Inspection on 16/05/07 for Tixover Care Home

This inspection was carried out on 16th 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 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

Tixover Care Home 05/10/09

Tixover Care Home 10/05/09

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Tixover Care Home Tixover House Tixover Grange Stamford Rutland PE9 3QN Lead Inspector Mrs Carole Burgess Key Unannounced Inspection 16th 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 Tixover Care Home DS0000069210.V337330.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. Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tixover Care Home Address Tixover House Tixover Grange Stamford Rutland PE9 3QN 01780 444491 01780 444572 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) Barchester Healthcare Homes Ltd Ms Catherine Jane Finlayson Care Home 48 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (48), of places Physical disability (48), Physical disability over 65 years of age (48) Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Tixover House is registered to provide personal care to male and female service users whose primary care needs fall within the following categories; Physical Disability over 65 years of age PD(E) 48 Physical Disability over the age of 55 years PD 48 Old age not falling within any other age category OP 48 Dementia over 65 years of age DE(E) 15 No more than 15 persons with Dementia should be accommodated within Tixover House Care Home. The maximum number of persons to be accommodated in Tixover House Care Home is 48 New Service 2. 3. Date of last inspection Brief Description of the Service: Tixover House is part of Barchester Healthcare Homes Limited, and provides both residential and nursing care. Qualified nurses are on duty throughout the 24-hour period. The home is close to the village of Tixover on the A47, surrounded by open countryside. It is set within well-maintained grounds and is bright, clean and modern in design. All areas of the home and gardens are accessible to people who use wheelchair. Many rooms have en-suite facilities and can be personalised with the resident’s own furniture, if so desired. There are attractive communal sitting rooms, and a dining area on the ground floor. There are additional toilets, and assisted bathing and showering facilities for less able residents. There is an ‘in house’ laundry service and all food is freshly prepared and cooked ‘on site’. The Statement of Purpose and Service Users Guide (both give information about the home) are provided for all new residents, and a copy is available in the reception area, with the home’s most recent inspection report. Fees at the time of inspection were: £600 - £750 pr week. Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. The site visit was unannounced and took place over seven hours. The Inspector selected four residents and tracked the care they receive through a review of their records, discussion with them (where possible), other residents, their relatives, the care staff, and observation of care practices. The Inspector spoke with staff members regarding training and support. The Registered Manager and other staff spoken with were positive and helpful during the inspection. Planning for the inspection included assessing notifications of significant events sent to the CSCI by the home. There have been no complaints received by the CSCI regarding the home since its registration in February 2007. What the service does well: What has improved since the last inspection? Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 6 The home is registered as a new service. This is the first inspection since the new registration with this company but another company in the group previously owned it. There have been many recent improvements in décor and facilities since the service was registered in February 2007. Many areas of the home have been redecorated, new curtains and pictures hung, and the central heating boilers upgraded. 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. Tixover Care Home DS0000069210.V337330.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 Tixover Care Home DS0000069210.V337330.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, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with detailed information about the home, and have their health, welfare and social care needs assessed, so that they can be fully met once they move into the home. EVIDENCE: The home provides prospective residents and their relatives with a detailed Statement of Purpose and Service Users Guide (both give information about the home) to help them decide if the home is the right one for them. Each resident has a copy in his or her room. The Registered Manager has also produced an excellent additional booklet, ‘Welcome to Tixover House’, that provides clear information in large print Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 9 about things such as the staff, room facilities, meals, activities, safety arrangements and the complaints procedure. Copies of the residents’ contracts (terms and conditions) are kept in the home in a separate file and residents, or their relatives, are provided with a copy. A resident said that she had been given a contract when she moved to the home. Four residents’ care plans were seen. Each contained a satisfactory preadmission assessment to show that the home could meet the resident’s specific health, welfare, and social care needs. The Registered Manager or her deputy completes the assessment. Personal details, relative and GP contact numbers, a past and present medical history, current health care requirements and medications, personal preferences and social interests and hobbies were included as part of the assessment. The home does not provide intermediate care. Tixover Care Home DS0000069210.V337330.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. This judgement has been made using available evidence including a visit to this service. Residents are well cared for in respect of their health, personal and social care needs. EVIDENCE: The Registered Manager is in the process of introducing the Barchester Healthcare Homes Limited new care plans for all of the residents. The ‘old style’ care plans are detailed and give carers detailed information about the health, personal and social care needs of the residents. The recently completed care ‘new’ plans have yet to be agreed and signed by the residents and/or their representatives. The ‘old’ style care plans were signed by the resident or their representative, and had been regularly reviewed and updated to reflect the resident’s current care needs. Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 11 The home is recommended to make sure that all new care plans are seen, agreed and signed by the resident, or their representative, so that all of the residents care needs continue to be met. Contact with healthcare professionals such as Chiropodists, District Nurses and GP’s were noted; treatments carried out as recommended, and recorded in the resident’s care plan. Medication policies and procedures were sound. Residents are able to continue to self medicate following a risk assessment to ensure that they are safe to do so. Medications is only administered by nurses, and senior carers who receive annually updated training to safeguard the residents, and ensure to that they receive their medication as prescribed. Observation during the inspection showed that staff have a good awareness of how to protect residents privacy and dignity. Staff spoke to residents in a respectful, friendly, quiet and supportive way. Four residents and two relatives all said that staff were kind, caring and respectful. Tixover Care Home DS0000069210.V337330.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. This judgement has been made using available evidence including a visit to this service. The staff work hard to ensure that residents experience a safe, stimulating and homely life style. EVIDENCE: The home has an activities organiser who arranges a planned programme of activities. A colourful, printed poster of forthcoming activities is given to all the residents. Quizzes and entertainers, such as a harpist, appeared to be popular with the residents. Other activities such as arts and craft, one to ones, needlework and hairdressing are on offer. Residents can choose not to join in, spending quiet time in their room, watching television or sitting in one of the quiet sitting rooms. A newsletter provides information so that residents and their families remain up-to-date with events and activities at the home. There are pleasant gardens and a patio area where, in the warmer weather, residents can walk or sit. Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 13 Residents are able to have their own television and telephone in their room should they choose to do so. Special and festive days are celebrated, as are residents’ birthdays. One resident said that they all have a birthday party and a cake with candles and that the home supports special family events, such as family gatherings to celebrate special anniversaries. A number of residents said that the staff made Christmas very special as there was something happening every day throughout the Christmas period, which they really enjoyed. Residents said that they are able to have visitors at any time and a number of people came to visit, and were spoken with, during the course of the site visit. Staff support residents with making choices in their everyday life. All residents spoken with said they got up and went to bed when they wished, were able to choose what they wanted for their meals, and what to wear, and were well supported by very caring staff. Two visitors said that they thought that the care was very good and were impressed that their relative looked well, was more active and had put on weight since moving to the home. There are regular church services and communion in the home for those who wish to attend. Small pets may be allowed. The home has two cats, one belonging to a resident, and tropical fish. All meals are prepared in the home’s kitchen: there are choices at all main meal times. A cooked breakfast is available every day. One resident said she always had her cooked breakfast in her own room. Two residents said that lunch could be better, complaining about ‘tough meat’ and vegetables being ‘too crunchy’. The Registered Manager said that she was aware that some residents had not been happy with some of the lunches and had discussed this with the chef, and reassured residents that the food was freshly prepared and their concerns would be addressed. Two residents said that they enjoyed their meals, which were very good, and that there were always choices at every meal. Afternoon tea consists of freshly baked cakes or an alternative is provided if required. There is a ‘satellite’ kitchen on the ground and the first floor where staff can make drinks and snacks for the residents. Residents have a nutritional assessment in their care plan to ensure that their dietary needs are being met. Special diets such as diabetic and soft diets are catered for. Additional advice is sort from health professional such as the diabetic specialist nurse, to ensure residents receive the correct diet for them. Tixover Care Home DS0000069210.V337330.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints are sound resulting in satisfactory protection of residents’ rights. EVIDENCE: The CSCI has not received any complaints about the home. Residents’ comments showed that people feel at ease discussing any concerns with the staff. Information regarding advocacy services is available from the Registered Manager. However, this information could be provided elsewhere so that residents are able to access advocacy for help and support, without going to a member of staff, if they choose. The home has received two complaints since February 2007. One concerning poor care practice; the carer no longer works at the home, and one is ongoing. The Registered Manager is dealing with this with in a thoughtful and professional manner. Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 15 The home’s complaints process reflects the Safeguarding Adults policies and procedures and staff are being provided with appropriate training. They were able to demonstrate the correct procedures for safeguarding the residents from abuse. There were letters and cards of thanks from relatives which said things such as: the staff had a ‘genuine caring attitude’; that ‘care was second to none’; and ‘we feel blessed having you to look after our mum’. Tixover Care Home DS0000069210.V337330.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, 21, 24, 25 & 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A comfortable, clean, safe and high standard of accommodation is provided for the residents. EVIDENCE: The home is clean, safe and well maintained with many adaptations to suit residents’ specific needs. It is decorated and furnished to a high standard that creates a comfortable, light, spacious but homely environment. Many areas of the home have been recently upgraded, decorated and improved. Residents and relatives said that the home was well maintained. One resident said it was like ‘a good hotel’. Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 17 Residents have access to attractive safe gardens and all areas of the home are fully accessible for people who use wheelchairs. About half of the residents’ rooms have en-suite facilities and were clean and well decorated. Residents are able to move to an en-suite room if one becomes available. All rooms have ‘nurse call’. Residents are able to bring items of their own furniture and possessions with them to personalise their rooms. All of the residents’ rooms were highly personalised, many with the resident’s home furnishings. There are sufficient toilets, bathing and assisted bathing facilities for residents who do not have en-suite facilities or require extra help. Residents and two relative praised the home for the high standard for its cleanliness and décor. The home’s health and safety arrangements such as regular maintenance and servicing of equipment, regular fire drills and monitoring heat control valves on hot water taps show that the providers are mindful of their responsibilities to make sure that residents live in a safe environment. The Registered Manager pointed out a room, which had a strong odour, where the flooring requires replacing. This should be done as soon as possible to ensure that general hygiene, and the dignity of the resident is maintained. Tixover Care Home DS0000069210.V337330.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 good. This judgement has been made using available evidence including a visit to this service. Staff at the home are sufficient in numbers to meet the residents’ needs. EVIDENCE: Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 19 There were forty-eight residents at the time of the site visit. Staffing levels, at the point of inspection, were in line with those suggested by the Department of Health Residential Forum Guidelines and were sufficient to meet residents’ needs. During the early shift there are seven or eight staff; late shift there are six or seven staff; and four staff at night. There are always trained nurses on duty, day and night. In addition, during the day, there are cooks, cleaners, kitchen and laundry staff and a maintenance person. A member of staff and a resident said that they could do with more staff. One resident said that there seemed less staff at the weekend. The Registered Manager said that the providers were responsive to staffing in order to meet the care needs of the residents. Other residents spoken with said they felt that there were sufficient staff, that the staff worked hard, and that their care needs were met. Four staff files were checked during the inspection and showed that there is a satisfactory recruitment process. All staff had had Criminal Records Bureau (CRB) checks and the necessary references to make sure that residents were safe from abuse. Training for staff is well supported. The home has a team leader who is also a trainer. There is a training room with Internet access for staff to access Barcheter’s training programmes and to watch training videos. Staff undertake training in specific areas such as fire training, first aid, moving and handling and safeguarding adults. A new member of staff had had a comprehensive, recorded induction programme, which included Health & Safety, infection control, moving & handling, recognition of abuse and communication skills. Ten staff have recently undertaken first aid training and two senior staff have completed dementia care training. Further training for all staff in dementia care is to be arranged. The Registered Manager said that seven carers had completed a National Vocational Qualification (NVQ) in Care Level 2 or 3 (one had achieved Level 4) and that there are three overseas nurses working as carers who have the equivalent of NVQ Level 3. This demonstrates that staff have the necessary skills to provide safe care for the residents. Tixover Care Home DS0000069210.V337330.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, 33, 35 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Registered Manager provides supportive leadership to staff, ensuring that residents receive a good standard of care. EVIDENCE: Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 21 The Registered Manager is an experienced nurse, with an NVQ Level 4 and the Registered Managers Award, and works in a supervisory and management role in addition to the care staff numbers. Excellent interaction between staff and residents ensures that there is a culture of openness and friendliness in the home and residents feel comfortable and at home in their surroundings. The home conducts a yearly quality audit (satisfaction survey) for residents to complete. The results are published in the Statement of Purpose and Service Users Guide to provide residents and prospective residents with additional information about the home. There are also monthly audits on different aspects of care to ensure that standards are maintained and improved for the benefit of the residents. The Registered Manager has started various group meetings for residents, relatives, staff and housekeeping staff to provide residents and staff with the opportunity to contribute to the running of the home. The home only keeps money on behalf of two residents. This is kept in a safe and records are maintained. Everything else is paid by invoice. The Registered Manager has started to do annual appraisals for all of the staff, which she hopes to complete by July 2007. Recorded supervision (regular review of staff’s personal and training needs in relation to their work) is to be implemented. This is considered to be good practice to ensure that staff continue to provide the expected standards of care for the residents. Staff monitor accidents, such as residents’ falls and professional advice is sort where required. Residents who have accidents or falls not requiring hospital treatment are monitored closely by staff, and reassessed at 12, 24, and 36 hours to ensure there are no unnoticed complications. Barchester Healthcare Homes Limited audits accidents centrally to identify and address risks to safeguard the residents. Health and Safety Policy and Procedures, such as regular recorded fire drills fire alarm tests and hot water checks are completed, to ensure the health and safety of the residents and staff. Tixover Care Home DS0000069210.V337330.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 3 X 4 X 4 4 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 4 X 4 X 4 X X 3 Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP7 OP17 OP26 Good Practice Recommendations Residents’ new care plans should be agreed and signed by the resident, or their representative, to ensure that care needs are fully identified. Residents are provided with information regarding advocacy services, which they are able to access privately if they choose. The flooring in the room, identified by the Registered Manager during the site visit, should be replaced as soon as possible to ensure that general hygiene, and the resident’s dignity is maintained. Tixover Care Home DS0000069210.V337330.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Tixover Care Home DS0000069210.V337330.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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