Inspection on 12/02/07 for Spring Lane Care Home

This inspection was carried out on 12th February 2007.

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

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Spring Lane Care Home Spring Lane Care Home 170 Fortis Green Muswell Hill London N10 3PA Lead Inspector Mr David Hastings Key Announced Inspection 09:30 12 & 13th February 2007 th 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 Spring Lane Care Home DS0000061606.V323692.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. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Spring Lane Care Home Address Spring Lane Care Home 170 Fortis Green Muswell Hill London N10 3PA 020 8815 2000 020 8815 2001 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) Springdene Nursing & Care Homes Ltd Marilyn Prenilla Amrill Belgrave Care Home 63 Category(ies) of Dementia - over 65 years of age (63), Old age, registration, with number not falling within any other category (63) of places Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first inspection since the home opened. Brief Description of the Service: Springlane is owned by Springdene Nursing and Care Homes Ltd who own three other residential homes in North London. Springlane is the companies’ most recent development and has undergone a comprehensive refurbishment. This is the first inspection since the home has been registered with the CSCI. The home is divided into five floors. The main lounge, activities room and dining area are situated on the ground floor. The rooms on the ground floor are currently not occupied. The first and second floors each have fifteen rooms for older people. The second and third floors have fifteen and twelve rooms for people with dementia. Both these floors have a separate lounge and the forth floor has it’s own dining room. The entire home has been refurbished to an excellent standard. All sixty-three rooms have a wash hand basin and toilet. Fifty-one of the rooms are fully en-suite. There is a small lounge on both the first and second floor. There is a reception area on the ground floor and there is a pleasant garden at the rear of the home. There are two lifts to all floors. The home is situated in a residential area close to local shops and public transport. The stated aims and objectives of the organisation are “to provide homes that are safe, social, comfortable and healthy to live in. The home will be run for the benefit of the residents: that is its prime purpose”. The current scale of charges are £575 - £750 per week. Copies of this report are available form the home or from the CSCI website. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two days and in total lasted twelve hours. Seven staff, twelve residents and six relatives were spoken to. A tour of the premises took place and care records were inspected. The inspector was assisted by the manager and service manager who were open and helpful throughout the inspection. Prior to the inspection 18 feedback forms from relatives, 18 forms from residents and 8 forms from health care professionals were received by the CSCI. These were overwhelmingly positive about the standard of care provided by the management and staff at the home. One resident commented, “I am well looked after. All staff are caring, considerate and helpful”. Residents that the inspector spoke with were very positive about the care and support they received. A few issues of minor concern were highlighted in the feedback forms. These issues have been addressed in this report. At the time of the inspection there were forty people residing in the home. What the service does well: What has improved since the last inspection? What they could do better: Two requirements and six recommendations have been issued as a result of this first inspection by the CSCI. A clearer admissions procedure is required so that that the home does not admit residents whose needs they cannot meet. Quality monitoring at the home is good however the results of any quality audits need to be made available to residents. It is recommended that monthly reviews of care plans record the views of residents. Three recommendations have been issued as a result of the CSCI pharmacist inspection. The home must ensure that residents’ clothes are clearly labelled. The provision of Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 6 activities should include all residents both in groups and in one to one activities. These means that all residents in the home are kept occupied and engaged as they choose. The inspector is confident that these requirements and recommendations will be complied with by the manager and provider within the timescales given. 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. Spring Lane Care Home DS0000061606.V323692.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 Spring Lane Care Home DS0000061606.V323692.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): 1,3, 4 and 5 (6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about moving in to the home. The registered manager makes sure that all service users have an initial assessment so that they know the home can meet their needs before they move in on a trial basis. Service users and their representatives can visit the home before deciding to move in. The management and staff at the home have the skills and understanding needed to meet the needs of the people living there. EVIDENCE: The home has a satisfactory Service User Guide, which contains all the information required by this standard. Sixteen out of eighteen service users said they received enough information about the home before they moved in. Five pre admission assessments were examined from service users who have recently moved into the home. These were detailed and covered the elements Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 9 required by this standard. Service users and their representative that the inspector spoke with said they had been involved in these assessments and confirmed that they had visited the home prior to admission. Records indicated that service users had moved in on a trail basis and reviews of their placement had taken place after four to six weeks. Records indicated that one service user who’s primary care need was a mental health issue was admitted to the home last year. It was clear that this placement was not satisfactory and the service user had to be moved elsewhere. The home is registered to accept older people who may also have a diagnosis of dementia. The home is not registered to accept people who have mental health problems as their primary care need. The care of people with dementia is different from those people with mental health issues. This matter was discussed at length with the manager and the admissions officer. A requirement has been issued that no service user can be admitted to the home in the future who has a mental health issue as their primary care need. Both service users and relative that the inspector met said they felt the staff at the home could meet their needs and were overwhelming positive about the care they received. Staff interviewed had a good understanding of the needs of the service users in their care. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff know the service users well and provide an excellent standard of care and support which maintains service users’ privacy and dignity. Service users health, personal and social care needs are well documented in their plan of care. Service users receive the correct medication that has been prescribed for them, at the right times and they are only given medication by those staff who have been trained to do so. EVIDENCE: The inspector examined ten care plans during the inspection. These plans gave detailed information for staff on how to meet the assessed needs of service users. Staff that the inspector spoke with had a good understanding of the care needs of service users and how the care plan enables all staff to provide a consistent approach to the care provided. There was evidence that plans are being reviewed regularly and appropriate risk assessments were seen. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 11 These risk assessments included pressure care, manual handling, falls and risks associated with dementia. There was evidence from service users’ files that they had good access to health care professionals. Service users confirmed that they could see a doctor or other health care professionals when they needed to. The CSCI pharmacist undertook an inspection of the home’s medication receipt, administration and disposal. The report will be sent to the home and kept on the CSCI file and will be referred to in the next inspection report. There were no major issues identified and three recommendations were given as a result of the inspection. Throughout the inspection it was observed that the staff were supporting service users to receive personal care with privacy. The service users were also observed to be well groomed and to be receiving a high standard of personal care. Service users that the inspector met said they were treated with dignity and respect. One issue was highlighted by the feedback forms and from speaking to service users and relatives during the inspection. Service users told the inspector that sometimes the correct clothes are not returned from the laundry. The manager informed the inspector that this was due in part to clothes not being properly labelled. A recommendation has been issued that the home’s policy on labelling clothes should be reviewed to ensure that all clothes and properly labelled on admission and when purchased for service users subsequently. Spring Lane Care Home DS0000061606.V323692.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can choose from a varied range of activities provided by the home. The home provides a varied, wholesome and appealing menu, which is regularly discussed and reviewed at residents’ meetings. Service users are able to exercise choice and control over their lives. Visitors to the home are encouraged and made welcome. EVIDENCE: The home employs two activities coordinators. Records indicated that service users could choose from a range of activities including trips out of the home. The inspector met both activity coordinators and was impressed by their commitment and enthusiasm to the work. Most group activities take place on the ground floor. The activities coordinators also work some of the time on the dementia units. On the second day of the inspection a number of service users were going out to visit the British Museum. The registered manager assured the inspector that service users Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 13 often go out of the home to the local shops with staff. There are a number of group activities available for service users during the week. Some service users and their relatives did mention that weekends and evenings were quiet. Other service users said they did not want to join in group activities. A recommendation has been issued that all staff record every individual service user’s hobbies and interests on their care plan so that all staff working at the home are able to keep service users engaged and occupied as and when service users require. All visitors to the home that the inspector met or obtained feedback from said they were made very welcome when they visited the home. Management and staff always offered visitors tea or coffee and there was particular praise for the reception staff at the home. The complaints book highlighted an issue with a very small minority of visitors being rude to staff. This was discussed with the manager and the inspector suggested that statements reminding visitors of the need for courtesy might help support staff. Care plans gave good examples of how choice is offered to service users in relation to activities, food, clothes and personal care. Service users told the inspector that they felt they had choice and control over their lives. Records of residents’ meetings also provided evidence that service users could have a say in the running of the home. There was evidence that service users could choose the menu they wanted and service users told the inspector that the chef would make them something else if they did not want what was on the menu for that day. There was evidence that service users regularly discussed the menu plan at service users’ meetings. Snacks are available throughout the day. Service users were observed enjoying their lunch in relaxed and pleasant surroundings. Staff were giving discreet assistance were needed. Service users commented that the food was very good at the home. The inspector visited the kitchen during the inspection. It was found that fridge temperatures were being routinely recorded. The kitchen was clean and well maintained and there was plenty of fresh fruit and vegetables available. Spring Lane Care Home DS0000061606.V323692.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 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All complaints are taken seriously and dealt with in an open manner within set timescales. Service users are protected from abuse by clear policies and procedures and by a well-informed, trained staff group. EVIDENCE: The complaints records were inspected. The manager records all complaints and concerns, however minor. These records were recorded in a comprehensive manner and there was evidence that they had all been investigated. It was clear from discussion with the manager that complaints are taken seriously and dealt with in an open and professional manner. Service users were aware of the complaints policy. The home has a satisfactory adult protection policy and procedure, which is in line with the Department of Health’s guidance “No Secrets”. Staff have received training in adult protection. Staff interviewed had a good understanding about the types of abuse faced by older people and the procedure for reporting any suspicions to the appropriate authority. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained, safe and decorated and furnished to a high standard. Service users have safe, comfortable bedrooms with their own possessions around them. The domestic staff work hard to ensure the home is always clean and free from offensive odours. EVIDENCE: Springlane has been completely refurbished since being purchased by the new provider. All areas of the home are decorated and furnished to a high standard. The garden provides a paved area with seating. Service users that the inspector spoke with were happy with the layout of the home and their individual bedrooms. Rooms that the inspector visited had been individualised with the person’s own furniture and personal possessions. There is a large communal lounge on the ground floor with a dining area and smaller lounges Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 16 on the other floors. Service users said they liked to sit in the ground floor as they could see what was going on. The fourth floor has a self contained lounge and dining area. The home was clean and free of offensive odours. The home has good policies in connection with infection control. Records indicated that staff have attended infection control training. The laundry is situated in the basement and contained the appropriate washing facilities for the home. Service users and visitors praised the work of the domestic staff at the home and said the home was always clean. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users benefit from a positive, well trained and competent staff team. The manager ensures that staff receive the training they need to carry out their work in a professional manner. Service users are supported and protected by the home’s recruitment policies and procedures. EVIDENCE: On the day of the inspection there were forty service users residing at the home. Staffing levels appeared sufficient for the number of service users and their level of dependency. The rota was examined and matched the names of staff on duty. Service users were very positive about the staff group. One service user commented, “I’m very looked after” another commented that the staff were, “ very good, they have a lot of patience”. The manager informed the inspector that 70 of care staff have obtained NVQ level 2 or equivalent. This exceeds the requirements of Standard 28 of the National Minimum Standards for Older People. The inspector examined a satisfactory training programme and there were copies of relevant certificates on file. Training covered mandatory training as well as training in dementia and diversity. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 18 Staff interviewed were positive regarding the training they had undertaken at the home and the training opportunities available to them. Three files of recently employed staff at the home were examined. These all contained the information required by Standard 29 of the National Minimum Standards including proof of identity, written references and CRB disclosures. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users and staff benefit from a manager who takes her responsibilities seriously and makes sure the home is well run. Service users are able to have their say in the way the home is run and their input is used by the management to improve the quality of the service. Staff are being appropriately supervised. Service users financial interests are safeguarded by clear policies and procedures. The home has good systems in place to monitor health and safety compliance. EVIDENCE: Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 20 It was clear from discussion with the manager that she has the competences and skills required to run the home effectively. Staff and service users were very positive regarding the manager’s abilities. One visitor was particularly impressed with the way the manager deals with issues, “both large and small”. One service user described the manager as, “a very good, lovely woman”. There was evidence that the manager updates her training as and when required. There was evidence from regulation 26 reports, residents meetings and six monthly customer satisfaction surveys that service users’ views are sort and used to monitor the quality of the care provided by the home. The information from these sources needs to be complied and published for existing as well as prospective service users and their representatives and other stakeholders. A requirement relating to this has been issued in the relevant section of this report. A recommendation has also been made under this standard that service users’ views are sought and recorded during their monthly care plan review. Records indicated that staff undertake supervision approximately every two months. Staff confirmed that they received supervision from the management of the home. Small amounts of money are held by the home on behalf of service users. This money is used to buy various items for individuals such as toiletries and to pay for hairdressing and outings. A sample of these accounts were examined and found to be accurate with clear audit trails. The fire logs were inspected. Weekly fire alarm checks and regular fire drills are recorded as taking place. Satisfactory records were examined in relation to gas safety, electrical installation, Legionella tests and fire alarm maintenance. Portable Appliance testing is carried out by the maintenance person. The service manager assured the inspector that the equipment used to carry out these tests did not require the maintenance person to undertake any outside training. Records seen indicated that staff are undertaking the required training in health and safety issues such as first aid and moving and handling. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 21 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 4 X 2 3 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X 4 X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 3 X 3 Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14(1) Requirement The registered manager must ensure that no service user is admitted to the home in the future who has a mental health issue as their primary care need. The registered manager must ensure that the outcomes of quality monitoring reviews are complied and published for existing as well as prospective service users and their representatives and other stakeholders. Timescale for action 01/03/07 2. OP33 24(2) 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP10 Good Practice Recommendations The registered manager should ensure that the home’s policy on labelling clothes is reviewed to make sure that all clothes and properly labelled on admission and when purchased for service users subsequently. The registered manager should ensure that all staff record DS0000061606.V323692.R01.S.doc Version 5.2 Page 23 2. OP12 Spring Lane Care Home 3. OP33 every individual service user’s hobbies and interests on their care plan so that all staff working at the home are able to keep service users engaged and occupied as and when service users require. The registered manager should ensure that service users’ views are sought and recorded during their monthly care plan review. Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Spring Lane Care Home DS0000061606.V323692.R01.S.doc Version 5.2 Page 25 - 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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