Inspection on 25/07/06 for St Andrew`s Home

This inspection was carried out on 25th July 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Andrew`s Home 09/02/06

St Andrew`s Home 21/09/05

St Andrew`s Home 28/01/05

St Andrew`s Home 10/09/04

St Andrew`s Home 11/03/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 St Andrew`s Home 92 Drewstead Road Streatham London SW2 1AG Lead Inspector Lynne Field Unannounced Inspection 25th July 10:00 DS0000022753.V298563.R01.S.doc Version 5.2 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 DS0000022753.V298563.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 Adults 18-65. 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. DS0000022753.V298563.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrew`s Home Address 92 Drewstead Road Streatham London SW2 1AG 0208-769-0668 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) Crown Wise Limited Ms Ruma Devi Luckeenarain Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) DS0000022753.V298563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to three persons only can be aged 65 years and above Date of last inspection 9th February 2006 Brief Description of the Service: St Andrews Home is a private home registered for eight adults with mental health problems. It was first registered in January 1995. The home is in a residential street near a park, within walking distance of Streatham High Road with all its transport and other facilities. It is decorated and furnished to a high standard. The home provides service users with the various degrees of support that they need with daily living. Where appropriate, the home also helps to prepare service users for more independent living, although it is recognised that for some of the service users, this may not be possible due to the extent of their mental health problems. The registered proprietor said the current range of fees is charged from £500 per week. Additional charges are made for things such as hairdressing and toiletries. At the time of the inspection there were no vacancies. DS0000022753.V298563.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out on 25th July 2006. The registered provider and acting manager were present and took part in the inspection process. There were eight service users in residence on the day of the inspection. The inspector spoke to two care staff as well as meeting all the service users. All the service users gave their view of the home and all said they liked living there and that staff were kind. The inspection included a tour of the home and examination of records on care plans, staff records and records relating to running the home. During the inspection staff interaction with service users was observed to be very kind and caring and was conducted in a respectful manner. What the service does well: What has improved since the last inspection? What they could do better: The record keeping of the service users money could be recorded more clearly and a more robust accounting system needs to be in place to ensure service user’s money is accurately recorded. DS0000022753.V298563.R01.S.doc Version 5.2 Page 6 The registered provider is also the registered manager. The deputy manager has been appointed as the acting manager to allow the registered provider to concentrate on developing the business of running the three homes they own. The acting manager must apply to become the registered manager. 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. DS0000022753.V298563.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000022753.V298563.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their needs assessed by senior staff before they move to the home and know that staff have decided that the home can meet their needs before they move there. EVIDENCE: There have been no new service users admitted to the home since the previous inspection in February 2006. The registered provider told the inspector that prospective service users have their needs assessed by senior staff before they move to the home. Prospective service users and their relatives can come and look around the home and meet staff before they decide to move there. DS0000022753.V298563.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Families and professionals are involved when reviews are held. Care plans are thorough and reflect service users’ needs and goals. Risk assessment reviews take place and are recorded. EVIDENCE: Four service user files were inspected. The inspector was told the home had reviewed and was developing a new format for the care plans. Service user’s had been asked for their views of the new format. One service user had written and signed to say they “Did not like care plans as they felt they were being told what to do” and “Want staff to leave them alone” Care plans give a thorough description of service users’ behaviours, reactions and preferences and how the service user was to be treated. Care plans are reviewed six monthly or more regularly if needed and monthly for the service users over the age of 65. Strengths and needs are listed and goal setting plans DS0000022753.V298563.R01.S.doc Version 5.2 Page 10 have been developed and are evaluated monthly. Individual risk assessments are monitored and reviewed by the staff with service users every six months or when the need arises. Details of any changes to the risks are recorded in the service users care plans. All the care plans, the service user and the registered provider had the signed service user contracts and risk assessments that were seen by the inspector. Cultural needs of the service user’s are documented in the care plans, for example, one service user needs to go to a hairdresser who knows how to treat black peoples hair because their hair could break if it is not treated correctly. Cultural needs about skin care and diet were also recorded in the care plans. The inspector saw evidence on file that placement review meeting are being held with care managers and include the service user’s family. The registered provider told the inspector that they had contacted Southwark Social Services, who are the placing provider, to arrange a review for one service user. They were told Southwark did not know this service user. The home is following this up by contacting the placing provider again. DS0000022753.V298563.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in age, peer and culturally appropriate activities, leisure activities and are part of their local community. They are actively encouraged to develop daily living and social skills by the registered provider and staff of the home. Service users are encouraged to keep in regular contact with friends and family. Meals are varied and enjoyed by service users. A healthy diet is provided and mealtimes are relaxed and flexibly timed to fit in with individual activity plans. EVIDENCE: One service user told the inspector she was able to choose activities she enjoys doing. She said she sometimes goes out alone or goes out with another service user for walks. At other times she will go to the local café for a cup of coffee or DS0000022753.V298563.R01.S.doc Version 5.2 Page 12 tea. She told the inspector she could always make a drink or have a snack in the home but said “it was nice to go out for a coffee and a cake”. One service user told the inspector they liked living at the home because they had the freedom to come and go to their room as they pleased. They said they enjoyed using the computer and listened to music in their room. Another service user said they “go out and walk around where they feel like”. A coach outing has been arranged and one service user has said they do not want to go. They told the inspector they did not want to go out or do anything and did not get bored. The manager told the inspector they always tried to encourage service user’s who were reluctant to go out and would try again on the day of the coach trip. All service users’ have a personal activities folder, which contains different activities the service user likes to do. This includes cultural needs activities, daily activities and home activities programs. This includes any dietary and related health needs, such as a cooking program and skin care. These are discussed and agreed with their key worker. Service users continue to be encouraged to help with household chores. This is discussed at service users meetings where it was recorded that all service users expressed their satisfaction with their allocated chores. One service user offered and made the inspector a cup of tea in the small kitchen area in the conservatory. The acting manager said the home encourages service users to keep in contact with their families and friends. Service users with families are always invited to the service users’ reviews. One service user was talking about going on holiday to their sisters home in West London. They told the inspector they were not sure if they would to go to visit their sister for their usual holiday “Because they did not want to make the long journey this year”. Another service user told the inspector their brother “visits often”. Meal times at the home are flexible. When the inspector arrived on the day of the inspection, one service user was still having their breakfast, three had finished theirs and another arrived to have their breakfast about half an hour after the inspection had started. Service users cleared away after they had eaten and washed up. Service users said they enjoyed the food served at the home. They said they decided what was on the menu with the staff, which was planned for the next four weeks. Service users said they could choose from the menu or if there was not anything they wanted on the menu that day, the staff would make them something of their choice. Service users said there was plenty of food to eat. One service user told the inspector “the menu was nice and she had put on weight since coming to live in the home”. DS0000022753.V298563.R01.S.doc Version 5.2 Page 13 The inspector saw the book where the meals are recorded. If there is a change to the menu it is recorded in this book along with a record of the temperature taken of the food before it is served. DS0000022753.V298563.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal support, in the way they prefer. Medication is being handled safely. EVIDENCE: The inspector looked at four service user’s care files. These contained all the information that staff would need to support the service users in their preferred personal care routines. There were details of how much help an individual requires with different personal care tasks. A key worker system continues to operate, with each service user having a member of staff from within the team to co-ordinate their support and care planning. The record of health appointments attended indicated that each service user is supported by staff if this is what the service user requires, to attend an appropriate range of healthcare appointments in line with their individual healthcare needs. One service user told the inspector they “go to have an DS0000022753.V298563.R01.S.doc Version 5.2 Page 15 injection every three weeks” and they were “having to go to have a scan”. Outcomes of appointments are recorded in the service users file. The inspector checked two service users’ medication. This is stored securely in a locked medication cabinet in the staff office. The inspector checked two of the service users medication at random. All medication stocks checked where in order. One service user is about to start self-medication and this will be monitored and risk assessed by the team. This was discussed at the service users’ review with the social worker. The inspector was shown a copy of the action plan that had been drawn up at the review. The inspector was shown the report by the local pharmacist who comes into the home every six months to check the medication. This indicated there were no issues that needed to be addressed by the home. The home continues to audit the medication audit and the manager does this weekly. Once a month, the registered provider does their own spot check. This is done as part of the providers’ Regulation 26 visit. DS0000022753.V298563.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user’s views are listened to and acted upon and there are safeguards in place to protect them from abuse, neglect and self-harm. EVIDENCE: The home has a complaints policy, a copy of which is in the service users’ guide. The inspector saw the complaints book. There was one complaint recorded since the last inspection by a service user about another service users’ inappropriate behaviour. The staff spoke to the service user who apologised for the behaviour and said they were confused and it would not happen again. Staff contacted the service users’ CPN and spoke to other staff in the home. The service user who complained was supported during her key worker sessions. They told the inspector they were happy with how the complaint had been dealt with and the support she had from the staff of the home. The registered provider told the inspector all complaints are taken seriously and appropriate action had been taken to ensure service users’ complaint was addressed immediately. The actions and outcome taken by the home were recorded and the service user had signed this to say they were happy with the outcome. DS0000022753.V298563.R01.S.doc Version 5.2 Page 17 One member of staff told the inspector about the training they had recently had on adult protection. They described the different types of abuse that staff need to be aware of and what signs they might notice in a service user who may be being abused in some way and what they would do if they suspected this. For example, they said, “There might be a change in the service users’ behaviour” or “Unexplained bruises or cuts”. They said they would tell the registered provider or the acting manager who would deal with it. The inspector was shown a copy of the minutes of the service user’s meeting, which are held monthly. The manager told the inspector the home try’s to have the meetings when all the service users are present. DS0000022753.V298563.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is bright, clean, comfortable and safe. Service users rooms are comfortable and are decorated to reflect their personalities. EVIDENCE: The inspector was given a tour of the home, which is clean and well decorated. The home has a large dining room leading on to a large lounge/conservatory room at the back of the house, which over looks the garden; this acts as the main lounge. There is a small kitchen area where the inspector observed service users making themselves drinks and a light snack. There is a personal computer in the conservatory that was being used by a service user. He told the inspector he enjoyed using it and because it was in a communal room he did not feel shut off from the other service users. Another service user, who is musical, played a couple of tunes on the piano for the inspector. Staff said, unfortunately, he did not play very often. The conservatory leads on to the DS0000022753.V298563.R01.S.doc Version 5.2 Page 19 garden, which was landscaped in 2005, to provide a patio area with a barbeque, secluded out door seating area and water feature. Both rooms were well used on the day of the inspection. The only access to the upper floors is by the staircase. The home is unsuitable for service users with impaired mobility, except the ground floor, where there is one bedroom with ensuite facilities. Bedrooms are personalised and reflect the taste and interests of the service user and each have a wash hand basin. Service users said they are happy with their bedrooms. There is a facility in each bedroom for receiving incoming telephone calls. There is a separate toilet for visitors, service users and staff on the ground floor and two other toilets and a bathroom on the next two floors. There is a sauna room with a shower that was refurbished just before the previous inspection in February 2006. There is a laundry, which is next to the kitchen, has a washing machine and a dryer. There is a sink installed for clothes that need to be hand washed. Service users told the inspector they were assisted by the staff to do their washing and one service user said they enjoyed doing the ironing. DS0000022753.V298563.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective staff team that know the service users well. Recruitment practices ensure service users are being supported and protected. EVIDENCE: The registered provider said there had been one new staff employed at the home since the last inspection and the home’s recruitment policy and procedure was followed in accordance with equal opportunities policies. On the day of the inspection the new member of staff was not on duty but the registered provider told the inspector the home had a six-week induction program that the staff follow. This includes manual handling, fire training and adult protection. This is recorded in their staff files. One member of staff said they recently been on a course for the safe handling of medication and they had been given a certificate to confirm this. The inspector examined three staff files. The home operates a recruitment process which includes formal interview, taking up two references, CRB checks and POVA checks prior to appointment. DS0000022753.V298563.R01.S.doc Version 5.2 Page 21 Throughout the inspection the inspector observed staff interacting with service users and the qualities seen included good listening skills, a calm and confident manner, and a good grasp of the basic areas of need they needed to meet, including communication. Four members of staff are still in the process of taking an NVQ Level 2 or 3. The registered provider stated that it is planned for all staff to be qualified to at least NVQ level 2. The manager is taking NVQ qualification at Level 4. Both staff the inspector spoke to said they had supervision every two months, which was recorded and kept, in their file. The inspector saw copies of these on their files. The member of staff and the manager signs this. DS0000022753.V298563.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users know the home is well managed and planned. The health, safety and welfare of service users is promoted and protected. EVIDENCE: As stated in the last inspection report the registered provider for the organisation is also the registered manager for this home. At the last inspection the deputy member of staff who has been acting manager following a successful interview, had agreed to apply to be the registered manager. The registered provider is satisfied that the acting manager is able to undertake the post. The acting manager is in the process of taking NVQ level 4. At the last inspection the inspector was told the manager would make an application to become the registered manager. A requirement has been given but this still has not happened. DS0000022753.V298563.R01.S.doc Version 5.2 Page 23 The inspector was told that service users’ money was kept in individual accounts and each service user has a safe in their room. One service user keeps their money in a safe in their room. This is monitored and checked by the senior staff in the home. The inspector checked three service users money and found a number of discrepancies in the recording of one service users’ money although it was all accounted for. The home needs to have a robust accounting system in place. This is the subject of a new requirement. The registered provider has been conducting monthly, unannounced visits to review the service and copies of the reports have been sent to CSCI to evidence the provider’s monitoring of the service. Records indicated that all fire and electrical systems and equipment in the home are serviced and inspected appropriately and that all internal checks are conducted at appropriate intervals. DS0000022753.V298563.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 X 27 3 28 4 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 3 3 x 2 3 x DS0000022753.V298563.R01.S.doc Version 5.2 Page 25 Yes 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 YA37 Regulation 8 (2) (a) Requirement Timescale for action 30/09/06 2. YA41 17(2) The registered person must ensure an application for the registration of a manager of the home is made to the Commission for Social Care Inspection. The registered person must 30/09/06 ensure there is a robust accounting system and checks in place to safe guard service users’ money. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000022753.V298563.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000022753.V298563.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!