Inspection on 03/08/07 for St John`s Wood Care Centre

This inspection was carried out on 3rd August 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

St John`s Wood Care Centre 30/07/08

St John`s Wood Care Centre 11/05/06

St John`s Wood Care Centre 29/11/05

St John`s Wood Care Centre 21/07/05

St John`s Wood Care Centre 20/01/05

St John`s Wood Care Centre 26/04/04

St John`s Wood Care Centre 22/05/03

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE St John`s Wood Care Centre 48 Boundary Road London NW8 0HJ Lead Inspector Pippa Canter Unannounced Inspection 10:00 3 August 2007 rd 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 John`s Wood Care Centre DS0000010324.V333596.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 John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St John`s Wood Care Centre Address 48 Boundary Road London NW8 0HJ 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) 020 7644 2930 020 7644 2940 manager.stjohnswood@lifestylecare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd Earl Elliott Care Home 100 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (60), of places Physical disability (14) St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide nursing care and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories:Old age not falling within any other category (Category OP) (no more than 60 persons). Service users with a physical disability who are aged 18 - 65 years (Category PD) (no more than 14 persons). Service users with Dementia who are over 65 years of age (Category DE[E]) (no more than 26 persons). The maximum number of service users who may be accommodated is 100. 9th & 10th May 2006 2. Date of last inspection Brief Description of the Service: St Johns Wood Care Centre is a registered care home providing 24-hour support and nursing by registered nursing staff and trained carers. . The home is owned by Southern Cross Healthcare who are established in the development and management of Nursing homes and is the Registered Provider for St Johns Wood Care Centre. The care home has block contracts with three London Boroughs and the fees reflect this, Westminster £659.83, Brent £620.80 and Camden £662.80. The home has a range of fees taking account of those people pay privately at £850, are within the younger physically disabled at £800 and those who may be very frail at £675. . St Johns Wood Care Centre is purpose built and was first registered in February 2001. The home provides nursing care for up to 100 residents. The home is situated in a prime residential area approximately ten minutes walk to local amenities and public transport. Outside space is available in the from of a roof garden and a balcony on the first floor. . The home is set out as follows: * Lower Ground Floor - up to 14 Younger Adults (18 - 65yrs) with physical disabilities - YPD Unit (Nursing). * Ground Floor - up to 23 Older People (OP) Nursing Care. *First Floor - up to 26 Older People with Dementia. *Second Floor - up to 18 Older People - Nursing Care. * Third Floor - up to 16 Older People - Nursing Care. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 5 St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over one day during the week and lasted from mid-morning until early evening. The inspector spent a total of 8 hours on site. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the Annual Quality Assurance Assessment completed and returned by the registered manager. We reviewed and summarised the incident and any monthly reports supplied by the home. As part of the inspection process postal questionnaires were circulated for people living in the home as well as relatives. To date twenty eight have been returned. Any comments have been incorporated into this summary and other sections of the main report. People living in the service and staff were spoken to and the serving of lunch was observed and there were other periods of observation in one unit using the Short Observational Framework Inspection Tool (SOFI). This is an inspection process designed to collect evidence about the quality of care for people living in a home who have cognitive impairment. In this home, the SOFI tool was used on the Dementia Care Unit. Staff were observed going about their duties and interacting with residents. Six care plans were looked at and compared with the care being provided. Service users were asked for their views about living in the home and staff were also interviewed about aspects of care, staffing levels, supervision, complaints and adult protection. Staff recruitment, supervision and training records were also looked at. All those who have contributed to the inspection process are thanked for their input. What the service does well: The service has an established and well-presented care planning system, which supports staff to meet the needs of people with complex health and personal care needs. The home has fostered good relations with medical and social care professionals. The home has been purpose built. It is secure and there is full disabled access. All bedrooms have ensuite facilities. The home is generally well decorated, furnished and maintained. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 7 Since the last inspection a Dementia Care Unit has been developed. Observation within this unit identified that it was a positive experience for people living there. A person centred approach is being developed and people are treated as individuals. The home is effectively managed with a full complement of staff that have gone through a thorough and robust recruitment and selection process. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. St John`s Wood Care Centre DS0000010324.V333596.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 John`s Wood Care Centre DS0000010324.V333596.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into the care home are confident that they have all the necessary information to ensure that the service is suitable to meet all their needs. EVIDENCE: A requirement had been set at the last inspection to revise both the statement of purpose and the service user guide. Both documents have been amended and meet requirements. A total of six care records were examined. The records seen were about people who had been admitted since the last inspection. People were asked to comment about their experience during the admission process. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 10 All six care records examined contained pre-admission assessments. Those referred by Social Service Departments had copies of assessments and care plans under the care management process but the home has also completed pre-admission documentation. Assessment specific to dementia have been introduced. This was detailed enough to ensure that all needs would be addressed on entering the home. Following admission risk assessments are also completed. The manager confirmed that all newly admitted service users and family members are given information about the service. Wherever possible arrangements are made to meet new referrals in their own home prior to admission. Comments from people who used the service confirmed that they had enough information about the service although from different sources. These were, “Yes I received enough information about this home through my wife.” “My children gave me all the information I needed.” “I received information about the service from my social worker.” St John`s Wood Care Centre DS0000010324.V333596.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. 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. There is continuous assessment, care planning and review which makes sure that the personal and healthcare needs of the people living in the home are met EVIDENCE: A sample of six care plans were examined, which also included looking at the daily recording for the previous three weeks. The care records were a sample from each floor and client group accommodated in the home. The sample was chosen based on racial origin, gender, dementia, complex health needs and recent admissions. In each case we met with the person concerned but could not discuss their care with them in all cases. The relatives, health care professionals and care managers involved with each person was also asked for their feedback. A comparison was made between the care recorded in the daily records and the care being received by each resident. A sample audit was taken on each floor of the medication administration systems. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 12 All care plans were found to be up-to-date and reflected the needs and wishes of each individual service user. The care records were comprehensive and important health and personal care needs were clearly identified. Where additional assessments were indicated, such as manual handling, risk of pressures sores and nutritional risks, these had been carried out and were reflected in the care plans. Samples of falls risk assessments and incontinence were also available. From observation and discussion with people using the service is was clear that service delivery matched the care plans. A comment from a person living in the care home was “They are always there for my needs.” A relative said, “ Staff do exceptionally well and are very observant.” As from previous inspections the care records clearly show referrals to and the involvement of other health care professionals. The records show that the registered nurses have identified changes in condition or behaviour and have referred to the General Practitioner (GP). All service users are registered with a local GP. Entries in care records show clear evidence of collaborative care with interventions from Occupational Therapist, Physiotherapist, Chiropodist, Dietician and a Tissue Viability Nurse. Dental and Optical needs are also addressed. Observation on the day of the site visit, discussion with staff, feedback from people using the service and the examination of the care records confirmed that staff respect the privacy and dignity of the people they look after. A relative commented, “They respect my mother’s need for privacy to shut her door.” A sample audit of the management of medication in the home was taken on each floor. The medication administration records of the people being case tracked were looked at. The audit highlighted that there are satisfactory arrangements in place for the accurate recording of receipts, administration and disposal of medication. St John`s Wood Care Centre DS0000010324.V333596.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. 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 this service. People living in St Johns’ Care Centre are supported to live a life of their choosing. EVIDENCE: The inspector spoke to both the Activities Organiser and observed some of the activities taking place. The menus were examined and discussion with the Head Chef took place. Six care plans were looked at and compared these to the care being received. The inspector received feedback from the resident sand visitors to the home. The six care plans were comprehensive and reflected the wishes and preferences. The care home has started to introduce life history books to be completed by the resident and their representative, which will give more background information. These are very much in the early stages and staff must realise that it will be an ongoing process to keep them updated. An activities organiser and a programme of events is well established in the care home. During the day the inspector saw both individual and group St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 14 activities. An organiser is deployed on the Dementia Care Unit and there is clear evidence of the activities that people have been involved in. During an observation session during the afternoon, all the service users were engaged in some activity and there were examples of good interaction between the staff and the residents. The residents’ body language and interactions showed them to be relaxed and comfortable in their surroundings. Comments received were, “Yes, at times I go to other floors like the ground floor to join others for activities and I always like it.” “There is always activities arranged in the home but I prefer to watch television in the lounge with other residents.” “There is always activities arranged which I always attend as I enjoy it.” The care home has an open visiting policy and promote active family involvement. The care home makes visitors and relatives feel welcome as well as maintains a good level of communication with families. Comments from visitors were, “You get a warm welcome”, As a visitor, you can come at any time. The staff are very friendly.” The menus are on display and were noted to be varied and offer a range of choices. The menu reflected peoples’ choices as meat eaters, vegetarians and varying cultural tastes. The food served at the lunchtime meal looked appetising and peoples’ preferences were being served. St John`s Wood Care Centre DS0000010324.V333596.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. 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. People living in the home are fully protected by the approach to complaints, incidents and allegations. EVIDENCE: The care home has a robust complaints and comments procedure. There is a clearly defined whistle blowing policy. There are clear policies and the prevention of abuse and the protection of vulnerable adults. The service has an active in-house training programme in this area. There have been seven complaints within the last 12 months. Complaints, incidents and accidents are being recorded. These records were crossreferenced with the care records of the people being case tracked. Feedback from people using the service and their relatives all confirmed that they knew how to make a complaint and felt comfortable about approaching the staff with any concerns. The accident reports were compared with the Regulation 37 notifications sent by the service since the last inspection. The number of Regulation 37 notifications have reduced. Discussions with the manager highlighted that the staff team are taking a proactive approach to falls prevention and increased monitoring is the key. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 16 There have been two incidents of adult protection. The first case was not managed by the home according to the interagency adult protection procedures. This was eventually resolved and the manager learnt from the experience as the second incident was managed effectively and correctly. The care home has made improvements in this area and a comment from a relative highlighted this, “They regularly liaise with residents regarding any concerns or problems they may have. The service users are encouraged to disclose anything that may worry them.” A relative commented, “ My mother is not one of life’s “joiners”, and the activities organiser has found a way of enabling my mother to join in sometimes without her feeling forced to do so.” St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. People who reside in the home live in comfortable, homely and clean surroundings. Improvements have been identified that will further enhance the environment for residents. EVIDENCE: The inspector visited every floor in the home and sampled a number of bedrooms. These were the ones belonging to people who were being case tracked. Permission was sought from the people concerned. Overall the home was well presented. The Dementia Care Unit has been refurbished and air conditioning has been installed in the lounge as this has no natural ventilation. There is a redecoration plan in progress and the home would benefit from capital investment. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 18 All bedrooms are single occupancy with ensuite facilities, which ensures the privacy and dignity of people occupying them. There are a variety of seating areas and dining areas. It was in the dining areas that the inspector observed that the arrangement and size of dining tables might not be suitable for people in wheelchairs. Space appeared cramped and wheelchairs were colliding underneath the tables. Bedrooms afford ample room and service users and relatives are being encouraged to personalise them. The home provides a safe environment. A nurse call system is installed throughout the home and there is a fully integrated fire alarm system. Both systems are maintained by regular servicing. Overall the home was found to be clean and tidy. The home has an infection control policy. Clinical waste is stored in suitable containers and collected on a regular basis through contractual arrangements by a reputable collection agency. Bottles of hand cleanser are available, together with protective clothing such as disposable gloves and aprons. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that staff have the knowledge, skills and appropriate attitudes to meet all their needs. EVIDENCE: Comments received from people who live in the service and visitors about the staff were as follows: “The staff are always helpful with happy faces in a job that is not always easy for them. They are kind and very caring.” “The care is good. We get well looked after.” “On a scale of 1 to 10, I would say 8”. “You can talk to the staff at any time.” “Looking after old, disabled, often disorientated people is very hard and Nurse ******, as well as `some of the carers, do exceptionally well. ***** is wonderfully kind to my sister and is very observant.” “The carers are well trained and always work under the direction of a nurse.” “The standard of care she receives is excellent.” Training records showed that a training programme is in place. The home provides a placement for nurses on conversion courses and student nurses, St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 20 which has a positive impact on the professional development and skill mix of the team. The home has a full complement of staff and therefore do not use agency workers, which makes sure that there is a consistency in the care delivery. Discussions with staff and an examination of records show that there is a robust and through recruitment and selection process in place. Training records show that staff have access to relevant training courses and are supported in their professional development. There is a varied skill mix within the team. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 21 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 & 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being managed effectively in the best interests of the people who live there. EVIDENCE: The current manager has successfully completed the registration process. The manager had completed an Annual Quality Assurance Assessment (AQAA) prior to this inspection. The information within the AQAA and further discussions with the manager during the site visit demonstrated a good level of awareness of the strengths of the service and the areas where improvements are necessary. Comments received about the management of the home were: “I feel they do a good job.” “They seem to keep it running very smoothly.” St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 22 “It is well run.” “The care home appears to be very well managed with excellent staff at all levels.” The judgements in preceding sections of this report have contributed to the judgement in this outcome area. The care home has a welcoming environment and promotes an open and transparent style of management. People using the service are protected by the policies and procedures and the feedback feeds into any improvements to the service. We looked at the records of people’s personal finances that are handled by the home. The system is managed by the administrator. It is an effective system that safeguards people and it provides a clear audit trail. A sample of health and safety records were looked at. These confirmed that the home is being managed responsibly with essential checks being made. The provider monitors health and safety in the home. There are robust procedures in place to monitor compliance. St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 23 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 X 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 24 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. Refer to Standard Good Practice Recommendations St John`s Wood Care Centre DS0000010324.V333596.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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 St John`s Wood Care Centre DS0000010324.V333596.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. 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!