Inspection on 19/09/07 for The Cottage

This inspection was carried out on 19th September 2007.

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 Cottage 24/03/10

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 The Cottage Heath Farm Heath Road Scopwick Lincoln Lincolnshire LN4 3JD Lead Inspector Wendy Taylor Key Unannounced Inspection 19th September 2007 09:00 The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 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 Cottage DS0000069857.V342243.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 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 Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cottage Address 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) Heath Farm Heath Road Scopwick Lincoln Lincolnshire LN4 3JD 01526 320312 autismcareuk.com Autism Care (UK) Limited Mr Peter Stuart Wakelin Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection New Service Brief Description of the Service: The Cottage is located near to the village of Scopwick, and is approximately 10 miles from the town of Sleaford, Lincolnshire. It is part of a complex of services, which include three other registered homes and a main administration centre on the same site. In the village of Scopwick there is a village shop and pub, and Sleaford offers a good range of shops and other amenities. The Cottage is registered for 10 people who have Autistic Spectrum Disorder and a learning disability. The accommodation is a spacious single storey building, which offers a range of living and recreational areas, including a wellkept garden area. The Cottage is owned by Autism Care (UK), and the Responsible Individual for the service is Mrs Maggie Sykes. Mr Peter Wakelin is the Registered Manager. Information provided by the Registered Manager shows that the current fees for the service range from £1982.74 to £6302.10. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced inspection since The Cottage was registered in April 2007. The visit took place during September 2007 and lasted for approximately 6½ hours. Ten people were living at the home on the day of the visit. The care and support received by three service users was followed in detail, using a method called case tracking. The service users currently living at the home have communication needs and were not able to fully express their views about the service, therefore case tracking included spending time with them and observing the care and support they received. Their care plans, medical records and daily notes were looked at, as well as some general house records and staff records. Staff and the registered manager were spoken to during the visit, and information already held by the commission, such as a self-assessment and notifications was also used as part of the inspection process. During the visit some of the service users were going out to do activities such as trampolining and going for lunch, and some were enjoying in-house activities. Staff said they enjoy working with the service users and there is very good teamwork within the home. What the service does well: The Cottage is managed very well, and the staff make sure that all of the service users get the right care and support. They make sure that service users are helped to stay healthy, and can see people like doctors, psychologists, chiropodists and dentists whenever they need to. They treat service users with respect and they are given lots of training to help them understand individual needs. Service users have very detailed assessments and care plans. The plans give lots of information about what they like and dislike, and how they like to communicate. Staff help them to make choices and decisions about things such as what they want to eat, what activities they want to do, and where they want to go; by using symbols, storyboards and pictures. Service users can choose from a good range of activities like going for walks, playing football, horse riding and bowling; and there are lots of things for them to do in the house as well like art sessions, cookery, aromatherapy and watching TV. The Cottage DS0000069857.V342243.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 Cottage DS0000069857.V342243.R01.S.doc Version 5.2 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 Cottage DS0000069857.V342243.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users and their representatives have access to clear information and support, which helps them to make an informed choice about where to live. A very detailed and individualised assessment process ensures that service users needs can be met. EVIDENCE: There is an up to date statement of purpose and service user guide in place. A copy of the service user guide is kept in each service user’s personal file. Information to help people make a choice of where to live is available in formats such as pictures, words and photographs. The manager said that there are plans to monitor the quality of the support provided for new service users during their assessment and moving in period. A draft checklist to begin this process was seen. Pre inspection information shows that there are plans to review the service user guide so as to make it more user friendly. Records show that the process for new service user’s moving into the home is individualised and can include pre admission visits if this is suitable for the person. Records also show that as well as care staff, other specialist staff from the provider organisation, such as psychologists or specialist programme advisors, help to carry out the assessments. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 9 A wide and very detailed range of assessments are used to make sure that service users needs are clearly identified and planned for. Assessments are specific to the needs pf people with autistic spectrum disorder. They cover areas such as communication, social interaction, imagination, emerging skills, health and sensory needs. Needs such as culture and religion are also included in the assessment process. The records show that everyone who is involved in the service user’s life is given a chance to join in with the assessment process. The manager said that care staff are currently reviewing initial assessments so that progress for service users can be seen. Pre inspection information indicates that part of the assessment process includes the identification of any staff training that may be required to meet the service user’s specific needs. Training records confirm this (see Standards 31-36). This information also shows that there are policies in place for the referral and admission processes. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Comprehensive and detailed care plans ensure that service users needs are fully met, and they are able to make choices and decisions about their lives in a safe and supported way. EVIDENCE: Pre inspection information shows that there are policies in place for care planning, reviews, privacy, dignity and choice. This information also indicates that service provision is based on supporting service users to make positive choices, and achieve their aspirations and wishes. Care plans reflect this in a structured and individualised way. They are divided into three sections covering needs identified in specialist assessments, health assessments and risk assessments. Plans are very clearly cross-referenced to the relevant assessments and cover needs such as road safety, moving between activities, anxiety, communication, falls and managing behaviours. There are also care plans that support service users with decision-making processes highlighted by The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 11 recent government legislation (Mental Capacity Act, 2007). The manager said that there are plans to train all staff about this legislation, and there is up to date information about it within the home. The specialised system of assessment and care planning used within the home helps service users to communicate their needs and wishes through visual methods such as pictures, and it breaks task down into simple steps so that service users can have more independence. It also helps service users to have a better understanding of how their day is structured. For example one service user was seen setting their own plan for the day, using picture cards to communicate this; and another service user was supported with a series of story boards for daily routines, so as to help reduce their anxiety. The care plans refer clearly to staff being consistent with carrying out the planned support. There is evidence in records to show that care plans are reviewed on a monthly basis by care staff. There are also at least two reviews per year, at which everyone who is important in the service users life can join in; for example parents, social workers and psychologists. Anyone who is involved signs to say they agree with the outcomes of the review and the care plans. As well as care plans, staff are developing person centred plans with each service user. These plans contain lots of photographs and pictures to show what the person likes to do, who is important in their lives, and what their hopes are for the future. Records show that staff are trained in how to develop and use person centred planning systems, and that they have regular meetings where they can share and update their knowledge about individual service user’s needs. During the visit staff demonstrated a very detailed knowledge and understanding of each service users needs, and they talked about how they maintain privacy and dignity for service users by, for example, knocking on bedroom doors before entering and making sure they have personal space when they need it. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a range of leisure activities, which help them to develop their social and personal skills. Menus meet individual needs and preferences. EVIDENCE: Each service user has an individual activity plan, which includes things like playing football, horse riding, going for walks, bowling, aromatherapy and library visits. Individual activity plans are printed in a key fob format for staff so that they have a quick reference as to what a service users routine is. During the visit some service users were going out for lunch and others were going out to use trampolines. Those who stayed at home were supported to do things like play football, watch TV or relax in their rooms. There is a resource area for service users to have individual activities such as art sessions, and there are also computers for them to use. The visual communication systems mentioned earlier help service users to say what they want to do. Pre The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 13 inspection information shows that there are plans to look for a wider range of community-based activities to offer to service users Pre inspection information shows that there are policies in place to enable contact with family and friends; and that keyworkers compile reports for families to keep hem up to date with their relatives’ progress. Records show that service users are supported to make visits to see their family, go on family holidays and have people visit them at home. Staff also help them to make phone calls to people when they wish. There is evidence in the dinning and kitchen areas that service users can choose their own meals and their own mealtime routines using picture cards and menus. Individualised menus to meet health needs, general preferences or cultural needs were seen. Staff demonstrated that they are aware of and understand the individual needs, and they help to keep a relaxed and inclusive atmosphere by taking their meals with the service users. There was a good range of foods available in the home during the visit, and service users were offered drinks regularly. There is a small kitchen available where service users are supported to develop their food preparation skills using the visual communication system. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are protected by good medication procedures, and they benefit from having very good access to a wide range of health care services. EVIDENCE: Pre inspection information shows that policies are in place for needs such as continence, first aid, pressure relief and medication. The information also shows that there is a health action plan in place for each service user, which identifies how they want their health needs to be met. Completed health action plans were seen in files and they cover needs such as sleep, fluid intake, diet, personal hygiene and medication. Where specific health needs are identified, for example continence or epilepsy needs, there is background information available about the condition. Staff were seen to promote dignity and privacy in all of their interactions with service users and with each other; for example during handover of shifts service users were referred to by preferred names or titles, and personal needs were supported and discussed in private. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 15 The health action plans and general records show that service users have access to services such as psychology, psychiatry, specialist dentists, chiropodists and opticians. The manager described individual support processes such as that undertaken over a number of weeks to help a service user to be able to accept and use a new health related service. Support to maintain a healthy lifestyle is reflected in person centred plans (see Standards 6-10) and in records such as weight charts and menus. A standardised system for ordering and recording medication has been introduced recently. Records for those service users who were case tracked were completed in full, and satisfactory administration procedures were seen. The manager described the system for recording medication that is used only where necessary and said that any use of these medications has to be authorised by an on-call manager. The system allows for the use of these medications to be monitored to make sure that administration is appropriate and effective. Records show that senior staff receive training about medication and how to administer it, and this training is updated. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by up to date policies and procedures; and by staff who are well trained and know how to keep them safe. EVIDENCE: Pre inspection information shows that there is a complaints policy in place, which is available in a symbol format and is displayed in the entrance hall. Information about keeping service users safe is available within the home and there is an up to date copy of Local Authority guidance and procedures for Safeguarding Adults. Care plans refer to keeping service users safe, and making decisions (see Standards 6-10). The people who act as advocates for service users are listed in person centred plans, and the manager said that although access to formal local advocacy services is limited, they continue to make referrals where necessary. The manager also said that there is a system in place for any reported incidents to be reviewed to make sure that the actions taken are appropriate for each service users. Records show that during induction staff receive training about how to keep people safe, and the manager said that there are plans to provide update training for all staff within the next year. Staff said that they have received training and they demonstrated that they have a very clear knowledge and understanding of the procedures for keeping service users safe. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 17 Since registration there have been no complaints received about the service. One allegation has been made and records show that it was reported and managed appropriately, with staff working together with the Local Authority. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable environment that meets their needs. EVIDENCE: A partial tour of the building showed that general maintenance is up to date and the environment is clean and tidy. The manager said that a new bathroom is due to be fitted in the very near future. Bedrooms are well personalised and equipment is available to meet individualised needs, such as light boards, touch boards, specialist seating and safe housing units for electrical equipment. Rooms and their functions are identified with appropriate pictures, which helps service users to use their home more independently. There are also individualised storyboards in some areas to help individuals with their routines. Service users are able to use the gardens around the building when they want to, and the manager said that there are plans to develop a sensory garden. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 19 Staff demonstrated an understanding of infection control procedures and were seen using things like hand disinfectants, gloves and aprons appropriately. Cleaning materials were stored in a locked cupboard. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good training and support for staff ensures that service users needs are met; and robust recruitment processes protect the service users. EVIDENCE: The recruitment records for three staff members were looked at and they contained information such as references, criminal record bureau checks, identification and application forms. Rotas show that there is a consistent staff team, and enough staff on each shift to meet the needs of service users. Records show that staff receive training in subjects such as epilepsy, autism, behaviour management approaches, dementia and maintaining dignity. They also show that staff have access to nationally recognised care qualifications at various levels, and the manager said that there are plans to increase the number of staff who are studying for the qualifications. Staff said that they have good access to training, and that it helps them to feel confident in providing appropriate care and support to service users. They also described training in subjects such as fire safety and health and safety; and specific induction programmes for promotion into posts such as Team Leader. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 21 Staff said that they have regular supervision and records confirm that sessions take place at least six times a year. Staff said that they are able to talk about issues that affect their work, and their training and development. They also said that they could speak to their supervisors in between formal sessions if they need to. The minutes of monthly staff meetings are available and show that issues such as care planning, general communication and admissions are discussed and staff said that this keeps them up to date. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the quality monitoring systems ensure it run in the best interests of service users; and those systems promote their safety. EVIDENCE: The manager of the home has been in his current post for approximately three years and has extensive experience of providing support for people who have needs within the autistic spectrum. He has completed the Registered Managers Award, and has begun to study for a nationally recognised management qualification. Staff said that the manager listens to what they have to say, and they feel respected and supported as part of the team. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 23 Records show that audits are carried out for things like health and safety, medication administration and environmental quality. Surveys to monitor the quality of issues such as life at the home, staffing and management are carried out annually with relatives and other stakeholders. Outcomes from a recent survey indicate an overall satisfaction with the current service. The provider also makes sure that monthly monitoring visits and regular audits of service users finances are carried out. The home is accredited with a national organisation as a provider of quality services for people with autism. Daily records are completed in detail and during the visit, staff carried out a detailed shift handover process. Information such as service users needs and achievements, accidents/incidents, maintenance requirements, appointments and staff issues were included in the process. The manager said that he plans to review the completion of daily care plan notes so that they are more effective within the overall care plans review process. Fire safety checks and a fire safety risk assessment are in place, as well as assessments for moving and handling and substances that are hazardous to health. The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 4 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 X The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 25 N/A 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. 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. Refer to Standard Good Practice Recommendations The Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Cottage DS0000069857.V342243.R01.S.doc Version 5.2 Page 27 - 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!