Care Home: Acorn Lodge

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What the care home does well We found the home is run in a very flexible way for the benefit of people who live there. Some residents have lived at the home for a number of years and have developed friendships, which was seen to be evident throughout the time spent at the home. Comments included, " we always do everything together", " they like to come and go as they please, those with limited mobility, usually gather together in the lounge for a chat and to see what`s going on". We talked to staff members who demonstrated they have a good knowledge of the individual care needs, social and cultural needs of residents living at the home so that they are not disadvantaged in any way. Comments included, " we know them so well many have been here a long time". "we are always flexible in how we approach care so that we meet the individual needs of the people who live here". What has improved since the last inspection? We looked at the homes environment and found there is ongoing maintenance around the home to improve the environment by way of decoration, and maintenance of facilities for the benefit of people who live there. Some rooms have been decorated and others have had replacement covers for radiators. The dining room floor and kitchen floor has been renewed with non-slip floor covering. "Its lovely in here now isn`t it, I like sitting in here". Work has commenced to improve the bathing facilities in the home, including improving shower access, so residents can use this facility with ease. Replacing the main bathroom, with a "wet room", so that all residents can use this facility independently or by receiving assistance from staff. Plumbing systems have been improved so that there are no offensive odours in the home. The manager has looked at staffing levels so that there is always sufficient staff on duty at any time of the day or night to meet the needs of people living at the home. CARE HOMES FOR OLDER PEOPLE Acorn Lodge 183 Reads Avenue Blackpool Lancashire FY1 4HZ Lead Inspector Mrs Jackie Riley Unannounced Inspection 6th May 2008 09:15 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 Acorn Lodge DS0000009866.V365384.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. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn Lodge Address 183 Reads Avenue Blackpool Lancashire FY1 4HZ 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) 01253 300036 Mr Anand Seedheeyan Mrs Savitree Seedheeyan Mr Daniel Lea Care Home 10 Category(ies) of Dementia (6), Mental disorder, excluding registration, with number learning disability or dementia (4) of places Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th September 2007 Brief Description of the Service: Acorn Lodge provides residential care for ten service users. The care home is situated in a residential area close to all community amenities, including shops and the public transport system. Access to the home requires service users to be mobile without the need for mobility aids. The care home has two floors accommodating service users. They include five ground floor single rooms one with en- suite facilities and five first floor rooms, one double and four single. There is a ground floor shower and toilet room, close to the entrance of the home. There is no lift access to the first floor therefore service users occupying first floor rooms must have good mobility. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owners and staff and the services residents can expect if they choose to live at the home. The most recent inspection report is available in the hallway area for people to view. At the time of the site visit the range of weekly fees were £279.00 to £360.00. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit that took place on the 6th May 2008, over a period of approximately 5.0 hours as part of the inspection process. We spoke to the registered owner, who visits the home daily. The registered manager and one other staff member on duty. In addition to this we spoke to a group of residents in the lounge and three other residents individually. Residents living at the home have a range of mental health disorders; therefore some residents have difficulty communicating. A lot of the comments made in this report are based upon what we saw although comments will be included from other sources such as staff. The response we had from surveys was poor therefore comments from this source will be limited. During the time spent at the home we made general observations of the interaction between residents, staff and management, to gain a general overview of how residents are communicated with. We talked to people using the service, and asked staff about those peoples needs. We also looked at care plans, records, and daily notes for three people, this is called case tracking. We also toured the home to look at the environment. The records of two members of staff were also looked at. What the service does well: We found the home is run in a very flexible way for the benefit of people who live there. Some residents have lived at the home for a number of years and have developed friendships, which was seen to be evident throughout the time spent at the home. Comments included, “ we always do everything together”, “ they like to come and go as they please, those with limited mobility, usually gather together in the lounge for a chat and to see what’s going on”. We talked to staff members who demonstrated they have a good knowledge of the individual care needs, social and cultural needs of residents living at the home so that they are not disadvantaged in any way. Comments included, “ we know them so well many have been here a long time”. “we are always Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 6 flexible in how we approach care so that we meet the individual needs of the people who live here”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Acorn Lodge DS0000009866.V365384.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 Acorn Lodge DS0000009866.V365384.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): 2,3, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have information about what services they can expect when living there. Admission and assessment procedures are in place so the home can meet individual needs. EVIDENCE: We looked at the records of three resident’s, which are being reviewed so that all the information is maintained in one file, this also ensures the residents rights to privacy and confidentiality are met. The records we looked at had assessment details recorded, so that staff had a good insight into what the needs of residents are and how they will be met. The information was up to Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 9 date and showed reviews are taking place so that information is current and reflects the needs of the residents living at the home. Comments from the manager included “I am spending time making changes to all the residents records so that the information is in one place and this helps the staff team”. There was evidence of the assessment details from other agencies making placements at the home, so that the staff team have the knowledge of the individual needs of the residents being admitted. There has been only one resident admitted to the home since the previous inspection and this resident had moved from another care home within the group owned by the provider. The information had been updated and there was evidence this resident had received information about the home and the services it would provide by coming for short stays prior to a permanent placement being made. Standard 6 was not assessed, as Acorn Lodge does not provide intermediate care. Acorn Lodge DS0000009866.V365384.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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously. Resident’s welfare is monitored and health needs are identified and met. EVIDENCE: We found the records of resident’s we followed were accurate and had good information about their health and social care needs, which supported staff to maintain and promote each individuals daily needs. We saw care plans were up to date and reviews were taking place, so that resident’s needs were being monitored and any changes recorded. We spoke to staff who said, “ there are not many changes occurring, but this does not stop us monitoring residents needs”, “residents have been here a long time and that helps us to recognise any changes that happen”. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 11 The records we looked at included risk assessments, which looked at all areas where residents may be put at risk by including internal and external risk. This confirmed to us so that risk is being managed for the resident’s safety and protection. We saw daily entries made by carers demonstrate the care given. We spoke to staff who said, “we record what we do or see so that there is a good record of what we do”. We looked at how the home manages its medication practices and found staff responsible for administration have received training in medication dispensing. Some of this training has been carried out some time ago and it is therefore recommended staff receive updated training so that they are familiar with changes, which may occur in the way medication guidance is provided. There are no controlled drugs being administered by the home. We saw there is a drugs cabinet fixed to the wall for safety and security. By looking at the homes medication records and following two residents records specifically, it was confirmed that records are up to date and there is no stockpiling of drugs. Resident’s rights to dignity and privacy were found to be acknowledged by a workforce who are aware of the need to make sure the rights of residents are met with respect at all times. This was confirmed by observing the way staff treat people and communicate with people living at the home. Staff were seen to carry out their tasks with sensitivity and patience on all occasions. We saw residents communicating well with staff members, and they appeared relaxed and receptive to things going on around them. We saw staff encouraging participation with others in a way in which did not infringe their dignity. Comments included, “We make sure staff respect residents and this is part of our training”. Residents spoken to were very happy with the care they receive, comments included, “there always around if you need anything”, “they can’t do enough for you”. Acorn Lodge DS0000009866.V365384.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily life and social activities are designed to be flexible to meet the needs of people living in the care home. EVIDENCE: There is no dedicated cook at the home; members of the staff team are responsible for the preparation of food. We saw a varied menu, which is flexible to meet the individual needs of residents living in the home. Comments included, “there is always choice”, “staff know what we like and don’t like”. This was confirmed by talking to staff, residents and observing a lunchtime meal, which was seen to be enjoyed by all residents. The dining experience was seen to be a positive one and one where residents communicate freely with other residents and staff. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 13 Special diets can be catered for including low fat and diabetic controlled diets. We saw evidence on individual files where a resident required additional nutritional supplements and staff were able to tell us about how this is being done. Staff spoken to say, “we always cook fresh produce every day and know what individual choices are”. There is a flexible activity programme in place, based upon what the individual choices of the residents are. Staff said to us that they like to take things day by day depending on the choice and mood of the residents. We saw two residents like to go out independently on a daily basis. Other residents who have limited mobility are assisted by the staff team to carry out various tasks or activities. Information received prior to the visit says it continually looks at how residents can be entertained, and sometimes this includes activities beyond the home with staff support. Two residents spoken to said they just like staying in their rooms and doing their own thing. We found in general residents like to make their own choice in their day to day lives, and we found that staff respect this. The manager said, “residents have their likes and dislikes when it comes to activities, residents have their favourite things they like to do”. Recently the manager and staff have encouraged birds to come and feed by the lounge window, using feeding troughs. Residents were seen to enjoy watching the various birds and wanted to tell us about the range of birds they see. “they are so entertaining”, “we like to sit here and watch the birds come down for the nuts”, “the manager has put them there so we can watch them, they are so funny sometimes”. We saw there were no restrictions on visiting by relatives or friends. A residents spoken to confirmed visitors are welcome in the home at any time and this is not seen as a problem. There were no visitors present throughout the site visit and no surveys were received from relatives prior to the inspection of the home, Acorn Lodge DS0000009866.V365384.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for recording and reporting of complaints are good ensuring people feel listened to. Staff have access to safeguarding adults training for the protection of users of the service. EVIDENCE: We saw the home has a complaints procedure, which is made available to residents or their relative or advocate during the admission process. We saw the contact addresses for outside agencies including the Commission are in place so that people have access to independent agencies if they are not happy about something in the home. We spoke to a number of residents about how they might raise a concern if they are not happy about something which affects them, they told us they have written information about what to do, but they said they are happy to talk to the manager who, “always puts things right”. We saw all residents have written literature in their rooms about whom to complain to in the home and independently if they are not happy about something. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 15 Comments we received said; “people tell us if they don’t like something or are not happy about something”. There have been no complaints received by the Commission in the previous twelve-month period. We saw the home has a procedure in place for dealing with allegations of abuse. Staff spoken to are aware of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect, and have received training in this area through induction training, national vocational training, and external safeguarding training. Some of the training in this area took place over two years ago and it is recommended staff receive updated training in this area so that people are protected by current guidance and protocols. Staff comments included, “I have had training for it, and it’s covered in NVQ training”. Acorn Lodge DS0000009866.V365384.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): 19,21,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is designed to be homely, however due to limited maintenance it has the potential to be detrimental to residents living there. EVIDENCE: We looked around the home and found it to be of a domestic nature by way of design, which promotes a homely atmosphere. We saw there has been improvement to the general decoration of the home, including decoration of individual rooms, replacement of dining and kitchen flooring. Comments included, “my room has been decorated and its much brighter now”, the dining room floor is nice, I think its better than carpet, it makes it look bigger”. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 17 We saw there is still need for improvement in the environment including on going maintenance, so that breakages, including radiator covers are repaired in a timely manner for the benefit of residents living at the home. We looked at the bathing facilities in the home and found at the time of the inspection residents were having difficulty in accessing the ground floor shower. We spoke to the manager about this and were told changes to this facility were taking place in the next few days so that it would improve access by residents. We were also told the main bathroom on the first floor is to be refurbished as a ‘wet room’, to assist residents when bathing. The homeowner has informed us this work is now been undertaken. People who live at the home told us they liked the way they can use their rooms as and when they choose. One resident said, “I like my own space and can keep my room the way I want to”. Access to the home would be difficult for residents with mobility problems. This is addressed by including the information in the homes written literature, so that people know what to expect when they choose the home to live in. Residents living at the home are all mobile, however some residents would need walking aids should they go out. We saw there is a small range of walking aids including walkers and wheelchairs. Some residents like to spend time in the rear garden area, which has a small patio area, and is not overlooked. This area is also used for residents who smoke, as the home has a no smoking policy. Residents spoken to say they did not mind smoking outside. Comments included, “its like this everywhere now, I can understand it I suppose, you just get used to it”. Acorn Lodge DS0000009866.V365384.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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are good ensuring suitable personnel are employed. The deployment of the staff team throughout the day is sufficient to meet the needs of residents. EVIDENCE: We looked at two staff files and spoke to the manager about the recruitment and training of staff working at the home. We found there have been no changes to the staff team since the previous inspection. Staff records showed us there are systems in place for the safety and protection of the residents, these included, application forms, reference checks, fitness checks so that staff are safe to work in the home with people who may be vulnerable. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 19 Some staff working in the home also work in other homes within the care group. Whilst there is evidence the staff members have undergone checks the records should be complete so that all the information is available for inspection. We saw there are training records for staff who work in the home. They showed us staff receive training in areas, which make sure they are equipped with the knowledge and skills to meet the needs of the residents living at the care home. Some staff require updates in training for protecting people, lifting and handling. We spoke to the manager and staff available about this and were told the home uses external trainers to provide this training, which has been allocated for staff to attend in the coming months. Comments included, “staff training is looked at through supervision or if they see something they think will be useful, which we can arrange”. By looking at staffing rotas and information about how people received care told us the home is staffed to meet the needs of people living at the care home. Acorn Lodge DS0000009866.V365384.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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well and systems and policies in place for the protection and safety of staff and residents are good. EVIDENCE: The manager has the necessary skills and experience required to support the staff and residents and enable the home to meet its stated purpose and objectives. Comments included, “He is always there is you need to tell him something and know it will get sorted out”, “He is really supportive”, “the office door is always open”. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 21 Staff spoken to say they find the manager to be supportive providing clear leadership. Comments included, “we are well supported by the manager”, “it’s a small home and we all work together”. There is ongoing quality monitoring carried out through informal discussion with all users of the service including staff. In addition formal resident and staff meetings are held on a regular basis, so the views and wishes can be taken into account by the management team for a positive outcome for people who use the service. The management team take the views of people who use the service seriously, so that changes can be made to improve the service wherever possible. We spoke to the manager about how resident’s monies are managed by the home and were told the home does not manage any monies for individual residents We looked at the service details for appliances in the home and found they are serviced in accordance with current guidance for the health and safety of all users of the service. Acorn Lodge DS0000009866.V365384.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 3 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 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 3 X 3 X 3 X X 3 Acorn Lodge DS0000009866.V365384.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. Standard OP19 Regulation 23 Requirement Timescale for action 31/08/08 2. OP21 23(2)(a) Whilst there have been improvements in the general maintenance of the home this must continue to make sure the environment is to a satisfactory standard for the comfort of people living there. Whilst improvements were being 31/08/08 made to the bathing facilities of the home they must be completed so that they are easily accessible and are suitable for the benefit of people who live there. 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 OP29 Good Practice Recommendations Staff working at the home but employed for the majority of their contractual hours in another home in the care group should have available for inspection completed recruitment files so that they can be inspected. DS0000009866.V365384.R01.S.doc Version 5.2 Page 24 Acorn Lodge 2. OP31 The registered manager should continue to complete management qualifications so that they have the knowledge to carry out their role. Acorn Lodge DS0000009866.V365384.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Acorn Lodge DS0000009866.V365384.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!