Inspection on 05/07/05 for South Bristol Rehabilitation Centre

This inspection was carried out on 5th July 2005.

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 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

South Bristol Rehabilitation... 26/06/07

South Bristol Rehabilitation... 22/11/06

South Bristol Rehabilitation... 05/01/06

South Bristol Rehabilitation... 09/03/05

South Bristol Rehabilitation... 11/10/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOMES FOR OLDER PEOPLE South Bristol Rehabilitation Centre 30 Inns Court Green Knowle Bristol BS4 1TF Lead Inspector Sandra Garrett Announced 5 July 2005 09:30 th 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 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. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service South Bristol Rehabilitation Centre Address 30 Inns Court Green Knowle Bristol BS4 1TF 0117 9038392 0117 9038395 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bristol City Council Mrs Susan Ann Moore PC Care home 20 Category(ies) of OP Old age (20) registration, with number PD Physical disability (2) of places South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 2 persons over 50 years with a Physical Disability Date of last inspection 9 March 2005 Unannounced Brief Description of the Service: South Bristol Rehabilitation Centre is operated by Bristol City Council Social Services and Health and Bristol South & West Primary Care Trust, providing short-term care and rehabilitation for up to 18 people who are 65 years and over. The centre can also provide support and care for two persons aged over 50 in the physical disability category. The centre is jointly operated and funded by both social services and health. The aim is to provide support and rehabilitation for older people who need both specialist input and/or a period of respite after illness or trauma so that they can return to their own homes. A residential programme of care is provided over a period of eight weeks, although this can be extended if necessary. The centre is situated on the second and third floors of a former older persons’ care home. It is therefore accessible and has a number of aids and adaptations. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out to ensure management and Staffing levels are appropriate to meet service users’ needs, following recent changes in personnel. The inspection was carried out over two days. Documents examined included service user and relative comment cards, preinspection questionnaire, plus care and administrative records. Nine service users were staying at the centre at the time of the visit and five were spoken to. What the service does well: What has improved since the last inspection? It was pleasing to note that all ten requirements from the last inspection in October 2004 have been met. Requirements were in respect of food, complaints, health and safety, service users’ security, physical access and overall management of the centre. Service users can be confident that their health and wellbeing is given the utmost importance. The appointment of a temporary manager to cover long-term absence has enabled better communication and improvement in staff morale, that will benefit service users. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 6 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. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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 standard(s) 1 & 3 The Statement of Purpose and Service Users Guide provide good information for new service users that meet their needs. Clear assessment information in respect of service users and their needs is in place. Specialised facilities, equipment and staff are provided for Service users’ rehabilitation. EVIDENCE: The amended Statement of Purpose and Service Users Guide were found to be comprehensive and detailed. Some minor amendments were still needed i.e. to ensure accessibility for visually impaired service users and to make sure the Commission’s details were correctly inserted. As many service users are admitted to the centre from hospital, clear preadmission assessments were available i.e. original occupational therapy assessments and hospital transfer forms with information about pressure areas, wounds etc. The centre carries out assessments on admission that form the basis of weekly goals for each service user to meet during the period of their rehabilitation. Assessments are carried out by centre staff that include the physiotherapist and occupational therapist. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 9 Dedicated staff including physiotherapist, occupational therapist and centre nurse are provided and all care staff are trained to give rehabilitation support to service users that enable them to regain strength and confidence. This package of support ensures an early return to their homes following the intensive programme of rehabilitation. In a weekly review sheet that documents progress, a service user had commented ‘I’m pleased with my progress so far. I take all advice from the physio as its in my best interests and I want to get home’. The service user confirmed that s/he had indeed said this. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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 standard(s) 7 & 8 Service users are involved in the planning of their care and rehabilitation. Provision of care plans for all service users must be maintained. Care and healthcare records need attention to ensure holistic care provision. EVIDENCE: Service users care plans were clear and recorded all actions towards achieving individual goals. Some service users also had nursing care plans. Photographs that were a requirement from the last inspection were seen in each service user’s records. Care records were clearly written from service users’ viewpoints and demonstrated their abilities and need for assistance with tasks. All care records seen were written from a person-centred perspective and in the language of the service user. Service users confirmed the comments that were seen. All goals are reviewed weekly and clear records were in place that documented the reviews and outcomes. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 11 Some service users with wounds or pressure areas identified from preadmission information, had neither care plans or risk assessments in place for these. Nursing care plans were in place for some issues. However it wasn’t clear how these had been drawn up, by whom and how they would be monitored in between district nurse visits, or how they fitted with the existing rehabilitation action plans. A requirement was made to ensure risk assessments and care plans were put in place for those service users with wounds or pressure areas. It was pleasing to note that they had been done for the service users concerned by the second day of inspection. The situation in respect of the six intermediate care places needs clarification. These were originally contained within a local authority care home and were to be used for people discharged from hospital who needed care that was less than pure rehabilitation e.g. for a period of respite before going home or while adaptations are made to their homes. It had been agreed for South Bristol Rehabilitation Centre to take over the six places. At the time of this inspection one service user was being cared for in one of these. This service user required maximum care and no care plan was in place. It was not clear whether the service user’s identified needs were for nursing care or personal care only. This must be made clearer so that the service user is aware of what can be provided and staff are clear that they can meet assessed needs. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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 standard(s) 12,14 &15 Improvements are being made to provide social activities for service users to enjoy during their stay at the centre. Personal support is not always offered in such a way as to promote service user choice. The meals in the centre are good offering both choice and variety. EVIDENCE: The manager gave information about improving social time for service users. This had been done by organising a ‘strawberries and cream tea’ during the televising of Wimbledon fortnight. Service users confirmed that they had enjoyed this very much. Film nights are also planned. From records seen a service user’s preference to sleep in an armchair at night was not always respected by staff. Further the needs arising from this choice had not been met. The manager immediately remedied the situation but without discussing it with the service user who didn’t know why changes had been made. A good practice recommendation is made to ensure service user choices are respected and they are consulted about them. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 13 A requirement from the last inspection in respect of ensuring menus reflect supper choices available, was met. Menus seen gave lots of choice and clearly showed what food was available at suppertime. These included snacks, soup or cheese and biscuits. Service users said they enjoyed the meals provided that were found to be of good quality, tasty and nutritious with lots of choice at each meal. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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 standard(s) 16 The complaints recording system in place needs improvement. Complaints may not be given the priority that service users are entitled to expect EVIDENCE: Information about complaints and how to make them was seen in different places. Each service user had a copy of the local authority complaints leaflet and complaints information is given to them on admission. Information about complaints was also found in the Service Users Guide. Service users said they would know how to complain but felt they had no complaints at this time. However a requirement made at the last inspection in respect of complaints recording was not met. There was no clear system of complaints recording in place. A multi-faceted complaint had been received and well documented by the manager. However it was not clear whether all aspects of the complaint were upheld or not. It was pleasing to note that the manager put in place a clear system of complaints recording by the second day of inspection. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 15 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 standard(s) 19,22 &24 The standard of the environment within the centre is good providing service users with an attractive and homely place to stay. The environment has been improved for disabled service users and visitors. Further improvements to fittings within the centre are needed in order to protect service users from harm. EVIDENCE: The centre has been developed for rehabilitation purposes only and a high standard of specialised facilities are in place. These included a physiotherapy gym, separate domestic kitchens e.g. for gas and electric so that service users can practice preparing meals, plus aids and adaptations, including hoists and wheelchairs. The centre was very clean and hygienic at this visit with no unpleasant odours. Homely sitting and dining areas were seen although most of the service users said they preferred to stay in their own rooms. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 16 It was pleasing to note that requirements made at the last inspection in respect of the environment had been met. These included: covering the radiator in one of the bathrooms and clearing it of obstruction, making one bay in the centre car park accessible for disabled drivers and ensuring each service user has a lockable space in their room in which to keep private or valuable items. This is commended. From one service user’s comment card received prior to the inspection it was noted that:’ would have appreciated a bench to sit outside on sunny days’. However in some areas other radiators were seen that were not covered that could mean residents are at risk if they fell against them. A new requirement is therefore made to ensure all radiators are covered. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 & 30 Progress has been made in addressing staff shortages to ensure service users receive consistent care. Staff morale is improving although should be maintained through better communication with management. The standard of vetting new staff must be improved to ensure service users are not put at risk. Specific training in identified areas should be provided to ensure staff can meet the needs of any service users admitted to the centre. EVIDENCE: Recruitment of staff has remained an issue although the team manager said that recruitment is now taking place, particularly to recruit health and social care assistants for the Bowmead beds. Admissions had been restricted to enable staff to manage a smaller number of service users and their care needs. Staff spoken with said that they feel much happier now that they were working their contractual hours and are doing the work they are meant to be doing. Comments from service user and relatives comment cards revealed satisfaction with staff and the care they received e.g. ‘Personally I have had a very good time hear under the circumstances and all the staff have been super’, ‘I feel completely at ease knowing that Dad has been so well looked after’ and ‘the care that my mother received was 100 ’ South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 18 On the second day of inspection a telephone call between the manager and the local authority personnel department was overheard. This revealed that a staff member returning to the home a few months after leaving could restart without the appropriate checks being received to ensure service users’ protection. Clear advice was given about this and a requirement made to make sure that no staff member starts work until the results of such checks are received. Staff training records were seen. These demonstrated essential mandatory training, including manual handling, basic food hygiene and first aid takes place at regular intervals. Further all staff had undergone Protection of Vulnerable Adults training in the last year. Staff said that a community psychiatric nurse runs occasional mental health training. However they also said they would like training on dementia awareness or care as approximately 25 of service users have some degree of dementia or confusion. A requirement is therefore made in respect of this. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37 & 38 The manager has a good understanding of the areas in which the centre needs to develop and is aware of his own training needs in order to put development plans into practice. The centre has a clear programme of self-review that includes seeking the views of service users and their families. Some attention is needed to ensure confidential service user records are maintained. Improvements are needed to health and safety issues to ensure service users are protected from risk of harm. EVIDENCE: The acting manager although having little experience of managing care facilities, demonstrated his willingness to undergo specific training. NVQ Level 4 has been applied for but a memo from the local authority’s training department was seen that stated no assessor was available at the time to start working with him. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 20 The manager also gave information about an Open University professional certificate in health and social care and managing care that he has signed up to start later in the year. The manager had also made an application to the Commission to become the registered manager of the centre that was a requirement from the last inspection. Staff spoken with said that they feel the management of the centre had improved, was more flexible and reasonable leading to better team working. Staff said they feel happier as they are listened to and their opinions respected more. A district nurse visiting the centre echoed staff views and said that the relationship with the centre had been ‘fantastic’ lately – that she attributed to management changes. The manager said he had revised the exit questionnaires given to each service user and their relatives on leaving the centre. This had a range of open questions about information given to them about the centre, the environment and their room, cleanliness, staffing, choices and activities. Service users are invited to give their opinions on three things the centre does well and three things that it could improve upon. Collated information gained from the new questionnaires was not available at this visit and will be followed up at the next inspection. Daily records written in respect of service users were person-centred. However some records were seen written in the centre’s message book that should have been written in individual care records. A requirement is therefore made in respect of this to ensure service users’ rights to confidentiality are maintained. A requirement made at the last inspection in respect of ensuring daily recording of food probing and fridge/freezer temperatures was met. All records seen had been recorded daily and a sudden spiking of a freezer temperature had been promptly dealt with. The manager or deputy had countersigned the records to demonstrate they had checked them. This is good practice. Accident records were examined and a number of incidents adversely affecting service users had not been sent to the Commission as required under regulation. Further one service user had had three falls in a short period and was seen to be unsteady on her/his feet. However no specific risk assessment in respect of this was in place. Fire safety risk assessments were overdue for review e.g. response to fire alarms risk assessment was last reviewed in March ’04. A fire drill had been carried out in early July although this was also overdue and meant that two drills per year had not been carried out. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 21 A problem with the lift was identified during the inspection. The control panel didn’t always work when the button was pushed and the lift itself wasn’t always level when arriving at each floor. The risk assessment for use of lifts was due to be done in early May ’05 but it wasn’t clear if this had been done or not. A new requirement encompassing these issues is made in order to ensure service users are protected from risk of harm. South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x 3 x 3 x x STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x x 2 2 South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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. 2. 3. Standard OP7 OP19 OP29 Regulation 15(1) 13(4)(a) 19(1)(a), Sch 2 Requirement Care plans for all service users must be developed to ensure meeting of assessed needs All radiators must be covered No staff member can start working at the centre until a satisfactory povafirst check has been received as part of the Criminal Records Bureau check Training in Dementia awareness and care must be planned and provided for all staff The control panel of the lift must be examined and if necessary repaired or replaced. Fire safety risk assessments must be regularly reviewed and updated and fire drills carried out at least twice yearly. Notices of incidents affecting service users must be sent to the Commission. Specific risk assessments in respect of frequent falls must be put in place Timescale for action 1 September 05 1 September 05 3 August 05 4. 5. OP30 OP38 18(1)( c ) 13(4)( c ) 30 September 05 1 September 05 South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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. Refer to Standard 14 Good Practice Recommendations service users should be consulted and their right to make choices should be maintained wherever possible South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG 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 South Bristol Rehabilitation Centre D56_D05_S37003_SouthBrisRehabCentre_V232092_050705_Stage4.doc Version 1.30 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. 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