Inspection on 18/01/07 for Springfield

This inspection was carried out on 18th January 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

Springfield 16/02/06

Springfield 06/10/05

Springfield 25/02/05

Springfield 23/06/04

Springfield 03/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Springfield 1-3 Lowther Avenue Garforth Leeds West Yorkshire LS25 1EP Lead Inspector Stevie Allerton Key Unannounced Inspection 18th January 2007 10:00 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 Springfield DS0000001505.V323203.R02.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. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Address 1-3 Lowther Avenue Garforth Leeds West Yorkshire LS25 1EP 0113 2863415 0113 2878600 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) Springfield Care Services Mrs Glenys Lawson Care Home 55 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number disorder, excluding learning disability or of places dementia (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (3), Old age, not falling within any other category (30) Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The places for MD are for specific, named service users. Date of last inspection 16th February 2006 Brief Description of the Service: Springfield Care Home is situated in a residential area of Garforth, which is located on the outskirts of Leeds. The home is presently registered to care for fifty-five service users in two separate buildings. Springfield accommodates forty residents and Springfield Grange accommodates fifteen residents and is primarily a dementia care unit. Bedroom accommodation is provided in both single and double rooms, many of which have en-suite facilities. There is ramped access to both properties and passenger or stair lifts available to assist residents with mobility problems to reach the bedrooms on the upper floors. Both properties have pleasant communal areas for the residents to relax and/or dine in and communal toilet facilities are conveniently situated in both properties. The home is well served by public transport and there is a car park to the rear of the property. Current fees are from £410.00 to £460.00 per week. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out without prior notification and was conducted by one inspector over the course of a day, starting at 10.00am and finishing at 5.45pm. This was the first visit made by this inspector to the home. The Manager was on duty throughout the day and other staff team members assisted the inspector. Survey forms were sent out to a sample of residents prior to the visit and six were returned. One relative also spoke to the inspector by phone. Survey forms were also sent out to a selection of health and social care professionals and one was returned. The inspector would like to thank everyone who took the time to talk and express their views. Before the visit, information about the home since the last inspection was reviewed. This included looking at any notified incidents or accidents and other information passed to CSCI, including reports from other agencies, such as the Fire Officer. This information was used to plan this inspection visit. The inspector case tracked three residents. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, the inspector assessed all twenty-two key standards from the Care Homes for Older People National Minimum Standards, plus other standards relevant to the visit. The inspector spent time with residents and spoke to relevant members of the staff team who provide support to them. Documentation relating to these service users was looked at. Where possible, contact was also made with external professionals, to obtain their opinions about the quality of services provided at the home. What the service does well: The Statement of Purpose, the document that describes what the home’s philosophy is and what it provides, is very well written. Apart from being well laid out and easy to read, explanations are given about terms in use such as “care plans”. This approach involves service users in planning their own care from the start. Residents say that they value the support that the home gives them to carry on enjoying social and leisure activities, whether these are arranged by the Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 6 home for the larger group, or helping someone to pursue their own preferred activity. Residents enjoy the meals and say that they have a good variety and choice. Complaints are handled well. Residents and relatives say they feel confident to raise concerns as they arise and the records show that all complaints are taken seriously. There is a willingness to improve the service and to learn from mistakes that have been made. Staff recruitment is done thoroughly, ensuring that all background checks are carried out so that residents are protected. Staff are well trained. The home is well managed and the Manager is supported by other senior staff with particular roles, such as staff training. The standard of written policies and procedures for the staff is excellent and shows the home’s commitment to ensuring that no-one is disadvantaged by written instructions. Regular quality surveys are undertaken and there is evidence that the home responds to suggestions on how to continuously improve the service. What has improved since the last inspection? What they could do better: Springfield Grange is an old building that does not provide up to date facilities for the residents; this also applies to the older part of Springfield. Planning permission is currently being sought for a new build, in conjunction with upgrading some of the facilities in Springfield. This new project needs to happen at the earliest opportunity in order that all residents can benefit from up to date standards in their home. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 7 The way that accidents are recorded could be improved by the addition of an extra section, prompting staff to note the time and date that residents’ relatives were informed of an accident. 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. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Springfield DS0000001505.V323203.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 (Standard 6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written documents, describing what the home does, are presented in a way that is easy to read. Care terminology, such as “plan of care” is explained very well, involving the service user from the start in determining how they will be cared for. There is also a very good description of how personal information about each person will be held and managed. The assessment information in the files of the service users who were case tracked showed a range of needs, that the home is able to meet. EVIDENCE: The updated Statement of Purpose was seen, along with the new Service User Guide, or “Welcome” pack. The new Service User Guide is to be given to all new people admitted. Both documents are presented in bold print and the layout is easy to read, descriptions and explanations given where appropriate, e.g., not just referring to care plans, but describing what they are and how they are used. The processes of assessment and admission are also explained. The service users’ care files that were inspected contained assessment information. Springfield DS0000001505.V323203.R02.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 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The format of the care plans makes it easy to identify the key areas of staff input needed for each person and what the assessed areas of risk are. This increases the likelihood that staff will deliver an appropriate level of care to each person. Residents have input to the care planning process and feel that they have a lot of say in how they are cared for. Specialist training in Dementia Care Mapping enables the staff team to devise appropriate care plans for those who have dementia. Principal Care Assistants’ training in medication ensures that good practices are maintained. EVIDENCE: Three service users with a range of needs were selected for case tracking. Their care plans all reflected their individual assessed needs. There was evidence that District Nurses and GPs give their professional input, as was seen during the visit. One GP comment card stated that there was a lack of privacy to examine residents. There are staff policies for Palliative Care and Confidentiality. Risk assessments are in place, with a succinct overview located at the front of the care plan file. The written care plans give opportunity for the resident or Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 11 relative to have input into the assessment process and to sign their agreement to the plan. In instances where someone does not have full access to their own personal allowance, due to problems with misusing alcohol, this is clearly recorded in their care plans. The Manager and two Deputies have had training in Dementia Care Mapping. There was evidence in the care plan files seen, that these are reviewed and updated monthly, with six-monthly reviews held in conjunction with the resident and their key worker. Residents said that they were consulted and involved in determining their own care. The staff were observed giving medication at tea-time; there were lots of extra prescriptions of antibiotics, as so many of the residents had chest infections at the time of the visit. The two Principal Care Assistants were observed working together to ensure that all of the drugs were given and recorded correctly. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The range of activities available to the residents is sufficiently varied so that everyone’s social needs are met. Individuals’ preferences are respected and assistance is given to making sure that those who want to carry on going out in the community can do so safely. Meals are of a good standard and a source of enjoyment for everyone spoken to. The quality of the fresh food supplies (meat, etc) is very good. EVIDENCE: Service users were spoken to during lunch at Springfield and during the tour of both buildings in the afternoon. None of those resident in the dementia unit at Springfield Grange were able to discuss their experience at the home, but they appeared to be comfortable and reasonably contented with the staff and their surroundings. Each person has a yellow folder containing a document that the staff use, called “Using Activity to Meet Psychological Needs”. This provides ideas of the type of activity that each person likes and records their enjoyment of each activity as it takes place. One member of staff takes the lead in organising activities and entertainers for the home as a whole. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 13 There is the usual range of social activities, plus a visiting aromatherapist and regular outings in the home’s minibus. Pets are allowed, subject to approval by the Manager; there is a written policy regarding this. One woman spoken to said that she preferred to organise her own social activity and enjoyed regular outings with her daughter. She had just got a new wheelchair, which collapses into a smaller space than the previous one, making it easier to get into the boot of her daughter’s car. One man spoken to said that he continued to attend a day centre once a week, which he valued for the opportunity to socialise and have a change of company. Another woman said that she had not been able to continue going to the day centre she used previously. Comments were very positive about the home in general and people felt they could easily decide how they spent their day. Lunch was taken with the residents in one of the dining rooms at Springfield. Cooking is carried out by a qualified chef (who was not on duty at the time), helped by kitchen assistants. The meals are produced in Springfield kitchen and transported next door to Springfield Grange in a hot trolley. There is a choice of main course and dessert at lunchtime and a choice of hot or cold meal at teatime. Local suppliers are used for meat, fruit & vegetables. Everyone said that the quality of the meals was always up to a good standard and there was a good variety on the menu. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good level of written guidance in how to handle complaints, incidents of challenging or aggressive behaviour, and adult protection issues. The written records demonstrating how complaints have been handled were good, demonstrating the home’s commitment to learning from mistakes and improving on their service. There is an open approach to complaints, which are taken seriously, even if made anonymously. EVIDENCE: The complaints procedure was seen, along with the records of complaints received by the home, and their written responses to these. The home’s Statement of Purpose describes complaints management as an opportunity to learn and improve the service; the written records seen did not conflict with this. Even an anonymous complaint led to a written response to the staff and a subsequent change of practice. Staff have written guidance in how to handle a verbal complaint. There is also staff guidance in how to handle challenging or aggressive behaviour, and an Adult Protection policy. Staff receive training in Adult Protection during their induction period. Residents and relatives indicated that they felt confident to raise matters directly with the home if they felt something was wrong. Springfield DS0000001505.V323203.R02.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 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite the obvious shortcomings of Springfield Grange, and the older parts of Springfield, both properties are comfortable and kept safe. The standard of accommodation in Springfield’s extension is very good and, if any new build and/or improvements can be done to a similar standard, the residents will benefit greatly from more privacy and better levels of furnishings and décor. At present, the staff are doing their best with the resources they have. The standard of hygiene and cleanliness seen on the day was good. EVIDENCE: A tour of both buildings was carried out, the communal areas and a selection of bedrooms were seen. A full audit of Springfield Grange was not undertaken, as there had been no changes since the last inspection and the intention is for that part of the service to be re-provided (planning approval is currently being sought to demolish and rebuild). Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 16 At the last Fire Officer’s report, the fire safety standards were being maintained. The handyman’s records showed that staff identify repair and maintenance jobs, which are noted when completed. One staff member is the fire safety co-ordinator, currently drawing up new risk assessment documents. Smoking is permitted in one of the lounges on the ground floor at Springfield. All of the bedrooms that were seen (4 in Springfield Grange and 8 in Springfield) were tidy, clean and well decorated. A new carpet has been ordered for the main lounge in Springfield. Some of the bathrooms are not being used – discussions took place about plans for improving the facilities in the older part of Springfield in conjunction with the new build, to include more en-suite facilities. Laundry is all done in-house, with washing machines that disinfect to a high standard. Springfield DS0000001505.V323203.R02.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 & 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The recruitment practices and initial training are of a very good standard, staff supported by a wide range of training opportunities following their induction. The high percentage of staff with National Vocational Qualifications (NVQ) is commendable. Residents are protected by the robust recruitment procedure and the level of professionalism within the staff team, who present as respectful, polite & friendly. EVIDENCE: Staff files were looked at for the most recent recruits, assisted by Debbie Smith, the Human Resources Co-ordinator. All of the required checks had been carried out. Staff are set on for a 3 month probationary period, after which an initial appraisal is carried out; a contract is then issued if all has gone well. Policies show that all staff are employed in accordance with the General Social Care Council (GSCC) Code of Conduct. Training records for the new staff showed that Adult Protection, Health & Safety, Moving & Handling, Infection Control and client specific training courses had been provided by the organisation. A two day induction course, based on Skills For Care standards takes place at the organisation’s training site and the mandatory training completed within the first 6 weeks of employment. The HR Co-ordinator said that she tries to look for interesting courses to put on for the staff, as well as making sure the mandatory training is up to date. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 18 The training noticeboard downstairs is changed every 2 months, providing a current visual aid memoire on the latest training topic (currently First Aid). Some training is planned for next week on dealing with challenging behaviour; palliative care is also to be a future topic. Staff rotas show that there are sufficient care staff on duty both day and night, to meet the needs of the residents. Most care staff alternate between both houses, so that they get to know the needs of all of the service users. Residents said that the staff were excellent, very supportive and friendly. Staff observed as they were going about their work, demonstrated some good inter-personal skills. Domestic/housekeeping staff who were spoken to said that they were included in all of the staff meetings and training. Springfield DS0000001505.V323203.R02.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, 37 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The presentation of the policies and procedures in plain English and larger print is commendable. This ensures that no member of staff is disadvantaged by not having English as a first language or by being visually impaired. The use of regular quality surveys ensures that residents and relatives have opportunity to make comment about the home and that action is taken to continuously improve the service. The records in place ensure the protection of service users and the efficient running of the home; however, one minor area for improvement was identified in the way that the accident forms are completed, which would improve communication between the home and relatives. EVIDENCE: The home’s Manager is a qualified and experienced person who is held in high regard by the residents and their relatives. The managerial support for the Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 20 staff at the home is well organised, with appropriate administrative & recording systems in place. A selection of regulatory and operational records and documents was seen, including: • The Statement of Purpose • Service Users’ Care Plans • Medication records • Fire Safety records • Health & Safety records • Accident records • Complaints records • Risk assessments • Financial records • Staff rotas • Staff personnel records • Training records All were available for inspection and appeared to be kept in good order. Advice was given on including some additional information on the present accident form. The home’s policies and procedures have been updated and produced in plain English and in a larger print style, making them easy to access for staff from other countries (workers of Eastern European and African origin are employed on the staff team) and those with impaired vision. The Statement of Purpose describes the home welcoming the input of residents and relatives in the way the home runs. This is done through 6 monthly surveys and through joint residents/relatives meetings. The latest quality survey was sent out in December, some of the replies were seen during the visit. There were many positive comments, e.g., one about the laundry stated “the quality and speed of the service is quite extraordinary”. The Statement of Purpose also makes mention of “respecting religious, ethnic & cultural diversity” and trying to meet the needs of people from minority faiths, where necessary. There is also a specific racial harassment policy. A representative of the organisation makes monthly reports on the conduct of the home available to CSCI. Springfield DS0000001505.V323203.R02.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 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 3 X 3 X 4 3 Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP38 Good Practice Recommendations Accident recording would be improved by the inclusion of a section stating when residents’ next of kin were notified of serious accidents. Springfield DS0000001505.V323203.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Springfield DS0000001505.V323203.R02.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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