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Inspection on 22/06/06 for The Hyde

Also see our care home review for The Hyde for more information

This inspection was carried out on 22nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

In accordance with requirements of the previous report the necessary improvements have been made to care planning, arrangements for social and recreational activities, and staff training on the subjects Protection of Vulnerable Adults and fire safety. Since the previous inspection Mrs Melody Walters has become the registered manager of The Hyde and discharges her duties effectively.

What the care home could do better:

Poor standards of practice with regard to medicine handling and associated record keeping were identified and require significant improvement for residents` health and welfare to be properly safeguarded.

CARE HOMES FOR OLDER PEOPLE Hyde (The) Walditch Bridport Dorset DT6 4LB Lead Inspector Gloria Ashwell Key Unannounced Inspection 11.00a 22 & 28th June 2006 nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hyde (The) Address Walditch Bridport Dorset DT6 4LB 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) 01308 427694 01308 427766 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Mrs Melody Walters Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of three of the following bedrooms to be used as doubles at any one time: 1, 2, 5/6, 7, 18, 21, 29. 20th October 2005 Date of last inspection Brief Description of the Service: The Hyde is a large Victorian mansion situated in 20 acres of gardens and woodlands close to the village of Walditch and approximately 1½ miles from Bridport. The Hyde is registered as a care home for up to 28 older persons requiring personal care and has been under the ownership of BUPA since 1998. On the ground floor are communal rooms including a large lounge, separate dining room and a smaller lounge known as the ‘library’. The accommodation is spread over three main floor levels and includes a total of 26 bedrooms; 16 bedrooms have en-suite hygiene facilities. A passenger lift provides access to some bedrooms on the first and second floors. The main staircase leading to the lower landing and bedrooms is fitted with a stair-lift. To access some other bedrooms it is necessary to use a small flight of steps although there are two stair-lifts enabling access to bedrooms at first floor levels. The extensive gardens and grounds are well tended with garden furniture available so that residents can sit and enjoy the rural setting. There is car parking space at the front of the house for use by visitors. A bus to nearby Bridport stops at the main gates to The Hyde. Laundering of clothing and household linen is carried out at the home and arrangements are made for chiropodists, opticians and other health and social care professionals to visit individual residents. Fees are charged weekly; at present fees for permanent residents range between £450 and £980 per person, weekly respite care fees are £550 per person. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a statutory inspection required in accordance with the Care Standards Act 2000. The inspection was unannounced; the inspector arrived at 11.00 on 22 June 2006, toured the premises and spoke to residents and staff and registered manager Mrs Walters to arrange the next visit which took place at 10.00 on 28 June 2006 when documentation relating to care provision and the premises was discussed and examined. The duration of the inspection (both days combined) was 5 hours. During the inspection the inspector spoke to registered providers registered manager Mrs Walters, care and household staff, 14 residents and the visiting relatives of one resident. The inspector observed staff interaction with residents and the carrying out of routine tasks. At present 24 permanent residents are accommodated at The Hyde; on the first day of this inspection there were also 2 residents receiving short term ‘respite’ care. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same resident were examined, and the resident spoken with. Additional information used to inform the inspection process included the monthly reports regularly sent to the Commission by the provider and the Preinspection Questionnaire completed in advance of the inspection by Mrs Walters. Since the previous inspection a number of completed Comment Cards were sent to the Commission: 30 from residents, 5 from the relatives of residents, 8 from local doctors and 2 from health and social care professionals. All comments indicated satisfaction with The Hyde; a number were very positive and one observed “An amazing experience being here at The Hyde. One couldn’t dream of such a beautiful home and grounds and such lovely staff”. During this inspection compliance with all key standards of the National Minimum Standards was assessed. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Poor standards of practice with regard to medicine handling and associated record keeping were identified and require significant improvement for residents’ health and welfare to be properly safeguarded. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 7 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. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so Standard 6 does not apply) Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Prospective residents (or their representatives) are provided with information about The Hyde and are encouraged to visit in advance of admission to establish their impressions of life at the home and the standard of available accommodation. Prior to admission, the needs of each proposed resident are assessed and the home then writes to prospective residents confirming the ability to properly care for them. EVIDENCE: The records of a recently admitted resident included details of pre-admission assessment which had been carried out by the Registered Manager when she visited the prospective resident at her private address. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 10 In advance of making the decision to enter the home the prospective resident visited The Hyde to view the premises and meet residents and staff and later a close relative also visited. Initially this resident was admitted for a period of respite care and during this time made the decision to remain permanently at The Hyde. The inspector spoke to the resident who confirmed satisfaction with the home and said “I came for a fortnight and decided to stay as I knew it was excellent. All the staff and the ones in charge are good, pleasant and considerate”. Comments received by the Commission in advance of the inspection included “I have not been here long but I felt ‘at home’ very quickly”. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is generally good but urgent improvements must be made to standards of medicine handling and associated record keeping. This judgment has been made using available evidence including a visit to the service. The standard of care is good and in accordance with a written plan of care for each resident ensuring that staff have sufficient information upon which to base their care practice. Residents health needs are fully met and periodic audit of accidents is recorded to minimise risks of recurrence. Records of medicines prescribed by doctors must be improved to ensure the correct administration of medicines. Residents wishing to do so can manage their own medicines in accordance with risk assessment. Residents are treated with respect and their privacy and dignity is protected at all times. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 12 EVIDENCE: Residents believe they are properly cared for; comments received by the Commission in advance of the inspection included “I am very happy and contented here. I feel very secure in the home.”. Care records of 4 residents were examined; each contained risk assessments forming the basis for care plans and daily records describing the care of each resident. To ensure correct identification records contain a recent photograph of each resident. All accidents are recorded, but subsequent actions taken to minimise the risk of recurrence are not always recorded; the home periodically audits accidents and is recommended to further increase the benefits of the current system by auditing against ‘time, place, person, activity’ to identify any trends or patterns and subsequently to introduce measures to reduce the risks. Residents wishing to do so can manage their own medicines in accord with a risk assessment process; a number of the currently accommodated residents manage their own medicines. For those whose medicines are administered by staff, records indicated that on most occasions medicines had been accurately administered and residents said that they receive the correct medicines at correct times. However, records showed that a medicine prescribed for a resident for 7 days had been administered on only 3 occasions; there was no signature to indicate administration or omission on the other occasions. Also, records indicated that a medicine prescribed to be taken 4 times daily by this same resident had only been offered twice each day. On one occasion since the last inspection a resident was wrongly administered the medicines prescribed for another resident, fortunately with no lasting ill effects. It is required that arrangements are made to ensure that medicines are accurately administered in accordance with the prescribers’ instructions, to ensure that residents health needs are properly met and they are not placed at risk of harm by receiving medicines they have not been prescribed. Improvements must also be made to the recording systems including signing and dating and countersigning all handwritten instructions, stating the actual dose administered on each occasion when a variable dose is prescribed, stating the reason for administration of ‘as required’ medicines and always signing or entering the code (e.g. R : refused) for all instances of administration. It is also recommended that an index of pages used in the Controlled Drug register Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 13 be kept, to ensure accuracy in administration and the consequent provision of prescribed health care to residents. The registered manager was aware of many of the failings of the current medicine handling system in advance of this inspection and in consequence the home is in the process of changing the medicine system to another type of Monitored Dosage System to ensure compliance with standards and the safety of residents. Residents feel they are treated properly by staff. Comments received by the Commission in advance of the inspection included “I think I am very lucky to live here as all the staff are wonderful and very caring”. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The quality of daily life in the home is good with residents assisted to maintain as much independence as possible. Social and leisure activities are suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. On the ground floor there is a large well-appointed dining room; residents may also take meals in their bedrooms. EVIDENCE: Residents are very satisfied with all aspects of the home, including the range of activities, meal provision, staff and premises. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 15 The home employs Activities Organisers to arrange local excursions, visiting entertainers, one-to-one and small group social and recreational activities. A monthly programme of planned activities is provided to each resident. Residents enjoy the activities and consider them appropriate and of good variety; comments received by the Commission in advance of the inspection included “We play all card games and Rummikub – this is the favourite”. Visitors are welcome at any time and those present during the inspection said they are always made to feel welcome and placed at ease by the staff. The inspector observed the serving of lunch in the dining room and noted the animated conversation and evident enjoyment of the meal residents were engaged in. Residents said they were very satisfied with the quality, choice and quantity of food provided; one resident said ”If there is something we don’t like, we only have to ask and they will give us something else”. Written comments included “High standard of menu”. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The complaints procedure provides information on the procedure to follow to persons wishing to make complaint; all complaints are recorded and properly investigated. The home protects residents from harm and abuse. EVIDENCE: To ensure residents and their representatives have access to the complaints procedure it is included in the service user guide to the home and a copy is provided to each resident. Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. Comments received by the Commission in advance of the inspection included “Never have cause to complain. All the staff are excellent and very pleasant and helpful at all times, and courteous”. The home keeps records of all complaints received and investigated. Since the last inspection two complaints have been received; both related to the behaviour of other residents and following investigation both complaints were partly substantiated. Both have been satisfactorily resolved. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 17 The home adheres to a policy/procedure for the prevention of abuse and all staff have received training in this subject to ensure that they remain vigilant to protect vulnerable residents from risks of abuse and know how to properly manage any allegation or suspicion of abuse. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The Hyde is a well-appointed and comfortable home. On the day of inspection the home was clean, pleasant and hygienic and there was evidence indicating that this is the usual standard of provision. EVIDENCE: The Hyde is a spacious home, with good sized bedrooms, bathrooms equipped for the use of persons requiring assistance and attractive communal rooms. The home is clean, tidy and comfortable throughout; there were no unpleasant odours. Residents said this was the usual high standard; one described it as “A lovely happy residence - well run, clean and caring”. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. Staff receive appropriate training and are competent to carry out their jobs. EVIDENCE: Trained staff lead the care teams and at all times the home is in the overall charge of an experienced care worker. Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. Staff are enthusiastic about their work and feel they provide a good standard of care to residents and are properly supported by the management and training provision. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 20 The records of 2 recently employed staff members were examined and found to contain all essential information including two written references, an interview assessment, health details, evidence of identity and of induction training. The provider organisation has an enthusiastic approach to staff training; recent topics have included Protection of Vulnerable Adults, First Aid, moving and handling, infection control and fire safety training. At present 75 of the care staff currently employed by the home hold a National Vocational Qualification in care; the home thereby meets the standard for at least 50 of the care staff to hold an NVQ. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home is well managed and staff understand their work and receive training appropriate to their needs. Residents and their representatives are satisfied with the home and feel staff care for them well and put them at their ease. The home has implemented a quality assurance system to ensure that residents remain satisfied with all aspects of the home. The home does not manage the finances of residents. The premises and equipment are properly maintained in good condition. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 22 EVIDENCE: Mrs Melody Walters commenced work in the home during October 2005 as acting manager; her application to become the registered manager was approved by the Commission during May 2006. Mrs Walters is an experienced manager and demonstrated high degrees of competency in both aspects throughout the inspection; she is currently training for a National Vocational Qualification in Management (Level 4). The home has ongoing systems for quality assurance; satisfaction survey are periodically issued and occasional meetings for residents and their relatives takes place. To ensure continuity of approach the home operates in accord with an extensive selection of clear and appropriate policy and procedure documents, including those for care provision, management and the premises. The home does not manage the finances of residents; residents who are unable to undertake this responsibility personally have nominated relatives, friends or other representatives to do this on their behalf. Staff trained in First Aid and health care are on duty in the home at all times. The home failed to notify the Commission of the drug error referred to in Standard 9 of this report; it is required that in accordance with Regulation 37 of the National Minimum Standards the Commission be promptly notified of all events endangering the safety of service users. The premises are well maintained and there are regular checks/tests of all equipment. (On the second day of this inspection engineers were working on the passenger lift but were unable to return it to functioning so necessary reliance was placed on the stair lifts to enable residents to move between floors.) Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Timescale for action 28/08/06 2. OP9 13 3. OP9 13 4. OP37 37 Arrangements must be made to ensure that medicines are accurately administered in accordance with the prescribers’ instructions. Handwritten entries in 28/08/06 medication instructions must be signed and dated by the writer and countersigned by a member of care staff who has checked the entry for accuracy. A record must be kept of the 28/08/06 actual dose administered on each occasion when a variable dose is prescribed. In accordance with Regulation 37 28/08/06 of the National Minimum Standards the Commission must be promptly notified of all events endangering the safety of service users. Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 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 OP8 Good Practice Recommendations It is recommended that the home further increases the benefits of the current accident recording system by auditing against ‘time, place, person, activity’ to identify any trends or patterns and subsequently to introduce measures to reduce the risks. It is recommended that an index of pages used in the Controlled Drug register be kept. It is recommended that the reason for administration of ‘as required’ medicines be stated on the Medication Administration Record (MAR). 2. 3. OP9 OP9 Hyde (The) DS0000026823.V297994.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Hyde (The) DS0000026823.V297994.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. 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