Inspection on 09/05/07 for Whitehaven Care Home

This inspection was carried out on 9th May 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

Whitehaven Care Home 25/09/06

Whitehaven Care Home 20/12/05

Whitehaven Care Home 05/07/05

Whitehaven Care Home 17/11/04

Whitehaven Care Home 10/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Whitehaven Care Home 22 Whitehaven Horndean Portsmouth Hampshire PO8 0DN Lead Inspector Peter J McNeillie Unannounced Inspection 9:00 9th May 2007 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 Whitehaven Care Home DS0000011581.V336475.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. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitehaven Care Home Address 22 Whitehaven Horndean Portsmouth Hampshire PO8 0DN 023 9259 2300 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) Mr Roland Fiford Ms Beverley Walton Ms Beverley Walton Care Home 15 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (15), Old age, not falling within any other of places category (15) Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the DE category must be at least 60 years of age. Date of last inspection 25th September 2006 Brief Description of the Service: Whitehaven is a privately owned and managed care home registered to provide non nursing care and support for up to fifteen persons aged at least 65 years some of whom may have dementia. The home is sited is situated in a quiet residential area in the South Hampshire town of Horndean with easy access to Portsmouth and the M27 motorway and main routes to the north of the county. All residents are accommodated in their own single room. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In compiling this report we considered information/evidence from a number of sources both external and internal to the home. Apart from a visit to the home and observations made during the site visit previous reports, examining residents /staff records, talks with residents, staff, management, visiting relatives health professionals, and reading reports produced by the registered person as required by the regulations were also taken into consideration. As a result of this key unannounced visit which was the first inspection for the year 2006/07 and took place on 09/05/7 between the hours of 09.15am and 02.45 pm all previous requirements were checked and had been complied with. Following this visit no requirements or recommendations were made. The results and findings contained in this report will determine the frequency and type of future inspections. At the time of the inspection residential fees were £515 per week What the service does well: What has improved since the last inspection? Following the last inspection requirements relating to a number of outcome areas were made in particular the choice of home, complaints and protection Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 6 staffing and management of the home which were all described as adequate and the environment, which was described as poor. All previous requirements have been complied with and the quality in all outcome areas now described as good apart from the area which deals with daily life and social activities which was assessed as excellent. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Whitehaven Care Home DS0000011581.V336475.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 Whitehaven Care Home DS0000011581.V336475.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 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to the service. The system for assessing resident’s needs prior to admission ensures residents needs can be met. Intermediate care is not available. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 9 EVIDENCE: Following the last inspection requirements were made that: “No one is to be accommodated without it being established pre admission that his or her needs can be met and Steps must be taken to ensure that all service users needs are being met”. The resident to which the requirement referred at the time of the last visit was in the process of being found alternative accommodation more suited to meet their needs as the homes management had identified that the admission was an error. At the time of the inspection, in accordance with the homes admission policy and procedure no resident was being admitted to the home without a face-toface assessment being undertaken by the manager or a member of the homes management team. During this inspection four residents’ records chosen by the inspector were viewed. All of the files indicated that in line with the homes admission policy and procedure a detailed assessment of needs and risk had been undertaken prior to an admission being agreed by a member of the management team that ensures all identified needs can be met. The records also indicated that all residents had been consulted and participated in the assessment process which would also seek the views of other health/social care professionals such as doctors, district nurses, community psychiatric nurses, physo geriatricians and care managers. When spoken with residents confirmed they had been consulted and fully understood why the process was necessary Where the resident was not able to give consent or fully understand the assessment procedure, the resident’s representative or external health and/or social care professionals would always be consulted and their advice and expertise sought. To ensure the quality of their admission the home also includes admissions as a separate issue in their satisfaction surveys referred to in more detail later in this report. Any previous requirements made in respect of this outcome area have been complied with. Whitehaven Care Home DS0000011581.V336475.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): 7,8,9,and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for planning care are clear ensuring that the health, personal care and medication needs of residents are met and their privacy and rights respected. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 11 EVIDENCE: A sample of four residents records were viewed and a number of residents spoken with individually and in groups. All of the residents spoken with expressed total satisfaction at the care they were receiving and the manner in which it was delivered. Comments such as “You always see a smile in this place”, “ Nothing wrong here”, “Perfect, home from home” and “Hotel service” are a sample of comments made by residents when describing what living in the home was like. Visitors also spoke well of the home, a relative stated,” The home was excellent, staff very niece and helpful always keep me informed, “A visiting hairdresser described the home as “The best she visits” a sentiment echoed by a visiting dementia specialist. All of the files viewed included care plans (which were reviewed monthly) based on assessments of need, risk and consultation with a range of external health and social care professionals such as doctors, district nurses, geriatricians and care managers as well as the resident or residents representative if appropriate. To ensure that staff fully understands the needs of persons with dementia a representative from the local Alzheimer’s society visits on a regular basis to give advice support and training to all staff and management. Residents confirmed any personal care was given in private and staff always knocked and waited before entering their bedroom. The inspector observed this practice. Residents are also able to make and receive telephone calls in private. Following the last inspection the following requirement was made “The manager must ensure that insulin is drawn up and given within the guidelines of safe and best practice initiatives only and the medication keys are held in line with recommended practice and that the drug fridge temperatures are monitored to ensure medications are stored at the appropriate temperature”. Following the inspection the manager contacted the district nurse regarding the drawing up of pre-filled syringes of insulin. We were shown a file of correspondence to confirm this. The outcome at the time of the inspection was that the position of the district nurses and their professional body is that whilst the practice of drawing up pre-filled syringes of insulin is not best practice, it is acceptable practice. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 12 A complete review of all drug/medicines policies and procedures was also undertaken and amendments made to ensure full compliance with the national minimum standards and the requirement. The new procedure includes an in house regular drug audit involving records and the administration of drugs/medicines being carried out by the manager. Records viewed confirmed all resident’s drugs and medicines, which are securely stored, are administered and disposed of in accordance with the homes revised medication policy and procedure by trained staff in consultation with the district nursing service. At the time of the inspection no residents were self-medicating. Staff, management and residents confirmed residents were free to choose the source of all personal services such as chiropodists, dentists and opticians and doctor. At the time of the inspection 6 doctors from two local practices visiting, this also allows choice re the gender of the doctor. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. The social activities, family contacts and the provision of varied and nutritious meals were well managed and reflected service users interests and choices. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 14 EVIDENCE: The home employs a specialist entertainment /activities organiser. Records viewed, comments from residents, staff and notices seen during the inspection confirmed a full programme of activities and social opportunities both in house and community based were available. Examples include, bowling, reminisance, puzzles, library, knitting, reflexologist, music, visiting entertainers and any other area that residents wish to participate. Residents confirmed they were fully consulted and were able to exercise choice in all aspects of their lives i.e., when to get up and go to bed, mealtimes, where meals are taken and whether to participate in activities. To ensure that appropriate activities are arranged for person with dementia the home consults with a member from the local Alzheimer’s society previously mentioned in this report. Residents are supported to maintain family contact by weekend visits if possible. Residents who are able to receive and converse with visitors in private confirmed visitors are welcome at any time and that accommodation is also available within the home for relatives to stay overnight. A dual formatted menu (written and pictures) was available. All of the residents spoken to expressed satisfaction at the quality, quantity and choice of food available. A number of the residents being accommodated have dementia. To ensure all of these residents receive a well balanced diet all staff have received specialist nutritional training on how dementia can affect a resident and how best to support them. During a tour of the home it was observed that all staff ensuring that residents had a drink available of their choice i.e. water, squash, tea, or coffee. Residents confirmed drinks were always available at all times. Since the last visit by C.S.C.I. the home has received a food hygiene/food standards award following an inspection by East Hants District Council. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that residents are able to complain and are protected from abuse. EVIDENCE: An in house Adult Protection policy/procedure that operates in tandem with the policy and procedure produced by Hampshire County Council designed to protect vulnerable residents from abuse was available as were records to confirm all staff had received training. Records viewed and staff spoken with confirmed they had received training in recognising abuse and demonstrated they knew what to do should they witness or suspect the abuse of any resident. The homes complaints procedure which also formed part of the service users guide included information on how to contact The Commission for Social Care Inspection (C.S.C.I) was seen as was a record of complaints. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 16 Residents stated they felt comfortable in discussing any concerns they had with the homes management and confident any matters raised would be dealt with fairly and promptly but went to great lengths to assure us that everything was satisfactory and they had no complaints. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for service users which meets their needs. EVIDENCE: Following the last inspection two requirements relating to the environment were made. Requirement 1) “The manager must ensure the health and safety issues are addressed regarding the outside space, paving and steps down to the lawn”. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 18 Requirement 2) “The registered person must ensure all floor coverings are clean and fit for purpose in the dining room, lounge and laundry”. A tour of the home indicated it was fit for its stated purpose, accessible, safe, clean, hygienic and free from adverse odours. Furniture was comfortable and homely and in keeping with the décor. Residents commented how satisfied they were with the accommodation. With regard to requirement 1) paving has been re-laid eliminating a potential trip hazard. Risk assessments have been undertaken with regard to residents using the patio and steps down to a lawn. To improve the external area even more the home has applied for a government grant aimed at care home for capital projects. Progress will be evaluated at a future visit to the home. Requirement 2). New floor coverings have been provided in the dining room, lounge and laundry. The previous report commented that the home was poorly signed from the street. Since the last inspection a discreet but visible sign has been provided that blends in with other property in the area. The matter of access to the laundry with dirty linen has now been addressed following consultation with Health Protection Agency Nurse and The Hampshire Fire and Rescue Service. We are satisfied both requirements had been addressed and complied with. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all users of the service. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 20 EVIDENCE: The staff rota indicated that 3 carers a member of the management team plus a cleaner and cook were available on each shift. Residents stated, ”We never have to wait.” The staff are so helpful” “When we want help it is always there”. Staff were observed to carry out their duties in a cheerful, calm unhurried manner taking time to talk with and assist residents. The manager confirmed that staffing levels are closely monitored to reflect the assessed needs of residents and would be increased if the need arose. At the last inspection a requirement was made that ”All staff recruited must have the necessary checks undertaken prior to employment”. We viewed three staff files chosen by the inspector. All files included evidence confirming staff are employed in accordance with a robust recruitment and selection procedure designed to protect residents. The procedure involves the completion of an application form, the signing of a rehabilitation of offenders declaration, an interview, satisfactory Criminal Record Bureau and Protection of Vulnerable Adults and reference checks followed by the satisfactory completion of an in house and recently adopted “skills for care” and induction training and probationary period of employment. Files also included a copy of a job description and contract together with evidence of all training undertaken. Apart from a very comprehensive resource library containing information on a vast range of topics involving care for the elderly in particular those residents with dementia, all staff had access to a number of training courses. The list of training available included, immobility assessment, nutrition, protection of vulnerable adults, manual handling, care for the older person, risk of falls, medication management, dementia, first aid, infection control etc. As part of their terms and conditions of employment all care staff are expected to undertake National Vocational Training in care to at least level 2. At the time of the inspection 76.9 of staff were qualified to at least N.V.Q.level 2 with a further 15.4 on a course. Only one member of staff has not been involved in N.V.Q. training and this is due to them emigrating. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 21 The recruitment retention and training of staff who are given three days paid training leave per year is given a high priority by the homes management who have also enrolled in the Investors in People programme and are due to be assessed in September 2007. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home, which is safe, well run and protects residents financial interests also ensures residents views and opinions of the service are sought. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 23 EVIDENCE: The Registered manager who apart from many years working as a qualified nurse in nursing homes is also qualified to N.V.Q. Level 4 in management. Staff spoken to confirmed the manager operated an open door policy and encouraged staff to full contribute to the running of the home with ideas that not only improved the home operational capability but improved the quality of lives of residents. Residents informed us were consulted about the home and how it is run, this was confirmed when viewing satisfaction questionnaires completed by residents, resident’s relatives/representatives and visiting health and social care professionals. A separate questionnaire covered admissions. The results from all parties are summarised and an action plan that details any areas that require attention developed. Following the last inspection requirements were made relating to: 1) The maintenance of the heating system to ensure the temperature of the air temperature was adequate, 2) A review of the homes infection control policy and procedure. 3) The covering of hot radiator surfaces and the locking of a door leading to a hot water tank. With regard to requirement No1 at the time of the visit the day was hot so the inspector was not able to assess the temperature. However residents stated it was always, “Toasty “ Never Cold” “Very pleasant”. A certificate from a CORGI registered engineer confirmed the boiler had been serviced as had other equipment in the home for which service documentation was also available. Requirement 2 covered infection control. At the time of the visit a health and safety policy and procedure designed to keep residents safe was in place. Apart from training staff in areas of health and safety such as moving and handling, fire, first aid, food hygiene, the control of substances hazardous to health the policy also covered infection control. Throughout our visit we observed all staff using aprons, gloves, amd antiseptic hand gel which was available in all rooms. No areas of concern were noted. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 24 At the time of the inspection the door to the hot boiler was locked as required following the last inspection. As commented earlier in this report the day of the inspection was hot consequently the heating was off . The covering of radiators as described in requirement 3) was discussed with the manager who informed us that all uncovered radiators which had been de commissioned were due to be removed. When asked if this would affect the air temperature in the future the manager assured us this would make no difference, as the radiators had not been in use for some time. In view of the findings made at this inspection all of the above requirements have been complied with. Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 25 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 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 26 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. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Whitehaven Care Home DS0000011581.V336475.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!