Inspection on 01/02/06 for Westhorpe Hall Residential Home

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Westhorpe Hall Residential Home 27/02/09

Westhorpe Hall Residential Home 10/07/07

Westhorpe Hall Residential Home 18/07/06

Westhorpe Hall Residential Home 20/06/05

Westhorpe Hall Residential Home 18/01/05

Westhorpe Hall Residential Home 20/09/04

Westhorpe Hall Residential Home 10/03/04

Westhorpe Hall Residential Home 21/11/03

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Westhorpe Hall Residential Home Westhorpe Stowmarket Suffolk IP14 4SS Lead Inspector Mary Jeffries Unannounced Inspection 1st February 2006 13:45 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 Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 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. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Westhorpe Hall Residential Home Address Westhorpe Stowmarket Suffolk IP14 4SS 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) 01449 781691 01449 781691 Mr K Hunt Ms Virginia R Hunt Ms Virginia R Hunt Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2005 Brief Description of the Service: Westhorpe Hall is a listed country manor house set in its own grounds and in the village of Westhorpe. It has much character, and has been converted to provide long-term residential care for up to 21 older people. The house is approached by a private drive that crosses an ancient moat. There is car parking and gardens that are accessible to the residents. The main house offers accommodation on ground and first floor, with a modern single storey extension to one side. The ground floor comprises two sitting rooms, dining room, kitchen, office, bathroom, WC’s, and several bedrooms in the newer wing. A wood-burning stove had recently been installed in the main lounge, replacing the open fire. The first floor is served by two staircases, both fitted with stair lifts, to two separate wings. The remaining bedrooms, two bathrooms and WC are on this level. In total there are 15 single bedrooms and 3 doubles; one of the doubles is being used as a single room. Four of the single rooms are less than ten square metres in size, and one of the double rooms is just under sixteen square metres. The latest revisions to care standards make these rooms sizes acceptable, on the basis that these facilities were registered before the NCSC came into being. On the first floor of the home, there are several changes of floor level, which have to be negotiated, and a number of doorways have raised lips, which are a tripping hazard. This poses some limitations on the needs they can meet in terms of residents’ mobility. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on one afternoon in early February 2006. It took three and a half hours. The inspection was facilitated by the deputy manager. Seventeen service users were living at the home at the time of the inspection; three of these were there for a period of respite care. A group of three service users, and one other service user were spoken with in some depth. Four others were spoken with, but more briefly as they either didn’t want to speak or significant time had been spent with them at previous inspections, or they had communication difficulties. Two sets of visitors were met with briefly, and offered the opportunity to speak with the inspector separately, which they chose not to take up, having indicated their high levels of satisfaction with care provided and the home generally. Another visitor spoke with the inspector in more detail. What the service does well: What has improved since the last inspection? A detailed complaints log has been maintained. Hazardous products were all appropriately stored. The home has had a five year electrical inspection Action has been taken in respect of three other requirements and three recommendations made at the last inspection, but either not yet completed or evidenced. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 6 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. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 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 Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 Service users cannot presently expect to have all the information they require to assist them make a choice about the home within the Service Users Guide. EVIDENCE: A recommendation had been made at the previous inspection that the terms and conditions and residents’ views should also be within the Service User Guide. The home had advised in response to this that this would be done at the next print run, in February 2006. The Statement of Purpose and Service users guide were both on prominent display within the home. The amendments had not yet been made. The home’s residents log was inspected and it was noted that a service user who had stayed for respite between the 15th and 18th of November had been 62 years of age at the time of their stay. All other service users in the home were over 65. This was discussed with the deputy manager, who advised that the service user had poor mobility and recurring brain tumours, but had left earlier than planned as they had found the home was not for them. The deputy manager was advised that at 63 years of age, and needing care for reasons Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 9 other than old age, this service user had been admitted outside of the home’s registration categories, and was technically an offence. All of the other relevant standards had been inspected at the unannounced inspection in June 2005 and had been found to be met. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Service users care plans do not currently define the goals that their care is aiming to meet, nor do they contain risk assessments for service users who might be vulnerable so it is possible that not everyone will have positive and preventative care delivered. EVIDENCE: Five care plans were seen, all had been regularly reviewed. A requirement had been made at the last inspection that goals on care plans should be clearly defined and the home had started to take action on this, but not completed it for all service users. The home had introduced a new care plan format, and was working through the home in room order in updating to these plans. The work that had been started on defining goals was very detailed, and a discussion took place with the deputy manager about how this process might be made simpler. Each area of care had detailed entries, but were not translated into the aim in respect of each that it was agreed the carers should be working to. The home has demonstrated some good work on goals with service users, and the inspector was advised that one service user who was present at the last three inspections and spoken with had been discharged to sheltered accommodation. This was confirmed in the service users register. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 11 The inspector was advised that four service users had pressure areas, that three of these were visited regularly by a district nurse, and the other had been but that their involvement had finished as only a slight red mark remained. Records of nursing notes were seen which confirmed this information. One of these service users had been admitted with a pressure area. There was a section on care plans for pressure area care, and a space to indicate risk, but no more detailed risk assessments that could be used to determine the risk of a service user developing a pressure area were in place. A full inspection of the administration of medication was undertaken at the last inspection and no errors were found. A requirement had been made however, that, the Responsible Persons must ensure medication administered is observed to be taken, unless the resident has been risk assessed to self medicate. The manager advised that further training by Boots pharmacist had been provided since the inspection. A service user spoken with said that staff do not observe service users taking their medication as a matter of course, and gave an example of a service user who was observed and one who wasn’t. The service user explained that staff did not observe them take their medication, as they knew she was fully with it and responsible. This was the case, this service user remembered the month when the Inspector had last visited and what they had spoken about, and had a very positive attitude to life. This matter was raised with the deputy manager who advised that staff were supposed to observe in all cases, however the Inspector went into the dining area to observe administration of medicines at tea time and it was seen that the carer giving out the medicine did not wait to see that the medication given had been taken by one service user. Risk assessments for these two service users were not seen, and the manager subsequently confirmed these had not been done. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 Service users can expect their families to be welcomed into the home and included in their care if this is in the interest of the service user. Service users can expect that they are likely to positively enjoy their lifestyle at the home. EVIDENCE: Standard twelve was inspected and found to be met at the last inspection, however in the course of speaking with service users about other standards, it was striking how up positive most of them were about their lives and the quality of life they enjoyed. With the group of three service users and the individual service user spoken to in depth, they could be described as having “a twinkle in their eye.” This was put to the group of three, and one of them commented, “You will find that here.” The service user who was spoken to alone confirmed that they were “very well indeed.” They spoke of the accommodations with diet that the cook made since they had had a period in hospital with a gastric ulcer. They were enjoying a large print book, and advised that these were delivered every fortnight. The service user whose husband was supporting within the home appeared very content and had a happy countenance. One service user with a pressure area who was spoken with was not very communicative. Staff explained that they could understand more than they could communicate. They were asked Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 13 how they found the home, in terms of living there and the care they received. This service user was less positive, but was not negative, responding to an enquiry made with thumbs up or down signs as middling. Another service user advised the inspector several times that they hoped the home would look after them until they were 99. They were in a very update mood as they busied them self, assisting with tasks in the home. The atmosphere through out the home was positive, whilst some service users sat quietly, others were involved with relatives or tasks or interests, and staff on duty had a warm countenance. One visitor spoken with who was the husband of a service user said that the home looked after their relative, and that they looked after them as well. The deputy manager advised that this partner brought in firewood for the home, and this was appreciated. They explained that they visited very frequently, and the home offered a meal to them. The service user had been at the home for a long time, and required assistance with feeding which the partner attended to do. They were seen with this service user at mealtime, and the service user and their partner were clearly enjoying their affectionate bond during this intimate task. This service user was extremely forgetful, but no diagnosis of dementia was seen on file and the deputy manager advised that to their knowledge, their had not been one. Another group of relatives spoken to advised that they were very happy with the care that the home provided, and that they felt it was a home from home. The home had received a card form a relative thanking them for a birthday party they had put on for one service user which a number of relatives had attended. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users can expect their complaints to be properly dealt with. EVIDENCE: The complaints log was inspected. It contained two complaints that the CSCI were aware of, and the Deputy confirmed that there had been no other complaints. These were detailed fully. The second of these complaints had been received by the CSCI since the last inspection. The CSCI referred the complaint to the provider to investigate, but the complainant was not satisfied with the outcome. The paper work provided by the provider was subsequently reviewed by the CSCI. The complaint had five elements relating to a relative’s dissatisfaction with care provided during a respite stay. One element was withdrawn, one element was unresolved, two elements were not upheld and one element was upheld. The deputy manager advised that the home had learnt lessons regarding the need to record more thoroughly as a consequence of this. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,26 Service users can expect to live in a comfortable attractive home that is well maintained. EVIDENCE: Following the last inspection, when it was identified that the five year electrical inspection for the home was overdue, the home was required to forward a wiring the need for a copy of a current electrical wiring certificate. The manager subsequently advised that an inspection had been done, and that the home had been required to rectify some matters. The correspondence and certificates detailing this were seen to be in place. The inspector toured the ground floor, including the kitchen and the laundry. None of the service users were in their rooms, but one gave the Inspector permission to see their room. The home was well maintained, and decorated and clean. Bathrooms and toilets on the ground floor were all checked and found to be clean, and to have paper towels and liquid soap. There remained a faint lingering odour in one service user’s room, although the carpet appeared Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 16 to be very clean. The deputy manager advised that the home had been in liaison with the firm who provided carpeting, as they agreed this was the case, and that the firm had recommended that the floor beneath the carpet required attention. It was agreed that copies of correspondence to validate action was being taken on this matter would be forwarded to the CSCI. The accommodation whilst not best suited to its purpose, being a very old building, is however very homely and in a good environment. There are various sitting areas so that service users do not have to be in a room with a television, and one lounge has a wood burning stove which adds to the atmosphere. One service user said that the only thing that they would like to change about the home, but stressed that this was not by any means a complaint and that they were “not grumbling”, was that the set of three toilets on the ground floor were for men and women, and they would prefer it if they were not mixed. At the time of the inspection the home’s washing machine was being repaired. The floor in the laundry had three different surfaces, tiles on entry, a carpet covering most of it, and a rough concrete floor. The deputy manager advised that they had “ put in for “ new vinyl flooring for the laundry. The home has two lounges, one had the television on and one had the radio on. The home had not provided a loop system to assist service users who were hard of hearing with the TV, and the TV was turned up quite loud in the lounge. The back lounge was found to have an ambient temperature of 23 degrees, although there was no supplementary heating: it had been noted previously that this room could get chilly in bad weather conditions. The deputy manager advised that they had found that if they kept the door to the bedroom corridor that ran off this lounge closed, that this wasn’t a problem. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not applicable. EVIDENCE: These standards were not inspected as they had all been inspected and found to be met at the previous inspection. There were two carers, one a senior, on duty at the time of the inspection. The cook assisted with meals. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,37,38 Service users can expect information about them to be kept securely, but records need further developing in terms of risk assessments for pressure areas, and goals for care plans to ensure that all needs are identified and appropriate courses of action are taken in terms of meeting these needs. EVIDENCE: A business and financial plan was not available, following the last inspection the manager advised that this was being worked on. The home’s certificate of registration and public liability certificate were on display and correct. Following the last inspection the manager had advised that a policy in working with volunteers had been produced. This was not available on the day of the inspection, the deputy manager was aware of it and agreed to forward the policy. They advised that the home had one longstanding volunteer who had initially worked at the home on The Duke of Edinburgh award scheme, but now was an infrequent voluntary visitor. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 19 Service users records were kept in a locked cupboard. Service users spoken with confirmed that they knew they had care plans but were not interested in seeing them. Daily records were completed three times a day for each service user, i.e. by each care shift. It was established at the last unannounced inspection that whilst the home had an appropriate policy for the control and storage of substances hazardous to health that had been recently reviewed, a cleaning product in the kitchen that should have been locked away was not safely stored, and a requirement was made that cleaning products must be kept in the cupboard for substances hazardous to health. The kitchen was inspected and it was seen that all hazardous substances were in the locked cupboard No other inappropriate storage was found throughout the ground floor. Fire extinguishers were seen to have been serviced in January 2006. A service user was seen to be transferred into a wheelchair by two carers using appropriate techniques. Another service user who was spoken with said “ I’m in a wheelchair now. They take me to the toilet and they take me down to my room……..they help me into the bath and back out. They were asked if they felt safe in the carers hands and said “ Oh yes, no problems. They leave the buzzer where I can reach it and I never have to wait long.” The cook advised that they were working on a Hazard Analysis Critical Control point (HACPP) risk analysis for processes involved with the homes food, but that this had not yet been completed. The working documents were seen. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 4 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 2 X X 3 2 Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 21 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 OP1 Regulation 5(1)(c) Requirement The terms and conditions and the last inspection report must be within the Service User Guide. The home must not admit service users outside of the categories that they are registered to provide care for. A policy for pressure area risk assessment and care should be in place. The Responsible Persons must ensure medication administered is observed to be taken, unless the resident has been risk assessed to self medicate. The home must be kept free of unpleasant odours. The laundry floor finish must be impermeable, and if vinyl is used then care must be taken to ensure that there is no gap at the floor edges. A Hazard Analysis Critical Control point (HACPP) risk analysis must be completed for processes involved with the production of the home’s food. Timescale for action 28/02/06 2. OP4 4 01/02/06 3. 4. OP8 OP9 13(4)(c) 13(2) 31/12/05 20/06/05 5. 6. OP26 OP26 13(3) 13(4) (a)(c) 20/06/05 15/03/06 7. OP38 13(4) (a)(c) 28/02/06 Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 22 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 OP2 OP7 OP20 OP34 OP36 Good Practice Recommendations Residents’ views should be included within the Service User Guide. Goals on care plans should be clearly defined. The recommendations from the Occupational Therapist report should all be carried out. The Responsible Persons should provide a business and financial plan. A policy on the employment of volunteers should be in place. Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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 Westhorpe Hall Residential Home DS0000024524.V281771.R01.S.doc Version 5.1 Page 24 - 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. 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