Inspection on 18/05/05 for The Manor Cottage

This inspection was carried out on 18th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Manor Cottage 17/03/08

The Manor Cottage 10/12/06

The Manor Cottage 15/01/06

The Manor Cottage 20/02/05

The Manor Cottage 07/09/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Manor Cottage Beckspool Road Frenchay South Glos BS16 1NT Lead Inspector Chris Lewis Unannounced 18 May 2005 09:30 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Manor Cottage Address Beckspool Road Frenchay South Glos BS16 1NT 0117 9560161 Manor Cottage Care Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Marie Marcia Mowbray Care Home for Older People 26 Category(ies) of OP Old age (26) registration, with number of places The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Not applicable Date of last inspection 20th February 2005 Unannounced Brief Description of the Service: The Manor Cottage is a listed building, parts of which date back to the 15th Century. It has been carefully restored, with a large extension added to the rear. It is situated in the village of Frenchay within walking distance of Frenchay church and common. There are shops and other community amenities within one mile of the home and the centre of Bristol is four miles away. The home is registered to provide personal care for up to twenty-six older persons. The property is built on three floors with lift access to each floor and a stair lift to two rooms. All bedrooms have en-suite facilities. Parking is available on the side and rear of the premises and there is a pleasant garden and patio area that can be accessed by service users via french doors in the sitting room. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by Christopher Lewis. He was able to meet a significant proportion of the residents and a number of relatives and friends and was able to have unrestricted discussions with them about the way life is in the home. The Inspector also spoke at length to the Manager and the Administrator and also to other individual members of staff. Staff were also observed going about their duties. Virtually all of the home was seen except for a few of the resident’s bedrooms. The garden and patio areas were also viewed. A selection of care records were examined, along with such things as menus and the home’s policies concerning aspects of day-to-day living. What the service does well: What has improved since the last inspection? The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 6 The home has dealt with the issues that came up and were made requirements at the last inspection. They have also dealt with matters arising from best practice recommendations. They now store drugs that are controlled correctly and they keep eye medication in a fridge. Records of kitchen refrigerators and freezer temperatures are now kept up to date and the record is signed off by the Manager. Fire alarm checks are now maintained and the Manager conducts extra spotchecks on staff readiness to respond should a fire break out somewhere in the building. Food is now probed to check that it is being served at the correct temperature and the process of reviewing health and safety policies has begun. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 and 5 (6 is inappropriate as the home does not offer intermediate care). Residents’ care needs are assessed and well met and the home is committed to providing good levels of information for prospective residents. EVIDENCE: The Inspector was able to view the very comprehensive brochure and welcome book which is given to each service user on admission to the home. Evidence was seen from conversations with the Manager, Mrs Mowbray, and from the examination in some detail of three residents files that a detailed assessment of the needs of each resident is undertaken. Full risk assessments on various aspects of daily living, such as mobility, are also completed. Personal profiles were well-written and clearly showed that the home works hard to properly evaluate and regularly update residents assessments. Anybody (or member of their families) who may be interested in becoming a user of the service is usually visited in their home or hospital setting by the The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 9 Manager who conducts an initial assessment. Prospective residents are then invited to spend a day at the home to see if the facilities and so on are what they are looking for. Relatives, if appropriate, may also stay for the day to get a feeling as to whether the home is suitable or not or they may leave the prospective resident if they so wish. It was evident from conversations with both residents and staff that a significant proportion of residents are local people who may have become familiar with the home over a period of time before moving in. The home has a clear criteria for admission and the care plans reviewed by the Inspector proved that they are committed to providing high standards of care. Residents and staff spoke positively about the managerial approach of Mrs Mowbray and her Administrative Manager, Helen Ravensdale. Staff were observed to be speaking to and helping residents in a gentle and respectful way. A high proportion of the home’s residents were spoken with by the Inspector, all expressed a great deal of satisfaction with the care they receive. One resident described the staff as “good as gold”. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11. Residents needs are formally and comprehensively reviewed. Staff appear to be caring and warm in their approach to residents. There is a safe system in place to handle residents medication. EVIDENCE: The care plans of three residents chosen more or less at random set out very clearly the basic care needs of residents and the actions that staff needed to take. The plans included a history of the resident and the person’s likes and dislikes. Mobility assessments are updated each month. A daily record for each resident is kept, which were up-to-date and legibly filled out. Mrs Mowbray signs off records to show that she has seen the documentation. Residents are able to retain their existing GP’s on admission providing the GP’s surgeries are situated within a reasonable distance of the home. However, most residents are registered with five local GP practices who operate from a local medical centre and who have agreed in all cases to take on new residents if required. The home keeps a record of GP visits and telephone calls to surgeries. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 11 A chiropodist visits the home on a weekly basis (usually a Tuesday evidenced by the activities chart reviewed by the Inspector). None of the residents have pressure sores. The Inspector was satisfied overall that the home was diligent in monitoring the health care needs of all residents and that they respond to any medical issues appropriately. The procedures for the ordering, administration and disposal of medication were examined by the Inspector. Medicines are stored in a drugs cupboard and in a secure trolley which is normally kept in a locked cupboard in the smaller of the two lounges. Temazepam is now stored in the controlled drugs cupboard as required at the last inspection and opened medication requiring refrigeration was viewed in a refrigerator situated in the office. The Inspector viewed the medication charts of three residents he had spoken with earlier in the day who appeared from the conversations to be being treated with a variety of drugs. The charts were clearly filled in and easy to read. Medication is dispensed from blister packs; three were examined at random and were in order. The location of oxygen cylinders within the building was clearly displayed by the front door for the information of the fire service if needed. The Inspector was concerned that the drugs cupboard appeared to be very warm; it is required that a thermometer is placed in the cupboard to maintain the temperature. Some of the medication stored in the cupboard must be kept below a certain temperature. The Inspector was of the view that the impending upgrading of the kitchen (see later in the report) might be an ideal opportunity to try and consolidate the storage of drugs and medicines. While not of major concern and accepting that there are issues with the design of such an old building, there was a degree of unsafety in the inspector’s mind about the various cupboards, trolleys and fridges used for storage in various parts of the home. It would be better practice to keep track of medication by storing as much as possible together. The home disposes of any unused medication by returning it to the pharmacist who regularly calls in. A significant number of residents were spoken with by the Inspector, either individually in their rooms or collectively in the main lounge and all confirmed that the home treated them with respect and dignity. Staff were highly praised by residents and staff spoken with displayed a very positive manner towards residents. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 12 Residents are able to choose whether to stay in their rooms or whether they wish to join others in the lounges or garden. Each of the room’s en-suite facilities seen by the Inspector were of a high standard and kept very clean. Residents are able to see visitors in the privacy of their own rooms or in the communal rooms or garden if they prefer; the choice is their’s. The Inspector was able to meet with several relatives and friends of residents during his visit, all of whom expressed satisfaction with the home. A resident recently died in the home after a long illness – the resident had begun to need nursing care but the home continued to care for her with the support of the district nurse. Residents during the admission process may fill in a sympathetically framed questionnaire in which their wishes should they die in the home are recorded. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12 & 15. The majority of residents social and recreational interests are being met with some recent lapses due to sickness and poor weather. A wellbalanced and nutrious diet is provided. EVIDENCE: The Inspector saw evidence on the notice board of activities organised both within the home and trips out. At the time of the inspection, a musician was entertaining residents in the lounge with a selection of Hawaiian music. Residents who were spoken with largely enjoyed the things that the home was able to arrange and they confirmed that they were able to join in or not as they wished. Records of past activities were viewed, as were copies of the home’s newsletter, which mentioned previous events in a very readable manner. The Manager stated that poor weather, some staff difficulties and sickness had curtailed some activities, but that matters were now largely back on track. Those spoken with during the inspection spoke in glowing terms about the food provided in the home. Menus past or present showed evidence of a variety of well-balanced and nutrious meals on offer. There was a choice of dishes The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 14 available each day, with alternative hot meals or salads on offer should the resident not wish to have any of the set menu. A lunch time mixed grill was sampled by the Inspector and was first-rate, tasty and well-cooked. The kitchen itself was rather cramped and units are beginning to show signs of age. It is understood that the kitchen is to be completely refurbished in the near future. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 & 18. The Home addresses complaints made about the service and there are systems in place to protect residents from abuse. EVIDENCE: Information on how to make a complaint about any aspect of life within the home and to whom to address such a complaint is included in the service user’s guide. The Inspector was able to examine the complaints book – no complaints have been received since the last inspection. A questionnaire (a copy of which was seen) is given to residents once a year to seek people’s views on such matters as: staff helpfulness; food; activities; cleaning and so on, plus a section for any other comments a resident wishes to make. This is a good method of seeking the real feelings of residents, particularly as the questionnaire emphasises that the writer may remain anonymous should they so wish. The Manager stated that a “residents association” is being reviewed with representation included from residents’ families although, disappointingly, little interest from relatives has been received so far. The residents views on a change of meal-times in the evenings was recently sought by the Manager, an example of her participative style. The change was to give a slightly longer afternoon so that people did not have to rush back for their meal if out for the day with relatives. All were in favour of the new times except for one resident (who mentioned her dislike of change to the The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 16 Inspector). The resident was accepting, however, that she should go with the decision of the majority. The home has a policy and guidance on the protection of vulnerable adults. The Manager has been trained as a trainer in the issues concerning POVA. Material has been cascaded down to staff who are now going on to the next level of training. As mentioned before, staff appeared to help residents in a caring and sensitive manner and residents spoke very highly of the way in which they were treated. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 17 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 standard(s) The Home is well maintained, safe, comfortable and satisfactory for the needs of residents both internally and externally. EVIDENCE: The home offers a well looked-after and homely environment. The nature of such an old building is such that there are some issues over the lack of storage space. As said above, the refurbishment of the kitchen will hopefully lead to a rationalisation of the use of space for freezers, fridges etc. There is a lift to all floors and wheelchair access to the home. The grounds and garden, front and rear, are well-maintained and easily accessed. One resident has been made to feel more ‘at home’ by being encouraged to help with some aspects of the garden which is commendable practice. There are two lounges provided, one of which does not contain a television. The domestic-style furnishing makes the home a comfortable place to live. Some of the doors to bedrooms are showing signs of wear and would benefit from with a coat of paint or varnish. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 18 Accessible toilets are located close to the dining rooms and lounges. Communal bathrooms are clean and well-maintained and free of any offensive smells. The individual bedrooms have been personalised to reflect the tastes of residents with photographs, mementos and so on. The standard of furniture and fittings is satisfactory and three residents, specifically asked, felt they were safe within the home. The home is well ventilated and warm with plenty of natural light. Radiators were fitted with guards. The home overall was clean at the time of the inspection and residents confirmed that in general a high standard of cleanliness is maintained. Soap and hand-towels were available in the toilets and bathrooms and alcohol rub was in place for visitors use in the reception area. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 and 30. Staffing numbers appear adequate, there are clear recruitment and training policies in place. EVIDENCE: Residents appeared safe and content within the home’s environment. On the day of the inspection, there was an adequate number of staff on duty. The majority of care staff are either undertaking or have completed NVQ2, although the Manager stated that she does have a problem with persuading some of the longer-serving members of the team to undertake NVQ. In addition, several of the care staff have qualifications already which make a return to some of the basic requirements of NVQ a little tedious. Staff stated that the Manager had “turned training around” in the home since she took up her post. Among other things the Manager is qualified to teach manual handling techniques. Examples of the home’s recruitment processes were seen which were satisfactory. A basic format for use during an interview was available. All staff are taken initially on three months trial during which time one week’s notice applies on either side. After this, one month’s notice is required. Interviews cover such matters as basic duties, dress codes, CRB requirements and hygiene. An increasing number of care staff are being recruited from countries within the expanded EU such as Poland, people who, in the opinion of the Manager, are excellent and sensitive workers. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 20 The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Management appear committed to providing a caring and safe environment for residents. Records are well-kept and residents are living in a safe environment. EVIDENCE: Mrs Mowbray has been in the post as Manager of the home since May 2004. In the inspector’s opinion, the management style reflects her approachability for staff and residents alike and she presents as someone who is a good team leader, not afraid to “get her own hands dirty” should the need arise. She was described as commanding respect despite being younger than many of the others working within the home. Financial files are kept locked securely away in the office and can be accessed only by the Manager or the Administrator. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 22 Service users are largely responsible for their own day-to-day financial affairs; however, the home will look after people’s cash if they so wish which is kept in a safe. Examples of cash sheets showing money taken in and out were seen. The home’s health and safety policy statement was seen and all staff have now received Health and Safety input. Health and Safety issues are also now part of the induction process. Staff are supervised formally every 3 months and examples of supervision recording was seen which was of a good standard. Annual appraisals are undertaken. Staff meetings are organised around every 6 months; one is due very shortly. Meetings of senior staff are held more regularly. Fire alarm checks are now maintained as evidenced by a properly completed and signed-off sheet. All staff are fire-trained. The Manager has obtained a fire warden’s certificate and she does spot-checks early mornings etc to ensure that staff know the procedures should a fire break out, especially during the hours of darkness. Fire drills have been undertaken as required. A security system is in place with coded security locks fitted on external doors giving the home an overall feeling of being a safe place to live. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 3 3 STAFFING Standard No Score 27 x 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x 3 3 3 3 The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 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 OP9 Regulation 13(2) Requirement A thermometer must be placed in the drugs cupboard and the temperature of the room kept at or below that recommended for drugs stored therein. Timescale for action 01/07/05 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 OP9 & OP38 Good Practice Recommendations The home may benefit from a rationalisation of its storage facilities; the refurbishment of the kitchen may be an ideal time to consider this. The Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG 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 Manor Cottage D56 D05 S51893 The Manor Cottage V226205 180505 Stage 4.doc Version 1.30 Page 26 - 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!