Inspection on 29/11/06 for Whitebirch Lodge

This inspection was carried out on 29th November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Whitebirch Lodge 06/08/07

Whitebirch Lodge 05/02/06

Whitebirch Lodge 06/07/05

Whitebirch Lodge 07/10/04

Whitebirch Lodge 07/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Whitebirch Lodge 104 Canterbury Road Herne Bay Kent CT6 5SE Lead Inspector Jenny McGookin Key Unannounced Inspection 29th November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whitebirch Lodge DS0000023624.V312506.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. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitebirch Lodge Address 104 Canterbury Road Herne Bay Kent CT6 5SE 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) 01227 374633/374633 01227 360620 Krystlegate Limited Mrs Marilyn Ann Squire Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2006 Brief Description of the Service: White Birch Lodge is a detached three-storey building that has been extended to include the ground floor accommodation in the building next door; both properties are owned by Mr and Mrs Squire. The Home provides 24-hour personal care and support to 17 older people who are over 65. Service Users are accommodated on the ground and first floors and a stair lift provides access to the first level. There are 17 single bedrooms, all of which have en suite WC facilities. All rooms are fitted with a television aerial point, a telephone point and an emergency alarm call point. The Home is about half a mile from the seaside town of Herne Bay, within easy reach of shops, public amenities and transport. There is off-road parking at the front for up to eight cars. Mr. Paul Knight is currently the Acting Manager, and intends to apply for formal registration by the Commission. He has over two years experience in managing a care home and has completed the necessary qualification for a Manager. The current fees for the service at the time of the visit range from £297 - £400 per week. Additional charges are payable for hairdressing, chiropody and extra supplies of newspapers. Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. There is also an e-mail address for this home: hernebay@home-service.uk.com Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on an unannounced site visit, which were used to inform this year’s key inspection process; to check progress with two matters raised from the last inspection (February 2006); and to review findings on the day-to day running of the home. The inspection process took ten and a quarter hours and involved meetings with five residents (including two over lunch), the manager, two senior carers and the cook. Interactions between the staff and residents were observed at various stages throughout the day. The inspection involved an examination of records; the selection of three residents’ case files, to track their care; and three personnel files, selected at random. Twelve bedrooms were checked for compliance with the National Minimum Standards on this occasion, along with some communal facilities / areas. What the service does well: What has improved since the last inspection? What they could do better: A concerted effort needs to be made to ensure all records are complete and that they properly evidence reported practice. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 6 The registered person shall submit an action plan to obtain the requisite level of NVQ trained staff. 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. Whitebirch Lodge DS0000023624.V312506.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 Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives do not have all the information needed to choose a home but they are encouraged to visit and to try this home out before a decision is made that it can meet their needs. This home does not provide intermediate care. EVIDENCE: There is a Service User Guide pack, which contains a range of loose-leaf documents, usefully describing a range of facilities, services and service principles. However, this pack will require further attention to provide all the information prescribed by the National Minimum Standard, so that prospective residents or their representatives have all the information they need to reflect on, in order Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 9 to make an informed decision. The home has an admission checklist, which should include the issue of the Service User Guide, contract, complaints procedure etc but there were gaps in the records selected on this occasion. Only two residents showed any recognition of one of its contents. A more robust application of the checklist would compensate for residents not being able to recall this with any accuracy. When asked, residents said that the decision to apply to this home was in practice influenced more by its locality (i.e. close to where they or their relatives lived), than by any public information produced by the home itself. There was good evidence of prospective residents (where able) or their representative visiting the home before the admission, to meet the staff and other residents. And the home’s admission policy confirms that this can be followed up by longer visits and trial stays. One resident was very appreciative of the way a place was kept open for as long as she needed, in order to make a decision about coming in to stay. Although one resident spoke about the heartbreak she felt over the loss of her home, the others were generally very content to entrust the choice of home to the judgement of their representatives, and said they were very happy there. Each resident is offered a formal month’s trial stay. On their admission, the home carries out further assessments and risk assessments. The home can generally demonstrate its capacity to meet the needs of residents. See section on “Environment”; the section on “Health and Personal Care” for a description of services provision; and the section on staffing for information on deployment and training. This home does not provide intermediate care. Should the home provide rehabilitation and/or convalescence, all the elements of National Minimum Standard 6 will apply Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care, which residents receive, are based on their assessed individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Three residents’ files were selected for case tracking on this occasion, to represent the latest admissions (i.e. over the past year) and these were followed through with one-to-one discussions with residents (where they were able and willing) and staff. The format of the care plans used by this home properly identify a range of health and personal care needs in the first instance, and these are intended to be supplemented by daily reports, risk assessments and records of access to a Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 11 healthcare professionals. However, there were several gaps in the records seen, which will require addressing to better evidence practice. Since the last inspection, records of contacts with healthcare professionals have, however, been re-organised to better meet Data Protection principles. Care plans are subject to six-monthly reviews and there was good evidence of one resident’s risk assessments being reviewed on a monthly basis. Practice was not as well evidenced in the other two. All the bedrooms are single occupancy and have en-suite facilities, so that personal care and medical interventions can be assured of some privacy. However, unlike most other residential care homes (where this is standard provision – in line with the National Minimum Standard), none of the bedroom doors in this home have locks. Records confirm that residents are periodically offered this facility and that they have invariably declined, which may well be a mark of trust. Observations confirmed feedback from one resident, when asked, that staff knock on bedroom doors before entering. Since the last inspection, the home has changed its medication arrangements – from the dossetts system to blister packs. One of the senior carers said that Boots came in and went through the process with staff, using dummy packs. Staff were then competency tested by a trainer – this involved practical tests as well as question and answer tests. The senior carer said she felt this was a fail-safe method (because it was colour coded and personalised). Medication is always double checked. There is one medication trolley and it is kept properly tethered when not in use. There is restricted access to its key. This is judged an appropriate arrangement. Records confirm that the residents’ capacity to self medicate is identified as part of their assessment. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 12-15 Residents are able to choose their life style, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Most residents indicated that they were generally very content with their lifestyles in this home. The daily routines are as flexible as healthcare needs will allow. Some of the residents spoken to on this occasion, clearly preferred their own company and would read, write or watch their own television rather than join in with group activities, and their choice is respected. One keeps a pet budgie in her room. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 13 There is an Activities Co-ordinator who comes in twice a week to support residents with games such as Dominoes, reminiscence-style quizzes on tape. There are visiting entertainers such as a musical duo with a keyboard. There are also outings such as visits to a local theatre e.g. to see musicals, and morning trips around coastal areas in the home’s own minibus e.g. in summer. There are Keep Fit exercise classes and one resident is taken to a hydrotherapy pool. A couple of residents attend a day centre and one attends a local Age Concern group. The Service User Guide commits the home to support residents to meet with religious representatives, but this aspect was not pursued on this occasion as it was not raised as an issue by anyone. The home has open visiting arrangements, and meals can be provided for visitors. One resident spoke about the visitors she had, and how she enjoyed going out with them. There is a cordless handset for communal use, which can be taken into bedrooms for privacy but residents can also arrange to have their own lines installed (one had just had a large digit phone installed that day) and several bedrooms now have telephone points. Catering needs and preferences are properly established in the first instance as part of the admission process, and amended or updated thereon. There is a three-week menu which is changed in summer and winter, and which is applied flexibly. Records and feedback confirm that the menu (generally, traditional English fare) is varied and alternative options are available. Although the current cook has had no specialist training in catering for the elderly of for special needs (e.g. diabetic, vegetarian, dementia) all of the residents spoken to on this occasion said they were generally very satisfied with the meals. A lunch was sampled and judged well cooked and presented. A mobile serving trolley was suggested so that the residents could select from it. There is some specialist equipment such as large handled cutlery, plate guards and beakers with spouts. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 16,18 The processes are in place to enable complaints to be taken seriously and investigated. Residents know that their rights will be protected. EVIDENCE: The home has a complaints procedure, which properly describes the process and the timeframe involved. However, the copy supplied for inspection required updating to take into account the Commission’s latest contact details so as to be fully compliant with the National Minimum Standard. There has only been one complaint since the last inspection, which usefully raised questions about the role of the proprietor, Local Authority and Commission, where complainants wish to take matters beyond the scope of the home’s own procedure. When asked, none of the residents spoken to on this occasion had never had any cause to make any complaints, but said they knew who they could talk to if they did. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 15 The home’s Service User Guide pack includes a charter of rights and a range of policies designed to protect residents from abuse, and to enable staff to report poor practice, should it occur. And this is usefully underpinned by staff training. Residents have said they feel safe. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home provides residents with a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The location and layout of this home is suitable for its stated purpose; it is accessible, safe and well maintained; and it meets the residents’ needs in a comfortable and homely way. The home provides sufficient communal space and facilities. Residents have a choice of communal areas, and were seen making good use of each of them. Furnishings tend to be domestic in character, and there are homely touches throughout. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 17 There is equipment and adaptations to support residents and staff in safety in their daily routines and to maximise residents’ independence. All the residents have access to the privacy of their own bedrooms and all bedrooms have en-suite facilities. Two bedrooms are under 10 sq. metres but the rest are at least ten square metres and most are well in excess of the National Minimum spatial Standard. With the exception of locks on doors, each room inspected was furnished and fitted in compliance with the elements of this standard. Each bedroom inspected was judged maintained and decorated to a very satisfactory standard. Each bedroom inspected was personalised. All areas of the home inspected were judged well lit, heated and maintained to a very satisfactory standard of cleanliness and safety. There were no unpleasant odours. There was, surprisingly (given the scale of the home), no dishwasher and it was noted that staff were used to using the kitchen to access other parts of the home and site – which was not judged good health and safety practice. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 27-30 . The home needs to better evidence that the residents are protected by its recruitment procedure. Staff have the experience and a range of skills to meet the residents’ needs, and their numbers and deployment are judged satisfactory. EVIDENCE: This is a stable staff team, and the staffing arrangement on the day of this visit was judged sufficient to meet the assessed needs and dependency levels of the residents. Staff who are tasked with giving direct care always have ready access to one of two senior carers, to an onsite manager during the week, and to the proprietors, who live nearby. There is, in effect, always someone with sufficient delegated authority to take responsibility in the event of an emergency, to keep the residents safe. And there are sufficient numbers of ancillary staff / catering staff to maintain standards of cleanliness and catering which are judged exemplary. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 19 Flexible team working arrangements, and communication were identified as key strengths of this team. Residents generally spoke very highly of the staff. Meetings with the manager and senior staff indicated a robust recruitment process, and a sound investment in training in induction (to TOPSS standard) and in key health and safety related matters thereon. The home benefits by having its own in-house trainer and assessor. However, only 17 of the current staff team have obtained NVQ Level 2 or above. This lack of take-up has been attributed to the fragmented staff contracting arrangements, individual motivation and funding issues and must be addressed as a priority. And there were gaps in the personnel records selected, at random, for inspection, which must be attended to, to properly evidence reported practice. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 31,33,35,38 The management and administration of the home is based on openness and mutual respect. A start has been made to introduce effective quality assurance systems. EVIDENCE: The qualifications and experience of Mr Paul Knight, as described, are judged generally appropriate to his role as acting manager, and the submission of his application for formal registration as manager by the Commission is expected sometime early in the new year. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 21 See section on staffing for a description of the arrangements for support and on-call advice. There are clear lines of accountability within the staffing structure and overall organisation; and the home is a member of the Kent Care Homes Association and the National Care Homes Association, with all the professional backing that implies. At the time of this visit, the acting manager had sent out a quality assurance feedback survey to formally gauge the level of satisfaction amongst stakeholders. It was too soon to judge the effectiveness of this, but residents and staff were already joined in expressing their confidence in the way this home is run. There is as yet no formal business planning process. All planning is done informally within the family. As a matter of policy, the home only manages small amounts of pocket money for the residents and does not have Power of Attorney, Appointeeship or Guardianship for anyone living there. The expectation is that the resident’s relatives, friends or solicitors would assume responsibility for this. The home keeps computer records and hard copy records and the arrangements for their safe storage and access were judged secure. One matter raised for attention at the last inspection had been addressed. And all property maintenance records seen were up to date and systematically held. Whitebirch Lodge DS0000023624.V312506.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP28 Regulation Requirement Timescale for action 31/01/07 3. OP37 5, 6, 4, 16 The home’s Service User Guide shall comply with all the elements listed by the standard. 18 The registered person shall 31/01/07 submit an action plan to obtain the requisite level of NVQ trained staff. 17 The registered person shall 31/01/07 ensure all records required for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 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 OP1 Good Practice Recommendations A more robust application of the admission checklist is recommended to compensate for residents not being able to recall the issue of a Service User Guide and other preadmission documentation with any accuracy. DS0000023624.V312506.R01.S.doc Version 5.2 Page 24 Whitebirch Lodge 2. 3. 4. OP15 OP15 OP26 A mobile serving trolley was suggested so that the residents could select from it. Specialist training in catering for the older people, vegetarians, diabetics and people with dementia was suggested to enhance provision further Kitchen. The following matters are raised for consideration: • Given the scale of the home, there should be a dishwasher • The kitchen should not be used as a thoroughfare to access other parts of the home and site. Whitebirch Lodge DS0000023624.V312506.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Whitebirch Lodge DS0000023624.V312506.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. 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