keeping, risks to service users have not been eliminated due to the decanting and keeping of some medicines in containers, which have not been labelled by a pharmacist. EVIDENCE: The registered person confirmed that all people who live at the home are registered with their own general practitioners and have regularly accessed dentists, psychiatrists, chiropodists, and opticians. It was evident from the records that health care appointments have been made for service users. One service user said they were able to attend their appointments independently. People who live at the home can carry out self-care tasks with minimum support. The staff who were spoken to gave satisfactory description of how they ensure the privacy and dignity of the people who use the service while supporting them with their personal care. The staff administer medication. The assessment of the staff files and a discussion with the registered person showed that the staff who administer medication have attended medication training. Medication is kept in a locked cabinet in a room on the ground floor. The temperature of the area where Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 14 medication is kept is monitored and recorded daily. The recordings showed that the temperature has never been above 25°C. The inspection of the medicines showed that some medicines have been decanted and kept in containers different from the ones they had been obtained from the pharmacist. Such a practice can have a negative impact on the health and safety of the people who live at the home Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory systems in place to ensure that service users are protected from abuse. The people who use the services are reassured by the home’s complaints procedure. EVIDENCE: Four people who were spoken to said they could talk to the staff and the manager if they have concerns. It was observed during the inspection that the staff interacted with service users appropriately. The home’s complaints procedure has been displayed at the home and included in the service users’ guide. No complaints have been recorded since the last inspection. The home’s adult protection policy reflects the local authority’s policy on the protection of vulnerable adults from abuse. There have been no recorded allegations of abuse. The staff spoken to are aware of what adult protection is and how they can deal with any issues of abuse. It was noted in the staff files that they have attended training on the protection of vulnerable adults from abuse. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered person has made positive progress in raising the standard of the home by addressing a number of requirements from the last inspection. However, the standard of the fridge/freezer is below the expectations of the people who use the service. Service users’ health and safety is exposed to risks due to the unhygienic manner in which the fridge/freezer has been maintained. EVIDENCE: The home is located within a close proximity to the Cambridge Road in North London and service users have easy access to a range of shops, leisure and transport facilities. The home comprises two buildings, one at Main Avenue and the other across the Road at Poynter Road. All service users in both buildings have their own bedrooms and those who are able to use have been offered bedroom and front door keys. The communal areas in both buildings include sitting rooms, toilets, kitchens, dining areas and gardens. The carpets of the stairs by the office in Main Avenue have been replaced as required at the last inspection. The registered person has ensured that people who live at the home have access to the kitchen. As mentioned above the fridge/freezer in the small kitchen has not been cleaned and contained Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 17 food/drink items, which have been kept past their expiry dates consequently producing bad smells. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have benefited from trained and experienced staff provided by the home. However, practices relating to the recruitment of the staff are poor and these have potentially put service users at risk. EVIDENCE: Five staff files were inspected. It was evident from these files that the staff have attended a range of training programmes including managing challenging behaviour, mental health awareness, first aid, adult protection, health and safety, fire prevention, infection control, food hygiene, and medication administration. The registered person confirmed that the home liaises with an independent training provider whose role it is to identify and organise relevant courses for the staff. Discussions with the registered person showed that training needs of staff are discussed in their supervision sessions. The home has a recruitment policy which necessitates that new staff are recruited on the bases of successful interview and provision of written references. One new member of staff has been recruited since the last inspection. It was evident from the files that two written references have been received for the new member of staff. However, the inspection of the files showed that the new member of staff have a CRB certificate which they obtained for their previous employment. The registered person said the new Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 19 member of staff has applied to the CRB as part of their current employment. There was no written document to support this. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The system of quality assurance is good and service users and other stakeholders are consulted. The health and safety arrangements put in place at this home are below service users’ expectations as demonstrated by the presence in the home of some electrical appliances which failed safety tests and the outstanding recommendations of the environmental health officer. EVIDENCE: The current registered manager is experienced and committed to the development of the service. He works closely with the owner of the home and the care staff. He is supported by an assistant manager who has worked at the home for a number of years. Discussions with the registered manager and the deputy indicated that they support each other and the staff and they are open to ideas. They stated that they have attended management and mandatory training programmes. The managers have a responsibility to ensure that the rotas are done and shifts are covered. They also supervise the staff. It was noted during the discussions that the registered person is planning to move to Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 21 manage another project owned by the same provider. The registered manager and the provider are aware that it is a requirement to employ a manager who can apply to be registered with the CSCI should the present manager leaves. At the last inspection health and safety requirements relating to portable electrical appliances, fire drills and smoking policy were made. Records showed that electrical appliance tests have been carried out and six of the 126 items checked were identified as “fail”. It was not evident from discussions with the registered person or from the records whether or not the six electrical items have been disposed of. However, records and discussions with the registered person showed that fire drills have been carried out and the issues related to the smoking policy have been resolved. A non-smoker service user spends most of the time in non-smoking room. The home’s records indicated that emergency lights and fire alarms are tested and recorded regularly. The gas boiler was last tested on 19/06/06. An environmental health officer visited the home on 30/05/06 and made recommendations in respect of pest control, refuse containers overflowing and risk assessment. The registered person is yet to show evidence that these have been complied with. A presentation regarding the changes to the regulation and inspection of social care services was made using the posters provided by the CSCI as part of this inspection. The home has developed questionnaires for service users, relatives and professionals. The questionnaires have been distributed to and collected from the respondents. The registered person has also collated the questionnaires and summarized the outcome with an action plan stipulating what actions need to be taken in order to improve the service. The registered person said the exercise would be repeated again this year. He also said that the home would continuously seek the views of the people who use the service regarding their experiences of living at the home. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 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 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA17 Regulation Requirement Timescale for action 21/07/06 2 YA17 3 YA20 4 YA30 5 YA34 16(2)(h)(i) The registered person must ensure that the food provided at the home is fresh. Loaves of bread, which have gone past their expiry date, must not be kept and used in the home. 16(2)(h)(i) The registered person must ensure that fresh fruits are provided for service users. The registered person must check regularly check fruit bowls and ensure that the fruits are fresh and suitable for consumption. Any old fruits must be disposed of. 13(2) The registered person must ensure that all medicines are administered from the containers in which they have been received from the pharmacist. Medicines must not be decanted to and kept in containers unlabelled by a pharmacist. 16(2)(g); The registered person must 23(2)(d) ensure that at all times the fridge/freezers are clean and free of bad smell. 19(1)(2) The registered person must (3) ensure that all staff employed by DS0000010620.V295945.R01.S.doc 21/07/06 21/07/06 21/07/06 21/08/06 Shila House Version 5.2 Page 24 6 YA42 23(2)(c) 7 YA42 16(1)(2); 17; 23 and working at the home have satisfactory current CRB checks undertaken for the purpose of working at the home. The registered person must ensure that the person without a current CRB certificate applies for a CRB check. The person without a CRB must work undersupervision. The registered person must ensure that all electrical appliances in the home are tested a qualified electrician and are certified to be safe to be used by the people who live and work at the home. The registered person must ensure that all matters raised in the environmental health officer’s (EHO) report are complied with. Written evidence of satisfactory compliance of EHO’s recommendations must be forwarded to the CSCI Inspector. 21/07/06 21/08/07 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 YA23 YA37 Good Practice Recommendations The registered person should introduce a policy, which ensures that there is a limited amount of cash kept at the home for each service user. The registered person should ensure that a manager, who can apply to the CSCI to be registered, is employed, should the existing manager leaves. Shila House DS0000010620.V295945.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Shila House DS0000010620.V295945.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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