Inspection on 01/11/06 for Stradbroke Court

This inspection was carried out on 1st November 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

Stradbroke Court 15/10/08

Stradbroke Court 16/12/05

Stradbroke Court 20/04/05

Stradbroke Court 06/10/04

Stradbroke Court 23/04/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE Stradbroke Court Green Drive Lowestoft Suffolk NR33 7JS Lead Inspector John Goodship Key Unannounced Inspection 09:45 1st November 2006 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 DS0000037419.V317933.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. DS0000037419.V317933.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stradbroke Court Address Green Drive Lowestoft Suffolk NR33 7JS 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) 01502 405494 Suffolk County Council Meike Weststrate Care Home 35 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (25), Physical disability (1) DS0000037419.V317933.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Two named persons, whose names were made known to the Commission in April 2005, aged 65 years and over, who require care by reason of dementia. One named person, whose name was given to the Commission in September 2005, who requires care by reason of mental health One named person, whose name was made known to the Commission in May 2006, who requires care by reason of Physical Disability 16th December 2005 Date of last inspection Brief Description of the Service: Stradbroke Court is a purpose built home for older people, which was refurbished a few years ago to a high standard. It currently provides 13 residential care places (including 2 short-term care places), 10 special needs places and 12 rehabilitation places. The four residents listed under the Conditions above are all accommodated within the 13 residential care places. The accommodation is all located on the ground floor and is divided into separate units. A day service is also provided in the building. This is not subject to inspection by the Commission. The fee level was £365 pounds per week at the time of the inspection. DS0000037419.V317933.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report documents an unannounced visit to the home. Under the Commission’s policy “Inspecting for Better Lives” this was a key inspection, intended to cover all the key standards as listed under each section. In fact all standards have been assessed using evidence from this inspection and from information already held by the Commission. Prior to the visit, questionnaires were distributed to residents and relatives for their views on the home. Twelve were completed by or on behalf of residents. Fourteen were completed by relatives. Their comments have been included in the relevant sections of the report. The manager was present throughout the visit, and arranged access to the various records and policies examined. The inspector toured the home and was able to speak to a number of residents in private. The visit lasted almost seven hours. What the service does well: What has improved since the last inspection? The manager has instituted a schedule for the systematic review of policies and procedures, to ensure that they meet current requirements. DS0000037419.V317933.R01.S.doc Version 5.2 Page 6 The provider has changed the way that medication is stored and transported around the home, by using medication trolleys giving greater security and safer conditions for the dispensing of tablets to be administered. 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. DS0000037419.V317933.R01.S.doc Version 5.2 Page 7 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 DS0000037419.V317933.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have all the information they need to assess if the home will meet their needs. The home also collects information to ensure it can provide the appropriate service to the resident. EVIDENCE: The Statement of Purpose and the Service Users’ Guide were up-to-date with the name of the manager and other staff names, and contained all the information required to help prospective residents decide upon the suitability of the home to meet their needs. Contracts were seen in those residents’ files which were examined. DS0000037419.V317933.R01.S.doc Version 5.2 Page 9 The admission process for the most recent resident was tracked with the manager. She explained that when a vacancy occurred, this was reported to the Allocations group of the local Social Care office, and names were put forward from the waiting list. The manager then reviewed the information on each person which was held on their social worker assessment to ensure that the home was able to meet the needs detailed in that report. In this case, a prospective resident was identified. The manager then visited them with their social worker and a pre-assessment review undertaken. A record of this was available in the resident’s file. The manager had offered the person the opportunity to visit the home but they had refused. This was later confirmed by the resident. There had been a six-week review of this person’s admission which included the resident and their relatives. The home had services for people needing rehabilitation, usually after a stay in hospital. There were strict guidelines for admission to the rehab unit to try to ensure that the planned period of rehab, usually 6 weeks, was not exceeded. Staff on the rehab unit were called Enablers to emphasise their role. Specialist staff such as occupational therapists were involved in the planning and review of each person’s programme. DS0000037419.V317933.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive and regularly reviewed to ensure residents’ current needs are being met, with appropriate use of outside professionals. The procedures for the administration of medicines ensured that residents were properly and safely medicated. Residents can be assured that their wishes will be respected at all times. EVIDENCE: The care plans for two residents who had been admitted to the home within the previous two months were examined. One person was living in the special needs unit, the other in the mainstream unit. The care plans showed that the plans were drawn up on admission and were regularly reviewed. They included medical information, records of visits by healthcare professionals, medication DS0000037419.V317933.R01.S.doc Version 5.2 Page 11 reviews and a weight record. The manager confirmed that all residents were weighed monthly; the home had a weighing chair to enable this to happen. There were appropriate risk assessments, relating to aspects of daily living, such as smoking, and to aspects of the person’s medical condition. There were records of the monthly plan review. Although the information was very comprehensive, there was a summary sheet prepared by each keyworker in the form of a spider diagram for ease of reference by care staff. The inspector was able to talk to both of these residents. One was in their room and appeared content to be there, although anxious not to have to answer too many questions. The other resident had just returned from the hairdresser who visited the home regularly. They were happy to show the inspector their room. This was tidy as “I am a tidy person.” The items in the wardrobe were neatly stored. There were photos of the resident and their family around the room. The resident said that they were very content with living in the home. Their care plan showed that that they had originally come in for respite care which had helped when full time residence had been needed. The record showed that they had gained a stone in weight since admission. This had been a target given previous concerns about this resident. The care plan also recorded the GP visits and hospital tests to diagnose a medical condition. None of the residents was able to manage their own medication. Medicines were supplied by a local pharmacy. The home had recently changed how they stored and dispensed the medication. It used to be kept in cupboards in the kitchen area of each unit. They had now bought two trolleys which were kept in a locked cupboard chained together. They were taken to each unit for the drug rounds. Although some staff had felt this was a retrograde step, those who spoke to the inspector accepted that it was a more secure and safe way to conduct the medication rounds. Medication could more easily be taken to residents in their rooms, and during the day medication was dispensed away from the work surfaces in the kitchen areas. Medicine Administration Record (MAR) sheets were sampled. All boxes were signed and codes for non-administration were listed. A list of specimen signatures and a photograph of each resident were attached at the start of each file. Staff who administered medication had been trained in-house. Their records verified when they had received the training. The manager was considering an external advanced course for some senior staff but this would depend on funding being available. Although certificates were issued for staff completing in-house training, there was no record of the contents of that training. The manager was advised to ensure that a syllabus was followed that covered the topics listed in the CSCI guidance document “Training care workers to safely administer medicines in care homes” (April 2006). DS0000037419.V317933.R01.S.doc Version 5.2 Page 12 The home had a policy of raising, during the six weeks initial review, the topic of arrangements which the resident wished to be followed on their death. This was then recorded in their file. DS0000037419.V317933.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. Residents can be assured that their wishes and preferences will be respected as far as possible. Aspects of daily living will be organised around the residents’ wishes, in order to give them maximum independence and influence over their lifestyle. Residents contribute to the decisions about meals, and nutrition is monitored and developed. EVIDENCE: One resident told the inspector that they could get up when they liked, although they were an early riser anyway. They usually went to bed about eight o’clock in the evening. One relative wrote that the food at the home was excellent. A resident said that “we have well balanced meals”. The assistant cook had recently conducted a survey of the catering service as part of their NVQ. The completed questionnaires were shown to the inspector, together with the action agreed to be taken to meet some of the suggestions. These included changing the menus DS0000037419.V317933.R01.S.doc Version 5.2 Page 14 to include more traditional dishes, offering more fish dishes, increasing the choice at breakfast, introducing a mid-week roast, more fruit in the fruit bowls and the possible introduction of a silver service. The staff had recently had a talk from the diabetic specialist nurse from the Health Trust. The home was planning to introduce the Malnutrition Universal Screening Tool (MUST) as a quality initiative to monitor residents’ nutritional health. The manager had been invited to join a study of access to nutrition services across the hospital, home care and residential sectors in Waveney. There were notices in the home advertising a coffee morning later in the month. The manager and a resident told the inspector that there had been a strawberry tea in the summer to celebrate the opening of the refurbished patio garden. The home had a store of arts and craft materials, and some of the results of using them were displayed on the unit notice-boards. Photos on the boards recorded special events. There was a reminiscence room with examples of everyday life over the last century. The home also displays many photos on the walls of old Lowestoft which many residents would remember. Families of residents on the special needs unit were asked to bring in family pictures so that an album could be created for each person. One resident told the inspector that they liked doing their needlework. Residents were able to visit the day centre which is part of the building, and join in some of the activities there. There had been a comment on the pre-inspection survey that “my relative would like to go out more sometimes.” The manager explained that, although the home did have a minibus, there was no budget for trips out. In the summer there had been a trip down to the front at Lowestoft, but this had only been possible because staff had volunteered to go on the trip without pay. The manager said that some families took their relative out for the day, or for lunch. DS0000037419.V317933.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): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be assured that any complaint they raise will be treated appropriately. The home’s policies and training help safeguard residents from abuse. EVIDENCE: All responders to the pre-inspection survey ticked to say that they were aware of the home’s complaints procedure. All except one had had no cause to make a complaint. One responder described a criticism they had about the attitude of a carer. They were dissatisfied with the outcome, although the manager explained that the resident was able to express their own wishes and they were happy with the carer. This matter had not been raised formally with the manager and had not been recorded as a complaint. The “Compliments, Comments and Complaints” book was examined. There were no complaints recorded, but many letters of appreciation. The home had a policy on the protection of residents’ legal rights including ensuring their right to exercise their vote if they wished. DS0000037419.V317933.R01.S.doc Version 5.2 Page 16 Training records showed that all staff received training in the protection of vulnerable adults, with senior staff receiving additional training on their responsibilities in dealing with allegations. One of the senior staff was able to describe the action they would take if they received an allegation. This was in line with the County policy. DS0000037419.V317933.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): 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a planned maintenance and decorating programme for the home. Residents have comfortable rooms with good facilities. Residents can choose from several communal areas, including the internal garden. Specialist equipment is provided when needed. EVIDENCE: The home had a clean and well-decorated appearance. The manager informed the inspector that the home was scheduled to be re-decorated externally in 2007. Individual rooms were decorated whenever they became vacant. A relative commented that their family were pleased that their mother was in such a lovely environment. A resident said: “The home is always immaculate. It has a fresh and clean atmosphere.” DS0000037419.V317933.R01.S.doc Version 5.2 Page 18 A tour of the building confirmed that the facilities were in good condition, with hygiene and infection controls measures applied appropriately. The home had seven day cover of domestic and laundry staff, contributing to the home’s cleanliness standards. Individual rooms were all personalised with photos and items of personal value. All rooms were en-suite. A resident who smoked was seen using the designated smoking area in one unit. One resident was being cared for in bed because of their disability. An overhead rail hoist had been installed together with a special bed. The resident told the inspector that they were content with living in the home and they were well looked after. It was the practice in the home to put the moving and handling assessments for all residents on the inside of their wardrobe doors, for instant access by staff without being on public display. It was noted that in one bathroom on the rehabilitation unit, clean towels were stored on open shelves in the bathroom. This was a cross-infection hazard. The hot water temperature of this bath was sampled and measured 43°C. Fridge and freezer temperatures were recorded, and it was noted that all were within the safe range. All opened food items in the fridges were covered and dated. The garden had recently been refurbished and redesigned with the help of community service workers to provide a more accessible space for wheel chair users, and to enable more of the space to be available. DS0000037419.V317933.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. The home is appropriately staffed in each unit the needs of the residents. Staff receive full training programmes which maintain their competence to provide good care. Residents are protected by the home’s recruitment procedures. EVIDENCE: There was a clear structure for the management of staff. There was a senior team leader, and team leaders for the day shifts and the night shifts. There was currently one vacancy for a day team leader but this was being used as a development opportunity for staff. The long-term absence of a night team leader was being covered internally with two acting team leaders. The home had used its own relief staff, and some agency staff, over the holidays. There were four carers and a team leader on duty throughout the day, with and extra carer “floating” during the early morning and the late afternoon. There was a training plan for the home for the year covering the mandatory and refresher training. Topics covered included food hygiene, health and safety, moving and handling, diversity, COSSH, and vulnerable adults. This latter training was split with different sessions for carers and for team leaders. In addition staff with particular responsibilities either had or were scheduled to DS0000037419.V317933.R01.S.doc Version 5.2 Page 20 attend courses on assessing functional ability, risk assessment, medication, and dementia care. The manager was a trained dementia care mapper, but had not used this technique in the home as she felt residents knew her too well which would skew the observations. She had done a dementia care map on a special needs day at the day centre. The personal files for two recently appointed staff were examined. All information required by the Regulations were present, including ID records, full employment histories, and a Criminal Records Bureau certificate. One person had started on receipt of the POVA check, which was in the file. Their CRB had not yet been received two months later. The inspector recorded the CRB disclosure numbers of all other staff appointed since the last inspection in December 2005, thus enabling these certificates to be destroyed. The files also contained records of the induction training completed by staff, their personal training record, and their supervision agreement, together with supervision session records to date. Over half of the care staff had completed NVQ Level 2 or above. DS0000037419.V317933.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): 31,32,33,34,35,36,37,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are safeguarded by the home being part of Suffolk County Council with a full range of care, financial and health and safety policies and procedures which are quality assured. These policies are put into practice by the home to ensure that residents’ best interests are at the forefront of how the home is run. EVIDENCE: DS0000037419.V317933.R01.S.doc Version 5.2 Page 22 Since the last inspection, the manager had been registered with the Commission for Social Care Inspection. The home had an agreed Business Plan for the current financial year, covering budgets, safeguarding adults, health and safety, workforce planning and development, recruitment, user involvement, quality assurance. The home followed the County Council’s accounting and financial budgeting and control procedures. Those residents who wished to look after their own financial affairs did so. Relatives or legal advisers took that responsibility otherwise. If residents wished to keep small amounts of cash with them for everyday needs, they were able to use secure facilities in their rooms. Quality assurance procedures included residents’ surveys such as the catering one described earlier, monthly visits from the senior officer of the department, and staff meetings. Separate staff meetings were held for night staff, and for the senior team. Housekeeping staff also met, and were doing so on the day of inspection. As described in the Staffing section, there was a planned programme of staff supervision in operation. There was now evidence that policies and procedures were being reviewed regularly. There was a schedule in the front of the file listing review dates and signing off when reviews had taken place. The fire risk assessment had been reviewed in August 2006 in order to meet the legal requirements. The fire log book recorded a full list of fire drills, tests and equipment maintenance. DS0000037419.V317933.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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 3 3 3 3 2 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 3 3 3 3 3 3 3 DS0000037419.V317933.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. 1 Standard OP26 Regulation 13(3) Requirement The registered person must make arrangements to prevent the spread of infection by storing towels in closed cupboards in communal bathrooms. Timescale for action 30/11/06 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 OP9 Good Practice Recommendations The registered person should ensure that the syllabus of the in-house training sessions on the administration of medication is available for inspection, and conforms to CSCI guidance. DS0000037419.V317933.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000037419.V317933.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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