CARE HOMES FOR OLDER PEOPLE
Willowdene Nursing Home Victoria Road West Hebburn Tyne And Wear NE31 1LR Lead Inspector
Mrs Katie Tucker Key Unannounced Inspection 8:30 11 , 22 and 25th January 2007
th nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willowdene Nursing Home DS0000000277.V325919.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. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Willowdene Nursing Home Address Victoria Road West Hebburn Tyne And Wear NE31 1LR 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) 0191 483 7000 0191 483 7101 pat@premiernursinghomes.com Premier Nursing Homes Limited Mr Patrick Joseph Morley Care Home 52 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (52), Mental disorder, excluding learning of places disability or dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (52) Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2 service users MD (E) also have a learning disability Date of last inspection 30th June 2006 Brief Description of the Service: Willowdene is a purpose-built home providing nursing and residential care for 52 older people that may have dementia-type illnesses or mental health needs. Within this total number, two people admitted may have a learning disability and five people are under the age of sixty-five and have mental health needs. The home charges up to £498 per week some of which will be funded, as is the free nursing care. Accommodation is on two levels served by a passenger lift and stairs, each with self-contained facilities including lounges, dining areas, bathrooms and WCs. Both internally and externally, the property is accessible for wheelchair users. All bedrooms have en-suite WCs. Off road car parking is available at the front of the home and there is an enclosed garden at the rear, which residents may enjoy in good weather. The property is situated just off the main road running through Hebburn, and is within walking distance of a range of local amenities, including a health centre, pharmacy, library, a shopping centre, places of worship and public houses. The area is well served by public transport and the Metro station is approximately half a mile away. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit was carried out over 2 days. While at the home time was spent talking with people using the service, staff and visiting relatives. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at their records. Some of the people have difficulty with speech and stating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. Also information from POVA investigations was used to make decisions about the quality of service. During this inspection all of the key standards were checked. What the service does well:
The manager and deputy manager are very competent. They have helped the staff understand residents’ needs and always try to make sure staff use the most up to date practices. And, they are very skilled at spotting gaps in the service and putting successful measures in place to improve practices. At each inspection it has been found that the home has improved. These positive developments are in most part due to the changes the manager and deputy manager have made. The nurses are very aware of person centre approaches to care and have been able to care for people who have complex dementia care needs. Staff try to use various other strategies before using any type of sedative medication. This leads to residents being more alert and able to join in everyday tasks. Relatives were very complimentary about the service offered at Willowdene. They were very happy with the way the manager held relatives meetings and made them aware of everything that was going on. People said ‘the service here is second to none, I was really lucky to get my relative in’, ‘I’ve always found the staff to be excellent at their jobs’ and the ‘manager and staff are really interested in our opinions and you can see they really want to do a good job’. One of the residents said ‘I couldn’t be happier the staff are very good’. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Some of the staff still need to develop the skills to work with people who have dementia, as they at times forgot to tell people what was happening. Also they spent a lot of time completing tasks and failed speak to residents. Nearly all of the staff used out dated techniques for assisting people to move from chair to chair. And, some of the staff were unable to use the hoist properly. Prior to the final visit to the home the manager gave staff refresher training and undertook to monitor practice. However, the current format for writing moving and handling risk assessments is not helpful and the hoist are very old so difficult to use. The building is nicely decorated but does not really assist people with a dementia find their way around. Willowdene is designed, as a specialist service for people with a dementia so needs to be tailored to meet this need. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 7 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. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 8 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 Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Although staff recently introduce new records work to replace existing records has only just commenced. Therefore the information in the majority of assessments is limited and, will impact on how the service plans to meet someone’s needs. EVIDENCE: Premier Nursing Homes Ltd are in the process of replacing the service user guide and statement of purpose, as the old one did not give residents the information they needed to make a decision about whether to move to Willowdene. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 10 A new assessment tool has been developed and this provides room to record information about the care needs of people with dementia or mental health needs. The implementation of these records will be monitored. Collectively staff had a good range of knowledge about triggers for behaviour, people’s preferences and how to reduce people’s anxiety. The staff spoke in a relaxed and sensitive manner towards service users. The manager and deputy manager have been assisting staff to use people’s life histories when working with residents. The manager is aware that gathering contextual life histories is essential. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 11 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 adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The previous care records design prevented staff from evidencing the good practices used at Willowdene. These have recently been changed and staff are starting to rewrite residents records. This is in the early stages so not all of residents’ records show how staff need to work with people. Medication practices are maintained to a good standard. EVIDENCE: The flaws in the previous assessment and care plan records led staff having difficulty evidencing their good practice. The nursing staff are very competent at identifying people’s needs and introducing effective measures to meet people’s needs but they were never able to reflect this in the care plans. The new assessment tool will support staff to evidence how and why they work with people. Plus, help staff write more about people’s emotional, social and spiritual needs.
Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 12 Case tracking showed that the new records were showing the good work staff complete with residents. The manager and deputy manager want to extend this by monitoring the new records to make sure they are truly adequate. The owners have now given them permission to alter and add onto the records, as needed. Although risk assessments are being used they need to be reviewed, as they do not include all of the actions associated with risk management. The manager was made aware of guidance that would help him develop an appropriate risk management tool. The lack of an appropriate format for risk assessments contributed to difficulties staff experienced when assisting people to transfer from chairs. Also risk management strategies must be applied more widely. At times staff discourage residents from taking everyday risk such as making their own drinks. Research shows that to maintain a sense of well being we need to continue to take everyday risk. Staff impose limitations on some residents because of their dementia or physical health needs such as needing to be accompanied when outside the home. When any restriction are in place to be recorded and the resident or relative need agree that it is acceptable. The manager was made aware of the effects of the introduction of the Mental Capacity Act 2005 in April, and how those people who were found to have capacity must be allowed to take any risk they see as fit and those who lack capacity must be cared for in ways that are the least restrictive. Willowdene Nursing Home DS0000000277.V325919.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 good. This judgment has been made from evidence gathered both during and before the visit to this service. Some staff are directing care at people rather than encouraging residents to make choices, voice their opinions and use skills they retain. However, the majority of time this is not the case. All staff need to use good practices. EVIDENCE: It was quiet in all of the units during most of this visit. Staff stated that there were no specific activities being organised at this time. Residents were chatting to visitors, listening to music and watching TV. An activities coordinator is due to start work soon. Over the last year manager encouraged two care staff to organising social events; sing a longs and other similar activities. Relatives were very positive about the activities staff had organised. However, it is important that in-between these types of organised events people have the opportunity to occupy themselves, preferably with activities the did when they were younger. Again, it was noticeable that there were no books, games etc readily available. The manager said that recent decorative
Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 14 work had caused these artefacts to be put away but he was very keen to introduce everyday activities. During the observation it was clear that some of the staff did not see the need to talk to residents or involve them in any sort of basic activity. They only engaged with more able residents. However, other staff behaved in a completely different manner and chatted with all of the residents, encouraged them to join in various activities, used life histories to get people to talk to them and knew people’s preferences. The cook is very skilled and has completed a wide range of training. He is very knowledgeable about the dietary needs of older people and always strives to provide good quality food. Case tracking showed that he was very aware of people’s preferences and knowledgeable about how to maintain a diabetic diet. He made sure people received varied diets, which met specific dietary needs. The cook also makes sure he has sufficient information to provide adequate and nutritious meals for all of the residents with various needs. Willowdene Nursing Home DS0000000277.V325919.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 judgment has been made from evidence gathered both during and before the visit to this service. The manager and staff have shown that they will check that the service is working for residents, help people to raise concern, work in partnership and take all actions necessary to resolve issues. Thus, residents can expect that poor practice will not be tolerated and the service will improve. EVIDENCE: The relatives have said they are confident that the manager would deal with any concerns. The manager always deals with all concerns in a proactive manner. He has welcomed residents and relatives views. Where people have raised concerns he has dealt with these to the satisfaction of all concerned. And, makes sure the actions have been taken are continued. Relatives said that the staff and the manager were ‘friendly’, ‘helpful’ and ‘kind’. One relative discussed concerns they had raised and how the manager had been really approachable and eager to resolve the concerns. Another relative said ‘I come everyday, the staff are always very friendly and there is never anything amiss’. Case tracking showed that all possible actions had been taken to resolve the concerns and all parties were satisfied. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 16 Willowdene has a policy in relation to protecting vulnerable adults from abuse, this is a generic policy for all of the homes but does outline when the police would need to be called. The new directors of Premier Nursing Homes Ltd are up dating policies. They have given the manager permission to make alterations to the policies and procedures so they reflect the practices at the home. Recently a protection of vulnerable adults concern was raised. The manager and staff worked in partnership with other agencies to resolve this matter. They were found to be open and extremely honest. All of the areas that were noted to need changing such as recording the administration of homely medication and improving communication between staff have been resolved. In nearly all instances measures to resolve these issues were put in place and found to be successfully working prior to the POVA concluding. The remaining issues such as making sure staff communicate effectively are working well and being regularly monitored. South Tyneside provides training for staff in how to adhere to POVA requirements so far the manager and deputy manager have been and all of staff are receiving this training. Willowdene Nursing Home DS0000000277.V325919.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 adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Although the general up keep of the home is good. The failure to make adaptations so it meets the needs of people with a dementia means that residents have difficulty using the building. EVIDENCE: Willowdene is located within a residential area of Hebburn. It is a purpose built property, with accommodation provided over two levels. A shaft lift allows access between floors. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 18 The new directors are planning to refurbish the home. Externally there is a garden, which is accessible to all residents. The manager is starting to develop a sensory garden and a number of the relatives talked about these imminent changes. They felt it would enhance the service on offer. Willowdene has been specifically set up to provide dementia care recently some environmental adaptations have started to be made to assist people with memory loss find their way around. But some aspects of the environment do not meet people’s needs such as colour scheme and lack of aides to help people find their way around. The manager is very aware of changes that could be made to make the environment more user friendly, such as using different colour schemes in different areas. These changes have started to be introduced. It was noticed at the last inspection that the temperature of the home, particularly on the first floor was in excess of 26°c and the recognised safe and suitable temperature is 21°c. This excessive heat leads to residents dehydrating quickly, higher levels of frustration and general lack of energy. A lot of dressing packs have to be stored below 25°c otherwise it starts to degrade. Also the temperatures in the laundry were even higher and this leads to poor working conditions and the potential for the linen coming from the dryer not to cool sufficiently to prevent a build up of heat. It is well known in the laundry trade that the lint on linen can be a source of combustion in dryer or following a drying cycle. It was required that air conditioning was provided. Some portable air conditioning units have been purchased but the owners need to make sure appropriate air conditioning is fitted in the laundry. Willowdene Nursing Home DS0000000277.V325919.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 judgment has been made from evidence gathered both during and before the visit to this service. Staffing levels meet the needs of residents. The manager is working hard to make sure staff always use recognised good practices, as this will help them support residents. EVIDENCE: The manager has been working hard to ensure that staff receive specific dementia care training, managing challenging behaviour, attend multi-sensory courses as well as mandatory training. Over 50 of the care staff now hold an NVQ level 2 and the remaining staff have been enrolled on this qualification. A number of staff have completed level 3 awards and one staff members is started level 4 in care. Two of the nurses are NVQ Assessors and the manager holds this award as well as an internal verifiers award. The staff files include the appropriate information. However in light of the changes to the regulations and introduction of the Disability Discrimination Act 1995, legislation relating to equality and diversity and amendments to the Care Home Regulations 2001 the application form and health statement need to be changed.
Willowdene Nursing Home DS0000000277.V325919.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): 31, 33, 35 and 38 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The manager regularly makes sure management systems support the staff to constantly review practices and strive towards deliver an excellent service to residents. EVIDENCE: The manager has strong leadership skills and a track record of ensuring good services are ran. He recently successfully completed the final part of the process to become the registered manager for Willowdene. He is working toward the Registered Managers Award.
Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 21 Premier Care Nursing Limited has a quality assurance procedure, which is now being used to review the service provided. The outcomes from the reviews provide the basis for an annual development plan for the home. And, the quality assurance system has helped the manager to identify areas of poor practice. However, the risk management policies, procedures and templates need to be reviewed and updated so they comply with Health and Safety guidance. The personal allowances are in good order. Only small amounts of money are held on behalf of residents. When money collects this is sent to the appointee or relative to put in people’s savings accounts. Staff were using poor moving and handling practices such as drag lift throughout the visit. The moving and handling assessments gave them inadequate information about the actions they needed to take to resolve issues such as location of seating or, any equipment to be used. The manager made sure staff received refresher training prior to the inspection being completed and will make the owners aware of the contributory factors such as the poor risk assessment format. A number of bedroom doors were wedged open. The manager had identified the potential risks this caused and was in the process of purchasing door guards. He has also ordered some more high/low beds so that staff will no longer have to use bed rails to prevent residents causing themselves injury by falling out of bed. Willowdene Nursing Home DS0000000277.V325919.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 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 Willowdene Nursing Home DS0000000277.V325919.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 OP3 Regulation 14 (2) Requirement The new assessments tools must be completed for all residents and monitored to make sure it is effective. Timescale for action 20/09/07 2. OP19 23 (1) (a) The owners must ensure that the 18/10/07 internal design of the building meets the needs of people with a dementia. (Required at the last inspection – timescale 12/10/06) Air conditioning units must be 31/05/07 installed and industrial extractor fans provided in the laundry. (Required at previous inspections - timescale 20/10/05) The owners must make sure the recruitment practice reflects the amendments and requirements of the regulations. 26/07/07 3. OP38 23 (2) (p) 4. OP29 19 5. OP38 13 (4) (b) Risk management strategies 31/05/07 must be in place and cover changes to the environment such as moving furniture, which would facilitate staff adopting safe moving and handling techniques. Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The manager should ensure all staff are equipped, via training and supervision, with the skills needed to deliver person-centred care. The manager should review policies and procedures to ensure they reflect practices at the home and amend them where necessary. 2. OP33 Willowdene Nursing Home DS0000000277.V325919.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Willowdene Nursing Home DS0000000277.V325919.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. 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!
