Inspection on 02/01/07 for Three Willows

This inspection was carried out on 2nd January 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

Three Willows 07/02/06

Three Willows 21/07/05

Three Willows 13/09/04

Three Willows 29/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Three Willows 35 Woodberry Way Chingford London E4 7DY Lead Inspector Rob Cole Unannounced Inspection 2nd January 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 Three Willows DS0000007216.V305445.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. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Three Willows Address 35 Woodberry Way Chingford London E4 7DY 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) 020 8529 1881 020 8529 1881 Mr James Deary Mrs Catherine Deary Sharon Allison Osbourne Care Home 21 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (2), Old age, not falling within any other of places category (21) Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To allow the home to provide care and accommodation for two (2) named service users with dementia category needs. One place for a service user, under the age of 65 years, with dementia. 7th February 2006 Date of last inspection Brief Description of the Service: Three Willows is a home providing care to 21 elders, situated in the Chingford area of the London Borough of Waltham Forest. The home is in a residential area, and is in character with other homes in the area. The home is close to shops and other local amenities, including transport networks. The home is privately run. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 2/1/07 and was unannounced. The inspector had the opportunity of speaking with service users, their relatives, staff from the home, and the homes manager was present throughout the inspection. The inspection also included a tour of the premises, and an examination of documents and records. The range of fees charged by the home is from £675 per week to £800 per week. Overall the inspector was satisfied that this is a very well run care home, and that service users receive high levels of individual support. Service users spoken to gave very positive feedback on the home, as did their relatives. One relative commented that “My fathers care needs are been met above and beyond the call of duty.” What the service does well: What has improved since the last inspection? What they could do better: Two requirements were set at this inspection, which must be addressed. The homes Statement of Purpose must be in line with National Minimum Standards, and used continence products must be stored securely. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 6 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. Three Willows DS0000007216.V305445.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 Three Willows DS0000007216.V305445.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 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. It is the view of the inspector that service users are provided with sufficient information about the home to make an informed choice about moving in. This information is provided through written documentation and the opportunity of visiting the home. EVIDENCE: The home has a Statement of Purpose and Service User Guide in place. Both documents are dated and subject to regular review, and are written in plain English. The Statement includes details of the services and facilities provided and the range of needs the home can meet. However, while it includes details of what is and what is not covered by the fees, it does not include details of the actual fees themselves. Further, information relating to the organisational structure is not accurate, for example it states that the home currently has an Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 9 acting manager in place and three senior care staff, while in fact the manager is now registered, and there is also a deputy manager in place along wit the senior care staff. The Service User Guide includes details of the homes physical environment and the complaints procedure, and is in line with National Minimum Standards (NMS). All service users are given their own copy of the Service User Guide. There was evidence that all service users are provided with a written contract/statement of terms and conditions. These have been signed by the service user or their family member where appropriate, and by a representative of the home. The homes manager carries out pre admission assessments on all service users prior to them moving in to the home. Those seen by the inspector were clear and comprehensive, and covered needs associated with mobility, medication and social and leisure needs. The home has an admissions procedure. This states that service users will be given the opportunity of visiting the home before making a decision as to move in or not. Service users spoken to confirmed that they were indeed given this opportunity. The procedure also stated that service users would initially move in on a six week trial basis, after which a placement review meeting would be held. Through observation and discussion there was evidence that the home is able to meet the collective and individual needs of service users, staff demonstrated a good understanding of their roles and responsibilities. The home does not provide intermediate care. Three Willows DS0000007216.V305445.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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that the home is meeting the health and personal care needs of service users. Service users are treated with dignity and respect, and have regular access to health care professionals as appropriate. EVIDENCE: Clear and detailed care plans were in place for all service users. These are subject to monthly review. Plans include information on needs associated with personal and health care, medication, diet, mobility and social and leisure needs. Plans are drawn up with the involvement of the service user, their family where appropriate, and the homes manager and deputy manager. Daily records are also maintained for all service users, which are linked to care plans. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 11 Risk assessments were also in place for all service users, and of a similarly good standard. As with care plans, they are subject to regular review. Assessments identify any potential risks, and also include strategies to manage and reduce these risks. Assessments include risks associated with falling and transfers. From observation and discussion with service users there was evidence that service users privacy and dignity is respected. Staff were observed to knock and wait before entering bedrooms, all service users were appropriately dressed on the day of inspection, and the manager informed the inspector that service users are given their own mail to open. Service users are able to use the telephone in the office if they want privacy. Screening is provided in double bedrooms. The home has a policy in place on death and dying. Service users (or their family where appropriate) views are sought on arrangements to be made in the event of their death, and these views were recorded on care plans. The inspector was informed that service users are able to stay in the home with a terminal illness, so long as the home is able to meet their medical needs. Staff have received training in bereavement issues. All service users are registered with a GP. Records are maintained of medical appointments, these included details of the appointments themselves, and of any follow up action required. Records indicated that service users have access to health care professionals as appropriate, including district nurses, chiropodists and opticians, and since the last inspection all service users now have access to dental care. The home makes use of the Continence Advisory Service, who supply continence products and advice. However, it was found that several bags full of used incontinence products were not stored in a secure bin. They were stored outside the home, some bins were provided, but these were full, and other bags were left out in the open. This presents a risk of the spread of infection, and it is required that used continence products are stored in secure bins. The home has a comprehensive medication policy in place, and all staff undertake training before they are able to administer medications. Medications are stored in a designated and locked medications room, and in a locked container within the fridge as appropriate. One service user is currently on controlled drugs, these were appropriately stored and checked. No service users currently self medicate. The home maintains records of medications entering the home and of those that are returned to the pharmacist. Since the last inspection guidelines are now in place on the administration of medications that are prescribed on a PRN basis. Medication Administration Record charts are maintained, those checked by the inspector appeared to be accurate and up to date. Three Willows DS0000007216.V305445.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 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Food provided is of a very high standard, and the home makes considerable efforts to meet the social and leisure needs of service users. EVIDENCE: The home had an activities programme on display, this advertised a varied activities programme, including bingo, quizzes and a gentle exercise group. The home provided various activities over the recent Christmas period, including a singing group visiting the home, a pantomime and a Christmas meal out at a restaurant. Service users spoken to informed the inspector that they very much enjoyed the various activities provided. Service users can access the community, for example visiting local pubs and parks. One service user visits a church weekly, while a nun visits the home weekly to give communion. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 13 The home has a visitors policy, which states that visitors are welcome at any reasonable time. The inspector spoke with visitors to the home during the course of the inspection. They informed the inspector that they always found the home very welcoming, and that staff demonstrated a good understanding of their roles and responsibilities. They further commented that they were always kept informed of any significant events regarding their relative. The home keeps records of menus. These evidenced that service users are offered a varied, balanced a nutritious diet. On the day of inspection service users were offered a choice of meals, all of which appeared appetizing and healthy. Service users commented that the standard of food was “excellent” and “very good,” and that it was always served in adequate quantities. Service users are offered three meals a day, including the option of a cooked breakfast, drinks and snacks are available throughout the day. Fresh fruit was available, and there was evidence that fresh fruit and vegetables are routinely incorporated in to the menu. All staff responsible for food preparation have received food hygiene training. The kitchen was clean and tidy, and food was stored appropriately. Records are maintained of fridge and freezer temperatures. Three Willows DS0000007216.V305445.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that the home has taken reasonable steps to ensure that service users are protected from the risk of abuse, and that their legal rights are protected. EVIDENCE: The home has a complaints log, this evidenced that complaints have been appropriately recorded and investigated, although the manager informed the inspector that the home had not received any complaints since the previous inspection. The home also has a complaints procedure, this was on display within the home, and included timescales for responding to any complaints received, and contact details of the CSCI. Service users spoken to demonstrated a good understanding of whom they could complain to if they so wished. The home has a copy of the Local Authorities adult protection procedure, and also its own policy on adult protection. This appeared to be in line with current legislation. All staff have undertaken training in adult protection issues. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 15 The inspector was satisfied that service users legal rights are protected, for example all service users are on the electoral register. Service users spoken to informed the inspector that they are able to vote in elections. Three Willows DS0000007216.V305445.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): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that the home is suitable to meet its stated purpose with regard to the physical environment. The building was well maintained, both internally and externally. Service users have adequate communal and private space to meet their needs. EVIDENCE: The home is situated in a residential area of Chingford in the London Borough of Waltham Forest, close to shops and other local amenities. The home is in keeping with other homes in the vicinity. The home was well maintained, both externally and internally, and on the day of inspection was clean and tidy. The home is built over two floors, and is accessible to service users via a lift. The Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 17 communal areas consist of two dinning/sitting rooms, a visitor’s room and a garden. Service users were observed to move freely around communal areas, and the manager informed the inspector that service users enjoy sitting in the garden in good weather. The garden had appropriate furniture, and also BBQ facilities. All communal areas are non-smoking, but service users are able to smoke in the garden, and in their bedrooms subject to satisfactory risk assessments. All bedrooms are ensuite, with a toilet and hand basin. In addition to this there are adequate numbers of toilet and bathing facilities around the home to meet service users needs. Baths have been adapted to make them accessible to service users. All bathroom/toilets were clean, tidy and free from offensive odour on the day of inspection. All bathrooms have working locks fitted to them. Bedrooms were well maintained, with adequate furniture, including wardrobes, table and chair and chest of draws. Bedding, curtains and carpets were well maintained and domestic in character. Service users were able to decorate their rooms to their personal tastes, for example with family photographs. Screening was provided in double rooms. Bedrooms meet National Minimum Standards on size requirements. All bedrooms have central heating, which is appropriately boxed in. Windows provide adequate natural light and ventilation. Service users have been offered keys to their bedrooms, subject to the completion of a satisfactory risk assessment. Electric lighting is domestic in character, and the home tests and records water temperatures in bedrooms on a weekly basis. Emergency lighting is situated throughout the home. The home has a range of adaptations to make the house accessible to service users. In addition to the lift, there are handrails situated around the home and in toilets, and baths have been adapted. Hoists are used, and these are regularly serviced. Corridors and doorframes are wide enough to allow easy access to wheelchairs, and ramps have been built to allow easy access to the garden. The home has a call alarm system installed in all bedrooms and bathrooms. The home has a policy on infection control, and on the day of inspection the home was clean, tidy and free from offensive odours. The laundry room was well maintained, and all service users have their own laundry basket to help ensure they always where their own clothes. The washing machines are appropriate to meet the homes needs, and hand washing facilities are situated in the laundry room and throughout the home. Protective clothing such as latex gloves are available for staff to wear to help control the spread of infection. Three Willows DS0000007216.V305445.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. It is the view of the inspector that the home is staffed in sufficient numbers, and by suitably experienced and qualified staff to meet the needs of service users. EVIDENCE: The home provides 24-hour care, including waking night staff and an emergency on-call procedure. There was a staffing rota on display within the home, this accurately reflected the actual staffing situation on the day of inspection. All staff have been provided with a copy of their job description and the General Social Care Council codes of conduct. Through observation and discussion there was evidence that staff have a good understanding of their roles and responsibilities, and that they have built up good relationships with service users. Staff were seen to interact with service users in a friendly and respectful manner. As well as care and management staff, the home also employs designated kitchen staff, cleaning staff and a handy person. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 19 All staff undertake a structured induction programmes on commencing work at the home, this includes the physical environment and service user issues. Staff receive on going training, recent training has included dementia, manual handling, food hygiene and adult protection. Of the fifteen care staff employed at the home, nine have achieved a relevant care qualification. The manager informed the inspector that it was the intention of the home that in time all staff will be given the opportunity of completing such a qualification. The home holds regular staff meetings, these are minuted, and all staff can contribute to the agenda. The home has policies in place on equal opportunities and recruitment and selection. The inspector checked several employment files at random, these were found to contain all required documentation, including proof of ID, employment references and satisfactory CRB checks. Three Willows DS0000007216.V305445.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): 31,32,33,35,36,37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that this is a well run home. Health and safety is managed effectively, and there are appropriate quality assurance systems in place. EVIDENCE: Since the previous inspection the home has now appointed a permanent manager, who has been registered with the CSCI. They have achieved the Registered Managers Award, and they informed the inspector that they will soon be starting to work towards an NVQ Level 4 in Care. Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 21 Staff and service users spoken to informed the inspector that they found the manager to be approachable and accessible, and on the day of inspection staff were observed to interact with the manager in a relaxed manner. The manager presented as having built up good relations with staff, service users and visitors to the home. The home does not hold money on behalf of service users. Service users either manage their own money, or an advocate, such as a relative, manages their money on their behalf. Care plan reviews, service user meeting and staff meetings all contribute to the quality assurance within the home. Monthly Regulation 26 visits take place, and copies of previous inspection reports were available to view in the home. The home issues questionnaires to service users and their families, completed questionnaires seen by the inspector contained generally positive feedback. All service users also have an annual review meeting to review the overall care and support provided by the home. The manager carries out regular audits, for example of health and safety and medication records. Record keeping within the home was of a good standard. Records are stored securely, staff and service users can access their records as appropriate. Since the last inspection all staff now receive regular formal supervision at least six times a year. Minutes are taken, and staff have access to a copy of their supervision records. Supervision includes discussions on performance, training needs and service user issues. The home has various health and safety policies in place as appropriate, including on COSHH and first aid. Staff receive health and safety training, for instance on fire safety and food hygiene. Fire extinguishers were situated around the home, and last serviced in November 2006. Fire exits were free from obstruction on the day of inspection. The home tests fire alarms weekly, and alarms were last serviced on the 13/11/06. Fire drills are held every three months. The home had in date certificates for gas safety, electrical installation and PAT. COSHH products were stored securely, and the home tests hot water temperatures. The home had in date employer’s liability insurance cover in place. Three Willows DS0000007216.V305445.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 2 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 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Three Willows DS0000007216.V305445.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. 1 Standard OP1 Regulation 4 Requirement Timescale for action 31/03/07 2 OP8 13 The registered person must ensure that the homes Statement of Purpose is in line with National Minimum Standards, and contains accurate and up to date information about the home. The registered person must 28/02/07 ensure that used continence products are stored in secure bins, which include a fitted lid. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Three Willows DS0000007216.V305445.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Three Willows DS0000007216.V305445.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!