Inspection on 15/05/07 for The Cotswold Home

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Cotswold Home 21/02/06

The Cotswold Home 22/09/05

Similar services:

Flint House

St Vincents

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Hillyfield Rest Home

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

CARE HOMES FOR OLDER PEOPLE The Cotswold Home Woodside Drive Bradwell Village Burford Oxfordshire OX18 4XA Lead Inspector Annette Miller Unannounced Inspection 15th May 2007 09.45 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 Cotswold Home DS0000065413.V339090.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. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cotswold Home Address Woodside Drive Bradwell Village Burford Oxfordshire OX18 4XA 01993 824225 01993 824226 pat.hamilton@efhl.co.uk 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) Elizabeth Finn Homes Ltd Mrs Marie Patricia Hamilton Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (51), Terminally ill (51) of places The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. On admission persons should be aged 60 years and over. Maximum of 30 persons with nursing needs. The total number of persons that may be accommodated at any one time must not exceed 51. 21st February 2006 Date of last inspection Brief Description of the Service: The Cotswold Home was purpose built in 1998 and is situated in open countryside two miles from Burford. The Cotswold Wildlife Park is nearby and residents who have the mobility and independence to walk to the Wildlife Park can do so if they wish. Country walks are also accessible from the home. The home is registered for 51 residents with a maximum of 30 places for people requiring nursing care. Two GP surgeries provide medical cover and on admission residents are asked which surgery they wish to be registered with. A dentist visits the home to assess residents but treatment is carried out at the dental surgery. Transport can be arranged in the home’s minibus. Physiotherapy is available twice a week. The services of an optician and chiropodist are also available. Accommodation is provided on two floors. The ground floor has 30 single bedrooms and these are for those residents requiring nursing care. The first floor provides 21 single rooms for residents with low to moderate dependency levels. Many of the residents on the first floor are fully independent. All bedrooms are equipped with en-suite toilet and hand basin. A passenger lift provides access to the first floor. There is a wide range of recreational activities available and the home has a group of committed volunteers who help the residents in a variety of ways. The Cotswold Home has a delightful courtyard garden, as well as a garden at the rear of the home, providing pleasant outdoor space for residents and their visitors. The fees for this home range from £518.00 to £950.00 per week. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted over 6½ hours starting at 9.45 am. The inspector looked at how well the home was meeting the national minimum standards set by the government and has in this report made judgements about the standard of service provided. The inspector toured the building and spoke to residents to find out what life in the home was like. Three residents were case-tracked. This means their care records were looked at in detail and the arrangements around their care observed. Each resident agreed to talk to the inspector in private to give a view of their care. The inspector also spoke to the registered manager about management arrangements and to members of staff to find out what level of support and training was provided to assist them with their duties. The Commission for Social Care Inspection sent out ‘Have your Say’ questionnaires prior to the inspection to obtain people’s views of the service. 11 residents, 3 relatives and 6 healthcare professionals responded. What the service does well: The home is well managed by an experienced manager who works hard to achieve good standards throughout the home. A motivated and experienced staff team supports her. The organisation provides good opportunities for staff to attend training to ensure they have the skills and knowledge to do their job well. The standard of accommodation is exceptionally high and provides people with safe, comfortable and clean surroundings in which to live. There is a good range of social and recreational activities for residents to choose from. Residents and relatives made many good comments, such as: “I could not possibly recommend the Cotswold Home more highly.” “Care is superb.” “Staff are kind caring and very competent.” The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cotswold Home DS0000065413.V339090.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 The Cotswold Home DS0000065413.V339090.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): 3 and 4. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move into the home. Intermediate care (Standard 6) is not provided. EVIDENCE: Admissions are not made to the home until a full needs assessment is done. The manager, or her deputy, undertakes these assessments in the person’s own home, or in hospital if that is where they are at the time. This ensures people’s care needs are fully assessed before admission, enabling the manager to decide whether or not the home can provide the care that is needed. A resident said on a CSCI questionnaire that the manager had visited her before she moved in and had answered all her questions, which she found helpful. This indicates the importance the organisation places on giving people the information and help they need to make informed decisions about their future care. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 9 The organisation has a good track record for providing regular training for its staff to ensure they have the skills and experience to deliver the services people need. Training records showed that a broad range of training was provided and that staff attendance was good. People who returned CSCI questionnaires commented on the skill of staff, although one person thought staff needed to have more training in dementia care. The home is not registered to admit people with dementia when this presents as a person’s main care need, but some people develop mild to moderate dementia after admission, which is why all staff should attend dementia care training and regular updates. The manager said that dementia awareness training was provided in 2006 and more training is planned. One resident thought his specific sensory loss care needs were not adequately dealt with and this was discussed with the manager so that appropriate action to resolve the problem could be taken. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The Cotswold Home DS0000065413.V339090.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 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health needs of residents are well met. Personal support is offered in such a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: The majority of comments received through the CSCI questionnaires and during the inspection showed there was a high level of satisfaction with the care provided. Comments from residents and relatives included: “Immaculate standards”; “The care given is superb – staff always very helpful and understanding”; “I could not possibly recommend the Cotswold Home more highly”; “My relative feels very secure”. The care plans of three residents were looked at and they all contained clear information about each person’s care needs, as well as the action that the nurses and carers had to take to ensure people’s needs were appropriately met. There was evidence of regular care plan reviews, which ensures people’s The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 11 changing needs are taken account of in a timely way. Care plans are drawn up in consultation with the resident or their representative. Residents are assessed for potential risks, such as trips and falls, and action to reduce risks had been identified. All residents have a physiotherapy assessment on admission to determine their level of mobility and to establish if physiotherapy is needed. The initial assessment is funded by the organisation. The home has a good range of aids and equipment that are well maintained to ensure people’s safety. For example, pressure relieving mattresses and cushions are provided to reduce risk of pressure sores developing, or to aid healing if a pressure sore exists. The health care needs of residents are managed by visits from local health care services. The majority of residents who returned CSCI questionnaires said they always received the medical support they needed. Two GP surgeries give medical support and residents can choose which surgery they wish to register with. Doctors do not make routine visits to the home, instead visiting individuals at the request of staff. The home has an efficient medication policy supported by procedures and good practice. The inspector looked at the medication record charts for three residents and found they were complete with the required entries and were signed by appropriate staff. Regular management checks are carried out to monitor compliance with the home’s procedures. Residents who wish to manage their medication are supported in doing this. An NHS nursing student was on a placement at the home to gain experience of the care needs of older people. She told the inspector she was impressed with the standard of care and also with staffing levels. She said she was well supported by the staff and always worked with a senior member of staff. Her comments showed she was enjoying the placement and the knowledge and experience she was gaining. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: The home employs an activity organiser who is responsible for planning and arranging daily events. She visits new residents to find out what they like doing and whether they have particular hobbies they wish to pursue. The activity programme is regularly reviewed to ensure it meets the needs of the people living in the home. Responses to the CSCI questionnaires and comments made during the inspection showed people were generally very happy with the day-to-day life in the home and the choices they had. 8 of the 11 residents who responded to the CSCI questionnaires said there was “always” activities arranged by the home that they could take part in. Comments included: “The activities arranged in this care home are absolutely excellent and make a great difference to our health, happiness and general well being. I participate in virtually all of them – with enjoyment”. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 13 “I am very impressed by the way there is something arranged nearly every day that I can take part in”. One to one social care is provided, but three people said they would like more individual attention, such as the opportunity for ‘chats’ and playing board games. These comments were discussed with the manager so that they could be taken account of when planning activities. The main dining room provides extremely pleasant dining facilities where residents can sit and enjoy their food in a sociable setting. There are also smaller dining areas for people who prefer to be in a quieter area, or need individual help. Meals can be served to residents in their room if they prefer. 9 out of 11 residents said on CSCI questionnaires that they “usually” liked their meals; one said “always”; one “sometimes”. On the day of inspection lunchtime was lively with residents and their guests mingling over pre-lunch drinks before going to the dining room. This event was the monthly themed lunch, on this occasion in recognition of Oxfordshire Art Week. These lunches provide a very sociable occasion for residents, which they said they enjoy and look forward to. Residents confirmed they could have visitors whenever they wished and that there was good provision for seeing their visitors in private. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints system with evidence that residents feel their views are listened to and acted upon. The vulnerable adults procedure ensures a proper response to any suspicion or allegation of abuse. EVIDENCE: There is a well established complaints procedure for dealing with complaints. The procedure is explained in the Statement of Purpose and a copy is also displayed in the home, so that people can be clear about what they need to do in the event of needing to make a complaint. The manager has dealt with one complaint since the last inspection, which was not upheld. No complainant has contacted the Commission with information concerning a complaint since the last inspection. Of the 11 residents returning CSCI questionnaires all felt able to speak to the staff and manager if they were not happy about anything to do with their care. New employees receive adult protection training to ensure they know how to respond to any suspicion of abuse. Training updates are regularly provided as shown on the home’s training matrix. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of accommodation is exceptionally high and provides people with safe, comfortable and clean surroundings in which to live. EVIDENCE: Comments received through CSCI questionnaires and on the day of inspection showed that residents and relatives think the home provides a very high standard of accommodation. One person said: “The surroundings are in applepie order, constantly repainted”. There is good access to the central courtyard garden and also to the garden at the back of the home, both for people who can go out alone and people needing to use a wheelchair. The gardens are immaculately maintained. A resident said on a questionnaire: “A really lovely garden/courtyard in which one can sit in suitable weather. Plenty of seats/chairs etc in sun or shade”. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 16 The standard of cleanliness throughout the home on the day of inspection was high and the domestic team are commended for this. Comments from residents about the environment included: “Very clean indeed”; “Really excellent and attractive”. The Fire Service and Environmental Health Department periodically inspect the premises to ensure good safety standards are maintained. The last fire inspection was in February 2005. The last environmental health inspection was in January 2007, when two recommendations were made to control the temperature of hot water at the staff sink in the kitchen and to show the date food containers are opened. The manager confirmed these matters have been dealt with. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. EVIDENCE: The inspector received many comments from residents and relatives through CSCI questionnaires and during the inspection about the kindness and helpfulness of staff. A resident said: “Staff are absolutely marvellous”. Another resident unable to communicate easily gave the ‘thumbs-up’ sign when asked about his care. A resident wrote on a CSCI questionnaire: “The care staff are readily available, kind, caring, very competent. They provide a happy atmosphere and are very friendly. I have the highest regard for them”. On the day of inspection 2 registered nurses and 4 carers were on duty on the nursing unit, with the head of residential care and 2 carers on the residential unit. The registered manager was also on duty, as well as the full-time activity organiser. CSCI questionnaires showed that 11 residents thought there was “always” sufficient staff available; 4 said “usually”. There is a large team of support staff consisting of reception, maintenance, kitchen and domestic workers. The inspector saw the home was running smoothly and was aware of a calm and relaxed atmosphere during the inspection. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 18 27 of the 37 carers employed have the NVQ level 2 in care (or above). This indicates the organisation’s commitment to this training ensuring carers have the necessary knowledge and skills needed to give good care. Three staff files were looked at to find out if the necessary information and checks had been obtained. Recruitment procedures were found to be generally good ensuring employees are appropriately vetted prior to appointment. The only shortfall was that the organisation’s application form asks for a 10-year employment history, whereas a full employment history is required so that any gaps in employment can be identified and checked. Induction training is well developed and provides new employees with the knowledge and level of supervision they need to be confident in carrying out their duties. For the first two weeks of employment new staff are not included in staffing numbers and work alongside experienced staff to gain an understanding of their role. A professional who returned a CSCI questionnaire said, “Staff always listen to my comments/suggestions and will act accordingly – very good team work”. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The registered manager has extensive experience of managing care homes for older people, and has managed the Cotswold Home since it opened in 1998. She is a registered nurse and has obtained the NVQ level 4 in management, known as the Registered Manager’s Award. This provides her with the knowledge that she needs to effectively manage the home. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 20 People’s comments included: “A very happy home, well run and managed with a reliable, consistent and well qualified staff”; “An extremely well and efficiently run home”; “This is on the whole a beautifully run home”. There are good quality assurance systems in place to enable the organisation to find out what people think of the service it provides. This assists in identifying where improvements are needed to ensure the present excellent standards are maintained. The pocket money accounts for three residents were checked and it was found the home has efficient systems to ensure effective safeguarding and management of residents’ money. The organisation takes seriously its responsibility to ensure the safety of people living in the home, as well as staff and visitors. The home employs maintenance staff to carry out the required safety checks and day-to-day repairs. External contractors are brought in to check specialist equipment on a regular basis. The Health and Safety Executive carried out a routine inspection of the home in April 2007. The manager said the inspector found that overall the home was in good order and well maintained. Three recommendations were made to repair a window latch in the Chapel, carry out a risk assessment for maintenance staff working from height and a risk assessment for the traffic flow in the car park to include deliveries, staff and visitors. The manager confirmed these matters have been dealt with. The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP4 Good Practice Recommendations The content of dementia awareness training should be kept under review to ensure it provides staff with the necessary knowledge and skills to provide the care that people need. The content of sensory impairment training should be kept under review to ensure it provides staff with the necessary knowledge and skills to prove the care that people need. A full employment history needs to be obtained from all new staff to enable any gaps in employment to be checked to ensure residents are safeguarded. 2 3 OP4 OP29 The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 The Cotswold Home DS0000065413.V339090.R01.S.doc Version 5.2 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. 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