Care Home: Ashtonleigh

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What the care home does well There is a high level of satisfaction about the care that the service provides. Accommodation is provided in a warm, welcoming and well-maintained environment that meets with the satisfaction of people living there. The staff and the service users have developed good relationships with each other and care is provided in a respectful manner. The meals at the home are good and offered choices to the service users. The manager is proactive and demonstrates clear lines of accountability for the service. There is an ongoing programme of refurbishment to ensure that the home is safe and well maintained. The care plans and records of care given ensure that the service users receive the support and help they require. What has improved since the last inspection? The ground floor lounge and dining room have been recently refurbished and new furnishing put in place. The provider has started undertaking unannounced visits to the service and records of these were available. This was a requirement from the last visit that has been met. What the care home could do better: Development of the service users/ relatives` involvement in their care plans would further ensure that all care needs are recognised and met. There is no new requirement from this visit. CARE HOMES FOR OLDER PEOPLE Ashtonleigh 4 Wimblehurst Road Horsham West Sussex RH12 2ED Lead Inspector Anita Tengnah Unannounced Inspection 1st August 2007 10:30 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 Ashtonleigh DS0000014377.V348197.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. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashtonleigh Address 4 Wimblehurst Road Horsham West Sussex RH12 2ED 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) 01403 259217 01903750194 ashtonleighrch@aol.com Ashtonleigh Residential Care Home Limited Mrs Nicola Ambler Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2006 Brief Description of the Service: Ashtonleigh is a care home registered to provide personal care for up to thirty older people. The home is a converted large detached house on the outskirts of the town of Horsham. It has large enclosed and well- maintained garden to the rear and a parking area at the front and side. It is in a residential area of the town. The accommodation is provided in twenty single rooms and four double rooms. Eighteen of the bedrooms have en-suite facilities. These are on two floors of the property with the upper floor being serviced by a passenger lift. The current fee charged is £320-£550 per week. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the service was undertaken as part of the inspection on the 1st of August 2007. The process included a tour of the service where a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. As part of case tracking 5 staff and 8 service users views were sought and care records were looked at. Information gained from the Annual Quality Assurance Assessment (AQAA) was used and included in this report, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. Positive comments were received from the service users regarding the care that they were receiving at the home. The commission received 14 comment cards from the service users and some contained input from their relatives. Care practices observed at the time of the visit showed that the staff and the service users had developed good relationships and care was provided in a respectful manner. Four relatives views were sought on the day of the visit, and they were complimentary about the staff, environment and care that the service was providing. What the service does well: What has improved since the last inspection? Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 6 The ground floor lounge and dining room have been recently refurbished and new furnishing put in place. The provider has started undertaking unannounced visits to the service and records of these were available. This was a requirement from the last visit that has been met. 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. Ashtonleigh DS0000014377.V348197.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 Ashtonleigh DS0000014377.V348197.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 3,6 The pre admission assessment process is good and ensures that service users’ needs are assessed and the home can meet them. The home does not provide intermediate care. EVIDENCE: The care records of two recently admitted service users were looked at as part of case tracking. Detailed pre admission assessments of needs were carried out and staff reported that this information is used to formulate their initial care plans on admission. Assessments of needs included manual handling assessments, skin integrity, fall assessments. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 9 Two relatives confirmed that they visited the home and one of them said that she had visited 15 homes before deciding that this was “the right home for her mother”. The manager reported that the service users are offered the choice of visiting the home prior to admission. The service users’ family visited, as most of them were unable to do so due to their frailty. Comments received from a newly admitted service user’s relative “ my father has settled in well and describes all the staff as very good”. The manager confirmed that the service does not provide intermediate care. Ashtonleigh DS0000014377.V348197.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans and records of care given were good. Staff had clear information about the support that the service users required with their care. The health care needs and access to external agencies are well managed. The medication management was good and ensured that the service users were protected. The service users are treated with respect and dignity and their right to privacy maintained EVIDENCE: The care plans of 2 service users were seen as part of this visit to look at how the home plans to meet the needs of the service users. The care plans contained information about the assessed needs of the service users and actions required in order to meet them. These included assessments such as Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 11 manual handling, continence, medication and nutritional assessment. Care plans including night care were put in place to demonstrate how these needs would be met. Daily records were maintained of the care given. Comments from the service users included “the staff are marvellous and I am very happy here.” Another service user said that “nothing is too much trouble and I am treated with lots of care”. Four relatives and 5 of the service users spoken with said that the “ staff were very kind and attentive”. Another relative said that she felt “confident to go away on holiday and not having to worry” about her mother. The care plans were reviewed regularly to reflect any changes in the needs of the service users. There was no evidence that the service users are involved in their care planning and this should be developed to ensure that all care needs are identified and action taken in order to meet them. The details of personal care for the two service displayed in the shared bedroom as discussed must be removed. All personal care details must be identified in care plans in order to maintain the privacy and dignity of people using the service. All the service users are registered with the local surgery. The manager reported that the home had good relationship with the local primary care trust and the service users were supported to access health care services as required. The GP visited undertook a weekly visit to the service and reviewed the service users as required. Advice was sought as required from external healthcare professionals, such as advice and training in wound care for the carers. Pressure relieving mattresses and cushions were available for the prevention and treatment of pressure areas. The manager is pro- active in ensuring that the service users access to health care / support. One of the service users required a nursing bed to enable her to mobilise and the manager said that this had been funded by the primary care trust. The home has a medication policy and procedure and record showed that staff adhered by these. A sample of the Medication Administration Record (MAR) seen at the time of the visit showed that all prescribed medications given were recorded appropriately. The manager reported that only the carers who had completed training in medication were responsible for medication management. Evidence of training in medication was available of the sample seen. The home maintained good records of medication received and discarded. All medication was stored safely and included controlled drug cupboard. The staff stated that there was no one administering their own medication at the time. Comments cards received and 5 of the service users spoken with confirmed that the home provided a good service and they had autonomy and choice regarding the activities of daily living. Comments included ”a very good home”. Another service user said “everyone of the staff is so kind” and that she Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 12 “always felt safe”. Others said, “we are all very happy”. Two of the service users stated that there were no restrictions about what time they went to bed or got up. A relative commented” they appear to treat all residents appropriately with a real understanding of individual needs.” All the service users were dressed appropriately for the weather and 2 visitors commented that their relatives “always look well dressed and cared for”. Comments received were “I have to live somewhere, this is as good as any” and “the place is better than I expected”. Another comment received” I have seen nothing but kindness towards the residents”. Ashtonleigh DS0000014377.V348197.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social and recreational facilities for the service users are good. The service users are supported to maintain links with the community and their family and friends. The service users autonomy and choices are respected in their activity of daily living. The meals are good and meet with the satisfaction of the service users. EVIDENCE: The manager discussed that the home has a planned programme of activities three times a week for the service users. These included bingo, exercise, quiz and sing along. One of the service users said that he was aware of the Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 14 “games” but he preferred not to take part. A number of the service users said that three of the service users spoken with said that there was enough going on and another service user said that she preferred spending time in the garden. The service users were observed sitting in different areas of their choice around the home. There were a number of thank you cards from the service users following the barbecue last week. There was a lady at the home who is registered blind and audio- tapes were available for her use. The staff reported that the vicar was available, as was the Roman Catholic Priest as required. The home has an open visiting policy and it was evident from the record of visitors as kept by the home that there was no restriction on visiting. Comment received and three service users confirmed that they have autonomy to receive their visitors in private. It was evident that the staff and the relatives had also developed good relationships with each other. Interaction observed was easy and friendly. Comments from the visitors were “everyone is very welcoming”. Other comments were that the “staff not only cared for our relatives but us also.” The service users spoken with said that they have autonomy and choice with their daily living activities. A service user commented that the staff attended to her “as I need them”. Another service user said, “ nothing is too much for the staff, you only have to ask. Comment from a relative included “can’t fault the home, my mother is always clean and tidy”. Another comment to what you think the home does well was “caring and cleanliness”. The home has a planned menu that is rotated on a regular basis. Comment cards received and the service users spoken with said that the meals were “ very good” and hot and cold drinks were available at all times. Comments included “excellent food” and “good choice “. The chef said that she saw the service users on admission and was aware of their likes and dislikes. At lunchtime while the meal was ready for serving one of the service users requested a sandwich instead of the hot meal and this was provided. The chef and a staff member reported that this service user often requested a snack at lunchtime and had her cooked meal in the evening and this was not a problem. A notice board in the communal lounge displayed the menu for the day, although three of the service users spoken with were not aware of the lunchtime menu. Meals included pureed and some diabetic diets. A service user spoken with and comment received indicated that the teatime meal could offer more variety. A service user suggested dishes such as fish fingers, fish cakes, and burgers; this was discussed with the manager. The chef and the manager both reported that they were always looking at ways of varying meals to meet with the satisfaction of the people living there. Comments from a service users was” the meals are very good and the chef is Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 15 excellent. Another comment to how do you think the care home can improve one service user said “choice of food.” The lunchtime meal was observed and appeared well presented, nourishing and well balanced and one of the service user said that she enjoyed meeting up with others at lunchtime. Staff were available to offer support with meals as needed. Staff discussed that lunchtime meals are organised as two seating, this allowed the staff time to assist those who required help with meals and this worked well. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaint management is excellent and the service users are confident that their complaints would be listened to. Staff have understanding of adult protection and further training will benefit them. EVIDENCE: The home has a complaint policy and procedure. Three of the service users spoken and 8 of the comment cards indicated that that they would approach the manager or staff if they had any concerns. Two service users said, “this is a good home and we are more than happy living here.” Other comments were that “we have no grumbles”. The manager maintained a log of all complaints received at the service. The log contained one complaint that had been promptly dealt with and resolved. The home has the adult protection procedure inn place. There has been one allegation of verbal abuse involving a carer a carer at the home that the manager referred to social services. The investigation has been completed and Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 17 the allegation was substantiated. The manager took the appropriate action and followed procedures for referral to the POVA list. The manager discussed that some staff had also been affected and further training in the prevention of abuse and whistle blowing procedures is planned. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the service users with a homely, clean and well-maintained accommodation that meets their needs. The infection control procedures at the home are good and ensure that the service users are protected. EVIDENCE: The inspector looked at the premises as part of the visit and a number of bedrooms, communal areas, bathrooms, and kitchen were viewed. The home was welcoming warm and all areas seen were clean and in good state of repair. It was evident that the home has an ongoing programme of refurbishment. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 19 Recent refurbishment included the lounge and dining rooms have been recently decorated. The furnishing in the dining room had been replaced and laws of good quality and appropriate to the needs of the service users. As part of the renewal the manager reported that furniture had been ordered for 10 bedrooms and the lounge. Comments from the service users included “the home is always clean”. Relatives commented that the home was clean and fresh, however some of the service users’ bedrooms would benefit from decoration. The manager stated that the bedrooms are decorated when vacant. Information was available on infection control and practice observed indicated that the staff were aware of these. The home has an internal laundry where all the service users laundry is undertaken internally. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 27,28,29,30 The staffing numbers are adequate to meet the present needs of the service users. The home has system in place to ensure that staff have the skills to deliver care safely. The recruitment process is very good. All checks are undertaken prior to employment to ensure the safety of the service users. There is a good training programme in place to ensure that staff are supported in their work. EVIDENCE: A sample of the staff roster indicated that there are one senior carer and two carers on all the shifts including night duty. Staff and service users spoken with confirmed that they felt that there was adequate staff to meet their needs. Comments from the service users were that there was “always” staff available when they needed assistance. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 21 The manager discussed that other support staff included 2 chefs, and 2 domestic staffs who covered weekdays and weekends. The cooks finished work at 4pm and the carers were responsible for teatime meals. The manager reported that the home has an extra staff member who worked x5 days a week and helped with the breakfast, laundry and also some shopping for the service users. Comments about staffing received 8 said “usually” there was enough staff. Four of them said “more staff “. Information received and discussion with the manager indicated that home has 4 carers who have completed NVQ 3 and a senior carer was undertaking NVQ at level 4. Five other carers were working towards NVQ 2. The home has a recruitment procedure and the manager interviewed all the applicants. A sample of 2 newly recruited staff records seen indicated that the home had a robust recruitment process that staff followed. Checks were undertaken and references secured prior to employment. The manager confirmed that the home induction process was based on “skills for Care” and records of these were available. The staff had acquired visas and registered to work in this country as required. The home has a good training programme in place to ensure that all staff have mandatory training in health and safety. The manager kept a training matrix to help monitor training achieved and needs. A course in the prevention of abuse is planned for August 07 following recent incident at the service. Five of the staff were undertaking the English language course at College to improve their language skills and the manager said that they would be then put forward for the NVQ 2. Ashtonleigh DS0000014377.V348197.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a manager who is highly regarded and has clear lines of accountability for the service. The financial interests of the service users are safeguarded through good accounting. There is an internal audit to ensure that the home is run in the best interests of people living there. There is a satisfactory procedure in place to ensure the health and safety of the service users is promoted. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home has a registered manager who is also a registered nurse with a number of years experience in the care of the elderly. Mrs Ambler was undertaking her Registered manager’s award that she plans to complete by the end of the year. The manager has an open and inclusive management style and demonstrated clear lines of accountability within the home. She undertook regular updates to maintain her skills and to upkeep her nursing registration. Service users spoke highly of the manager and said that she was “always here if you needed her”. Staff were also complimentary about the support and open door policy that the manager operated. It was evident from interaction observed that the staff and the service users and their relatives had developed good relationships with each other. Comments from service users included “the staff are kind and attentive”. A relative said, “staff always ready to listen and help.” Staff reported that the home did not manage any of the service users’ money. They had appointees or their relatives who dealt with their financial affairs. The service has an internal audit system in place. The manager reported that the service users views were sought and reflected in the AQAA. Comment from a relative included” newsletter and questionnaires enabled us to make positive comments and constructive criticism” and hopefully some of these would be noted. A requirement was made at the last visit for the provider to undertake monthly visit to the service as required under Regulation 26. A sample of the reports following these visits was seen at the service. This requirement has been met. Information received indicated that there are regular reviews of policies and procedures to ensure that they meet current legislation/ guidelines. There is an ongoing programme for the servicing of fire equipment, hoists, wheelchairs, lift and emergency lighting. All substances that are hazardous to health (COSHH) were kept locked away safely. Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 24 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 26 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 Ashtonleigh DS0000014377.V348197.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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