Inspection on 14/08/06 for St George`s Residential Home

This inspection was carried out on 14th August 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 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

St George`s Residential Home 01/03/06

St George`s Residential Home 26/07/05

St George`s Residential Home 17/01/05

St George`s Residential Home 16/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE St George`s Residential Home St George`s Road Millom Cumbria LA18 4JE Lead Inspector Nancy Saich Unannounced Inspection 14th August 2006 08:45 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 St George`s Residential Home DS0000022666.V301568.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. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Residential Home Address St George`s Road Millom Cumbria LA18 4JE 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) 01229 773959 Goldcare Facilities Management Limited Ms Janet Bosanko Care Home 38 Category(ies) of Dementia - over 65 years of age (5), Learning registration, with number disability (1), Old age, not falling within any of places other category (37) St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 37 older people (OP) of whom 5 may have dementia (DE(E)). 1 Person over 18 years of age with a learning disability (LD) Sufficient staff must be on duty at all times to meet the specialist needs of people in the service user categories identified. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 1st March 2006 Date of last inspection Brief Description of the Service: St Georges is a residential home that offers care and services to people in the categories described above. The home is a Grade II listed building that has been extended and adapted to provide accommodation for up to thirty-eight people. The home is set in its own grounds and is within walking distance of the centre of Millom. The home is owned by Goldcare Facilities Management Limited and Janet Bosanko manages the home on their behalf. The charges for the service range from £317 to £422 per week depending on care needs. Further information about the home can be obtained from the manager at the above number. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the key inspection for St.Georges. The inspector, Nancy Saich sent out questionnaires to people who live in the home some weeks before she visited. She also sent them to relatives and to others visitors who regularly come to the home. She only had a few responses from these questionnaires. She also asked the manager for some information that was received before the visit. She visited the home just before nine o’clock and stayed until teatime. During this time she met with residents and staff, spoke to one or two relatives and read files that backed up what they said and what she observed for herself. What the service does well: The home is good at making sure they go out to visit new residents so that they can give them information about the home. They help new people to settle in and make sure that they can give them the right kind of care. The home is good at helping people to stay as healthy as possible. They do this by looking after them well and by bringing in the doctor or nurse when necessary. They are also good at checking the medicines people take are right for them. Medicines were being looked after correctly. The staff in this home treat people properly. Residents feel they can talk to the manager about the way staff approach them and that she works with the staff to make sure that things like dignity, respect and privacy are maintained. Residents said • “The staff here are all nice, local people who work well together to give us proper care”. • “They are all very kind and caring” • “They helped me to settle in…” • “Nothing is too much trouble…” • “Never had a problem with the staff…” • “We can have a laugh together…”. The home makes sure that residents can choose how they spend their lives and give them choices and opportunities to join in activities and parties. Staff said they try to provide activities like card making, flower arranging, reminiscing and pamper sessions. The food in the home is plentiful and nutritious and as one person said “I look forward to meal times and get what I want. I am sure this helps me to keep well …”. This home has a really beautiful garden with lots of areas where residents can sit out during fine weather. It also gives residents a very pleasant area to look out on. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 6 The staff team are good at supporting residents if they have any complaints. Residents had no issues but knew how to complain and felt confident that the manager would deal with any thing that was worrying them. The staff team understood what might be considered to be abusive and also knew how they would deal with it. The residents felt that they were properly protected from any abuse and said that nothing like that was happening in the home. The staff in the home are well trained in the basic skills and knowledge they need to do their job. Residents and staff were very happy with the manager and the way she was looking after the home. The inspector judged that she had put a lot of effort into making improvements to the way the home is run. One of the ways she has done this is to send questionnaires out to residents, relatives and staff and then to base her business planning on these responses. Residents valued being asked in this formal way but also said that she often asked them individually about how they thought the home was being run and that she “listened to our opinions and did something about it….” The inspector thought that the systems for managing the home (everything from residents money to staff rosters) were working very well. What has improved since the last inspection? The home is now much better at writing down in ‘care plans’ just exactly what residents want and need to get the best possible care. The home has tried to improve the range of choices that residents have and to make sure that all the staff are aware that residents have rights as well as needs. The inspector judged that staff had really thought about how they helped and supported residents to be as independent as possible. There were lots of small but very important things seen during the day that showed her they were getting it right. The dining room has been greatly improved and enlarged. This room is now light and airy. There is a new carpet, new furniture and nice curtains at the windows. Mealtimes are now much more relaxed with plenty of time given to residents to enjoy their meals. The manager had improved the weekly rosters that make sure that there are enough staff on duty at all times and that experienced staff are always available. The manager has just finished a course that will allow her to train staff in safe methods of moving and handling in the home. The staff said she was working with them to make sure they were able to help residents in the best possible ways. The manager is now making sure that all the staff have the opportunity to talk about their work and any training they might need. One resident have evidence to show that this has helped staff to approach residents in the best possible way. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 7 The manager has made sure that fire safety is working well in the home and she has also improved the system for checking on food safety. The home has a new administrative assistant and she is supporting the manager to get all the records about the home into good order. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St George`s Residential Home DS0000022666.V301568.R01.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 St George`s Residential Home DS0000022666.V301568.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is good at making sure they only take new people who they know they can care for and who will fit into the group of people who live there. EVIDENCE: The inspector spoke to a number of people who had been in the home for only a short period of time. They said that the manager had visited them before they came in and that they had been given enough information so that they could make up their minds about coming into residential care. The inspector also read residents files and saw that this information was written down so that the staff could understand the needs of new people. She spoke to two people who were very new to the home and they said that the staff helped them to settle in to the home. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 10 The staff said that the manager made sure that the new person would fit into the existing group of residents. Residents’ files showed that social workers and doctors were also involved in this assessment before people came to the home. The inspector did think that the home might want to use this same kind of process for existing residents who had become more forgetful just to make sure they were not developing some kind of mental health problem – and to get more assistance if this was the case. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 the service. Residents in this home are given good personal care that helps them to be as well and as independent as possible. EVIDENCE: The inspector read all of the written plans that help staff to give residents the kind of care they need. These showed a considerable improvement and these ‘care plans’ now show, in a lot of detail, exactly what residents both want and need. She could see that the staff had spent a lot of time getting to this stage and that residents are now much more involved with both writing the initial plan and in looking at any changes needed. The inspector spoke to residents about the way staff cared for them and they were happy with the care they received. They were also happy that staff helped them to get good health care. They certainly looked well and said they were as healthy as they could be. The notes showed that the residents saw the doctor or nurse and had the right kind of help to follow their advice. They also saw chiropodists, dentists, opticians and other health workers. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 12 The inspector also looked at the medicines kept on their behalf and these were being looked after properly. The staff team made sure that the doctor checked on these from time to time to make sure the medicines given were still the best treatment for individuals. The residents were happy with the way the staff treated them. They thought they were kind and respectful and they felt that they were “in good hands”. One person explained how they could talk to the manager about any member of staff who maybe needed a little more guidance on how they approached residents and said that the manager dealt with this very well. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is good at providing residents with the kind of lifestyle they want and need. EVIDENCE: The inspector arrived at the home before nine o’clock and found that although some people were up and having breakfast others were still in bed or were in their rooms taking their own time to get ready for the day. The residents said that they more or less got up or went to bed as they wished. They also said that they chose what to do during the day. One or two people said that they had their meals in their own rooms and at least one person chose to spend all day in their room. Other people enjoyed socialising in the lounge areas. Residents said that they enjoyed TV and that the home has a good video library. They said they had parties and entertainments. A number of people were looking forward to the new activities organiser starting in the home and had some ideas of things they wanted to do. Several people said they enjoyed sitting in the garden and one or two people go down into Millom on a regular basis. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 14 Residents said that local churches came to the home. They received communion and had services and generally they felt that spiritual needs were well met by these activities. One or two people go out to the nearby church. The visitors’ book showed that a lot of people came to the home to see friends and relatives. Residents said they could have visitors whenever they wanted and that the staff made them very welcome. Residents said that their relatives had been invited to a recent cheese and wine party that everyone had enjoyed. The inspector ate a very nicely prepared and presented meal with the residents at lunchtime. Residents said the food was very good and always plentiful. Everyone ate well at this three-course meal and several people thought that the good food kept them as well as possible. They had been involved in creating new menus and were able to influence the choices they had. The inspector noted that the staff made sure they showed people what the choices were and this helped people who have dementia or have problems understanding what is said. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 the service. The home is good at making sure they listen to and act on residents’ concerns and in protecting them from harm. EVIDENCE: No one had any complaints during the visit to the home and the manager or the inspector had received none. Residents said they would talk to the manager if anything was wrong and they all felt confident that any complaints would be dealt with properly. The inspector spoke to staff and asked them how they would protect people if they thought they were in danger of being abused. She was pleased to find that the staff were very sure of what might be abusive and knew what to do about it. Residents said that the staff treated them properly and they knew what to do if they thought that something untoward was going on in the home. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22, 23,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Some parts of the home need to be upgraded so that residents have comfortable and safe surroundings in all areas. EVIDENCE: The inspector walked around the building and looked at both the communal areas and the individual bedrooms. The dining room had recently been redecorated and new carpets, furniture and curtains provided. This is now a very pleasant room and she noted that residents now spend longer over meals, as they seem more relaxed in this room. The home has a number of both small and larger lounges and sitting areas where people can be quiet or sociable, sit together or privately with visitors. Some of these have television sets but some, like the library, are seen as quiet areas. All of these areas were comfortable and people seemed relaxed in these rooms. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 17 Outside the home has a well-maintained and attractive garden. Residents said they enjoy looking out at the duck pond and the flowers. They said they had spent time outside during the good weather and there was a range of different seating areas. Bedrooms are very much the individual space of each person. Some of the rooms are full of personal possessions and mementoes, others are more simply furnished and this reflects the different personalities. One or two bedrooms could do with new bed bases as they were showing wear and staining. The manager said they had replaced beds and other furniture and were planning to buy more. The inspector thinks that some beds do need replaced and recommends that this be given some consideration. Some of the bedrooms on the first floor had problems with the windows. Some of the older windows may need replaced soon. Two of these windows did not have the right kind of window stops. One could be opened wide and this might prove dangerous. The other had an inadequate means of stopping the window from being opened wide. Urgent repairs were done on the day to take away the risk of someone falling out but the inspector judged that these windows need to be both safe and sound. The inspector noticed during the day that a number of residents were being moved around the home in wheelchairs that had no footrests. This practice can be very risky and is not very comfortable for residents who have to keep their feet up to prevent them dragging on the floor. The manager must make sure that there are footrests on wheelchairs all the time. The home was clean and only one room had a problem with odour. The manager agreed to make sure this was dealt with. Some areas of the home were a little untidy but residents didn’t have a problem with this. They thought that their home was clean and that staff looked after their clothes and bedding properly. There were signs all round the home that showed that staff were aware of how to prevent cross infection. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager must make sure that new staff are checked properly before they start to work with vulnerable people. EVIDENCE: The inspector saw four weeks of rosters. These had recently been updated and the inspector thought that the changes had improved the way the shifts were covered. Staff said they had either completed their National Vocational Qualifications in care or were well on their way to completing these. They said they had learnt a lot about their work by doing these qualifications. They also said that they had attended training in first aid, fire safety and moving and handling. The manager had completed her training in training others to move people properly and she was concentrating on making sure every member of staff was really confident about doing this well. She explained to the inspector about the plans she had for further training. One of the topics was to be dementia training. The inspector thought that given the number of people with memory problems staff would benefit from this kind of training and recommends that this be given priority. The inspector checked on recent recruitments and found that these had been done properly but that one person had started to work before all the necessary checks had been done. The manager said that she knew this person and had St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 19 supervised them while they were in the home. However it is very important that she checks every new person thoroughly. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. This home is being managed well to give the residents a secure and happy life. EVIDENCE: The home is run by a competent and well-trained manager. The residents had a lot of confidence in her ability to manage the home and to generally “keep things running like they should…”. She has made a number of changes and improvements in the last year that have helped residents to have as happy a life as possible. She has made sure that she has asked the residents and their families and the staff about how things are in the home. She sent out questionnaires and held St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 21 meetings to ask people what they thought was good about the home and what was not so good. From this she now has a plan that will help things improve even more in the home and that residents opinions will be heard. Along with this the company representative must visit the home to make sure that everything is running smoothly. Someone had been doing this but not always writing a report of the visit. The inspector asked that these reports be done and sent to her if possible so that she has a clear picture of how things are in the home throughout the year. The inspector checked the money kept on behalf of residents and she found that this was in order. The manager now makes sure that every member of staff has the opportunity to sit with her regularly to talk about their job, how the home is running and any training or development needs they have. The arrangements for fire safety is now much better than they were and this is part of a general maintenance scheme that operates well to make sure the home is safe and comfortable for residents. The manager is working on improvements to the systems for food hygiene to make the kitchen even better than before. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 X 2 3 2 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 23 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. 1. 2. 3. Standard OP22 OP25 OP29 Regulation 13 23 19 Requirement The registered manager must ensure that all wheelchairs have footrests. The windows in the home must be safe and functional. All new staff must have their names checked against the Protection of Vulnerable Adults list before they come to work in the home. Timescale for action 30/09/06 30/09/06 30/09/06 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 OP4 Good Practice Recommendations It is recommended that the registered manager arranges for new assessments for people whose cognitive abilities have changed since they came to the home. It is recommended that the manager check all the beds and replace those that are showing signs of wear. It is recommended that all staff receive training in understanding and working with people with dementia. DS0000022666.V301568.R01.S.doc Version 5.2 Page 24 2. 3. OP24 OP30 St George`s Residential Home 4. OP33 It is recommended that each month the company prepare a written report about the home that is available for inspection. St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 St George`s Residential Home DS0000022666.V301568.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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