Inspection on 22/09/08 for West House

This inspection was carried out on 22nd September 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

West House 08/12/09

West House 30/06/09

West House 25/09/07

West House 03/10/06

West House 06/03/06

West House 06/10/05

West House 30/03/05

West House 23/11/04

West House 31/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE West House 11 St Vincents Road Westcliff On Sea Essex SS0 7PP Lead Inspector Carolyn Delaney Unannounced Inspection 10:30 22 September 2008 nd 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 West House DS0000015565.V369463.R03.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. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West House Address 11 St Vincents Road Westcliff On Sea Essex SS0 7PP 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) 01702 339883 01702 346518 www.westhousenursinghome.co.uk Rootcroft Limited Barry Gelfand Barry Gelfand Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N To service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 25 25th September 2007 2. Date of last inspection Brief Description of the Service: West house is an established care home providing nursing care for up to a maximum of twenty-five older people. Although the home predominantly accommodates residents of the Jewish faith, this is not exclusively the case and residents of other faiths (or no faith) are also accommodated. The home consists of a traditional residential property, which has been modified and extended to meet the needs of older people. The shaft lift and stair lift gives access to all three floors where accommodation and communal areas are situated. The home is situated close to local shops and amenities and is within easy reach of the main shopping area; the seafront and local theatre are also nearby. There is a limited amount of parking to the front of the home. At the time of this report the fees for a place at the home range between £388.01 and £750.75 per week. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a routine unannounced inspection, which included a visit made to the home between the hours of 10.30 and 19.00 on 22nd September 2008. As part of the inspection process we reviewed information we have received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment which the registered provider / owner tell us what they do well, how they evidence this and the improvements made within the previous twelve months. Two relatives completed surveys. Six residents and four relatives spoke with us during the site visit and their views and comments were reflected in the report. We also observed how staff interacted with residents when supporting them with activities such as meals, mobilising and providing recreation and stimulation. During the site visit, records including residents’ care plans and assessments, and staff training files were examined. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. In addition some residents’ bedrooms were viewed. Information obtained was triangulated and reviewed against the Commission’s Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. What the service does well: Residents live in a well managed comfortable home. Before a person chooses to move in they are given information about the home to help them decide if they will be happy to live there. A team of trained and suitable staff assesses their health and medical needs. Residents are well cared for and receive the treatment they need. If a person is unhappy they know who to complain to and concerns are taken seriously and responded to promptly. Staff have information and are trained to recognise signs of abuse and to act if they see any ill treatment of residents. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 6 The manager and staff are approachable and residents and visitors are asked for their opinions about the home so that any issues can be dealt with to improve the services provided to the people who live in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. West House DS0000015565.V369463.R03.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 West House DS0000015565.V369463.R03.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 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who move into West house are assured that their assessed needs will be met. EVIDENCE: We were told by the manager in the Annual Quality Assurance Assessment that there is a website where people can access information about the home and the services provided. In addition there is a detailed statement of purpose, which sets out the aims, and objectives of the home and a service users guide, which is provided for people when they move in. This guide describes what it is like to live there and provides information such as staffing levels, meals, activities and how to make a complaint if a person is unhappy. On the day of the inspection copies of the service users guide were seen in residents bedrooms and a book where people could record any comments and suggestions they may have about the home. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 9 Before a person moves into the home nursing staff visit them and carry out an assessment of their needs. We looked at the assessments for two people who had recently moved into the home. These were detailed and described what care and support the individuals needed in respect of daily activities of living such a washing and dressing, mobilising and eating and drinking. One of these residents and their relatives spoke with us during the inspection. The resident said that they had moved into the home until their walking improved. This person said that ‘the home was good and that family visited regularly’. Relatives said that ‘they were happy with the home.’ At the time of this inspection Southend hospital had contracted six beds in the home for ‘step down’ care. This means that the person has been assessed as medically fit for discharge from hospital but may need more physiotherapy to improve mobility or may need a care package arranged in order to be able to move back home. We contacted the discharge coordinator for Southend hospital who said that this contract had ended but that there had been no issues and that they were happy with the service provided by the home and that ‘patients are well cared for’. West House DS0000015565.V369463.R03.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. People living in West house are well cared for and receive the support and medical treatment they need. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that residents are supported by good team of nurses and care staff and that residents and their families are actively encouraged to participate in the planning and review of care. Residents and relatives who spoke with us confirmed this. During the inspection visit the care plans for four people were looked at. There was information recorded about each person’s nursing and general care needs and how staff support the individual. Information was detailed however it did not reflect people’s capabilities so that staff could support residents to remain independent for as long as possible. For example where it was recorded that a person needed assistance with washing or dressing it did not reflect what if any part of this activity the individual could carry independently or with help. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 11 Residents and relatives to told us that people are well cared for. One person told us that their relative ‘is very well looked after and had they not moved into West house they may not be alive today’. Residents have access to medical treatment and routine healthcare checks for sight and hearing. Staff assess any potential risks to resident health such as risk of injury from falls or use of equipment and risks associated with reduced mobility such as pressure sores. Risks are reviewed periodically to help to protect residents from harm. We looked at the information the manager told us about injuries to residents. There had been one incident in the past twelve months where a residents required hospital admission due to a fracture following a fall. When a person moves into the home they are assessed as to whether they would be able to safely keep and administer their medicines and this is recorded. The majority of people who move in would prefer not to or are incapable of managing their medicines. There is a detailed policy for staff to follow when handling and disposing of medicines. Qualified nursing staff are responsible for administering, checking and keeping records of medicines received and disposed of. Staff undertake training periodically to maintain skills. We observed that medicines were stored safely and securely in the home. Medication Administration Records were completed accurately. Staff were observed to administer medicines in a proper manner. West House DS0000015565.V369463.R03.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents do not have opportunities for activities and exercise, which meets their needs and choices. EVIDENCE: We were told in the Annual Quality Assurance Assessment that an external entertainer visits the home once a week and that residents who are able are supported in going out to shows or to the seafront. In addition staff working in the home provide opportunities for activities such as games and quizzes. The manager plans to send key members of staff on training in respect of providing activities so as to improve experiences of people living in the home. A weekly plan for activities was available. Activities include card games, board games, and quizzes. An entertainer visits the home once a week. Three residents, two visitors and one person who completed a survey commented that there could be more activities in the home. One resident said ‘There are no suitable activities, we throw a ball to one another. Is that an West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 13 activity?’ Another person said ‘we never go out, staff say we can go out when the weather is better, but the weather is never better’. Visitors who spoke with us said that they are always welcomed to the home. There is a planned menu for meals and this is displayed on a white board in the lounge daily as a reminder. On the day of the inspection residents were offered grapefruit segments, soup and a main course of fishcakes, boiled potatoes, carrots and broccoli. Staff offered residents salad cream with their meal however more appropriate sauces were not offered. There was no alternative offered to the main meal served and staff confirmed this. Residents commented that the food ‘is ok’. One person said ‘the food is alright but nothing special’. Another person said ‘there is no choice if you don’t like it you can have a sandwich’. Staff were available to support residents during the mealtime and residents were given plenty of time to finish. A choice of spaghetti or cheese on toast was available for the evening meal. West House DS0000015565.V369463.R03.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated well and safeguarded from harm and their complaints and concerns are taken seriously. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that complaints and concerns are dealt with and records maintained. He also told us that staff are trained to safeguard residents from abuse. There is a policy for dealing with complaints and staff told us that they would report any concerns to the manager. From records it was indicated that there had been two complaints made since the last inspection. One complaint related to an injury to a resident when using a wheelchair, the other related to a change of medication and the residents relative had not been informed. Both complaints had been responded to and the outcomes for both recorded as unsubstantiated. There were no records as to how the complaints had been investigated and some elements of one complaint were valid. This was not reflected in the manager’s response to the complainant. Three visitors to the home spoke with us and said that they know how to make a complaint but had not had any cause to do so. Two relatives completed surveys and both of these people said that they felt happy that any concerns would be dealt with properly. One person said that ‘any issues have always been dealt with immediately’. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 15 Three residents said that they had no complaints to make but if they did they would speak with staff or the manager. Staff are recruited thoroughly and appropriate checks are carried to help ensure that they are suitable to work with older people. Staff receive training in respect of safeguarding residents from abuse and have access to policies and procedures to assist them in dealing with any issues, which may arise. There have been no complaints, concerns or safeguarding allegations made to us about the service since the last inspection. Residents told us that they were treated well and made positive comments about staff. One resident said ‘staff here are wonderful and caring’ and one relative commented that ‘staff talk respectfully to residents’. West House DS0000015565.V369463.R03.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and comfortable environment. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that there is a rolling programme for maintenance in the home. Bedrooms are redecorated once they become vacant and that carpets had been replaced in the communal lounge and new furniture, lighting and televisions had been provided in some resident’s bedrooms. Residents and visitors who spoke with us commented that the environment was ‘homely’ and ‘cosy’. Residents have access to a nicely furnished lounge area. There is no dining room however there are tables in the conservatory area. On the day of the inspection all of the residents were served their meals on small individual tables and residents were not asked if they would like to sit at larger tables. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 17 A cleaner is employed and all areas of the home, which were seen including bathrooms and residents bedrooms, were clean and free from unpleasant odours. Visitors commented on the cleanliness of the home. One person said ‘it is always clean and smells nice’ another person said ‘there are never any bad smells when I visit’. During the inspection the hot water from wash hand basins felt very hot to touch. When we tested the temperature we found it to be 57 degrees Celsius, There were notices displayed on the laundry door requesting that staff keep it locked. The surfaces of washing machines and dryers can become very hot. Both could potentially put residents at risk of injury. West House DS0000015565.V369463.R03.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. Residents have their needs met and are supported by a competent staff team. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the home provides a high standard of care and that since the last inspection the recruitment process has been made more robust. The manager said that he intends to employ more care staff and to ensure that staff are trained so as to best care for residents. The home employs sixteen fulltime and seven part time nursing / care staff. There is a low turnover of staff in the home (three part time staff have left the homes employment in the past twelve months) and this helps to promote continuity of care. There is one nurse on duty in the home at all times and five care workers in the morning and four carers in the afternoon. One nurse and two care worker cover night shift. Staff duty rotas were examined and from this we saw that these staffing levels were maintained and that the majority of staff do not work excessive hours without appropriate time off. However on occasions one member of staff work early, night and late shifts consecutively, which may affect the care and support provided to residents. Three members of staff who spoke with us said that they were supported and trained to meet the needs of residents. One person said ‘there is always a lot of training available’. Another person said ‘We work hard to care for residents’. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 19 Residents told us that ‘staff do their best for us’ and ‘they are marvellous’. One resident said ‘Nothing is ever too much trouble for them and they come when I call for help’. Visitors to the home told us that they found staff to be ‘helpful and well informed’. One person said that they visit the home regularly and at different times of the day and that ‘the care is always excellent’. There is a policy and procedure in place for the thorough recruitment of staff. The records for two people who have been employed since the last inspection were examined. All of the appropriate checks including references, PoVA First and Criminal Records Bureau (CRB) disclosures had been carried out to help ensure that they are suited to work with older people. When a person starts work they complete a period of induction so they can familiarise themselves with the policies, procedures, routines and the needs of people living in the home. There is a programme for staff training and development. Staff undertake training relevant to the needs of the residents. Training includes safe moving and handling, care planning and assessing risks, controlling the spread of infection, health and safety and safely managing medicines. The manager carries out regular supervision of staff to help ensure consistency in how residents are cared for. West House DS0000015565.V369463.R03.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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. West House is well managed and run in the best interests of residents. EVIDENCE: We were told in the Annual Quality Assurance Assessment that the home is well managed and the views and welfare of residents are paramount. The manager said that there is a comprehensive set of policies and procedures in place to protect residents, staff and visitors to the home. The manager said that he intends to introduce six monthly resident and relative meetings to provide them with the opportunity to discuss what improvements they would like to see in the home. Residents and relatives who were spoken with told us they would welcome this. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 21 Since the last inspection the manager has completed their Registered Managers Award training. Residents, staff and visitors who spoke with us said that the manager is ‘available and very approachable if they need to discuss anything’. The manager asks residents, relatives and other visitors to the home including health and medical professionals for their views about the home. From this he monitors the quality of the service provided and can plan to address any issues identified. Regular checks are carried out on the equipment and systems necessary for the running of the home. Staff regularly ensure that fire alarms and emergency lighting are in good working order. Qualified people service gas and electrical equipment and installations to ensure that they are safe and suited for purpose. Records are kept in the home to evidence all the checks and maintenance work carried out. West House DS0000015565.V369463.R03.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 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 3 West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16 (2) m &n Requirement Appropriate activities and exercise must be made available to meet the needs of people living in the home so as to keep them occupied. This requirement is outstanding from the last inspection. The premises must be maintained so as to minimise risks to the health and safety of residents. This refers to hot water and hot surfaces in the home. Sufficient staff must be employed in the home so that staff do not work excessive hours, which may impact upon the care of residents. Timescale for action 30/11/08 2. OP19 13(4) (a) (b) (c) 30/11/08 3. OP27 18(1) (a) 15/11/08 West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 24 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. Refer to Standard OP15 Good Practice Recommendations Menus should be reviewed to ensure that they reflect resident’s choices and an alternative should be offered to the main course provided. West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 West House DS0000015565.V369463.R03.S.doc Version 5.2 Page 26 - 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!