Inspection on 09/05/06 for The Abbeys

This inspection was carried out on 9th May 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

The Abbeys 01/05/07

The Abbeys 11/11/05

The Abbeys 12/05/05

The Abbeys 28/10/04

The Abbeys 11/05/04

The Abbeys 27/01/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Abbeys High Street Rawmarsh Rotherham South Yorkshire S62 6LT Lead Inspector Ms Stephanie Kenning Key Unannounced Inspection 9th May 2006 11:00 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 The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 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. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Abbeys Address High Street Rawmarsh Rotherham South Yorkshire S62 6LT 01709 719717 01709 710149 theabbeys@highfield-care.com 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) Southern Cross Operations Limited Alison Tripp Care Home 80 Category(ies) of Old age, not falling within any other category registration, with number (80) of places The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing clients are admitted to the Abbey Hill Unit only. Date of last inspection 11th November 2005 Brief Description of the Service: The Abbeys is situated just off a main road in Rawmarsh, Rotherham with public transport to the town centre nearby. It comprises of two separate buildings, both built as residential care homes. Abbey Hill is a two- storey building providing care for older people, including those who need nursing care. Abbey Dale is a three -storey building for older people who do not require nursing care. Passenger lifts give access between the floors and there are level entrances or ramps to the building including those giving access to the gardens. In total up to 80 people can be accommodated. All of the rooms accommodate one person and a few have an en-suite toilet. There are a variety of communal areas within the home and sitting areas in the garden. Southern Cross, a national care home provider, owns the home. Information about the service provided is contained in the service user guide and is available from the home, and a copy of the last CSCI inspection report is on display in the home. The weekly fees range from £329 to £625, at the time of the visit in May, with additional charges for hairdressing, chiropody, toiletries, and reflexology. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place over two days, the 9th and the 16th of May 2006, in total about 14 hours. It involved a partial tour of the building, discussions with service users, visitors, social workers and staff, reading documents and care plans, and observing practices such as assisting with meals, activities, and administering medications. About 20 surveys were sent to service users, but none of the surveys were returned to CSCI. All of the key standards were assessed at this visit, and almost all of them were met. What the service does well: What has improved since the last inspection? The home has taken action to meet the requirements and recommendations of the previous inspection. The Abbeys has been able to maintain adequate staffing levels recently and the lower occupancy levels has meant that the service users have been getting a better service. The care plans have improved in terms of their accuracy and have been reviewed on a regular basis, are audited by the manager, and service users were happy with the care they were receiving. Medication was better organised and stored and was being administered correctly, reducing the chance of errors. The daily organisation of the home was better, with clearer leadership and recognition of responsibilities, so that the records show a more accurate picture of the care delivered. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 6 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 Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 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 The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, and 5. Quality in this outcome area is good, and this judgement has been made using the evidence available. Potential service users have information and opportunities to visit the home in order to make an informed choice about where to live. Assessments are carried out to establish if the home is able to meet the needs identified. EVIDENCE: A new statement of purpose was available and contained the required information that, along with the service user guide, should give potential service users information about the home from which they could make a choice. Most service users stated that their relatives had made the choice, with being near to the relatives an important factor. Some service users had been transferred from other homes that could no longer meet their needs, and again it was relatives who had made the decision regarding which home to choose. Service users had been offered an opportunity to visit the home, or someone from the home had visited them at home or in hospital giving them an opportunity to ask questions about the home. All service users had an The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 9 assessment of needs on file including both the homes own assessment and if relevant the assessment from the placing authority and nursing care assessor. The home mainly cares for people of a white British origin, though there is someone from a different background that the home has been caring for effectively. A larger than usual number of admissions and discharges for the home reflects the number of people who have been for short term or respite care at the home, some on a regular basis that are appreciative of this service. The Abbeys does not provide intermediate care. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is good, and this judgement has been made using the evidence available. The needs of individual service users are written in a care plan and were being met by the care staff. Competent staff members administer medication and follow the procedures in order to protect service users. EVIDENCE: Each service user has a plan of care that links to the assessment of needs. Case tracking of six service users found the plans to be accurate and up to date, reviewed on a monthly basis to ensure that the plan is relevant. This is an improvement since the previous inspection when some plans were not up to date and accurate. The plans also showed that service users had access to appropriate health care services, such as General Practitioners’ and community nurses. The home has organised the services of a private chiropodist that charges £12 to £18 depending on need, due to the difficulties in obtaining the NHS service. Reflexology is available at the home costing £10 with alternate fortnightly sessions funded by the home. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 11 Assessments of need include nutritional and pressure sore risks, and professional support is obtained where a service user is assessed to be at risk. A variety of pressure relieving equipment was seen in use appropriately, with risk assessments for these and for bedrails, in place improving the comfort and safety of service users. These were being checked and maintained on a regular basis. A number of service users spent the majority of time in bed, being attended to on a regular basis by care staff. They appeared comfortable, clean and well cared for with evidence of meals, drinks and personal care recorded. All of this care was carried out in private, except for some assistance with drinks or food, when carers were seen to converse with service users and take their time over the task. Feedback from service users and relatives about the care staff was positive with comments about staff being lovely, helpful, good humoured, though sometimes very busy. Relatives felt that they were kept well informed about changes and felt involved in the care. Medication storage has improved by separating into different units, enabling better organisation and therefore improving safety for service users. The storage for returns to pharmacy has improved with adequate bins provided to take the amount for disposal. They were observed to follow correct procedures when administering medication and the records were being completed as required, reducing the opportunity for error. A number of service users had recently had a reduction in medication as a result of a review by their GP. Only staff members trained in the safe handling of medicines are able to administer medication for the protection of service users and another two people were waiting for this training before being able to take up their posts as senior care assistants. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is good, and this judgement has been made using the evidence available. Service users stated that they found the range and type of activities and outings suitable, and enjoyed choice and control of their lives, including at mealtimes. EVIDENCE: The home employs two people on a part-time basis to organise activities, events and outings. There was evidence at the home of a number of recent events such as a clothes party, monthly church service, and outings to pubs and restaurants. Frequent activities at the home include bingo and dominoes and service users stated that they really enjoyed these sessions. Entertainers coming into the home were also popular. Other activities were also referred to including one to one discussions and reminiscence, often happening with service users that spend a lot of time in their rooms. A popular activity is going for a walk in the local area where service users are familiar with the community. There is a minibus available to use for outings and service users talked about some of the places that they had enjoyed visiting. Despite all this activity service users said that it was not enough, that they would prefer more of the same activities, and more outings. During the inspection one outing had a number of service users that pulled out at the last minute, illustrating the The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 13 difficulties involved in organising outings to booked events. Another difficulty raised was the lack of budget allocated to activities, resulting in staff organising fund raising on a regular basis to assist with the costs of the activities. In addition to being able to choose how they spent their day, service users stated that they chose the routines for the day such as when they got up. Some people chose to spend time in their rooms, and one person explained that they liked company for part of the day but not all the time. Meal times are less rushed than previously seen with staff able to assist people in rotation. Service users were generally very happy with the quality of the meals and the choices offered, with some people saying that meals have improved recently. The home supplied a sample of the menus for the inspection and they show a good variety of food offered, with a choice of main course and other alternatives available. Most days have 2 vegetables served at lunchtime usually one fresh and one frozen, but it is difficult to see how the recommended minimum of 5 portions of fruit and vegetables can be obtained from the menu, and particularly for those who are unable to be proactive in asking for fruit. The cook was working on a separate menu for people requiring a soft diet. This was to incorporate more variety and improve the nutritive value following concerns by staff that this diet was more restricted. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,and 18. Quality in this outcome area is good, and this judgement has been made using the evidence available. There are clear policies and procedures for dealing with complaints and protecting people from abuse, and these had been implemented well. EVIDENCE: There was information on how to make a complaint displayed at the home and in the statement of purpose, and this included the CSCI contact details. The complaints log gave information about the action taken for each of the 5 complaints and the outcome. Service users and relatives all stated that if they had any concerns they would tell the person in charge, and felt that the manager and deputy were very approachable. The manager stated that the views of service users and relatives are important and she holds a surgery each week when anyone can call in to see her. In addition there are regular meetings when issues can be raised, and she welcomes feedback at any time. Several staff members stated that they had received training on recognising abuse and how to report any concern, including whistle blowing regarding a colleague. Procedures were in place for responding to suspicion or evidence of abuse along with the local authority procedures, to ensure prompt action to safeguard a service user. There are clear practices regarding service users monies that should protect service users from financial abuse at the home. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 and 26. Quality in this outcome area is good, and this judgement has been made using the evidence available. The home is a well -maintained, clean and fresh smelling environment providing a safe and comfortable place to live. Residents have been able to personalise their rooms to make them more individual. EVIDENCE: Both the buildings of the Abbeys were purpose built about 15 years ago and remain suitable for their purpose. There are ramps or level access that assists people in wheelchairs or those that cannot manage steps. Lifts provide access between the different levels, with Abbey Dale being on three floors and Abbey Hill being on two floors. The garden areas are also accessible. It has been recommended for some time that a covered walkway be provided between the two buildings to assist service users that attend events and activities in the other unit. This has not yet been provided. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 16 Generally the home was well maintained and decorated, and was clean and tidy, providing a safe and comfortable environment for service users. There was some damage to paintwork and radiators caused by trolleys or wheelchairs that looked unsightly, and some of the bathrooms and toilets were looking dated. Service users liked their rooms, and some had many personal possessions creating a homely environment. Heating, water temperatures, ventilation and lighting all appeared to be satisfactory and safe for service users. Routine maintenance checks and servicing of equipment were up to date and a rolling program of decoration in place. Laundry facilities were working, but there have been ongoing problems with some of this equipment on the Abbey Dale unit, that have caused delays to the service provided. The gardens required some attention regarding weeding and summer planting to provide a safe and interesting environment for service users, though this was already planned. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,and 30. Quality in this outcome area is adequate, and this judgement has been made using the evidence available. Staff members are trained and able to meet the care needs of service users, and generally there are sufficient carers to meet their needs. EVIDENCE: Copies of staff rotas were seen for a four weeks period, for both parts of the home and including nights. The mix of staff has changed since the last inspection due to less people being admitted that need nursing care, and resulting in a reduction in the number of qualified nurses at the home. More senior carers are employed to manage the care of people not requiring nursing care. Minimum staffing levels were being maintained, and as there was lower occupancy staff felt that they were able to meet service users needs and they did not feel as pressured as they did at the previous inspection. Service users commented however, that carers were still busy, though perhaps not as much as previously, and they sometimes had to wait for attention. Existing staff and agency staff are used to cover shortfalls wherever possible to ensure service users are cared for adequately. One problem caused by this was the large number of shifts that some people regularly work, with one person doing 10 shifts during the week of the visit and had done 13 the previous week. This was due to the lack of senior care staff, as they were waiting for safe handling of medicines training, occurring at the same time as long term sickness. Individuals spoken to regarding the amount they were working, stated that they preferred this as it gave consistency to service users and they were aware The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 18 that it was not likely to be long term. This needs to be resolved as soon as possible for the health and safety of both service users and staff. The domestic team are also covering a vacancy that is manageable due to lower occupancy, except for Saturday morning when it is difficult to get help. Recruitment follows the company procedures and includes the checks required for the protection of service users. A selection of staff files were examined and found to contain the required information. New staff members undertake an induction programme that is recorded, though they were not all completed. Records of supervision were seen on file and whilst better than previously are still not as frequent as required. The training records show that there is regular training at the home in both mandatory topics such as moving and handling, and other subjects such as adult protection. There is a training plan to help ensure that employees have adequate training for their role. Of the 31 care staff 16 have NVQ level 2 or above, that is 52 , meeting the required standard of 50 . The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, and 38 Quality in this outcome area is good, and this judgement has been made using the evidence available. The management of the home has shown a commitment to improving the services, has developed some good quality assurance measures, and is giving a clear leadership. EVIDENCE: Alison Tripp, a first level Registered Nurse, who has relevant experience in care of older people, manages the home. She is supported by the Regional Manager of Southern Cross who visits the home at least monthly to undertake the required visit and sends a copy of the report to CSCI. Each area of the home has a team that are being led and directed by senior staff, and are developing into the role. There were comments by the staff that in addition to the improvement in staffing levels, there is a sense of better organisation and sorting issues. There was praise for the manager from service users, social The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 20 workers and relatives, particularly about her approachability and helpfulness. Staff respected that she helped to cover shifts that were difficult to cover otherwise. There were a number of quality assurance measures in place, including reviewing of care plans, and then monitoring of them by the manager who lists her requirements and passes them back to staff to update. There were audits on other areas such as, complaints, accidents, and medication. Systems were in place and were working properly. The manager holds a weekly open surgery, and if no one attends she uses the time to walk around the home and talk to service users about their experience of the home. There are meetings with service users and relatives about every two months, and the minutes show that meals and outings feature regularly as topics for discussion. A survey to get feedback from service users had been prepared, but had not been sent out due to the CSCI survey arriving. There were clear systems of accounting to safeguard the financial interests of service users, with appropriate records and receipts kept, and secure storage. Not all have had received the required number of supervisions in the past year as noted in section six of this report. Records were being kept more clearly and appeared to be up to date and accurate. Accidents were recorded and analysed. Maintenance and service records were completed and up to date. Good risk assessments were in place, for example the use of bed rails, and once installed they are checked and maintained weekly. Fire prevention systems were in place and checked regularly. Work had been done in response to the Environmental Health Officer visit in January. Alongside the training for safe working practices, the systems in place at the home promote the health and safety of people at the home. The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 21 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 X 3 3 3 N/a 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 3 X X X X 3 3 STAFFING Standard No Score 27 2 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 3 3 3 The Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 22 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 OP27 Regulation 19 (5c) Requirement Ensure that the number of shifts worked by staff is not excessive in order to prevent health and safety issues. Timescale for action 01/07/06 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. 2. 3. 4. 5. 6. 7. 8. 9. 10. Refer to Standard OP12 OP15 OP19 OP20 OP20 OP20 OP26 OP27 OP30 OP36 Good Practice Recommendations Provide a budget to use for activities. Incorporate a minimum of 5 portions of fruit and vegetables into the daily diet of service users. Repair damage to paintwork and radiators. The installation of a covered walkway to connect the two buildings. Update the décor and presentation of bathrooms. Improve the weeding of the patio areas as planned. Consider providing more reliable laundry equipment. Monitor staffing levels especially with any increase in occupancy. Complete the induction records. Increase the number of supervision sessions for staff. DS0000003069.V291661.R01.S.doc Version 5.1 Page 23 The Abbeys Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ 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 Abbeys DS0000003069.V291661.R01.S.doc Version 5.1 Page 24 - 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!