Inspection on 21/01/06 for The Green

This inspection was carried out on 21st January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Green 15/09/08

The Green 17/10/06

The Green 06/10/05

The Green 10/03/05

The Green 23/08/04

The Green 01/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Green Bromborough Pool Bromborough Wirral CH62 4TT Lead Inspector Beate Roth Unannounced Inspection 21 January and 23rd 2006 10:00 st The Green DS0000019008.V279030.R01.S.doc Version 5.1 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 Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Green Address Bromborough Pool Bromborough Wirral CH62 4TT 0151 643 8567 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) Wirral Autistic Society Patricia Sarah Anne Hood Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: The Green is registered to provide personal care for 10 adults of either sex with a learning disability. The home consists of four flats that are accessible to one another and share the same main entrance. Two of the flats provide accommodation for two service users, and the other two flats provide accommodation for three service users. The home offers single occupancy bedrooms. Each flat has a kitchen with a dining area and either a through or separate lounge. There is a patio and a garden to the rear of the home. The home is close to local shops and to public transport services. Parking is available on the main road. The home is run by Wirral Autistic Society who have several care homes for adults with a learning disability in the area. Wirral Autistic Society provides a range of services and facilities, which are fully utilised by the service users, accommodated at The Green. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 2 days and lasted 6 hours. During the inspection time was spent in the office examining records and policies and procedures. Staff and service users were spoken with. A tour of the home was undertaken. Staff were observed delivering care to service users. The manager was spoken with. What the service does well: What has improved since the last inspection? What they could do better: A review of the behaviour management plan for a service user identified at this inspection needs to take place so as to ensure that it reflects the current guidance given to staff and meets the service user’s needs. In order to fully safeguard the wellbeing of service users, the home’s medication procedure must be followed by staff at all times. Staff are not to be employed at the home unless the registered persons are satisfied that they are physically and mentally suitable for the work they are to undertake. The health and safety of service users needs to be better promoted by ensuring checks of the fire The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 6 alarms and emergency lighting take place at the frequencies recommended by the fire service. Steps also need to be taken to ensure that fire safety training is provided to day staff on a 6 monthly basis and night staff on a 3 monthly basis. The content of the contracts/terms and conditions and the way they are drawn up could better support the interests of service users. 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 Green DS0000019008.V279030.R01.S.doc Version 5.1 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 Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 A full assessment would take place to ensure that a service user’s needs could be met. The contracts/terms and conditions could better support the interests of service users. EVIDENCE: There has been no new service users admitted to the home since the last inspection. New service users would be assessed by the manager for the home and by a representative from day services. The manager would visit a prospective service user where they are living. Information would be gathered from the service user, their carers, social worker and any other relevant agencies. An examination of an initial assessment pro forma at a previous inspection indicated that all the information recommended in this standard is available. An assessment would be made if a service user moved to the home from another home within Wirral Autistic Society. Service users and their carers can make as many introductory visits to the home as they wish. A sixmonth settling in period is offered. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 9 The contracts/terms and conditions between the home and the service user are in the process of being reviewed. At previous inspections it was recommended that service users be supported by family, friends and/or advocate, as appropriate when drawing up the contract and that clear information around any costs a service user has when they go out with staff is provided. At a previous inspection it was reported that when service users go out with staff they sometimes pay for refreshments for staff. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 In general, care planning reflects the assessed and changing needs of service users. EVIDENCE: A sample of service user plans were examined and contained detailed and clear information to enable staff to provide appropriate support around day-to-day living and personal goals. These plans are formulated at a service users review and cover the information required by the National Minimum Standards. A review had taken place within the last 6 months. The documentation available from reviews indicated that the service user, their relatives, social worker and other relevant individuals are invited to contribute to reviews. A service user spoken with said that they get the support they need from the staff. An examination of the service user plans indicated that, service users’ rights to live as independently as possible, in accordance with their abilities, is promoted by the home. Risk assessments are available which indicate why service users’ rights need to be limited in order to safeguard their wellbeing. Reactive plans, which detail behaviour management strategies are also available. These indicate that as a last resort physical intervention is used. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 11 The records made following an incident of physical intervention were satisfactorily maintained and indicated that physical intervention is not used frequently. Staff are trained in behaviour management strategies such as supportive holds and breakaway techniques as part of their induction. An accredited trainer is now providing instruction to staff. A behaviour management plan for a service user identified with the manager at this inspection needs to be reviewed. The management plan does not appear to be appropriate to the needs of the service user. Staff spoken with, do not feel the plan is appropriate and have developed an alternative way of managing any challenging behaviour. The current guidance given to staff needs to clearly available for staff to refer to. Service users are encouraged to contribute towards the running of the household. Service users go shopping and help with meal preparation in accordance with their abilities. Service users’ views are obtained through their individual key workers. The Green DS0000019008.V279030.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15 and 17 Service users are able to take part in appropriate activities that provide opportunities for their educational, social and personal development. Links with the local community are good and family relationships are appropriately supported. Varied and well-balanced meals are provided in homely surroundings. EVIDENCE: Service users attend day services five days a week where they are provided with a range of opportunities to promote their personal development. Service users have a timetable of activities, which has been drawn up to meet their needs, skills and individual preferences. Some of the opportunities available are horticulture, craftwork, community work experience, drama and physical education. Activities are provided by either Wirral Autistic Society’s day services or by outside organisations such as local colleges. Service users are provided with work experience opportunities in accordance with their abilities. There are opportunities for service users to become involved in the local community. For example, the service users visit local shops, go to the gym, cinema, bowling and participate in community life through attendance at The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 13 college courses. The home has access to private transport and there is easy access to train and bus services. At the time of the inspection 4 service users were away for the weekend visiting relatives. Staff reported that family links and friendships are promoted. The arrangements for contact with family are written into the service users’ care plans. Service users have the opportunity to meet people and make friends with people who do not have their disability, through attendance at social clubs and through community activities. Care plans indicate the dietary requirements of service users. Advice is obtained from a dietician if this is required. In general, these records indicated that well-balanced and varied meals are made available. A record is kept of food provided to service users. Care is to be taken to ensure that sufficient detail is entered into these records so that anyone inspecting it can determine if the overall diet is satisfactory. On some days the entries were not complete. A service user spoken with said that they choose their own meals and do their own shopping and cooking with staff support. The records of the meals provided indicated that varied and healthy meals were being prepared. The service user said that they get good support from staff if needed around meal planning. Domestic style kitchen’s are available that include a dining area. The Green DS0000019008.V279030.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The personal care and health needs of service users are well met. Service users are not fully safeguarded by the practices around the administration of medication. EVIDENCE: Records detail the support service users need with their personal care. Observations indicated that staff, promote the privacy and dignity of service users. Consistency and continuity of support for service users is provided through the key worker system. Staff receive training on promoting privacy and dignity during their induction. Records indicate that service users have access to medical/health care professionals as needed. Service users are supported to attend health care appointments. The record of accidents held at the home that were seen on the records for 3 service users, where suitably maintained. Following the last inspection there was incident in which medication was not administered according to the medication procedure, which did not support the wellbeing of service users. As a consequence, the procedure has been made more detailed and this has been discussed at a staff meeting. At this inspection, an observation was made of medicines being administered. The procedure was not followed. A member of staff did not put the medication into The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 15 the carrying case, as per the procedure. This was brought to the attention of the manager who said that this would be attended to without delay. The manager has revised the medication procedure in order to safeguard the wellbeing of the service users. This procedure must therefore be followed in order to ensure that service users are fully protected. Medication is stored securely. Members of staff interviewed reported that they have been trained in the administration of medication. A selection of medication administration record sheets and corresponding medication were inspected and found to be in order. Any service users who self – administer their own medication do so in accordance with a risk assessment. The Green DS0000019008.V279030.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Staff training and policies and procedures are in place to ensure that service users views are heard and appropriate action taken. EVIDENCE: Staff reported that they elicit the views of service users in accordance with their abilities. Information is available to enable a complaint to be made by a service user or on their behalf, of by an advocate. The complaint procedure includes the timescales for dealing with each stage of a complaint. The complaint procedure is displayed on the service users’ notice boards. The procedure is available in different formats to reflect the abilities of service users. A record is kept of any complaints made. The records indicated that a complaint had not been made since the last inspection. During this time no complaints have been made to CSCI. A service user who spoke to the inspector said that if they wanted to complain or comment about any aspect of the care they receive at the home they would know who to approach. Staff were aware of how to respond to a complaint. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 17 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, 28 and 30 In general the home provides a safe, comfortable and pleasant environment for service users. EVIDENCE: The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 18 The premises are accessible to all service users. The home offers access to local amenities, transport and relevant support services. The premises provide a comfortable environment to service users and are in general well maintained with evidence of on-going decorative work taking place. The paintwork to the hall and stairwells to one side of the home is showing signs of wear and tear. The woodwork around the windows outside the home and to the front door is also showing signs of wear. The office would benefit from re-decoration. The manager has identified these areas for redecoration. Since the last inspection action has been taken to address the potential risks presented by the two doors at the back of the home that were not secure. Each flat has a kitchen with a dining area and either a through or separate lounge. There is a patio and a garden to the rear of the home. Service users can receive visitors in private in their bedrooms. Staff are able to store personal belongings in the office. It continues to be recommended that alternative sleeping–in accommodation is provided as the current arrangements of two staff sleeping in, in the service users living rooms has implications for the service users’ being able to access this area. A tour of the home showed that the home was clean. There are procedures for staff to refer to about hygiene and infection control. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 19 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, 34 and 35 The number of staff available and the training provided to staff meets the needs of the service users. The recruitment practices do not fully support service users. EVIDENCE: The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 20 An examination of the rota for the week of the inspection and a discussion with staff indicated that staff are appropriately deployed to meet the needs of the current service users. At night there are two sleeping-in staff providing cover for the four flats. The manager has risk assessed this staffing arrangement. The manager reported that she keeps the staffing levels at the home under regular review and would deploy waking night/extra staff if necessary. There is a core staff team employed at the home. Bank staff are used to cover absences. Bank staff have been recruited to work for Wirral Autistic Society to cover absences in the homes if needed or to provide support within the day care service. Wirral Autistic Society provides specialist services for people with autism and is accredited by the National Autistic Society. The prospectus and statement of purpose outlines how the specialist needs of service users will be met. A comprehensive induction and foundation training programme is provided to staff. This includes training around meeting the needs of individuals who have autism. Staff are encouraged to undertake an NVQ in caring for adults with a learning disability. Specialist training is provided to staff to assist them to support service users. 3 staff at the home have completed a British Sign Language course and a further 3 staff are undertaking this training. Observations indicated that staff are respectful and supportive of the service users. The records of recruitment for two new members of staff were seen. In general, the recruitment records contained all the required information and were well maintained. There was no evidence that the new staff were assessed as being physically and mentally fit to work at the home prior to the commencement of their employment. Arrangements had been made for both these staff to have a medical assessment. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 There are systems in place to ensure that the health and safety of service is promoted, however, improvements need to be made. EVIDENCE: The manager of the home has had several years experience of management in a care setting. The manager has nearly completed an NVQ Level 4 in care and management. The manager has undertaken periodic training to maintain and update her knowledge skills and competence. Training around safe working practices such as manual handling, fire safety, infection control and first aid is made available to staff as part of their induction. There is a rolling programme of training opportunities provided and staff can access this when required. There are a range of policies and procedures available that promote safe working practices. Wirral Autistic Society has a health and safety advisor who is available to provide advice and who has responsibilty for promoting a safe environment within the homes. There was evidence of a safe environment being provided at the home. The The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 22 water throughout the home is regulated at the boiler to ensure it does not exceed 43 degrees centigrade. Records of thermometer temperature checks of hot water are undertaken. A risk assessment has taken place of the windows at the home and restrictors have been put in place. Risk assessments of the radiators have been undertaken. As a consequence radiator guards have been provided in some areas of the home. It is recommended that design solutions that control the risk from radiators that can exceed 43 degrees centigrade be provided throughout. A sample of safety check records and tests were inspected. In general these were in order. Evidence that the small electrical appliances at the home have been tested was available at this inspection. A sample of appliances seen had been marked to indicate that they were tested in October 2005. A gas safety certificate was available and valid until June 2006. An electrical wiring safety certificate was available and valid until October 2009. Fire alarm maintenance checks had been undertaken. The records of fire safety checks showed that no test of the emergency lighting was made in December 2005 and the fire alarm had not been consistently tested at 2 weekly intervals. The records showed that fire safety training has not been provided to a number of staff in the last 6 months. The manager reported that the fire drill is an additional method of providing fire instruction to staff. The names of the staff that took part in the drills were not recorded. A record of who is involved in the fire drill needs to be documented as this provides evidence that staff have received fire safety training at intervals recommended by the fire service of every 6 months for day staff and every 3 months for night staff. The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 23 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 X 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X X X X 2 X The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement The registered person must review the behaviour management plan for the service user identified at this inspection, so that it reflects the current guidance provided to staff and meets the service users needs. The registered person must ensure that the medication procedure at the home is adhered to at all times. The registered person must ensure that staff are physically and mentally fit to work at the home prior to their employment. The registered person must ensure that the tests of emergency lighting and fire alarms are carried out at the frequencies recommended by the fire service. The registered person must ensure that fire safety training is provided to day staff on a 6 monthly basis and night staff on a 3 monthly basis. Timescale for action 21/02/06 2 YA20 13 21/01/06 3 YA34 19 21/01/06 4 YA42 23 21/01/06 5 YA42 23 21/01/06 The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 25 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 YA5 Good Practice Recommendations It is recommended that service users be supported by family, friends and/or advocate, as appropriate when drawing up the contract. The service user guide/contract should provide clearer information on the costs service users may have to meet when going out with staff. It is recommended that alternative sleeping-in accommodation for staff is provided. The manager is to obtain an NVQ Level 4 in care and management. It is recommended that design solutions that control the risk from radiators that can exceed 43 degrees centigrade be provided throughout. 2 3 4 YA28 YA37 YA42 The Green DS0000019008.V279030.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Green DS0000019008.V279030.R01.S.doc Version 5.1 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. 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