Inspection on 31/01/07 for Sisha House

This inspection was carried out on 31st January 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sisha House 14/10/08

Sisha House 14/12/05

Sisha House 14/07/05

Sisha House 02/03/05

Sisha House 27/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Sisha House 124 Brondesbury Park London NW2 5JP Lead Inspector Julie Schofield Key Unannounced Inspection 31st January 2007 10:50 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 DS0000017426.V303338.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. DS0000017426.V303338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sisha House Address 124 Brondesbury Park London NW2 5JP 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) 020 8459 3455 020 8621 9736 Mr Ramzanali Bhanji Mrs Nurjehan Bhanji Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places DS0000017426.V303338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: Sisha House is a care home, which provides accommodation and personal care for 3 elderly persons. All service users enjoy their own single bedroom and each bedroom has en-suite bathing and toilet facilities. There is sufficient communal space for service users and for the proprietors who live on the premises. There is also a very large open plan kitchen/dining/seating area. The house is just off Willesden High Road with its shops and transport connections. It is within a couple of minutes walk of Willesden Library. The home has off street parking for 3 cars at the front of the property. Although a busy area, there is street parking within a 5-minute walk from the home. The home has a well-maintained garden at the rear of the premises. At the time of the inspection there were no vacancies. Information regarding the fees charged is available, on request, from the manager of the home. DS0000017426.V303338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a Wednesday in January and started at 10.50 am. It lasted for approximately 3 hours. During the inspection the Inspector met and spoke with the 3 residents and would like to thank them for participating in the inspection. The Inspector would also like to thank the proprietor and the manager for their assistance. During the inspection a site visit took place, records were examined and the serving of a meal was observed. What the service does well: What has improved since the last inspection? The manager said that changes to the building have taken place in 2006 and early 2007. The open plan kitchen/dining/seating area was being refurbished and the work had almost been completed. A fitted kitchen has been installed and the kitchen area has been tiled. The new colour scheme in this area has created a lighter and brighter room. The inside of the home has been repainted. The en-suite shower room on the ground floor has been refurbished and a new shower cubicle, basin and flooring have been installed. A call alarm system has been installed in the bedrooms. DS0000017426.V303338.R01.S.doc Version 5.2 Page 6 The proprietor has recently completed his NVQ level 2 studies and his certificate of achievement was available for inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000017426.V303338.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 DS0000017426.V303338.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. JUDGEMENT – we looked at outcomes for the following standard(s): These standards have not been assessed at this inspection. EVIDENCE: No new residents have been admitted to the home for several years. The home does not provide an intermediate care service. DS0000017426.V303338.R01.S.doc Version 5.2 Page 9 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 Reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. However risk assessments must be included in the care plans. Residents’ health care needs are met through access to health care services in the community. Supporting residents to take their prescribed medication helps the residents to maintain a healthy lifestyle. Residents live in a home where they are shown respect and their privacy is maintained. Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two of the 3 case files were examined. The manager said that either she or her husband would be able to verbally translate the care plan for each of the 2 residents, either into Gujarati or Karchi. It was noted that the weekly DS0000017426.V303338.R01.S.doc Version 5.2 Page 10 evaluations and monthly reviews of the care plans had ceased, although the six monthly reviews of the care plan and placement had continued. The minutes of 2 care plan review meetings that had taken place in 2006 were present on each file. It is recommended that the monthly evaluations/reviews recommence. Each of the review meetings had been convened by the home and the local authority had not sent a representative. It is recommended that the home contact the placing authority to request their attendance at an annual review meeting. Although each of the 3 residents is mobile a risk assessment with particular attention to the prevention of falls was absent from the files. The level of assistance required by residents, with personal care tasks varies and the manager provides both prompting and direct help. It was noted that case files contained evidence of access to health care services in the community e.g. appointments with the dentist, optician and podiatrist. Residents were accompanied on hospital outpatient appointments, if they wished. Residents had attended the diabetic clinic, eye clinic and psychiatric clinic. There was also evidence of access to screening services. In October 2006 all of the residents had agreed to have a flu vaccination. The manager gave an example of prompt referral to the GP in the event of a resident being sick. Medication was kept in a locked facility. A system of monthly blister packs is used and it was noted that the cartridge had a photograph of the resident, attached. The medication in the blister packs had been appropriately administered, prior to the inspection. One resident self medicates, with the agreement of the GP, and medication is kept in the resident’s room, under lock and key. Records were inspected and were up to date. The record sheets included a photograph of the resident. The manager and proprietor confirmed that they had undertaken medication training. A resident said that they were supported to take medication for high blood pressure and said that they were “happy to be helped”. A resident discussed the issue of privacy and dignity within the home. Each resident has their own single room and the resident said that they preferred to spend time in their room as they enjoyed their own company. They confirmed that they were able to do so, without any unnecessary interruption or intrusion. It was noted during the inspection that the manager knocked on the door of the resident’s room and waited until they were invited in, before entering. The resident said that the lock on their bedroom door was not working and that they would like it repaired. The manager gave examples of how the privacy of the residents was respected when assisting with personal care and when they received visits from their relatives. A resident said, “They respect my privacy”. DS0000017426.V303338.R01.S.doc Version 5.2 Page 11 DS0000017426.V303338.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Taking part in activities, particularly in the community, gives residents the opportunity to become more independent and to enjoy an interesting and stimulating lifestyle. The support of staff enables residents to maintain family contact. The right of residents to exercise choice is respected. Residents have a varied and balanced diet, with dishes to satisfy cultural needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that one of the residents likes to accompany her on visits to cultural centres etc and that she accompanies the resident to the mosque. The other two residents travel independently, using public transport. One resident attends a cultural day centre from Monday to Friday and goes to the bhajans each afternoon. Residents practice their religious observances in their rooms and this is respected. Residents confirmed their use of community facilities including the library, cafes and pubs etc. On the morning of the inspection a DS0000017426.V303338.R01.S.doc Version 5.2 Page 13 resident was going to the cinema. Residents have access to Asian satellite channels. One resident said that occasionally friends come to the home to visit them and the resident confirmed that visits took place in the privacy of their room and that the owners always made visitor welcome. Another resident has visits from their family, including the grandchildren, and on a previous inspection a family member confirmed the welcome given by the owners and said that refreshments are provided. The manager said that she provides a “hotel service” for residents and that they are given a key to the front door so that they can have access to the home at all times. A resident confirmed that they are able to have their meals at the time they choose and that the time could vary from day to day, according to what they were doing. The manager said that each resident liked to have their evening meals at a different time and that as this was a “small home” they were able to support the residents’ 3 different lifestyles. The manager said that it was not a house but a home, the residents’ home. Due to the refurbishment of the kitchen there have been changes to the menu. However the food prepared and served meets the religious, cultural and dietary needs of residents. Some take away meals have been included in the menu although a relative of the manager, who lives close by, is doing most of the cooking. During the inspection they delivered the lunch, which consisted of curried chicken, rice and a mixed salad for the Asian residents and plain chicken etc for the Irish resident. The food smelt appetising and residents said that the meal was “good”. One resident said that they have particular likes and dislikes and confirmed that the menu is amended to meet these. The resident said that they “get what suits me”. The manager prefers to use fresh ingredients for meals and one of the residents likes to visit a local shop and will either purchase goods, to be reimbursed by the manager, or arranges for the goods to be delivered to the home. There was a variety of fresh fruit in the home for the residents. One resident said that when they wished to eat their meal in their room they were able to do so. The resident prefers a quiet environment. DS0000017426.V303338.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 There is a complaints policy in place to protect the rights of residents and a resident said that they knew whom to talk with if they had a problem. An adult protection policy and protection of vulnerable adults training for people working in the home contributes towards the safety of residents. This training needs to be updated on a regular basis. Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place and it includes information on how to contact other agencies e.g. the CSCI. The manager said that no complaints have been recorded since the last key inspection in 2005. She said that she speaks to each resident on a daily basis and encourages him or her to give feedback. A resident confirmed that if they had a problem they would speak to the proprietors. It is recommended that the format of the procedure is reviewed as English is not the first spoken language for all of the residents. The home has an adult protection procedure in place and it includes a link to the local authority guidelines for the protection of vulnerable adults. The home has a copy of the local authority guidelines. The manager said that no DS0000017426.V303338.R01.S.doc Version 5.2 Page 15 allegations or incidents of abuse have been recorded since the last key inspection and was clear about reporting lines in the event of any allegation or incident. The manager has attended protection of vulnerable adults training although they said that this was some time ago. There are policies in respect of handling resident finances. DS0000017426.V303338.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 26 Residents enjoy a comfortable and homely environment with pleasant communal facilities. The home is located in the heart of the community and residents benefit from easy access to community facilities. Residents live in a home where standards of cleanliness are good. Single rooms with en-suite bathing and toilet facilities afford residents their privacy. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in within walking distance of the library, high street and transport facilities and 2 of the residents make full use of this. Since the last key inspection a programme of refurbishment has taken place in communal and DS0000017426.V303338.R01.S.doc Version 5.2 Page 17 private areas. There is a small neat and well-kept garden area at the rear of the house. Communal facilities in the home consist of a large split-level lounge and dining area at the front of the house and a large open plan kitchen/dining/seating area at the back of the house with access to the garden. The communal area at the back of the house was in the process of refurbishment. The total space is sufficient to meet the needs of the residents and the proprietors, who live on the premises. They also enable residents to have a choice of where they sit and relax. Each of the residents’ bedrooms has ensuite facilities i.e. a toilet and either a shower or a bath. In addition there is a toilet on the ground floor, close to communal areas and a bathroom, with toilet, on the first floor. Toilet and bathing facilities are sufficient for the 3 residents living in Sisha House and for the proprietors who live on the premises. A resident said that they liked their bathroom and having their own private facilities. Another resident said that they liked having their own shower. Each resident has his or her own single bedroom. One bedroom is situated on the ground floor and 2 bedrooms are situated on the first floor. Each bedroom is at least 10 square metres and contains furniture sufficient for their needs. Rooms were furnished in a “homely” manner. Two residents said that their rooms were good and the third resident said that their room was “alright, it suits me”. All areas seen during the site visit were clean and tidy and free from offensive odour. A resident said that the home was cleaned each day and that they were pleased that their room was cleaned when they were out. They were also satisfied with the laundry service in the home. Laundry facilities are included in the fitted kitchen as this is a care home for 3 residents, which was registered when the local borough was the regulatory authority. The manager has undertaken training in infection control procedures. DS0000017426.V303338.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Staffing levels are sufficient to support the current needs of the residents and residents enjoy a service tailored to their individual needs. Residents benefit from a service provided by carers whose work practice is based on an understanding of the needs of the client group. Their understanding has been developed and enhanced by NVQ training. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home accommodates 3 residents, 2 of which enjoy going out each day. The manager confirmed that either her or her husband or both of them were on duty during the day. They live on the premises and at night they are asleep but on call. A call alarm system has been installed and if a resident is in their room the resident can summon assistance at any time during the day or night. Suitable arrangements are in place to cover the caring duties if the manager and her husband are both off duty. Only the manager provides assistance with personal care tasks and the residents are mainly self-caring. A domestic is employed for cleaning the home. The manager cooks the meals. All staff DS0000017426.V303338.R01.S.doc Version 5.2 Page 19 working in the home have the linguistic skills to communicate with residents and have knowledge of the cultural and religious needs of residents. The manager and her husband are the only carers working in the home and Mr Bhanji has now completed his NVQ level 2 training. The certificate of achievement was available for inspection. As the manager has an NVQ level 4 qualification the home has exceeded the 50 target for carers to achieve an NVQ level 2 qualification and is to be commended. No recruitment has taken place since the last key inspection. The home does not have a team of carers, other than the manager and the proprietor. Both have undertaken training in safe working practices and the domestic has also undertaken training in these areas. DS0000017426.V303338.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 A competent manager promotes the efficient and effective running of a care home. Comments or suggestions made by residents or by those acting on their behalf are used to improve the quality of care provided. Residents’ finances are safeguarded by clear and complete accounts. Regular maintenance of the property and of the fire precautionary systems assist in providing a safe environment for residents. Training in safe working practice topics promotes the health and safety of residents although training needs to be updated on a regular basis. Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000017426.V303338.R01.S.doc Version 5.2 Page 21 The manager has run the home for over 10 years. She has completed her NVQ level 4 in Management qualification and the certificate has been previously made available for inspection. There are a number of certificates on file for both the manager and the proprietor, which demonstrate that they have undertaken periodic training to update their knowledge and skills. As the home accommodates only 3 residents feedback is on a one to one basis. All residents are able to communicate with the manager and proprietor and communication is in the resident’s first language. If relatives of the residents visit the home the manager is available, if required, and she said that she asks for feedback from them on the quality of the service provided. She said that she acts on suggestions or comments made. The records of money kept on behalf of service users were available for inspection. One resident manages their own finances while the home gives support to the other 2 residents. One resident receives their personal allowance each week and signs a receipt for this. The receipts were up to date. The other resident draws what they wish, when money is needed. Again a signature is obtained as acknowledgement that the money has been received. There is a running total in respect of the balance held. Residents have been given assistance when a letter has been sent by the resident to the Benefits Office. A discussion took place with the manager and proprietor regarding health and safety in the home. There were certificates to demonstrate attendance on training courses in respect of safe working practices. However the manager said that the attendance on a manual handling training course had been some time ago. There were records of the monthly testing of the smoke detectors and fire alarms and of 6 monthly fire drills being held in the home. A servicing certificate for the fire precautionary systems and for the gas appliances was available. The electrical wiring installation certificate was valid until 2008. Valves to regulate the temperature of hot water leaving the taps in the residents’ en-suite facilities have been fitted. The home has copies of risk assessments for the building and in the event of fire. There was also a fire hazard analysis and a fire hazard action plan. DS0000017426.V303338.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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 2 3 3 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 DS0000017426.V303338.R01.S.doc Version 5.2 Page 23 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. 1 2 Standard OP7 OP18 Regulation 13.4 13.6 Requirement Timescale for action 01/04/07 3 OP38 13.5 4 OP38 23.4 That the care plan includes a risk assessment, with particular attention to prevention of falls. That the manager attends a 01/06/07 “refresher” training course for adult protection procedures, every 2 years. That the manager and proprietor 01/06/07 attend a “refresher” training course in manual handling, every year. That smoke detectors and fire 01/03/07 alarms are tested on a weekly basis. 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 OP7 Good Practice Recommendations That the monthly evaluations/reveiws of the care plan recommence. That the home contacts the placing authority, in writing, to request their attendance at a review meeting, at least on DS0000017426.V303338.R01.S.doc Version 5.2 Page 24 3 OP10 4 OP16 an annual basis. That the provision or non-provision of a key for the resident’s bedroom door is subject to a risk assessment, which is discussed and agreed and then reviewed at the six monthly care plan review meetings. That the format of the complaints procedure is suitable for residents that speak English as a second language. DS0000017426.V303338.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 DS0000017426.V303338.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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