Inspection on 21/06/07 for The Old Vicarage [Stockland]

This inspection was carried out on 21st June 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 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 Old Vicarage [Stockland] 08/02/06

The Old Vicarage [Stockland] 01/11/05

The Old Vicarage [Stockland] 30/03/05

The Old Vicarage [Stockland] 06/07/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Old Vicarage Stockland Bridgwater Somerset TA5 2PZ Lead Inspector Barbara Ludlow Unannounced Inspection 21st June 2007 10:15 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 Old Vicarage DS0000015986.V346403.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 Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Stockland Bridgwater Somerset TA5 2PZ 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) 01278 652352 01278 652185 sue@restcare.co.uk Mr Sean James O`Brien Mrs Samantha Jane O`Brien Mrs Susan Mary Thomas Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To admit one named person outside the categories of registration as detailed in the notice dated 6th April 2006 The maximum number of persons accommodated at the home, including the named service user, will remain at 26 On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 27th March 2006 8th February 2006 Date of last inspection Brief Description of the Service: The Old Vicarage is a large three-storey property set in extensive grounds in the village of Stockland Bristol. The Registered Providers are Mr and Mrs O’Brien, and the Manager is Mrs Susan Thomas. The home is registered with the Commission for Social Care Inspection to provide accommodation and personal care to up to twenty-six people over the age of 65 years. The home provides accommodation to up to twenty people within the main building, and a further six service users can be accommodated in the bungalows within the grounds. The bungalows are connected to the homes staff call bell system. The home works closely with local health services. The weekly fee charged varies from room to room, private fees start at £420.00 in the main home and the bungalow accommodation is currently £495.00. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. This unannounced inspection visit was undertaken by one inspector over six and a half hours. The homes registered Manager was on duty and the homes proprietor was on the premises for the majority of the day. The outcome was very positive. Twenty five service users were in residence and time was spent in the communal areas and in private talking with them about life at the home. One visiting relative was seen and spoken with. The home had returned their Annual Quality Assurance Assessment (AQAA) to the Commission and the feedback questionnaires for relatives and service users were brought to the inspection for distribution. Time was allowed in the inspection timeframe for these to be returned, analysed and included in the body of this report. A tour of the premises was made and rooms were sampled. Time was spent speaking with staff and questionnaires were left for completion. The activities and daily life at the home was observed. Lunch, which is served in two sittings, was observed in the dining room. Service users, staff and management were most helpful. The inspector would like to thank all who contributed to the inspection process. What the service does well: Service users asked all said they are well cared for and live comfortably. The home is very clean, well maintained and offers a good standard of accommodation. The gardens provide a very attractive restful setting for the home and there are garden views from the communal rooms, which the service users enjoy. Staff received praise from service users, relatives and visiting professionals for their kindness and ‘good work they are doing’ and for being ‘respectful’. 70 of the staff group have an NVQ and the proprietors and manager actively promote training. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 6 The home is capably managed and staff are say they are well supported by the home Manager and proprietors. The home has good relationships with the community health services and offers a good standard of personal care. Feedback from a visiting professional was an ‘approachable and responsive service who are respectful of individuals’. What has improved since the last inspection? 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 Old Vicarage DS0000015986.V346403.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 Old Vicarage DS0000015986.V346403.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): 1,2,3,4,5, NMS 6 is N/A Quality in this outcome area is good. There is detailed information available about the care home and the service offered. Visits to see the home are welcomed. Pre admission assessment underpins an offer of a place at the care home to ensure that care needs can be met. Clear contracts are issued. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a brochure, which has photographs of the home. There is a detailed statement of purpose that is very clear and would be very helpful to a prospective service user or their family. One service user said they had heard of the home by ‘word of mouth’ and this had helped them in their choice of home. Another commented that from the The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 9 information they had ‘it was the ideal place to come and I’m very content and happy here’. Service user needs and lifestyles are supported and accommodated. Independence and individuality was seen to be respected and supported. The proprietor or the home manager would make the pre admission assessment to ensure that care needs can be met at the home before a place is offered. This offer would be made in writing. Three care plans and contracts were sampled. These demonstrated that the pre admission assessment underpins a personalised assessment of needs in the care planning process. Information is gathered from community health care professionals to support the assessment prior to a service users admission to the home being accepted. The manager had reported in the AQAA under ‘how we have improved over the past twelve months’, that the management have asked for ‘more district nurse involvement in assessments and more general information prior to admission’. One visiting health care professional commented that ‘record keeping is thorough and helpful when making visits’. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Service users are treated with respect and kindness. Care plans are in place and the care given is supportive of maintaining good health and well being. Medication is safely managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users had a care plan. Five were sampled. These were detailed and demonstrated review and attention to personal care, health and well being. Chronic ill health conditions were monitored in conjunction with the district nurse. Weights were monitored but a mix of measurements in imperial and metric made the assessment of weight loss or gain harder to follow. This was brought to the manager’s attention and a recommendation is made. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 11 Personalised assessment of needs included detailed management of anxiety, falls monitoring and risk assessment where bed rails were in use. Waterlow pressure area risk assessment scoring for one service user had not been reviewed since January 2007, yet the evidence suggested that there was an increase in the risk of pressure area damage occurring. This was discussed with the manager. Updating the risk assessment is done; but is also needed when there is a change in health and condition, this is recommended. The home has good relationships with the local health care services. One service user commented that the care was ‘excellent’ and said they see their G.P when they ‘need to’, have regular visits from the district nurse and always have a flu jab each year. Customer review forms are used and are completed with significant relatives if appropriate. Medication Administration Records (MAR) were sampled, these were up to date, very neatly maintained and fully completed. The prescribing pharmacists use printed labels on the MAR forms, which is not ideal as they may become detached. It is advised that this be discussed with the dispensing pharmacies with reference to the pharmaceutical guidelines for care home records. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is good. Service users asked were very satisfied with daily life at the home. Choice, freedom and independence are supported. Visitors are welcomed. Regular entertainment and trips out are organised. Meals times are social events and the food is varied and appetising. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users can choose how they spend their time. Two service users said they choose not to join in with the activities offered. Some service users said they prefer to spend time in their rooms. One service user makes use of the Summerhouse to paint and enjoy being outside in the garden. Another service user who has a car was seen going out. There has been some work undertaken with the local mental health staff to develop life stories for service users before admission to the home. It is hoped this will help staff to really get to know their service users and tailor activities to suit the individual. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 13 Activities staffing has increased to two persons. The extra member of staff working two mornings per week will meet service users who require more individualised care, on a one to one basis. The home has a visit from the mobile library once every three weeks. The hairdresser attends on a weekly basis. Service users have contact with the local community when joining local coffee mornings, attendance at the local flower show and trips out for afternoon tea. One service user who was very pleased with the care and service commented that they had ‘no contact with the community’ but had opportunities to go ‘out with their family’ if they wished. Service users generally seemed to be relaxed and comfortable during the day. There were no restrictions on freedom area the home. One person said they were ‘Very, very, happy here’. Feedback received in writing and from speaking with service users said the food was ‘very good’, ‘choice of meals’. One service user asked about the food commented that it was ‘pretty good’. They went on to describe the varied cooked options for breakfast. Early morning tea and mid morning tea and biscuits. Another person reported that the teatime options were ‘not very imaginative’. The manager said that the menus have been recently reviewed. Lunchtime was observed in the dining room. Two sittings are made and the first served to fourteen service users was at twelve o’clock. Three people had served lunch in their rooms. The remaining eight service users which included the residents of the cottages and the annex were served at the second sitting. The main meal was from a choice of fish, chips and peas or liver, gravy and vegetables including potatoes. Dessert was fruit sponge or melon. Drinks were served with the meals. Lunchtime was a social occasion and the tables and food were nicely presented and served. Care staff assist with the catering at teatime. Care staff receive food hygiene training. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 14 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): 16,17,18 Quality in this outcome area is good There is a complaints procedure. Service users said they would know who to speak with if unhappy and would complain if they needed to. Service users are safeguarded from harm through good practice and policies and procedures. Legal rights are upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed and is clear. There is a copy of the procedure in the home’s statement of purpose. There have been no complaints made to the home or CSCI since the last inspection. Letters of compliment had been received and these were seen. Service users asked and those responding in writing said they knew how to complain if they needed to. Staff said they felt confident and would be able to raise any concerns with the manager, proprietor or a senior carer. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 15 Recruitment procedures were examined for two new staff. These demonstrated good recruitment practice. One person has started work with a Protection of Vulnerable Adults (POVA ) First check (before their full Criminal Records Bureau check was returned) the manager confirmed that this member of staff had been fully supervised until the full check was returned. Workshops have been set up to run at staff meetings on the subject of POVA (safeguarding from abuse). One session has been held and one is planned for the next staff meeting. One service user was asked if their right to vote in local and general elections had been upheld, this person was clear that they have been put onto the Register of Electors and have been enabled to vote. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 16 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): 19,20,24,25,26 Quality in this outcome area is good. The home is very clean, well decorated and safety is maintained. There is a very comfortable and homely atmosphere. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a rural location and is a well adapted old building with some new features and cottages extensions from the main house. A tour of the premises was made. There are handrails and assisted toilets and bathing facilities. There are two communal bathrooms in the home; the ground floor bathroom has an assisted bathing facility. The first floor bathroom has a short length sit in bath for the more able service users on this floor. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 17 At the time of this inspection the provider and her architect were at the home looking at ways to improve the accommodation, which would include a second assisted bathroom. The CSCI recommendation for a second assisted bathroom is restated at this inspection. There is level access around each floor of the home and a stair lift between ground and first floor. The home looks onto attractive gardens and has window boxes at lounge level. These were filled with flowering plants by service users at the Friday gardening club. Service users said they enjoyed having these to look at. The home was very clean and there was no discernable malodour around the home. One very worn bed table was brought to the manager’s attention for repair or replacement. Health and safety measures are in place, these include safe hot water temperature delivery at bath outlets, radiator guards and wardrobes secured to prevent them toppling forwards and causing injury. Windows above ground level are restricted from opening too widely. The home has a fire detection system and alarm, which is tested weekly. There is a staff call bell system throughout the buildings. This is connected to the cottages, which are secured at night. Infection control is well managed with hand wash facilities for staff that include liquid soap and paper towels. This promotes good hygiene practice. The kitchen was very clean and tidy but the cleaning rotas had not been completed recently. All temperature monitoring was in place. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is excellent. There is a well managed staff team who have experience and training in delivering care to a very good standard. Recruitment is robust and offers protection from harm to service users at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home operates with sufficient staff in number on duty. At the start of this inspection there were six care staff on duty, with one due to help with activities. Staffing for the home included also one domestic worker, the cook and assistant cook, the maintenance person, the administrator and the contracted gardener. Staff were observed at work during the day, all interactions with service users were observed to be polite and kindly. Service users offered compliments about the care staff, this included, staff are ‘very respectful’, ‘do anything to make your stay good’, ‘looked after so well here’, staff are ‘excellent’. A relative commented that staff are ‘ever so good’. Staff receive regular training and updating for fire, manual handling and food hygiene. Other topics for attention have been abuse awareness training. Staff The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 19 are encouraged to train to NVQ Level 2 and Level 3 in care and to date the home has achieved 70 , which is above the National Minimum Standard. One visiting professional commented that service could improve with ‘increased access to training’; staff were considered to be always ‘positive’ about their work. Two new staff recruitment files were examined. The recruitment practice was satisfactory and demonstrated a thorough procedure. Supervision is given when staff begin working at the home with a POVA First check until the completion of the Criminal Records Bureau (CRB) check is completed and returned. Care staff were spoken with and feedback forms from five staff were received. Staff confirmed having received induction training, manual handling training and food hygiene training. All staff said they felt had a senior member of staff to confer with and were clear about reporting any concerns. They also confirmed having access to gloves and aprons when needed. Some staff were involved in care planning and all confirmed having a CRB disclosure check. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 20 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): 31,32,33,35,38 Quality in this outcome area is good. The home is well and openly managed. Quality is monitored. Records and finances are safely managed. The health and safety of the home is well managed and records are held. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an experienced manager and the proprietors have a regular input at the home. The management style is very relaxed and staff and service users asked were confident about approaching the manager or the proprietors with any concerns. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 21 The home has the necessary expertise in other areas such as administration, maintenance and catering. Proactive quality assessment is made. Quality audits are carried out, the current assessment covers personal care, health and dignity, meals and social care. Action has been taken to review menus following feedback from service users. The records are well managed and are safely stored, access is restricted as necessary. The maintenance records for the home were examined: Fire Safety, Fire Alarm, this is tested weekly and was serviced on 5.01.07 Emergency Lighting, checked on 4.06.07 Extinguishers, visual check, 21.06.07 Hoists and stair lift are serviced under contract, May 07. Wheelchairs are checked 6 monthly. Kitchen temperature monitoring records (hot foods and fridges) were up to date. The kitchen cleaning schedule was incomplete. The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 22 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 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 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 3 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard OP21 OP24 OP8 Good Practice Recommendations You are recommended to consider providing a further assisted bathroom (carried over from previous inspections) The bed table in poor repair should be replaced. Service users weight should be recorded always in either an imperial measurement or as a metric measurement. Not as a mixture of both as it is less easy to monitor weight gain or loss. The kitchen cleaning schedule should be maintained unless the environmental health department recommend otherwise. Where Waterlow risk assessment is used this should be carefully assessed and updated if there is a change in health and condition. 4 5 OP15 OP8 The Old Vicarage DS0000015986.V346403.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Old Vicarage DS0000015986.V346403.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. 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!