Inspection on 27/02/07 for Weybourne

This inspection was carried out on 27th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Weybourne 20/01/09

Weybourne 21/12/07

Weybourne 24/11/05

Weybourne 25/05/05

Weybourne 06/12/04

Weybourne 02/07/04

Weybourne 25/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Weybourne Finchale Road Abbeywood London SE2 9AH Lead Inspector Lorraine Pumford Unannounced Inspection 27 February 2007 12:00 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 Weybourne DS0000006862.V311413.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. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Weybourne Address Finchale Road Abbeywood London SE2 9AH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8310 8674 www.kcht.org Kent Community Housing Trust Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: Weybourne is a Home for 40 older people that is run by Kent Community Housing Trust. The Home specialises in the care of people with dementia, and the bulk of the service users are in this category. The Home does not provide nursing care, but health professionals visit the Home on a regular basis. The Home is a purpose-built unit on two floors in Abbey Wood. There is a parade of shops nearby, and Abbey Wood Station is a short distance away. There are thirty-three rooms on the ground floor and a further seven on the first floor. Seven rooms have ensuite facilities. There are four lounge areas, a large dining room, a small visitors room and a central courtyard garden that has flowerbeds designed for colour and scent. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over two half-day periods. The inspector spoke with both the acting manager (who had only been in post three weeks) and senior staff on duty. Three members of staff were interviewed in private and a number of staff and residents were spoken with during the course of the inspection. Information they contributed has been incorporated into this report. A number of relatives and the GP completed CSCI comment cards. Staff assisted service users to complete comment cards and these comments have also been included. During the course of the inspection a number of documents and records were examined and the files of four service users were examined specifically relating to their care. Additionally parts of the premises were inspected. Fees for the care and service provided are currently £459.99 to £484.19 for service users assessed as having dementia. There are additional costs for newspapers, hairdressing, chiropodist etc. What the service does well: Service users undertake a comprehensive assessment of need before being admitted to the home. Service users are admitted on a trial basis to enable them to settle in and ascertain if the home is able to meet their needs on an ongoing basis. Service users receive the health care they require. Service users privacy and dignity is respected by staff working in the home. The home employs two activity co-ordinators and service users benefit from a comprehensive programme both in and outside the home. Service users are able to bring their own possessions and mementos into the home. Adult protection training is in place to safeguard the wellbeing of service users. Staff are provided with a comprehensive training programme and 90 of care staff working in the home have attained an NVQ 2 or above qualification in care. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 6 The home operates a key worker system to support service users living in the home. There are sound procedures in place for staff to follow when handling service users’ money. 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. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are only admitted to the home following a comprehensive assessment of need. EVIDENCE: The acting manager was able to provide comprehensive documentation from health and social care professionals in relation to the admission of a prospective service user to the home. The Manager stated it was not always possible for service users to visit the home prior to admission due to the level of the individuals dementia, however service users relatives or advocates were able to do so, this was confirmed by a relative that the inspector spoke with. Letters are sent to all prospective service users or their representatives indicating that following the assessment the home is able to meet their needs prior to admission. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 9 The manager stated that all service users are admitted on a trial basis to enable service users to settle in and to ascertain if the home is able to meet service users needs on an ongoing basis. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ care plans need to be updated in response to changes in their health or needs. Service users’ privacy and dignity is respected by staff working in the home. EVIDENCE: Records pertaining to a prospective service user and two additional care plans were examined. The acting manager stated she was currently monitoring staff practice in relation to completing care plans. The sample seen included key information regarding service users and relevant risk assessments and moving and handling assessments had also been undertaken. There was evidence of routine reviews taking place and this was confirmed by a relative spoken with, however in the sample seen staff had not updated the care plan to include action to be taken by staff in relation to a service user who was experiencing frequent urinary tract infections. The acting manager stated this would be addressed. A requirement was made at the time of the previous inspection that service users should be given the opportunity to register with a GP of their choice. The Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 11 acting manager stated that in theory this was possible, however in practise they had been unable to find GPs prepared to take on additional patients and therefore the Primary Care Trust has had to allocate a practise for the home. Current service users will continue to receive a service from this practise, however the manager stated that new service users would be able to retain a service from the GP they had previous to moving into the home. The GP who completed a CSCI comment card stated staff worked in partnership with the practise and he was satisfied with the overall running of the home. The storage, recording and administration of medication were examined. Medication was found to be stored securely. Some issues arose in relation to the recording of medication; staff had hand written additional entries to the MAR sheet however the sample seen had not been dated or signed by the staff member responsible. Discussion took place with staff assisting with the inspection regarding the need for hand written entries to be signed by two members of staff to reduce the risk of error. On one MAR sheet seen a member of staff had amended the quantity of medication prescribed by the GP. Staff stated this would have only happened when directed by the GP to do so however, it was not possible for staff to provide written evidence of this. From discussion with staff and records seen it is apparent that staff have sound procedures in place to monitor Wafrian prescribed to one service user. Service users the inspectors met with appeared relaxed and comfortable. Good interaction was seen between staff and service users. Staff addressed service users by their preferred name, and spoke with them in a respectful manner. Staff were seen to respect the service users privacy and dignity when assisting with personal care. All of the relatives who completed comment cards stated they were satisfied with the overall care provided. Relatives felt they were kept informed of important matters concerning service users. One service user told the inspector he was happy and had every thing he needed. A relative spoke highly of staff and the patience they exhibited in caring for service users who have dementia. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are enabled to maintain links with family, friends and the local community. Service users are provided with a varied and meaningful activities and a balanced nutritional diet. EVIDENCE: Service users benefit from the home having two Activity co-coordinators who also hold relevant qualification to work with service users who have dementia. It is apparent that service users have access to a wide range of activities. Some of these take place in house such as art and crafts, board games and music and movement however others take place outside and staff assist service users to attend a local drop in centre for older people in the community. Staff have recently won a KCHT award for the work in helping service users to use the Internet to trace their family trees. The activity co-ordinator stated that they make the most of annual celebrations and in addition to traditional festivals such as Christmas and Easter other events are also arranged for example a local Irish dancing school had been asked to dance in the home on Saint Patricks Day. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 13 There were lots of photographs of activities displayed in communal areas to remind everyone of events that had taken place. Activities are also arranged to include service users friends and relatives. A relative spoken with confirmed this. The home benefits from having a visitors room appropriately equipped for the purpose and there is also a small telephone room to enable service users to make and receive calls in private. A relative spoken with stated she and her family are always made to feel welcome in the home. It was apparent from discussion with staff and from practice seen that staff endeavour to maximise service users personal choice and autonomy, for example asking service users where they wished to sit and enquiring about their preferred choices regarding clothing and refreshments etc. Bedrooms seen were individually personalised with service users own possessions, photos and mementos. Records seen indicate that service users are provided with a varied and nutritious diet. Service users and a relative spoken with stated the food was good. Menus refer to Soup, assorted sandwiches and veg. This information should be elaborated on to prevent repartition. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. 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 the service. Service users and their advocates can be confident that appropriate action will be taken to address any concerns they raise. Adult protection training is in place to safeguard the wellbeing of service users. EVIDENCE: Information provided at the time of the inspection indicated that the manager had received a total of five complaints in the last 12 months. Records seen indicated that these had been appropriately recorded and included the action taken to address the matters raised. The CSCI have received no complaints regarding the care or service provided since the last inspection. The policy and procedures regarding making a complaint are clear, concise and easy to understand and all relevant contact details for the organisation and the CSCI are provided. Service users and their advocates are given information about the organisations complaints procedure at the time of admission. Relatives and advocates who completed comment cards stated they were aware of the homes complaints procedure. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 15 All of the relatives who completed CSCI questionnaires stated that they had not felt the need to make a complaint regarding the care and service provided by the home. Staff spoken with the stated they had received adult protection training and were aware of the term whistleblowing. Staff spoken with stated they felt confident that they could go to senior staff working in the home if they had any concerns regarding the practise of colleagues. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home continues to benefit from ongoing refurbishment and redecoration. EVIDENCE: Four requirements were made at the time of the previous inspection in relation to the building. Remedial work was required to the dining-room floor to enable it to be effectively cleaned. Action has been taken to address this issue. The flooring in the telephone room was also hazardous and this has been replaced. Sluice rooms were previously found to be unlocked and action has been taken by staff to ensure that they are unlocked when not in use. Service users continue to benefit from ongoing refurbishment and redecoration and the home is now able to offer a number of bedrooms with ensuite facilities. Unfortunately a smell of urine pervaded the front hallway and some bedrooms. The manager stated that she was aware of this and was currently taking steps to address this issue. Flooring and seating in the reception area has been Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 17 replaced and staff are seeking to find a way to eradicate the problem permanently. Although service users bedrooms were individually personalised an audit should be undertaken in relation to each room as some furniture and furnishings are particularly worn and in need of replacement. Service users are provided with a piece of bedroom furniture which is lockable and those who are able also can choose if they wish to have a key to their bedroom. The inspector spoke with a service user sitting in his bedroom he stated that he was comfortable and had everything that he needed. Although the majority of service users choose to sit in the main lounge there are alternative lounges available and the home also has a designated smoking room. During the course of the inspection it was apparent that a number of service users bedroom doors do not close, further the handyman stated that some bedroom doors had been replaced during the recent refurbishment and there was general confusion as to which doors met fire safety regulations and those that did not. The manager was advised to contact the fire department and arrange for a fire officer to visit to ensure that the home meets current fire safety standards. The external area immediately outside some fire exits was in need of some maintenance to ensure that people leaving the building in an emergency have a safe passage. The current laundry is very out dated and must be updated to comply with Department of Health guidelines, for example the layout of the area means that foul and clean linen are being processed in the same are which increases the risk of the spread of infection. Soap and paper towel dispensers were situated in the laundry and in all toilets. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is insufficient written evidence that robust recruitment procedures have been followed to protect service users. There was evidence that KCHT are committed to providing comprehensive training to staff employed. EVIDENCE: A requirement was made at the time of the previous inspection that staff records should contain the documents specified in schedule 2 of the Care Homes Regulations 2002. A sample of four staff files were examined in relation to recruitment and three members of staff were interviewed in private. It was apparent that action is still required to address this issue as files seen did not include information regarding references, proof of identity or confirmation that CRB/POVA checks had been undertaken. All staff spoken with confirmed that these processes had taken place. The manager who has only been in post for a few weeks stated that she was currently undertaking an audit in relation to staff files as she was aware that this requirement was outstanding in the previous inspection. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 19 Staff spoken with stated they had undertaken an induction period when they commenced working in the home. Staff have also received training in relation to caring for service users with dementia, training in catheter care and palliative care. Staff spoken with stated that KCHT provided a comprehensive training programme and that the manager and senior staff actively encouraged them to participate in training opportunities. 90 of care staff working in the home have attained an NVQ 2 or above qualification in care. The home operates a key works system and staff spoken with were able to provide clear details of the additional support and tasks they undertake for service users they are responsible for. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a system in place for reviewing and improving the quality of care provided. Health and Safety training protect service users and staff working in the home. EVIDENCE: Although the manager has only been in the home for a relatively short period of time all staff spoke positively about her style of management and the changes she had made since her arrival. Good interaction was seen between staff and service users and there was a cheerful and relaxed atmosphere in the home. It is necessary for KCHT to make an application to the CSCI for the manager to be registered. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 21 Records seen indicate that a number of service users are unable to manage their finances independently; in these instances they are assisted by relatives or a local authority financial advocate who acts on their behalf. Small amounts of money are retained for individually named service users. The sample examined indicated that service users personal allowance tallied with the house records. Relatives are provided with a receipt when depositing money on behalf of service users and a record is kept of money deposited and withdrawn. In discussion with staff it is apparent that sound procedures are in place for staff to follow when handling service users money for the purpose of purchasing toiletries clothing etc on their behalf. Information provided at the time of the inspection indicates that there are regular safety and maintenance checks undertaken in relation to hoists used in the home, lifts, gas and electrical appliances. Staff spoken with stated that they had received statutory training regarding manual handling, food hygiene and fire safety. A number of staff hold first aid qualification and it is therefore possible for an appropriately qualified person to be on duty each shift. The manager stated that the home receives regular monthly audits from KCHT in accordance with regulation 26 of the Care Standards Act 2000. A requirement was made at the time of the previous inspection that the reports written following each visit should be forwarded to the CSCI. This now takes place on a regular basis. Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Weybourne DS0000006862.V311413.R01.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 OP29 Regulation 19(4(b) and (c) Requirement Staff records should contain the documents as specified in Schedule 2 (Restated requirement - previous timescale 11/01/06 not met) The registered person must consult with the fire authority and ensure that the home complies with current fire regulations. All designated fire doors must close effectively to prevent the spread of fire. The registered person must take action to eradicate the smell of urine apparent in some areas of the home. The registered person must take action to make suitable arrangements to prevent the spread of infection, in this instance up grade the laundry to meet the requirements of The Department of Health. An application must be made by the manager to be registered with the CSCI. The register person must be able demonstrate staff have DS0000006862.V311413.R01.S.doc Timescale for action 30/06/07 2 OP19 13(4)(5) 30/06/07 3 OP19 16(2)(k) 30/06/07 4 OP26 13(3) 31/07/07 5 6 OP33 OP9 CSA 2000 (11) 13(2) 30/06/07 30/04/07 Weybourne Version 5.2 Page 24 been directed to change the dose of medication prescribed to service users by their GP. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 It is recommended that two members sign handwritten entries to MAR sheets to reduce the risk of error. It is recommended that a more detailed record of food is Kept to prevent repartition of food provided to service users. An audit of furniture and furnishings should take place to ensure that they meet with the current National Minimum Standards. OP15 OP19 Weybourne DS0000006862.V311413.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Weybourne DS0000006862.V311413.R01.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. 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