Inspection on 15/05/07 for The Nunnery

This inspection was carried out on 15th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Nunnery 13/01/09

The Nunnery 19/12/07

The Nunnery 17/01/07

The Nunnery 20/04/06

The Nunnery 23/11/05

The Nunnery 13/04/05

The Nunnery 29/10/04

The Nunnery 23/05/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE The Nunnery 14 Denmark Street Diss Norfolk IP22 4LE Lead Inspector Ruth Hannent Unannounced Inspection 15th May 2007 10:00 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 The Nunnery DS0000036034.V340241.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. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Nunnery Address 14 Denmark Street Diss Norfolk IP22 4LE 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) 01379 643201 01379 642649 Mrs Jane Wentford Not applicable Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (22) The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old age, not falling with any other category (OP), twenty two (22) of either sex. Mental disorder, excluding learning disability or dementia (MD), One person (1) male, who shall be named in the records. 17th January 2007 Date of last inspection Brief Description of the Service: The Nunnery is situated close to one of the roads leading from the market town of Diss. Gardens to the rear slope steeply down the banks of the Mere, and there are panoramic views across the water to the town. The street frontage and main building is old, and there is a newer extension to the rear. A shaft lift provides access to the first floor. There is a lower ground floor (as a result of the sloping site), which is accessible via stairs or a stair lift. The home is registered to provide care for 23 people, and three of the rooms would be double. These rooms are currently being used for single occupancy as these residents do not wish to share. The current fees range from £340 to £520 per week. Email address is ‘thenunnery@aol.com’ The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report has been written following a key inspection site visit that follows a key inspection carried out in January of this year. The information used has had to be based on past inspections as well as this site visit as very limited information has been received at the Commission to enable clear judgements to be made. The Inspector did not receive a pre inspection completed questionnaire and the Manager was unable to produce a copy. Since the last inspection an Improvement Plan had also been requested but nothing had been received by the Commission to date. Only one resident comment card had been posted but was blank with no questions answered. Nothing has been received from health professionals or relatives. Although it was very disappointing that no paperwork had been received at the Commission, the site visit did show that some improvements have taken place since the last inspection with nearly all the requirements set either met or planned to be met. The environment still lets this Home down and although the care appears to be improving the Home is in great need of upgrading and refurbishment. What the service does well: What has improved since the last inspection? The Home now has safer administration of medication by having a locked trolley at all times. Potential residents have a thorough assessment prior to being admitted to ensure the service can meet the need for the individual person. The Manager has increased the staffing levels at weekends to ensure the care needs are met no differently than in the week. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 6 The opportunity to share concerns or complaints is advertised appropriately in prominent places for all people to see. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents are assessed and would not enter the Home if their needs could not be met. EVIDENCE: One resident has been admitted since the inspection in January of this year. The details within this document were clear and gave a picture of need for this person. The Home is suitable and can offer the care for this person appropriately. On talking to this very articulate person it was evident that lots of time had been spent with the Manager to ensure the support required would be in place and match expectations as near as possible. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans are clear and person centred; however some dignity when assisting with personal care is questionable with residents not dressed appropriately. EVIDENCE: The care plans are neat and are easy to follow with updates regularly occurring as needs change for each resident. These documents were looked at clearly and the support required by that person is in place. Two residents spoken to feel they are cared for and are happy to be in the Home. One person said he would “like a change of time within the care offered but as there are so many people to care for he would not say anything”. No comment cards had been received from residents or relatives prior to this visit and on showing the yellow comment paperwork to one resident they said they had not seen it before. Many of these residents have been in the Home for quite a while now and have nothing else to compare the Home with. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 10 The District Nurse was in the building on the day of the visit and is a regular caller. The Manager comment on the good team support they receive from the Community Care team. On the staff room wall is the procedure of when and how to contact the Nurse and the information required to carry out instructions. (Noted in the daily records for each person is a highlighted section when any medical intervention has taken place with a resident). This information is then transferred into the care plan onto a medical intervention sheet to show in brief what has happened, when and the treatment required. The District Nurse also acts as the link between the GP and the Home and often obtains a quicker response to medical needs. A past requirement of the need for a lockable medicine trolley has now been supplied and was seen in use on the day of the site visit. The medication store cupboard is neat and tidy and all returned medication is recorded and signed by two staff members. The actual administration procedure was not seen on this visit but had been observed twice over the past year on previous visits. The recommendation for a small fridge for medication requiring fridge temperatures is now in place and is having the temperature checked but no recordings are in place as yet. (Recommendation) The Home also has a resident who manages his own medication and needs a risk assessment in place that shows how the monitoring of the competency of that person to ensure safety with medication is happening. (Requirement) Although the staff appear to care and speak to residents in the appropriate manner it was noted that many of the residents were not wearing tights, pop socks or ordinary socks. This is not how they would have been before they required residential care and more appropriate clothing should be worn. The Home was also noted to be cold and two residents were using rugs to keep warm. (Requirement) The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is continuing to improve the lifestyles to match the residents needs and families and friends are encouraged to be involved. To offer the quality at mealtimes ways of serving the food could be improved on. EVIDENCE: The residents spend a lot of time playing skittles - having competitions and trying to beat each other to win a cup. One new person gets out on a motorised wheelchair around the local area. Entertainment and other activities do take place. There are plans to have art groups led by a keen resident in the near future. Residents observed during the morning session appeared to be enjoying themselves. There is a regular newsletter that updates residents on developments within the Home such as the large print books supplied by the library service and the monthly video showings that have just started. Since the last visit a new fish tank has appeared in the snug area. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 12 Visitors do call regularly as noted by the signing in book and talking to the residents. The April newsletter also stated that 100 of the recent quality assurance survey showed visitors were made welcome. The Manager is trying to find ways to provide drinks that people can make themselves in an area for visitors to sit in. (This was a suggestion by a relative on a recent quality survey form distributed by the Manager). This was discussed and will be implemented shortly. Within the care plans of recently admitted residents is an advocacy form introducing the resident to the service if they so require. One was seen completed and the person is now awaiting an appointment. On the notice board there is also a large poster advertising the service for relatives to also contact the organisation if they so wish. The meals are still provided as in the past with choice. The variety is there but the amount is on the plate or in the dish already. To allow people to make a choice it would be much better to allow residents to help themselves to vegetables, gravy or sauces as they wished, or a jug of custard/cream to help themselves. (Recommendation). A past requirement asking for a risk assessment to be in place when residents are in the dining room and left alone to eat their meal has now been done. On talking to residents they are all happy with the meals but sometimes they were perceived to be a little too big. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home does offer more opportunity for concerns or complaints to be addressed and residents are protected from abuse. EVIDENCE: The Manager stated that she had not received any complaints at the Home and the Commission had received one potential complaint prior to the last inspection that was resolved after a review by the Social Worker with little evidence to support the concern. (Managing the anxiety is more of a need for this person, which the Home is beginning to address). Noted in the entrance hall is now a laminated complaints procedure that encourages people to complain no matter how small and if not happy with the outcome, how to contact the Commission. Also on the April newsletter is a note that openly invites people to offer suggestions to improve ‘their home’. No written comments from any resident or family member have been received since the key inspection in January and on talking to one resident, that person would feel able to say if they were unhappy about anything. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 14 The Manager has just started to introduce ‘Knowledge set’ training programmes that includes a comprehensive package on the protection of vulnerable adults. The staff have been trained in the April of this year but this learning pack should keep the knowledge learnt alive and is to be introduced very soon. The Home does have a whistle blowing policy and on this occasion staff were not asked about reporting concerns, although staff have talked about who and how they would report if they had any concerns in previous inspections. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The overall environment is in need of refurbishment and redecorating to bring it up to a homely, warm and suitable place to live. EVIDENCE: Nothing has changed in the Home since the last inspection as far as improvements to the environment are concerned. Many areas are still shabby and in need of painting, many of the carpets appeared stained and wearing thin (the lounge carpet has cigarette burns that were there in the last few inspections). (Requirement) The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 16 The Manager has covered all the radiators with guards, which have not been painted and are stained from the residents and staff placing wet items on the top. Residents do not have access to the individual thermostats on their bedroom radiators and the home appeared cold. (Requirement) (Some residents were having a blanket on their legs to keep warm). The home does not have a room/hallway thermostat in the main areas that will control the temperature so the only control is by a switch that allows all radiators to come on. The bathrooms still have small electric wall heaters that can only be switched on at bath times and when residents are using the toilet have to enter a cold room. (Outstanding Requirement). It was noticed that commodes were dirty and mats that cover the seats are torn and not suitable creating a cross infection environment. (Requirement) The manager has found a company that will replace the mats but as these were a concern at the last inspection more effort needs to go in to replacing these items. The one shower room completed last year is a vast improvement on the original bathroom but is clinical in appearance, all white with no colour and no covering at the window by a curtain or a blind to make it homely. (Past Recommendation). Due to some of the rooms appearing shabby it was difficult to tell how clean they were. There was no odour to detect and there is a cleaning rota in place. (Seen on previous inspection). The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The skills and consistency of staff is good but the supervision and recruitment of staff needs to be consistent to ensure good practise and protection of the residents is improved. EVIDENCE: On the day of the inspection there were enough staff on duty to care for the number and requirements of the residents. The majority of the staff have been working at the home for a number of years and interact well with the residents. Residents spoken to feel able to relax with the staff as they feel they know and help with their needs. The Inspector has visited many times over the last year and residents feel able to speak openly about their care. Two residents spoken to feel the staff team are competent and treat them well. The manager has also increased the number of staff at the weekends to ensure the care both in the week and at weekends is offered in the same way. Staff are monitored on a daily basis by the manager who spends most of her time in the Home. The recording of supervision sessions on a one to one basis needs to be at least every other month. (Recommendation). The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 18 The Senior staff member on duty is working towards his qualification and some of his work was available to see in the staff room. The Manager does encourage the NVQ qualification and this has been seen over the past year on the random inspections. Two new staff members have been recruited since the January inspection and the personnel files of both were looked at. The information, including POVA first and CRB clearance were in place but on each file only one reference was within. The manager has been trying to obtain the second reference required but has not yet received anything and both these people are working within the home. (Requirement). The training of staff has become slightly more organised and a new type of training has been introduced called ‘Knowledge Set’ which appears to be very comprehensive. Areas covered will be Medication, Infection Control, Dementia, Nutrition and Wellbeing, Protection of Vulnerable Adult and workers who are not in direct care. Some of these packs were available and ready to start. The induction booklet for the new staff members was also seen, which held comprehensive details that had been dated and signed. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager must have better systems in place to enable an Inspector to see documents at any time to ensure the Home is running safely. The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 20 EVIDENCE: The Manager has been the owner/manager for many years. She holds a management qualification and is also an assessor for NVQ. Residents and families have recently taken part in quality checking survey that as a result has provoked some ideas on how to improve the service. One such idea was to offer a drinks making facility for visitors and residents that they would be able to make themselves when they met up. This is now to be trialled in the snug area where there is room for people to meet. Although these surveys are beginning to take place there is still room for developing and using other people to assist in the creation of a development plan for the home. (Recommendation). The Home does not handle resident’s money and actively seeks out an advocacy service to help any residents that needs assistance with their finances. Details issued in leaflet form to all new residents and posters are on display in residents areas. The Manager needs to make more of an effort in the Management side of her job. The office and filing system is disorganised with, on each visit over the past eighteen months, items required for inspection could not be found. The same has happened over the years with paperwork required by the Commission that may breach regulation that has not been received such as pre inspection questionnaires, improvement plans and records of deaths, illnesses and other major events. Once again for this inspection the paperwork had not been received and a new improvement plan written and sent after the inspection visit has now been received at the Commission with no sign of the pre inspection questionnaire. (Requirement) After much searching some evidence of servicing of equipment was found such as the lift 07/03/07, fire equipment Feb 2007, call bell system 23/11/06. No records could be found of boiler servicing and records held on water temperature checks need Management monitoring to ensure this record is correct. (The records show over every week that the temperature is always 40 degrees and never changes). (Requirement) The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 21 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 2 10 2 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 1 2 2 x x X 1 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 1 The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13.2 Requirement The residents who self medicate must have a risk assessment in place to ensure competency is monitored and is seen as safe as it is possible. The residents must be assisted with dressing that would be the same as they were prior to admission and have some form of clothing on their legs and feet. The Registered Manager must ensure that the Home is reasonable decorated and carpeted. (Outstanding Requirement) The Manager must ensure that the home is suitable heated and that heat in each bedroom can be controlled by the resident as and when they wish. The Registered Manager must ensure adequate heating is available and constant in the bathrooms. (Outstanding Requirement) The commodes in the building must be checked and removed if unsuitable and are liable to cause cross contamination. DS0000036034.V340241.R01.S.doc Timescale for action 01/07/07 2. OP10 12.4(a) 01/07/07 3. OP19 23.2.(b) 01/08/07 4. OP20 23.2 (c)& (p) 01/08/07 5. OP25 23.2(p) 01/08/08 6 OP21 23.2 (c) 01/07/07 The Nunnery Version 5.2 Page 23 7 OP29 19.1(c) Schedule 2 23.2 (c) 12.1(a) 37 8 9 OP38 OP38 The Manager must obtain two 01/07/07 written references BEFORE commencing with employment of new staff. All equipment that is serviced 01/08/07 and maintained has a record that is available for inspection The manager must promote and 01/08/07 make proper provision for the health and welfare of residents by recording and informing the Commission of events listed in regulation 37. 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 2 Refer to Standard OP9 OP15 Good Practice Recommendations The Home should have a record of the medication fridge temperature available for inspection. To offer quality and empower residents meals should be offered with choice at the table from vegetable dishes or gravy in a jug so people can choose how little or how much they would like. The staff should be offered supervision sessions that are recorded at least 6 times a year. The quality assurance process should be made more comprehensive to enable an annual development plan to be written. 3 4 OP28 OP33 The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Nunnery DS0000036034.V340241.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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