Inspection on 03/11/05 for The Cedars

This inspection was carried out on 3rd November 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

The Cedars 30/06/09

The Cedars 22/03/07

The Cedars 16/05/06

The Cedars 30/06/05

The Cedars 05/01/05

The Cedars 01/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The Cedars The Cedars (2 - 4) The Old Grove Surrey GU26 6BW Lead Inspector Susan McBriarty Unannounced Inspection 3rd November 2005 11:45 The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 Adults 18-65. 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 Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Cedars Address The Cedars (2 - 4) The Old Grove Surrey GU26 6BW 01428 608726 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) Robinia Care - South Region Victoria Johnston Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 18-50 years Four Service users to be aged between 18 - 65 Years Date of last inspection 30th June 2005 Brief Description of the Service: The Cedars consist of three bungalows, numbered 2, 3 and 4, that provide care and accommodation for fourteen adults with a learning disability and a physical disability. A garden area has recently been landscaped and surrounds the three bungalows. A fence surrounds the garden area and this provides a safe environment for service users. Each of the bungalows provides single service user bedrooms and offers a communal lounge, two bathrooms or shower rooms, a large kitchen and a laundry room. Bungalow 2 provides accommodation for four service users, and also accommodates the office facility for the service. Bungalows 3 and 4 each provide accommodation for five service users. All bungalows are suitably equipped for wheelchair users. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection the second for 2005-2006. During the inspection a number of documents were sampled including resident risk assessments, staff training documents, health provision information and resident medical files. A number of residents were out during the course of the inspection returning in time for their evening meal and the end of the inspection process. The inspector spoke with the manager, two residents, two staff members, the area manager and the head of maintenance as part of the inspection. An enforcement notice was served on the 27th July 2005 and the home had received a compliance inspection on the 28th September 2005. The Commission for Social Care Inspection is continuing to review the Robinia Care Group plc homes in Surrey as part of an investigation into a protection of vulnerable adults allegation. In another forum from this report a number of recommendations were made and these are in the process of being planned or completed by the Robinia organisation. Further recommendations or requirements may be made as a result of the review. What the service does well: What has improved since the last inspection? What they could do better: The majority of requirements made at the inspection on the 30th June 2005 had been met. However the inspector was informed by the manager that the organisation was now working toward providing each resident with a statement of terms and conditions and the issue regarding the shower remains outstanding. During the inspection of the 2nd November 2005 a number of requirements were made. In particular observations made by the inspector during the inspection that were of concern and reported to the manager require further investigation. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 6 The requirements made during the inspection are noted at the end of this report. 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 Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 the following standard(s): 2,3 Further work is required to ensure that the home provides pre-admission assessments and can evidence how they intend to meet the needs of a prospective resident. EVIDENCE: The inspector sampled a number of care plans, none contained evidence of a pre-admission assessment and limited information had been provided from other sources. The organisation had produced an admission procedure that was dated 2003. The residents of this home had all been placed prior to that date. It was required that the home confirm that all admissions, including internal transfer of any resident, are appropriately assessed prior to any admission. On the day of the inspection the Inspector was concerned that a specified staff may have difficulties in communicating with people who have additional communication needs. This matter was discussed in detail with the manager on the day of the inspection. A requirement was made that staff be assessed by the organisation to ensure they have the necessary skills to communicate effectively with the residents. The requirement from the inspection on the 30th June 2005 regarding the provision of a statement and terms and conditions had not been met. The CSCI informed the organisation through the inspection report that enforcement will be taken if the timescale of 31st August 2005 was not met. The manager stated The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 9 that the organisation was working on providing the residents with a statement of terms and conditions in order that they, their relatives and or representatives were clear about what the home would provide, the fee levels and what additional, if any, would be the responsibility of the resident. In a separate forum to the inspection process agreement had been reached regarding the provision of the statement of terms and conditions. The requirement remains with a further timescale. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 8,9,10 The residents of the home have complex needs and limited communication skills, this may impact on their ability to make their views on the running of the home known and for them to take part in staff meetings or other forums. Risks assessments are undertaken on all aspects of the resident’s daily living. The organisation has policies and procedures in place with regard to confidentiality. EVIDENCE: In order to be able to take part in the day to day running of the home and contribute to policies and procedures the complex needs of the residents’ and their associated communication difficulties would require to be taken into account. Significant levels of support would be necessary to enable a varying level of input from each resident. All daily living activities are risk assessed a number were sampled by the inspector and were found to have been reviewed in October 2005. The organisation has policies and procedures in place in order to ensure the confidentiality of residents is maintained as far as is possible. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 the following standard(s): 11,13,15,17 The routines of the home and activities accessed by the residents take into account the extent of their assessed needs. The home seeks to ensure healthy options are provided at mealtimes. EVIDENCE: On the day of the inspection the majority of residents were at the organisations day centre. The home has transport available and are able to offer alternatives if wished. The residents are able to communicate to others if they do not wish to go to the centre or take part in other activities. Documentation recording the actual activities of the home had improved. The home provides a clear timetable of activity for each resident. One person is provided with one to one support, the home was about to implement clear recording within the staff rots of that specified support need. The Inspector was able to view the documents being launched by the home. Where family contact has been maintained the home documents and records all telephone calls and visits to the home. Visitors can attend the home at any reasonable time. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 12 Given the small number of residents present during the inspection the inspector’s observations are based on limited information. One issue regarding communication has been noted previously. However other staff members were observed offering clear communication and responding to requests in a respectful and warm manner. The menu of the home was discussed and the inspector sampled the supporting documents regarding what had been planned for meals and what was eaten. The home prefers to ensure that healthy options are offered each day for example brown rice and pasta. The evening meal was observed, each resident having a different option all the food provided appeared fresh and appetising. Transport costs are now be paid on the basis of actual use of the home’s vehicle. The inspector sampled a number of records documenting where the resident went, how far in miles and the associated cost. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 the following standard(s): 19,21 The home has a good regard for the health needs of the residents and their best interests or preferred options where known will be taken into account by the home following their death. EVIDENCE: The inspector sampled a number of resident files and evidenced regular attendance with appropriate health professionals. The manager was able to discuss with confidence when particular appointments were due. The residents require the support of staff to attend appointments and many would have difficulty in reporting to staff the outcome of an appointment without such support. The staff team provide social nail care to the service users. A requirement was made to ensure that staff are appropriately trained to carry out this task. Within the records sampled the best interests or where possible the preferred option of each resident following their death had been documented clearly. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 22,23 Further work is required to ensure the home has appropriate policies and procedures in place to safeguard the residents. EVIDENCE: The home has a complaint procedure in place, the procedure states that if there is dissatisfaction with the CSCI a complaint may be made to the Ombudsman, this process is incorrect. A requirement was made that the home reviews the complaint procedure to ensure that the information is accurate. The homes protection of vulnerable adult procedures, whistle blowing policy and bullying policy require further work to ensure they meet local guidelines and or offer staff clear guidance to follow. The inspector had made a requirement during an inspection of another home managed by the Robinia group. The requirement is restated here. The inspector found the policy and procedure for the protection of vulnerable adults unclear and confusing. A requirement is made that the policy and procedure be reviewed in line with local guidelines for the protection of vulnerable adults. The organisation’s policy and procedure on bullying, whilst recognising that bullying was unacceptable by any party did not recognise the link to the protection of vulnerable adults policy and procedure. A requirement was made to review and update the policy and procedure. The whistle blowing policy did not offer a clear link to the protection of vulnerable adults and the procedure for its use was unclear. A requirement was made to review and update the policy and include a clear procedure. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 15 These issues were discussed in full with the manager at the time of the inspection. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 the following standard(s): These standards were assessed during the inspection of the 30th June 2005. EVIDENCE: During the inspection on the 30th June 2005 a requirement was made that a specified residents needs regarding lifting and moving were assessed appropriately. The specified resident has been assessed and the specialist equipment required to meet his needs was on order at the time of the inspection on the 2nd November 2005. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 17 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 Further work is required to ensure the home is able to meet all the standards. EVIDENCE: The home had copies of a number of job descriptions available, however copies had not been placed on the staff personnel files neither had the copies been identified in relation to specific staff members. This would be helpful should the need arise to clarify roles and responsibilities. One of the staff spoken to made clear to the manager and inspector that they had a copy of their job description at home and was aware of the content. A number of the staff are from overseas and have gained professional qualifications in their country of origin. The organisation is checking the equivalency of the qualifications against the National Vocational Qualifications (NVQ). A requirement was made that the organisation inform the CSCI of the outcome of the equivalency checks and confirm that this enables the home to meet the target of 50 of staff being qualified to at least NVQ Level 2 by 2005. The residents are mainly white British and are supported by a multi-cultural staff team. An issue of concern was brought to the attention of the manager during the inspection regarding the communication ability of specified staff and their decision making as observed by the inspector. A requirement was made that this matter be investigated further and the CSCI informed of the outcome. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 18 One staff member spoken with indicated that they received regular training and when they were due to receive refresher training would ensure that they placed their name of the training request list. In discussion with the manager and in sampling a training document it was clear records were kept of all staff training. As yet the home had not implemented a training plan that indicated clearly which members of staff had completed particular training and when refresher training was due. The information required to enable the home to provide clear evidence of expenditure had been provided and the manager had liaised with the finance department of the organisation in order to ensure a clear audit trail. All staff receives a two-week induction on beginning work at the home. Regular supervision was provided to staff and one staff member spoken with stated that they would use their supervision to discuss training when and if they felt it necessary. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42 Further work is required to ensure the home is able to meet all the standards in this section. EVIDENCE: The manager is covering the maternity leave of the registered manager and had just made application to register as required. The applicant manager has the registered managers award and a number of other qualifications that meet the needs of the role. On the day of the inspection the inspector observed the manager talking to staff and residents regarding what was happening in the home, introducing the inspector. The observations indicated that the staff and residents have a good relationship and that the manager was aware of who was in the home and why as well as being aware of what was happening in the home and taking action as required. The manager was able to indicate to the inspector that the organisation has a quality assurance audit process and that an audit had taken place fairly The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 20 recently. However a copy could not be located at the home and the manager was uncertain of the outcome of the audit although clear that this home had been involved. A requirement was made that the home investigates the outcome of the audit in order to be informed regarding any actions recommended and to inform the CSCI of the outcome. As already noted within this report a number of the policies and procedures reviewed during the inspection require review and update. Requirements were made and are noted at the end of this report. During the inspection on the 30th June 2005 a requirement was made that the path to the laundry area be risk assessed. This had been completed and risk assessed as requiring additional lighting. On the day of the inspection it was raining, the pathway was covered in leaves and due to the time of year it had become dark early. The manager had made more than one application for additional lighting; this risk assessed need had not been met. A requirement was made that the risk assessed need for additional lighting be met within reasonable timescale in order to ensure the health and safety of staff accessing the laundry area. Fire extinguishers had been checked on the 1st November 2005 and the wiring on the 6th October 2005. Leaflets regarding chemicals hazardous to health (COSHH) had been provided for staff reference as had leaflets regarding infection control. A requirement was made during the inspection of the 30th June 2005 that the home refers the matter of the storage position of the showerhead to the appropriate specialists. During the inspection of the 2nd November 2005 the inspector met with the organisations head of maintenance and area manager. The head of maintenance informed the inspector that the water board had made specific requirements to the organisation and that all but one had been met. The water board has required the organisation to provide showers with specialist fittings to ensure the safe use of water. The inspector was informed that the type of fitting required is not available for purchase. The matter remains outstanding. A requirement was made that the organisation forward copies of any correspondence or similar that confirms the information provided. The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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 2 2 X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 2 2 2 X 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Cedars Score X 2 X 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 X 2 X DS0000013588.V262782.R01.S.doc Version 5.0 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 2 Regulation Requirement Timescale for action 30/11/05 2 3 3 5 14(1)(a)(b)(c)(d) The registered person must confirm in writing to the CSCI that any person admitted to the home directly or through internal transfer will be assessed appropriately. 12(4)(b) The registered person must ensure that the home can demonstrate its capacity to meet the assessed needs of those admitted to the home. In particular 3.5 and 3.8 of The National minimum Standards Young Adults. 5(1)(b)(c) The registered person must ensure that service users are provided with a statement of terms and conditions and to review any that are in place to ensure they contain all the information required in Standard 5 of The National Minimum Standards. Timescales of 01/11/04, 11/03/05 and 31/08/05 have not been met. Enforcement action will be DS0000013588.V262782.R01.S.doc 30/11/05 30/12/05 The Cedars Version 5.0 Page 23 taken if this timescale is not met. 4 19 13(4)(c) 18(1) (c)(i) The registered person must ensure that staff members receive training from an appropriate specialist before undertaking social nail care cutting. The registered person must review the complaints procedure and ensure the information provided is accurate. The registered person must ensure that the policy and procedure for the protection of vulnerable adults is updated in line with local guidelines. The registered person must ensure that the organisations whistle blowing policy is reviewed and updated. The registered person must ensure that the policy and procedure on bullying is reviewed and update. The registered person must ensure that job descriptions are held at the home and relate to specified staff. The registered person must inform the CSCI in writing of the outcome of the outcome of the equivalency checks regarding staff qualifications to ensure the home meets the 50 of qualified staff by 2005. The registered person must ensure that staff employed to work at the home have the ability to communicate effectively with the service users. 30/11/05 5 22 22 30/11/05 6 23,40 13(6) 30/11/05 7 23,40 13(6) 30/12/05 8 23,40 13(6) 30/12/05 9 31 17(2) Sch’ 4 (f) 30/11/05 10 32 18(1)(c)(i) 30/12/05 11 33 18(1)(a)(c)(i) 30/11/05 The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 24 12 35 18(1)(c) 13 39 24 14 42 13(4)(a)(b)(c) The registered person must 30/11/05 ensure that a training development plan is implemented within the home. The registered person must 30/11/05 ensure that confirmation is providing in writing that the home is aware of the outcome of any quality assurance audit and the any action required for improvement. The registered person must 30/11/05 ensure that a risk assessment is documented and recorded when one staff member is alone in the home with one service user. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Cedars DS0000013588.V262782.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Cedars DS0000013588.V262782.R01.S.doc Version 5.0 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. 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