Inspection on 05/12/06 for Warde Aldam Christian Nursing Home

This inspection was carried out on 5th December 2006.

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

Warde Aldam Christian Nursing... 12/12/08

Warde Aldam Christian Nursing... 28/02/06

Warde Aldam Christian Nursing... 04/10/04

Warde Aldam Christian Nursing... 25/06/04

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Snydale Care Home

Abbey The

Whiteley House

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Warde Aldam Christian Nursing Home Westfield Lane South Elmsall Pontefract West Yorks WF9 2JX Lead Inspector Stephen French Unannounced Inspection 5th December 2006 09:00 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 Warde Aldam Christian Nursing Home DS0000006223.V322016.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. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warde Aldam Christian Nursing Home Address Westfield Lane South Elmsall Pontefract West Yorks WF9 2JX 01977 643697 01977 643452 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) www.southerncrosshealthcare.co.uk Trinity Care Limited Mrs Maureen McKechnie Care Home 60 Category(ies) of Dementia (40), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (60), Old age, not falling within any other category (60), Physical disability over 65 years of age (60) Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Can accommodate one named service user under 65 years of age One specific service user under the age of 65 category (DE), named on variation dated 1st November 2006 may reside at the home. 28th February 2006 Date of last inspection Brief Description of the Service: Warde Aldam Christian Nursing Home is situated on the outskirts of South Elmsall. Set back in its own grounds this single storey home has a large drive with parking to the front. There are extensive gardens to the front and smaller gardens to the sides and rear. Set on the top of a hill some of the views from some bedrooms, dining rooms and lounges of the surrounding countryside are spectacular. Warde Aldam consists of three separate units providing a home for up to sixty older people some of who may also have a physical disability or have a mental health problem. All residents are offered a room of their own, some of which may have en-suite facilities. There are various lounges available including quiet rooms and television rooms. There are three large dining rooms. There is also a smoker’s lounge for those who wish to smoke. Some of the toilet and bathrooms are shared and there is assisted bathing for those who require it. There is an activities room which is well equipped and activities are arranged on a regular basis for those who wish to participate. The home is support by other healthcare professionals including Community Mental Health Team, General Practitioners and Specialist Nurses. All areas of the home are decorated and maintained to a good standard. There is a homely and relaxed atmosphere created in the home and residents and their relatives are invited to comment on the quality of care and support provided. The provider informed the Commission for Social Care Inspection on 12/05/06 that fees range from £441.00 to £558.00 per week. Additional charges include hairdressing, private chiropody, newspapers and some selected activities. The manager confirmed that existing and prospective service users are provided with a service user guide detailing what services are provided and the aims and objectives of the organisation. Additional copies are available upon request Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 5 Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 5th December 2006. The inspector arrived at the home at 9:05 am and left 3:00pm. During this visit the inspector spoke to some of the service users, some of the staff and the home’s management team. The inspector read care records, audited a sample of medication, reviewed staff recruitment and training records and carried out a brief tour of the building. Prior to the inspection 20 service user questionnaires were sent to the home to obtain service users’ views about living at the home. On writing this report only six completed questionnaires were returned. Comments included, I like living her and I like the staff, Good choice of meals and the staff will do other meals for me if I want, He has been treated with unfailing compassion by the outstanding staff at the home. Some service users in the home are very frail and would not be able to complete a questionnaire. There were Fifty-eight service users resident in the home on the day of this visit. Relative surveys were also sent out and one was returned. Other information used in the inspection process included notifications from the provider to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home, copies of the monthly management visit reports produced by the provider and a pre inspection questionnaire completed by the manager. The inspection has concluded that residents’ needs, both personal and recreational, are met. Residents reside in a relaxed and informal homely environment As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Some of service users bedrooms have been redecorated. There has been further improvement to the environment in which service users who have mental health problems live. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 8 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. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 9 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 Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 10 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): 1,2,3,6 Quality in this outcome area is good. Service users are given the information they require to help them make a decision on if they wish to move into the home. Service users needs are assessed prior to their admission. The home does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that prospective service users are made aware of the homes statement of purpose and service users guide prior to admission and are welcome to have a copy of the service users guide if they wish. Copies of both of these documents are kept in the reception area. Three service users spoken Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 11 to said that they couldn’t remember if they had been given a copy of the service users guide, but thought that their relative would have a copy. Four service users questionnaires received by the commission stated that service users were given enough information about the home prior to moving in. Prior to a service user being admitted to the home the manager receives a community care assessment from the service users social worker, which details the personal and health care needs of the service user and determines the level of care they will require. The manager said that she or one of the unit managers visits prospective service users and completes a pre admission assessment to ensure the home can meet the service users needs. Completed pre admission assessments were seen for five service users confirming that the home is following its admission procedures. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 12 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. Care plans set out in detail the action needed to ensure the health care needs of the service users are being met. Service users are able to make decisions about their lives with the support of staff. Medication is administered safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has a care plan which is devised from information gathered from the community care assessment, pre admission assessment and information obtained from the service user and their family. The care plans identify the areas in which the service user requires assistance and highlights Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 13 nursing and health care needs. The plan informs the staff of the actions they must take in order to meet the service users needs. As part of the visit six care files were examined. These contained risk assessments for such things as moving and handling, skin integrity and nutritional status. Care plans had been reviewed monthly and there was evidence that service users, who wished to be involved in the review of their care, had taken part. Care plans were detailed and comprehensive. Service users spoken to on the day of the inspection informed the inspector that the staff were very kind and treated them with respect. Four service user questionnaires confirmed that service users receive the care and support from staff they need. On the day of the visit a carer was observed sat next to a service user manicuring her nails whilst another was sat at the dining table chatting to two service users. There was a very relaxed and informal atmosphere within the home and service users personal appearance had been attended to. One member of the qualified staff was seen to interact with a service user who was becoming distressed, and her approach and empathetic manor calmed the service user down. Qualified nursing staff are responsible for the administration of medication. Should a service user wish to self medicate then a risk assessment would be completed and staff would supervise the service user in taking their medication. Medication seen on the day of inspection was stored correctly. Policies and procedures are in place to ensure the ordering, storage, administration and disposal of medication is done safely. The stock balances of six service users medication was examined, and balances tallied with the medication administration records held by the home. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 14 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’ social, cultural, religious and recreational needs are being met and they are helped to maintain contact with their families and the local community. Service users are able to exercise choice and control over their lives. Meals provided are varied, wholesome and appealing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a full time activities coordinator. Social activities for the week are displayed on the notice board in the reception area of the home. Service users spoken to said that they were happy with the activities on offer and these included trips out to places of local interest, Sing a longs, Arts and Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 15 crafts as well as baking. On the day of the visit the activities coordinator was preparing for the Christmas period and there were hampers and raffle prizes in the reception area ready for the residents Christmas party, which was being held on the 18th December. The manager said that relatives are encouraged to visit the home as often as they wish. Members of local community groups visit the home at seasonal times and there is a church service held weekly for those service users who wish to attend. The home operates a four-week menu cycle and service users spoken to said how nice the food was and that there was always a choice. On the day of the inspection the lunch consisted of braised sausages and onions or Chicken casserole, vegetables and mashed potatoes. Staff were observed assisting service users who had problems with eating in an appropriate manor. The lunch was unhurried and there was a relaxed atmosphere in the dining room. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is good Service users and their relatives are confident that complaints will be handled appropriately. Service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy, which is displayed in the homes main reception. The manager said that service users are made aware of the policy on admission to the home. The manager investigates all complaints and evidence was seen that a complaint received in August 2006 regarding a missing item of clothing had been handled appropriately. The commission for Social Care Inspection has not received any complaints about this home. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 17 Service users spoken to, and questionnaires received, confirmed that they were aware of the complaints policy and were confident that the manager would address any concerns they had. The manager said that staff receive training in the protection of vulnerable adults as part of their induction and it is also covered when staff receive supervision. Discussion took place between the manager and the inspector about the benefits of staff attending formal adult protection training arranged by Wakefield Social services and the manager said she would look into this. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 18 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): 19,20,21,23,24,25,26 Quality in this outcome area is good Service users live in a safe, well-maintained, clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of this visit a tour of the home was conducted which included a number of service users bedrooms, communal areas and toilet and bathrooms as well as the laundry. Bethal unit, which is the nursing and residential unit was decorated to a satisfactory standard and very homely in its appearance. Service users bedrooms were personalised with their own items such as photographs, ornaments and small pieces of furniture. The bathrooms had Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 19 assisted baths to enable staff to bath service users who have mobility problems safely. The shower room was noted to have a problem with the drain, which the manager said was ongoing and had been mended on a few occasions. Upper and lower Cedar unit, which looks after service users who have mental health problems, was also decorated to a good standard. A number of service users bedroom doors had been decorated in pastel colours and brass door knockers and letter boxes had been added to help service users identify their own rooms. Along the corridors there were tactile pictures and touch boards, which service users can stop and touch. A room which had been an office has been decorated and changed into a quiet lounge for the use of service users and their families The reception area carpet between the two units is in need of replacement as it is stained and worn and one of the lounges is in need of redecoration. Another lounge has been redecorated since the last inspection and the dining room has had a new floor laid. The standard of cleanliness throughout the home was very good, there were no offensive odours detected in any part of the home. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 20 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. The staffing levels are currently sufficient to meet the needs of the service users. The recruitment practices protect the service users from harm and the staff show a great empathy towards this particular client group and are well trained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing duty rota was checked for the month of November and this confirmed that the home is working within the staffing notice set by the previous registering authority. A number of service users comment cards received by the commission for Social Care Inspection stated that they were happy with the number of staff on duty at the home. On the day of the inspection there appeared to be adequate numbers of staff on duty to meet the needs of the service users. Three staff details were checked for staff who have recently been employed by the home. The files contained application forms, interview assessments, two Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 21 written references and a health questionnaire. Before any new staff are employed checks are made to ensure that the employee does not have a criminal record or appear on the protection of vulnerable adults register. Evidence was seen that the home had undertaken these checks. Following employment care staff complete Induction training within the first six weeks of them starting work. They then complete foundation training within six months. This training is in line with the National Training Organisations standards. Currently the home has fifteen care staff who have an N.V.Q qualification and a further sixteen staff who are completing the award. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 22 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): 31,32,33,36,38 Quality in this outcome area is good The home is well managed and the views of the service users are sought and any shortfalls are addressed. Systems are in place to protect the health and safety of service users and staff This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is a qualified nurse who has had many years of experience in working with older people, a deputy manager supports her in her role. She has commenced the registered managers training award and has just completed a three-day course in health and safety. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 23 The manager completes monthly audits of the home and the services they offer, the last full audit conducted in November 2006 scored over 90 . Areas audited included, presentation of the home and exterior grounds, enquiries made by new service users, medication, care documentation, complaints and accidents finance and maintenance. The manager also completes monthly statistics and is responsible for ensuring staff receive the training they require in order for them to be competent at the job they are performing. Evidence was seen that most of the staff have received training in moving and handling, fire prevention and health and safety training. Two staff have completed a course to enable them to become moving and handling trainers. The home also seeks the views of the service users and relatives about the care that they receive by sending out service users questionnaires annually. The last surveys were sent out in February 2006 and the manager said that she has not received any feedback from the proprietors of the home as to the findings of the survey. Service users are also able to air their views on the way the home is run through meetings, the inspector saw the minutes of the last meeting held on the 16/11/06. A monthly newsletter is also produced which contains information on forthcoming events. It is expected that all staff receive at least six formal supervisory sessions per year during these sessions staff discuss future training needs as well as the philosophy and aims and objectives of the home. The manager said that although these sessions are a bit behind she is working hard towards getting them back on track. Service users personal monies are kept in a central account held by the providers, this is a non-interest account and individual records of all transactions are kept for each service user. Should a service user wish to purchase small items of clothing or pay for hairdressing then this is taken out of the account and a receipt is issued. A copy of transactions undertaken is available to the service user or relative. The fire alarm system is checked weekly and certification in relation to gas, electricity and water is in place and up to date. Electrical equipment such as hoists and the passenger lifts are serviced regularly. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 24 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 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 X 3 X 3 Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 25 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. 4. 5. Refer to Standard OP18 OP20 OP21 OP31 OP33 Good Practice Recommendations Consideration should be given in approaching the local authority to provide more formal adult protection training. The home should consider replacing the heavily stained carpet in the foyer between the two dementia units. The drain in the shower room should be repaired The registered manager should inform the CSCI upon completion of the Registered Managers Award. The results of the annual questionnaire should be made available to service users and their families. Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Warde Aldam Christian Nursing Home DS0000006223.V322016.R01.S.doc Version 5.2 Page 27 - 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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