Inspection on 19/09/05 for Stables, The

This inspection was carried out on 19th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Stables, The 28/09/07

Stables, The 01/06/06

Stables, The 11/01/06

Stables, The 22/03/05

Stables, The 18/01/05

Stables, The 25/02/04

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Cuerden Grange Rest Home

Springfield Cottage

Parkside

Park Lodge

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

CARE HOME ADULTS 18-65 The Stables 4 The Stables Crosby Liverpool L23 9YT Lead Inspector Lorraine Farrar Unannounced 19 September 2005 th 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 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 Stationary 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. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Stables Address 4 The Stables Crosby Liverpool L23 9YT 0151 931 5787 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Royal Mencap (Housing and Support Services) Care Home 4 Category(ies) of LD Learning Disability (4) registration, with number of places PD Physical Disability (4) The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 4 LD and up to 4 PD Two staff on duty at all times. One staff to be alone with service users only in the event that all the guidelines and risk assessments agreed by the CSCI are adhered to. Night staffing conditions of two sleep in staff to remain as previously agreed. Manager to obtain NVQ level IV in Care or equivalent by 2005. Manager to obtain NVQ Level IV in Management or equivalent by 2005. Date of last inspection 22/03/05 Brief Description of the Service: The Stables is registered to provide support and accommodation for four adults who have a learning disability. It is owned and run by Mencap a national organisation who provide a variety of support services to people who have a learning disability. The home is in a cul-de-sac in a quiet residential area of Crosby and fits in well with surrounding houses. It is a detached bungalow with fenced back garden and a detached garage which is used as a laundry and for storage. Inside a small entrance leads to a single toilet and through to a large living / dining room. The kitchen is off the lounge and is large enough for people using wheelchairs to access. Bedrooms and the office lead off a hallway at the back of the lounge, which also provides access to the two bathrooms. All of the bedrooms are single and the bathrooms are adapted for use by people who have a physical disability. There are a number of other aids fitted in the home including ceiling tracking, hoists and grab rails. The home and organisation aim to providing ordinary lifestyles for the people living there and the home is furnished and decorated to a high standard and does not look or feel like a care home. There are always two staff on duty, at night these staff sleep-in and during the day there is sometimes one staff in the house while another member of staff is out with one of the people living there. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included meeting with clients, discussion with staff, a tour of the building and reading care plans, records and documents in the home. What the service does well: Staff have a good understanding of clients, their personalities, choices and support needs and have the skills to understand and communicate with them both verbally and non-verbally. Care plans in the home are detailed and provide good information on the person, their preferences and how staff should support them effectively in all areas of their lives. Support is provided to clients to get out and about either on a 1-1 basis with staff or in small groups and the home have supported clients to get mini buses adapted for their needs. Personal care is provided on an individual basis and staff take time to support clients with their appearance as well as with their care needs. The home looks and feels like an ordinary domestic home and is decorated and furnished in keeping with this, bedrooms are individual to the person and meet both their needs and choices. Aids and adaptations are provided to support clients with their mobility needs with bathrooms providing space and adapted facilities. The organisation have good policies in place, which they follow for checking and recruiting new staff. The overall impression within the home is that of a domestic home with clients given the support and space to spend time as they chose and support provided discreetly by a staff team who are positive and take the time to get to know clients and support them in they way they prefer. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 6 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 Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 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 standard(s) These standards were not looked at during this inspection. EVIDENCE: The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 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 standard(s) 6,7,9 The home has clear detailed care plans in place which provided sufficient information to communicate with and support the clients in all areas of their daily lives. Possible risks to the client are identified and action taken to reduce the risk is written down and followed. Staff have a good understanding of the clients communication and how to support them to make decisions and choices in their every day lives. EVIDENCE: There are individual care plans in the home for all of the clients and two of these were read as part of the inspection. They had all been updated recently and changes had been made as needed. The plans give a lot of information about the person, what they do and don’t like, the type of support that staff need to give them, how they like to spend their time and how they let others know what they want to do. Staff spoken with were able to explain the type of support that they provide and how they communicate differently with each person. They have a good understanding of what each person likes and dislikes and how to provide support in a way that the person is comfortable with. Each client has their own keyworker who supports them with their finances, leisure and care plan. Clients and their families are as involved as possible in the contents of the care plan. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 10 Staff were able to give examples of the way in which clients are supported to make decisions about their daily lives and the choices that are offered. There are thorough risk assessments in place for all clients about different areas of their lives and the activities they take part in, these identify the risks and state what action has or should be taken to lessen it. They had been updated when needed and signed by staff. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 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 standard(s) 12,13,14,17 The home provides support to clients to access activities both at home and in the local community. This support is based on the person’s choices and support needs and clients can go out on their own with a member of staff as well as in small groups. Meals are varied and staff have a good understanding of the support clients need and the choices they make. EVIDENCE: Activities in the home are the same as those found in most domestic homes and include TV, music and DVD in the lounge, clients have been supported to buy things for their bedrooms that they enjoy, including music and flashing lights. The home have supported clients to get mini-buses via their mobility money and two of the people living there have their own bus with the other two sharing a larger vehicle. These have all been adapted to suit the persons needs, clients can therefore go out with staff either on their own or in small groups. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 12 Activities outside the house in the past month included, days out, going for a walk, shopping, local beach, lunch out and visiting local garden centre and one client is supported to attend a local resource centre. All clients are supported to go on a holiday each year, these are in small groups and chosen to suit the persons needs and choices. The home has a family style kitchen, which is large enough for people who use wheelchairs to get into. Shopping for food is done in local shops and supermarkets and staff said that whenever possible clients go with staff but at times this is not possible as there are not enough staff on duty for two staff to go with one of the clients. Staff were able to explain the clients choices and support needs with meals and food stocks and the menu showed that a variety of meals are offered and clients needs and choices provided for. Meals are eaten in the dining area of the lounge and staff sit with residents and offer support. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18,19,20 Staff have a good understanding or the support needs and choices clients have with regards to their personal care and ensure that these are met on an individual basis. Clients receive support to attend healthcare appointments however there is no consistent system for ensuring clients are offered regular healthcare checks and for recording any reasons why these do not occur. Staff have had training in dealing with medication and a system is in place for making sure this is dealt with correctly, however this system is not always followed and could lead to mistakes being made with an individuals prescribed medicines. EVIDENCE: Care plans have detailed information about the support clients need with their personal care, this includes information about their preferred routines and how to successfully support them in a way that they like. Staff were able to give detailed information about the way in which they support each person and how they meet their needs and choices. Through talking to clients it was evident that they are supported to choose as much as possible their routines and how they like to appear and that staff take the time to support them with their appearance as well as hygiene needs. The home has a number of aids and adaptations to help people with physical disabilities, this includes overhead tracking and hoist, grab rails and adapted shower and bath. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 14 Records in the home show that clients are supported to visit the GP and go to health appointments however it was not clear when clients last received support to access regular healthcare checks such as the dentist and optician. The home must make sure that they kept a record of these checks and that each client is offered the opportunity to have regular checks at the recommended times to make sure that any possible health problems are noted and acted upon. If for any reason a client cannot have a particular healthcare check this must be decided by the healthcare professional and clearly recorded by the home along with the reasons why. There is good information in the home to help staff supporting clients with health related issues such as epilepsy and consent to treatment. Records in the home show that most staff have had training in dealing with client’s medication. The home orders medicines from a local pharmacy who supply it is a cassette laid out for the times and dates it should be given. Medication records in the home were generally clear however one client had received cream from their GP and this had not been written or signed for on their medication sheet, this could lead to the client not getting their prescribed medication as directed by their GP. The medication cupboard was untidy and contained creams that were not labelled. In order to lessen the risk of mistakes the home should make sure that this is regularly cleaned and checked to make sure no medicine no longer needed or not labelled is returned to the pharmacy. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 23 The home provides training and local authority procedures for staff in recognising and dealing with abuse. They have systems and checks in place for dealing with residents monies, however these do not always work and one resident is owed money by the home which has not been paid regularly. EVIDENCE: The home has a copy of the local authority adult protection procedures and staff in the home have had training in protection from abuse. Care plans provided good information about how the home supports people with their monies and money counted during the inspection was correct. One client pays for Sky TV via their bank account and staff advised that this was then reimbursed by the organisation. However there was no record of this monthly payment being reimbursed since June 2005. The home must audit their records and ensure that outstanding monies are repaid. They must also review this system to ensure that the money is paid to the client either prior to or on the day that it is taken from their account. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24,25,26,27,28,29 Inside the home is well maintained and decorated and provides a comfortable, homely environment with aids and adaptations to support clients with their mobility. There are areas of the building, which need to be risk assessed to minimise the risk of accidents to clients, staff and visitors. EVIDENCE: The Stables has the appearance of an ordinary domestic home and is decorated and furnished to complement this. Furniture and décor are of a high standard and meet client’s needs whilst contributing to the overall comfortable and homely atmosphere. Each client has their own bedroom and these are furnished, decorated and adapted to meet their needs and choices. Two of the bedrooms are quite small and it was identified at the last inspection that the size of one clients room along with the layout could be a risk to both the person and staff supporting them. A requirement was given that the home should carry out a risk assessment of this room and the person’s needs, at this inspection there was no evidence that this requirement had been met. The home must carry out this assessment in order to identify the risks and the any short term and longer term action they can take to lessen them. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 17 Since the last inspection double glazed windows have been fitted to two of the bedrooms which has made them warmer and more comfortable There are two bathrooms in the house one of which has an adapted bath and the other a walk in shower to help people with their mobility needs. In addition each bedroom has a washbasin, there are toilets in both bathrooms and a separate toilet near the front of the house. It was identified at the last inspection that the flagged drive has loose flags, which could cause and accident and a requirement was given that a risk assessment must be carried out and work identified should be undertaken. At this inspection staff said that the organisation were addressing this however there was no risk assessment or plan available. The back garden of the home is enclosed and has a patio area and summerhouse, however it has a shabby appearance and uneven flags etc. The organisation have previously stated that they are aware of this and would be looking at carrying out work as budgets allow. However the area is now unsafe for clients to use and the home must carry out a risk assessment and any identified work before next summer when the garden will be in use. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 The home carries out the required checks and processes before appointing a new member of staff. EVIDENCE: Staff files contain copies of checks carried out including references, CRB and identification checks. A member of staff spoken with was able to explain the recruitment process she had been thorough. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,40 42 There is no appointed manager within the home who has overall responsibility for managing staff and overseeing the day-to-day running of the home and carrying out quality checks. The organisations policies and procedures were not available in the home, therefore staff are unable to locate the guidelines and information they may need to effectively support a client. The home carry out regular checks on equipment and ensure safety certificates are up to date and staff receive training in areas of health and safety. Some safety records had not been updated for several years and could be out of date and unsafe in an emergency. The home does not provide hot water in one of the toilets, which could lead to a spread of infection. EVIDENCE: The previous registered manager, Mr Richard North left the home the week prior to the inspection, the CSCI had been informed of this however at the time of the inspection staff were not clear as to who was managing the home on a temporary basis. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 20 The lack of an appointed manager can lead to uncertainty and lack of organisation within a care home. It is therefore a requirement of the inspection that the organisation inform the CSCI of who they have appointed to act as manager and that they register a manager with the CSCI within 3 months. No policy and procedures file could be found in the home during the inspection, this provides staff with advice and guidance on how to deal with situations that arise and the lack of this information could lead to situations being dealt with inappropriately. It is therefore a requirement of this inspection that the organisation provide up to date policies and procedures to the home. Records and certificates in the home regarding health and safety were all up to date and satisfactory. The home carry out regular checks on fire, water, lights and temperatures and risk assessments are in place for many of the activities carried out. Information on COSHH (Control of Substances Hazardous to Health) products is available however this was last updated in 2000 and may now be out of date, some of these products including bleach were on open view in the bathroom. The home must review their COSHH file to make sure there are assessments for the products they use, they must also carry out a risk assessment for the storage of these. Staff files have up to date certificates to show staff had had training in fist aid, food hygiene, fire and health and safety. Training for staff in manual handling was out of date, however staff advised and the homes diary contained information that this had been booked for the month following the inspection. The toilet near to the front door has a small washbasin however this had no running hot water, the nearest water outlet for people to wash their hands is either the kitchen or bathrooms located through the lounge. The lack of appropriate hand washing facilities could lead to a spread of infection, it is therefore a requirement of this inspection that handwashing facilities are provided in this room. The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 3 2 x x Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Stables Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 1 x x 4 x 2 x F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 22 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 25 Regulation 13(4) Requirement The home must carry out a documented risk assessment of the clients bedroom identified during the inspection. This should include the placement of furniture, the person’s mobility and support needs. This is a previous inspection requirement The home must carry out a documented risk assessment of the drive area and take action to prevent any risks identified. This is a previous inspection requirement. The home must ensure all medication perscribed for a client is recorded. The home must set up a system for auditing and cleaning the medication storage cupboard. The home must carry out a documented risk assessement of the back garden and take action to prevent any risks identifed. The home must audit records and pay any outstanding monies owed to a client fo the homes SKY TV. The home must review the system for paying for SKY TV Timescale for action 10/11/05 2. 24 13(4)(a) 10/11/05 3. 4. 5. 20 20 24 13(2) 13(2) 13(4)(a) (c) 13(6) 27/10/05 27/10/05 01/04/06 6. 23 27/10/05 7. 23 13(6) 10/11/05 Page 23 The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 8. 37 8(1)(a) 9. 10. 11. 12. 37 42 42 42 9 13(4)c 13(4)c 13(3) and ensure the money is paid to client account prior to or on the day it is due. The organisation must inform the CSCI in writing of the arrangements they have made for management of the home in the absence of a registered manager. The organisation must apply to the CSCI to register a manager for the home The home must review and update COSHH file The home must carry out a risk assessment for the storage of COSHH products. The home must provide running hot water in the washbasin in the small toilet. 27/10/05 06/01/05 08/12/05 10/11/05 10/11/05 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 Good Practice Recommendations The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo L22 0LG 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 The Stables F53 F03 S5386 The Stables V239155 150905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!