Inspection on 07/07/05 for Spring Grove

This inspection was carried out on 7th July 2005.

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

The inspector 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

Spring Grove 06/06/06

Spring Grove 06/12/05

Spring Grove 25/02/05

Spring Grove 11/05/04

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 Spring Grove 214 Finchley Road London NW3 6DH Lead Inspector Franki Solomon and for part of the inspection Hannah Hanley. Announced 7 July 2005 10:00am 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. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Spring Grove Address 214 Finchley Road London NW3 6DH 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) 020 7794 4455 springgrove0@btconnect.com Springdene Nursing & Care Homes Limited Mrs Martha Ohene Acquah Care Home 46 Category(ies) of OP Old age (46) registration, with number of places Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Spring Grove is Registered for the provision of personal care only for up to 46 frail elderly people. Date of last inspection 25th February 2005. Brief Description of the Service: Spring Grove is a private care home which provides support to vulnerable frail older people aged 65 and over. The home is registered to provide personal care to forty-six service users the majority of whom are privately funded. The home is furnished to a high standard and is one of three care homes owned by proprietors Springdene Care Homes Ltd. The building is purpose built over three floors with a smart hotel style front entrance and reception area. All floors can be accessed via 2 lifts. The home has forty single and three double ensuite bedrooms. The double rooms are set aside for couples. Residents also have access to communal toilet and bathroom facilities. Each floor has a small self-service kitchen. The homes main kitchen is on the ground floor adjacent to the dining room. A spacious communal lounge, art room and atrium is also on the ground floor. A library is on the 1st floor which leads out to the upper landscaped garden. The serviced laundry room, parking area and maintenance workshop is on the lower ground floor. The home is situated near to shopping and community facilities. The home provides 24-hour personal care. There is a staff team of forty seven including the registered manager, two deputy managers, team leaders, a fulltime housekeeper, activities co-ordinator, qualified chef, kitchen staff and maintenance operative all of whom are accountable to the Operations manager Mrs Diane Surtees. Springdene Nursing and Care Homes Ltd as the providers are responsible for the management and maintenance of Spring Grove. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first statutory inspection of the year. The inspection was arranged on an announced basis so that the manager would be present. Concerns had recently been raised with the Commission in respect of the care of a Service User and the findings from this are reflected in the report. Franki Solomon was accompanied by her manager Hannah Hanley. Franki Solomon continued the inspection which lasted approximately 5 hours. Present at the inspection at various intervals were the Registered Manager, the Operations Manager and one of the Directors. The inspector was able to observe the residents, the staff’s interaction with them. Four residents gave their views about living in the home and staff were interviewed. The premises and rooms were seen. A variety of records, care plans and training files were looked at. What the service does well: Staff clearly care about the residents. The home responds well to items and issues raised by residents and the Commission for Social Care Inspection. For instance when the residents requested more staff cover, senior management reviewed and increased the staffing levels, Requirements (under the Care Standards Act 2000) raised by the Commission are promptly complied with. The upkeep and maintenance of the home is clearly an ongoing programme and an enquiry about water temperatures from the inspector was diligently followed up by the maintenance operative. The Activities programme led by the Activities organiser is very varied, geared towards residents’ needs and interests and creative. On the day of the inspection, the residents were involved in the Art Group with an Art teacher. It was evident the residents were engrossed and enjoying the activity. Regardless of the skill or lack thereof, residents gained confidence through the encouragement by the Art teacher. The residents clearly took pride in their efforts. The Operations Manager, and the Director Dr Powell demonstrated an active interest in the inspection in order to ensure any issues or enquiries raised concerning the home or residents were resolved satisfactorily. The Registered Manager is a National Vocational Qualification (NVQ) Assesssor, who does in-house training and was planning a revised training programme for staff on the appropriate and required recording for Care Plans. The home deals with residents requests, issues or complaints very well and should be commended on their action taken on the issues raised in the Minutes of the Residents meetings. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Requirements have been made in this report of the issues identified below: • • • • • • Care Planning Medications Management Record keeping Development of a protocol in relation to seeking medical assistance Staff training in relation to the above More robust Quality Assurance monitoring to be undertaken by the Registered Persons From a sample of care plans, one indicated the recording in Care Plans could be improved, notes in the care plan taken was fragmented and not in chronological order. Note taking should be written to follow in sequence. Clear guidance and protocols are required so that the person in charge of a shift would be able to act promptly to seek medical assistance when a resident becomes unwell. From the same sample it was found that appropriate documentation to enable an individual plan of action for each identified need and to enable regular reviews of such was not in place. Training for staff in the areas of care plan forms, documentation, note taking, recording and referral to appropriate policies and procedures areas are required. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 7 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. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 8 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 Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 9 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) 3. Documentation demonstrated that on the whole service users have their needs assessed prior to and on admission to the home. However, such assessments needs to be carried out promptly and documentation put in place at the time of admission to the home. Standard 6 is not applicable as no Intermediate Care is provided. EVIDENCE: *The inspector viewed a sample of four care plans, three had the Needs Assessment documentation in the service users’ care plan. Dates for further reviews were not indicated. The fourth care plan did not have the Assessment of Needs at the time of the admission of the home in their current file. The assessments checked included identification of health, social care needs and activities of daily living such as for; • Personal hygiene • Dietary preferences Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 10 • • • • Mobility Risk Assessments in relation to falling Medication usage Continence and so on. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 11 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 &9. Generally the home demonstrated good record keeping in respect of assessment of service users’ needs and how such needs were being met on a daily basis. However care planning is not adequate to meet their assessed needs and managers are endeavouring to address this matter. Staff have not been sufficiently vigilant to ensure all medications administered to all service users aree recorded. The home has insufficient protocols in place in respect of summoning medical assistance. EVIDENCE: There was not an individual care plan for activities. Service users Care Plans checked demonstrated a plan of action to address service users’ each individual need which was in the form of a page for each plan of action. This format was not sufficient to demonstrate the service users’ changing needs nor did it have the space to record evaluation of each particular need. Care Plans on the whole demonstrated good ongoing daily records of the care being delivered. However, one service users’s Care Plan, although having Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 12 identified his each individual need as part of the assessment process, there was no Plan of Action in place of how such needs were to be met. The sample of care plans seen were set out in a letter form which was not easily identifiable as a care plan. The inspector did have sight of an earlier format which was laid out appropriately, and set out clearly: ‘Description of Risk’ ‘Client Family Views’ ‘Action Plan to manage risk’ with the space for the signature of the Keyworker and the Manager or Deputy with the date, and date of the next Review. A Care Plan could be set out similarly for instance for Nutrition; Continence; Pressure Sores; Any infection; Activities etc. – for each identified need a separate care plan which must always be signed off. Policies and procedures for medication were in place. However, from the sample of records examined, it was difficult to follow the administration of medication to one resident in respect of dates for medication such as eye drops commenced. Having discussed this matter with the Registered Manager it was established eye drops administered to one service user had not been signed for as having been administered on a number of occasions. From the sample of service users’ care plans viewed, the note taking and recording was fragmented on one Service User’s Care Plan regarding medication. The communication sheet and daily record did not tally in terms of medication administered. A homely remedy used in one instance was not recorded on the care plan or the MAR chart. The home is registered for personal care only and not nursing. There were no Protocols or criteria for when a G.P. should be called. Recent concerns about the lack of prompt action in relation to seeking medical assistance for one service user has highlighted the need for a protocol to be put in place which outlines the criteria for when a GP should be contacted to see a service user and for staff to receive training in this respect. The records examined showed that the Local Authority responsible for a number of residents, have responded to requests from the manager to undertake reviews of those residents’ care plans. Records evidenced that residents have access to a chiropodist and an optician. These visits were recorded but not on the residents’ individual care plan. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 13 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 - 15. Residents were able to engage in a variety of activities. Links with the community are good. Activities were appropriate to the residents wishes. Residents had contact with their families as they wished. The meals in the home were of a high standard and enjoyed by residents. EVIDENCE: The home had a very varied and creative Activities Programme developed in consultation with residents suited to their wishes. On the day of the inspection some residents had gone out. A visiting entertainer was performing. Also a group of residents were involved in an arts activity with a professional teacher. In discussion with the Activities Organiser, the inspector saw programmes, leaflets and flyers of the various activities. The inspector spoke with residents who confirmed these activities were enjoyed. Records indicated School children came to the home to entertain. The home did not have individual care plans for Activities. The inspector spoke with four residents who said the meals were enjoyable. The menus seen indicated food was varied and nutritious. The dining room was laid out in a smart hotel-style manner and tables dressed in an equally high standard. The inspector observed appetising food being served in a delectable manner. Residents had a choice from a five course menu. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.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 & 18 Complaints are dealt with appropriately and according to regulations. EVIDENCE: The inspector viewed the complaints procedure and complaints log. Since the last inspection in February 2005. Six complaints had been received. All had been responded to. Five were resolved satisfactorily. One complainant remained dissatisfied with the response to the concerns he raised. The commission are reviewing this matter as part of this inspection process. The home had their own Protection of Vulnerable Adults (PoVa) policies and procedures, as well as the London Borough of Camden’s PoVa Guidelines. The home also had a Whistle Blowing Policy which means that any staff witnessing or suspecting any abuse of a resident, they are, under the policy, compelled to report it to the Manager or any senior member of staff or the Directors. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.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 & 26. The home is purpose built of high standard, well maintained and safe, pleasant clean and hygienic. EVIDENCE: The inspector did a tour of the home. The home was free of odours and cleaned to a high standard. The gardens were well maintained. The home has a team of domestic cleaners who are on duty every day to do day to day cleaning, and also to undertake any immediate cleaning of accidental spills or untidiness. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 16 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. The skills mix of staff was satisfactory. The home’s recruitment policies, and procedures were assessed as satisfactory. However improvements in respect of in care planning, administration of medications, record keeping and critei are necessary for seeking medical assistance. EVIDENCE: The inspector looked at the home’s staffing rota and the staff team, staff files and the training file. These demonstrated the home had an appropriate number of staff with different skills and qualifications. Staff policies and procedures, together with the sample of staff files looked at demonstrated the home aims to ensure the safety of service users. The home has a training programme which the inspector examined. The manager is an NVQ Assessor and is responsible for in-house training. The manager advised training needs had been identified in terms of care plans and through appraisals. Training files evidenced both the Manager & Deputy Manager were Registered Nurses; of the 3 Team Leader, 2 had National Vocational Qualitifications (NVQ – Level 2) and a third was an Assessor for NVQ. Of the Care staff, at the time of the inspection two were undergoing their NVQ – Level 2 and anticipate to complete their training by August 2005 which would mean Spring Grove will have half their staff at the required training levels. A proportion of staff attended a Protection of Vulnerable Adults course with Age Concern. The home also has an in-house Video about Protecting Vulnerable Adults. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 17 The need for staff to undertake further training in respect of administration of medications and on criteria for seeking medical assistance was highlighted. Staff files indicated that all staff have 2 references and everyone had the Criminal Records Bureau (CRB) check. The inspector spoke with a number of residents. They all said they were satisfied with the support received from staff who were kind and patient. To the question from the inspector, those residents spoken to said they had no reason to complain. From the minutes of the residents’ meetings it was indicated that residents did not feel there was enough staff cover at certain times. This was rectified by management. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 18 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) 33, 35 and 38. There is insufficient monitoring and action taken by the Registered Manager in relation to ensuring: • • • Robust Care Plans are in place for service users; Robust procedures are followed in respect of medications managerment; Prompt accessing input from a General Practitioner. These issues are being addressed and requirements have been made in this respect. More attention is required in respect of meeting the health needs of service users as outlined in the main body of the report. Generally, Spring Grove aims to run their service and to provide support in the best interests of service users. Service users’ financial interests are safeguarded. EVIDENCE: Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 19 Findings in respect of standards 7, 8 & 9 highlights the need for the Registered Manager to closely monitor Care Planning arrangements, the manager of medications and access to medical care and take appropriate action to ensure such arrangements meet National Minimum Standards. The inspector examined a sample of residents’ monies held for safekeeping by the home. Accounts tallied. The financial policies and procedures were that only the manager and deputy manager manage the residents’ finances and the accountant audits the accounts once a week. There is now a system in place, providing quality monitoring reports. The requirement made at the last inspection for the Registered Manager to produce monthly reports have been met. The inspector viewed the fire drill records which were undertaken monthly. The inspector thought the water in one room was somewhat hot to the touch. The Operations Manager produced the water temperature records which indicated temperatures were checked weekly and to be within the required temperature. The Maintenance Operative also checked the water temperature at the time of the inspection with a thermometer which indicated the temperature was within required limits. The home’s own inspection under Regulation 26 recorded the front doors had been sanded, re-stained and varnished. Garden chairs, terraces had been power cleaned by the maintenance staff and garden rails had been painted. The inspector viewed the records for Portable Appliances Testing (PAT), these showed that testing had commenced in February 2005 ongoing until 22 June 2005. Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 20 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 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 4 15 3 COMPLAINTS AND PROTECTION 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x 2 x 3 x x 3 Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 21 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 3 Regulation 14(1)(2) Requirement The registered person must make sure the individuals assessment of needs are filed appropriately, accessible and available. The Registered Person must ensure service users Care Plans set out in detail the action which needs to be taken by care staff. This should include Social Activities. The care plan must be reviewed by care staff in the home at least once a month, more often if required and a date set for the following review. The Registered Person must take action to ensure a robust protocol is put in place which outlines the criteria for when to ask the G.P to see service user and all relevant staff receive training in this respect. The Registerd Person must ensure all medication adminstered, including homely rememdies, are appropriately recorded in care plans and Medication & Administration charts. Training of staff must be given in terms of documentation, Care Timescale for action 07/10/200 5 2. 7 & 12.3 12(1)(a) 14(2) & 15(1) (2). 07/10/200 5 3. 8.1 13(1)(b) 07/08/200 5. 4. 9.1 & 9.3 & 9.4 13(2) 07/08/200 5. 5. 30 18(1)(i) 07/08/200 5. Page 22 Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 6. 33 12(1) & 13(1)(2) & 15(1)(2) Plans format, note taking and recording of medication; appropriate filing of records in terms of initial assessment of needs, and records having to be in sequence.. The Registered Manager must ensure that more robust monitoring takes place in relation to Care Planning, Medications management and access to medical care (see Standard 7, 8, 9 & 33). 07/08/200 5. 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 Good Practice Recommendations Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Centro 4 20-23 Mandela Street Camden Town London NW1 0DW 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 Spring Grove G58 s10336 Spring Grove v169909 070705 Stage 4.doc Version 1.30 Page 24 - 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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