Inspection on 05/10/05 for The Firs

This inspection was carried out on 5th October 2005.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs 13/01/09

The Firs 16/08/07

The Firs 06/09/06

The Firs 07/02/06

The Firs 25/01/05

The Firs 11/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 The Firs Thorpe Road Kirby Cross Frinton On Sea Essex C013 0NJ Lead Inspector Ray Finney Final Unannounced Inspection 5th October 2005 09:30 The Firs DS0000017963.V255876.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 Firs DS0000017963.V255876.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 Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Firs Address Thorpe Road Kirby Cross Frinton On Sea Essex C013 0NJ 01255 862617 01255 860259 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) Mr Ahmad Fareed Kadar Mr Sheik Kemal Kadar Mr Sheik Kemal Kadar Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1), Physical disability (1) of places The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One person, under the age of 65 years, who requires care by reason of a learning disability and who also has a physical disability, whose name was provided to the Commission in July 2003 One service user, aged 65 years and over, who requires care by reason of a learning disability, whose name was made known to the Commission in July 2004 Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 8 persons) The total number of service users accommodated must not exceed 8 persons 25/01/05 2. 3. 4. Date of last inspection Brief Description of the Service: The Firs is an established care home for eight younger adults with learning disabilities. The home is located in a rural setting in a large country house in its own grounds, between the villages of Kirby Cross and Thorpe-le-Soken. Local shops, post offices and schools are found in these villages. Bedroom accommodation for all eight service users is on the first floor with stairs and a passenger lift for access. Toilets, bathrooms and showers are found on the ground and first floors. Communal areas on the ground floor comprise of a lounge, dining room and kitchen/dining area. There is wheelchair access to all communal areas and there are ramps to the front, side and rear of the building. The Firs is set in extensive grounds with established gardens to the front, side and rear of the building and off-road parking to the front. Attached to the care home is a day centre offering care and facilities for service users in the community. The centre offers a range of experiences such as a spa pool, ball pool and a sensory room. In addition there is a petting farm with sheep, goats, chickens and rabbits. Service users residing in the home are able to use these facilities. Access to the centre is separate from the home. The home offers transport based on the needs of the service users. The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place on 5th October 2005, for a total of 8 hours. The inspection process included discussions with service users and members of staff. The inspection also included a tour of the home, observations of interactions between service users and members of staff and evidence gathered from samples of records. The atmosphere of the home during the days of the inspection was lively and welcoming and the inspector was given every co-operation throughout the inspection from the Manager, Mr Colin Denny and General Manager, Mr Kemal Kadar. What the service does well: What has improved since the last inspection? What they could do better: Although the general standard of decoration was reasonably good in communal areas, some paintwork would benefit from being renewed. A toilet seat in the upstairs bathroom was quite worn with some scratches and the home would benefit from having it replaced. The environment in the communal living room and dining areas was quite sparse because of the behaviours of some of the service users. The home would benefit from introducing decorative items such as ‘mural’ type pictures and a variety of soft furnishings and cushions to enhance the living environment in a safe manner. The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 6 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 Firs DS0000017963.V255876.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 Firs DS0000017963.V255876.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): 1 and 3 The home ensured prospective service users had the information they needed to make an informed choice about where to live. The home was able to meet the needs and aspirations of the service users living there. EVIDENCE: A new Statement of Purpose and Service User Guide were drawn up and submitted to the Commission for Social Care Inspection. These documents had been updated to reflect changes to the management structure and set out the aims and objectives of the home and the facilities offered. The manager provided evidence that the home had started a programme of ‘Learning Disability Awards Framework’ training (LDAF) for staff. The home had input from Speech and Language Therapists around methods of communication such as picture cards for service users with communication difficulties. The inspector observed that staff communicated effectively with service users. Staff received training around epilepsy with Colchester Primary Care Trust. The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 9 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): 6, 7, 8 and 9 Although the needs and goals of service users were reflected in their personal plans, these would have benefited from having input from advocates and families throughout the review process. Service users received the support they needed to make decisions where they had the capacity to do so and where they had not, this was recorded in the individual plan. Service users were encouraged to participate to the best of their abilities in all aspects of life in the home. Service users were supported to take risks as appropriate within the limits of their abilities. EVIDENCE: The personal files of four service users were examined. All contained comprehensive plans of care that were clear, easy to follow and contained sufficient detail to enable staff to deliver individual care. The plans contained evidence of comprehensive risk assessments and evidence of social support and how healthcare needs are met. There was evidence in the care plans of objectives and review. The manager said that the home operated a keyworker system, in which members of staff contributed to service users’ care plans and the review process. No advocates were involved in developing plans The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 10 of care, but the manager said that he intended to contact advocates and relatives to attempt to involve them in the review process. None of the service users in the home were able to manage their own finances, although two service users had limited amounts of money to self-manage and this was evidenced in the care plans and risk assessments. The manager informed the inspector that there had been some advocacy input in the past, but local advocates had limited resources because of the high demand for their services. Records examined showed that service users with complex needs and profound learning disabilities who are unable to make choices and decisions have this recorded in the Service User Plan. Staff and service users spoken with said that some service users had opportunities to participate in the running of the home. Service users were involved in the recruitment of new staff. The manager informed the inspector that he had attempted to encourage participation in staff meetings but service users did not show an interest. The inspector observed that the home encouraged service users to take calculated risks to promote learning and independence. Two service users held limited amounts of money. One service user spoken with expressed a preference that the radiator in the service user’s room remained uncovered. The Firs DS0000017963.V255876.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): 12, 13, 14, 15, 16 and 17 The home supported service users to participate in activities that were age and culturally appropriate, although the complex needs of the majority of service users in the home meant they were unable to find or keep jobs. Service users were supported to participate in the local community and engaged in a range of appropriate leisure activities. Service users were supported to have appropriate personal friendships and maintain links with families. The home respected the rights of service users and recognised their responsibilities. Service users were offered a nutritious, varied and well-balanced diet that promoted their health and wellbeing. EVIDENCE: Information from the manager and the inspector’s observations indicated that service users with complex needs and profound learning disabilities were unable to carry our employment. Information from staff spoken with and an The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 12 activity planner examined showed that service users participated in college courses such as life skills, cookery and ‘What’s in the News?’ Staff and service users spoken with on the day of the inspection and records examined showed evidence of participation in activities in the local community. One service user used the library. The activity planner showed that the local swimming pool, Bowling Alley and a local public house were used by service users. One service user who expressed an interest was supported to vote at the last election. Service users in the home benefited from the use of the day centre on site; among the facilities offered by the day centre were a spa pool, sensory room, a ball pool and an art room. The inspector saw evidence of artwork produced by service users displayed in the home. Records of activity rotas examined showed that service users benefited from a programme of activities and courses both on site and within the local community. One service user spoken with told the inspector about going to “music and singing” and also going to “poetry and storytelling” at the Columbine Centre in Walton-on-the-Naze. Service users and staff spoken with said that family links and personal relationships were encouraged. The wishes of one service user to move on and live with a partner were being explored and the service user was supported to apply for inclusion on the council housing list. During a tour of the premises, the inspector observed that there were locks on bedroom doors and some service users were able to use keys. A keypad had been purchased for one service user who could not manage to use a conventional lock and key. The inspector observed the manager knocked on doors or asked permission from service users before entering rooms. One service user spoken with chose when to get up and when to have breakfast. The inspector observed a lot of good natured and friendly interaction between members of staff and service users. Service users were seen to be relaxed and comfortable with staff and management. Records examined showed that there was a four-weekly rotation of menus, although the housekeeper informed the inspector that the menus were varied according to what local produce was in abundance. The inspector was shown evidence that service users benefit from home made produce from the gardens of the home such as chutney, jams and eggs from the hens. The inspector observed that a variety of fresh fruit and vegetables were available. There was evidence that some service users chose to eat at a table in the kitchen rather than in the dining room. The housekeeper informed the inspector that one service user regularly enjoyed a one-to-one cookery session. The Firs DS0000017963.V255876.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 and 20 The home ensured that the service users’ physical and emotional health needs were met. No service users retained, administered or controlled their own medication at the time of this inspection and service users were protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Records examined showed that service users were supported to access dentistry services at Clacton Hospital. In addition, the home used the services of a visiting optician and a visiting chiropodist and where appropriate service users had input from community learning disabilities nurses. The manager informed the inspector that reflexology services had been available until recently and they were looking for a replacement practitioner. The homes procedures for dealing with medication were examined. A monitored dose system was in place. At the time of the inspection, no service users were self-medicating. The Medicine Administration Record sheets were examined and all found to be in order. The manager informed the inspector that training had been carried out by the community nurse specialist in respect of the administration of rectal diazepam. The Firs DS0000017963.V255876.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 and 23 The home ensured the views of service users and significant others were listened to and there was an appropriate complaints policy in place to ensure that views were acted upon. Service users were protected from harm by the homes policies and procedures. However, more rigorous checks on references throughout the recruitment process would be beneficial (see evidence for standard 34). EVIDENCE: Records examined showed that an appropriate complaints policy was in place and there were appropriate forms for the recording of complaints and concerns. The manager informed the inspector that no complaints had been received since the last inspection. Records examined showed that there was a whistle blowing policy in place. The manager said that new staff were given the General Social Care Council good practice guidelines booklet. Records examined showed that the home carried out POVA checks and CRB enhanced disclosure checks. The manager informed the inspector that it was not the home’s policy to use physical interventions; the strategy was to remove service users to a safe area if another service user presented with behaviour that challenged or was aggressive. The policy of the home was that only managers had access to service users monies. The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 15 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): 24, 25, 26 and 30 In the main, the home provided a homely, comfortable and safe environment but the communal living area would benefit from additional appropriate decorative items. Service users had bedrooms that suited their needs and lifestyles as well as promoting independence. Overall the premises were kept clean, hygienic and free from offensive odours. However, a toilet seat needed to be replaced. EVIDENCE: From a tour of the home the inspector observed that overall the environment was comfortable, bright and cheerful. The environment in the communal living and dining areas was quite sparse. The manager explained that the exuberant behaviours of the service user group meant that it was quite difficult to have pictures or ornaments. Upstairs had some ‘mural’ type pictures directly on the walls and the downstairs living room would benefit from similar decoration. There had been no changes to service users’ accommodation since the last inspection and the requirements for the standard for pre-existing care homes was met. Furniture in service users bedrooms was observed to be of good quality, domestic and unobtrusive. There was evidence of personal belongings, pictures and decorative items in service users’ rooms. All The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 16 bedrooms had lockable doors, although some service users did not have the capacity to use keys. The overall standard of cleanliness was good. Some carpets were stained, but the manager explained that this was as a result of coffee being tipped out by a service user on a regular basis; the carpets were cleaned regularly but it did not remove all the stains. There were no unpleasant odours in the home and a system of pleasantly perfumed air fresheners was in place. A toilet seat in the upstairs bathroom was scratched and showed signs of wear and would benefit from being replaced. It was noted on a tour of the premises that the home had a laundry room with appropriate facilities for washing and drying. The Firs DS0000017963.V255876.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): 32, 33, 34 and 35 On the whole the needs of service users were met by competent and qualified staff who were appropriately trained. However, the home would benefit from having a formal training and development plan and additional care staff need to undertake NVQ2 to meet National Minimum Standards. Service users were supported by an effective staff team. Service users were protected by the homes recruitment policies, although the procedure would benefit from more stringent checks on references. EVIDENCE: Of twelve care staff, three had completed NVQ2 training and one was in the process of doing the award. The general manager informed the inspector that they were looking at other areas of funding for NVQ awards. Records inspected showed that applications had been completed for some members of staff to commence LDAF training with a local provider. The manager said that this was the start of an ongoing programme. The general manager informed the inspector that training was arranged as and when it was needed but there was no formal training and development plan. Staff received training around epilepsy with Colchester Primary Care Trust. Records of rostered staff were examined. The area manager had used the ‘Residential Forum’ to identify required staffing levels. The manager informed the inspector that there was a regular staff team in place with a housekeeper The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 18 on duty daily. Records examined showed that there was evidence of flexible use of staff numbers according to planned activities. General cleaning tasks were carried out by care staff and the home should consider whether this was the best use of skilled care staffs’ time. Samples of staff files were examined and showed that required documentation was in place. However, the recruitment procedure would have been more robust if more relevant past employers had been approached for references. The Firs DS0000017963.V255876.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): 39, 41 and 42 Residents were able to be confident their views underpinned the selfmonitoring and review of the home. Service users’ rights and best interests were safeguarded by the home’s policies and procedures and record keeping at the home was good. The health, safety and welfare of service users were promoted and protected. EVIDENCE: A quality assurance system was in place and the records were examined. The manager was in the process of collating the information into a report format but it had not yet been completed. Records examined during the inspection included water safety checks, staff files, fridge and freezer temperature checks and records relating to the preparation and serving of food. Individual and home records were found to be up to date and in good order. The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 20 The inspector observed that radiator covers had been installed in most of the rooms. The manager said that the rooms of all service users who were vulnerable had now been completed. A cover was not going to be put on the radiator in the room of one service user, who told the inspector quite definitely that it was not wanted. The manager informed the inspector that a yearly Health & Safety check, including a Legionella check, was carried out by a contracted consultancy organisation. Records of water temperature checks were inspected and found to be in order. The Firs DS0000017963.V255876.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 3 X 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 3 2 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Firs Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 2 X 3 3 X DS0000017963.V255876.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15(1) Requirement Timescale for action 31/12/05 2 YA34 3 YA35 4 YA39 The registered person must ensure that service users who are unable to contribute to the reviewing process are represented by relatives or an advocate. This is a repeat requirement. 19(1)(a)(b) The registered person must ensure that the home operates a thorough recruitment policy to ensure the protection of service users. This is a repeat requirement. 18(1)(c) The registered person must ensure that there is a staff training and development programme in place. Each staff member must have an individual training and development plan. This is a repeat requirement. 24(2) The registered person must supply the Commission with a report of the results of any quality assurance surveys and ensure it is made available to service users and their representatives. 31/10/05 31/12/05 31/12/05 The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 23 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 YA32 Good Practice Recommendations The registered person should ensure that 50 of care staff in the home achieve NVQ Level 2 in care by 2005. The Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Firs DS0000017963.V255876.R01.S.doc Version 5.0 Page 25 - 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!