Care Home: Coppermill Care Centre

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What the care home does well The Manager has been in post for approximately four years and during that time has re-organised the management structure of the home, created activity co-ordinator posts, and made many improvements. The information made available to prospective residents and their relatives is excellent. The level of care was observed to be of a high standard, and the level of activities to be of an excellent standard. The design, decoration and furnishing of the premises are generally of a high standard also. Record keeping is excellent. Staff recruitment and training are also excellent. There have been a number offurther improvements since the last CSCI inspection, detailed below, that will further improve outcomes for residents. What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Coppermill Care Centre 10 Canal Way Off Summerhouse Lane Harefield Middlesex UB9 6HS Lead Inspector Robert Bond Unannounced Inspection 19th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coppermill Care Centre DS0000038202.V367936.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. Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coppermill Care Centre Address 10 Canal Way Off Summerhouse Lane Harefield Middlesex UB9 6HS 01895 820130 01895 820149 coppermill10@yahoo.co.uk 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) Coppermill Care Limited Johan Neeskens Care Home 52 Category(ies) of Dementia - over 65 years of age (52), Old age, registration, with number not falling within any other category (52) of places Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE (E) The maximum number of service users who can be accommodated is: 52 5th October 2006 Date of last inspection Brief Description of the Service: Coppermill Care Complex is a 52 bed purpose built care home that is registered for older people, including those with a diagnosis of dementia. It is owned by Coppermill Care Ltd, director Mr Shah. The building was opened in 2000 and is on three floors, with a lift between them. Dementia care units are to be found on each of the three floors. The home is adjacent to a development of private housing and small business units on a former industrial site alongside the Grand Union canal. The home is fully accessible throughout for wheelchair users, with wide corridors and large single bedrooms that are all en-suite. An enclosed garden is at the rear. Limited parking is available at the front of the building. The area is isolated from shops and services, the nearest being a mile away in Harefield. There is no public bus service nearby but the home has a company car that is available to take residents out and to collect relatives from Harefield village. Three activity co-ordinators are employed in the home. Referrals are taken from self-funding residents but most residents are funded by Local Authorities, in particular the London Borough of Hammersmith and Fulham, and the London Borough of Hillingdon. The fees range from £375 to £670 per week. Respite care is offered in some circumstances, for a minimum period of two weeks. Coppermill Care Centre DS0000038202.V367936.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 3 star. This means the people who use the service experience excellent quality outcomes. This inspection was a ‘key’ inspection that considered the home’s performance against the key National Minimum Standards (NMS) for Care Homes for Older People as published by the Department of Health. Although the last key inspection took place in October 2006, we undertook an Annual Service Review (ASR) in on the 20th March 2008. Reference to the findings of the ASR are contained within this report. The home submitted to us in advance of the inspection an Annual Quality Assurance Assessment (AQAA), which is referred to also within this report. Equality and Diversity were considered by us throughout the inspection process. The home is commended for the high profile given to these aspects in terms of training and information provision. We spent 5 hours at the care home. We interviewed the Registered Manager (hereafter referred to as The Manager), the administrative assistant, one of the Floor Managers and one of the Activity Co-ordinators, met other staff, talked to residents, toured the premises, and examined a variety of records. The Manager reported that the home was fully staffed with no agency staff being used at present, and that the home was fully occupied except that one place has been dispensed with as one bedroom has been turned into an additional dining room. The Inspector assessed the outcomes of 22 of the NMS, and found that 7 were fully met and 13 were exceeded, whilst 2 were only partly met. This led to the Inspector making 3 requirements. What the service does well: The Manager has been in post for approximately four years and during that time has re-organised the management structure of the home, created activity co-ordinator posts, and made many improvements. The information made available to prospective residents and their relatives is excellent. The level of care was observed to be of a high standard, and the level of activities to be of an excellent standard. The design, decoration and furnishing of the premises are generally of a high standard also. Record keeping is excellent. Staff recruitment and training are also excellent. There have been a number of Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 6 further improvements since the last CSCI inspection, detailed below, that will further improve outcomes for residents. 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 Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Coppermill Care Centre DS0000038202.V367936.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 Coppermill Care Centre DS0000038202.V367936.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 and 3. (Intermediate care is not available with this care home). Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective and actual residents, and their relatives, are provided with an excellent range of printed information by the home. Comprehensive assessments of need are undertaken before residents are admitted, and additional specialist assessments are undertaken by staff from the home at the earliest opportunity. EVIDENCE: The home’s Statement of Purpose and Service Users’ Guide have been improved and are supplemented by other documents on display in the home’s foyer such as ‘Putting People First – Equality and Diversity’, and an information folder giving information on a large variety of religious and cultural services, as well as details of activities available locally for residents of ‘other than heterosexual orientation’. This is commended. We found that the Statement of Purpose did not mention that the home sometimes offered respite care, but this omission was corrected on the spot. Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 10 We examined in detail the care files of three residents, one of whom was receiving respite care. In each case a comprehensive assessment of the residents’ care needs had been undertaken in advance of the placement at Coppermill commencing. Letters are sent by the home to confirm that the home will be able to meet the prospective resident’s assessed needs. The home’s management also undertake their own specialist assessments of need, including ‘handling’ assessments, ‘pressure sore’ assessments, and ‘mental capacity’ assessments. The latter is in response to the requirements of the Mental Capacity Act, and is a practise that is also commended. Coppermill Care Centre DS0000038202.V367936.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 good. This judgement has been made using available evidence including a visit to this service. Residents health, personal and social care needs are fully met, residents are fully protected by the home’s medication policies and procedures, and residents are treated with respect and their privacy upheld. EVIDENCE: We examined three care files in detail, including one for a resident receiving respite care. Each file contained a detailed and individualised care plan. The care plans were based upon the comprehensive assessments and provided the care staff with specific instructions on how to met the residents’ care needs. Personal care and health care were covered in sufficient detail but social care was not. However we subsequently interviewed an activity co-ordinator who demonstrated that social needs were fully dealt with using a different format (see activities outcome group). The care plan of the resident receiving respite care was dated two days after he moved in. Whereas the care files of the long-stay residents contained recent photographs, that of the respite resident contained no photograph. The Manager said this was because although the home has a digital camera, it does not have a colour printer. Therefore photographs are only printed fortnightly when the administrative assistant is able to visit a photography shop. Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 12 We saw evidence of regular reviews of care plans, and the involvement of residents and their relatives in drawing up and agreeing the contents of care plans. We also saw a care plan specifically related to the Mental Capacity Act that detailed any restraint or restriction imposed upon the resident (such as locked doors to the dementia care unit, or the prescription of medication to reduce aggression or agitation). The provision of health care to residents is clearly documented within the care files where records show the dates of General Practitioner and Community Nurses, dentists and chiropodists. The Manager said that no residents had any pressure sores. Residents’ weights are recorded monthly. We suggested an improvement to the recording system that was immediately put into effect. The Manager reported that a dietician had visited the home and been well satisfied. We sampled the medication storage facilities within the care home, and checked the recording of medication administration, its receipt and its disposal. We also noted the medication training records of those senior members of staff allowed to administer medication. Everything was in order. Care staff are trained during their induction and subsequently via supervision to ensure that residents are treated with dignity and their privacy respected. We talked in depth to one resident who confirmed that this happened in practice. She said she was very pleased with the way the home was managed. A similarly high level of satisfaction was reported by residents and their relatives when we undertook surveys for our Annual Service Review. Completed surveys were received from 3 residents, 11 relatives of residents, and 1 visiting health professional. All demonstrated a high degree of satisfaction with the home. Typical comments from residents included, Coppermill meets all my needs, Everything is okay, I have no faults to complain about, and I can say that the Home is very nice and the patients are very well cared for. The staff as a whole are very friendly. Typical comments from relatives included, I have never seen anything that would worry me about leaving my wife in their care, The home is kept very clean, Extremely good staff, very aware of health issues, They are polite and create a relaxed mood, and The care home treats the elderly with dignity and respect. The pharmacist who visits the home said, I find all their work very professional. Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 13 Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ social, cultural, religious and recreational needs are very well catered for and family and community links are well maintained. Residents are offered real choices and encouraged to maintain their financial independence. The diet is said to be wholesome, appealing and balanced. EVIDENCE: One of the care files we examined contained a ‘life-story’ written by the husband of a resident who now has dementia. We were also shown social activity records by one of the home’s activity co-ordinators that demonstrated that a ‘map of life’ is compiled on each resident in order to appreciate their interests and preferences. A 7 day a week timetable of activities is then drawn up to meet their social and recreational needs. This process is commended. Coppermill now employs three activity co-ordinators so that each unit within the home can benefit from their specialist input. On the day of our inspection we noted bingo being played, and a quiz being enjoyed. In both instances a large number of residents were involved. This degree of involvement is also commended. In addition to regular day outings, six residents plus staff have recently had a holiday together in Bognor Regis. This development is further commended. Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 15 An activities folder for the benefit of relatives was noted. Relatives are encouraged to visit the home and annual relatives’ meetings are held. Barbeques and garden parties are held to which relatives are invited. The home also produces a newsletter for residents and relatives, a facility that is commended. Roman Catholic and Anglican priests take turns in officiating at a monthly church service within the home. This is an example of choice as both priests are said to welcome people from the other main faith group. Residents are also provided with information about local services for minority faith interests and details of activities available locally for residents of ‘other than heterosexual orientation’ is also available. This is commended. Residents and their relatives are encouraged to handle their own financial affairs, and the use of individual financial or legal advisors is facilitated by the home. Residents told us that they were pleased with the food served. A dietician has checked the menus and the Manager says she was well satisfied. We checked the menu and found that a full choice was available at every meal. Residents are involved in devising the seasonal menu. Special meals are provided from time to time, for example on St. Patrick’s Day. This practice is commended. Coppermill Care Centre DS0000038202.V367936.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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident that any complaint will be fully investigated, and that residents are appropriately protected from abuse by staff who have been trained in the procedures for reporting abuse. EVIDENCE: The AQAA provided to us by the home states that no complaints have been made to them since before the previous CSCI inspection, and that no referrals to Hillingdon’s Safeguarding Adults co-ordinator have been necessary during the same period. No complaints have been made to the CSCI about the home in recent times, indeed the feedback from residents and relatives as detailed in the ‘health and personal care’ outcome group of this report is very positive. We examined the home’s complaints leaflet and found it to be satisfactory. We examined the home’s records of staff training in the Protection of Vulnerable Adults and found them to be in good order and demonstrating that almost all the staff have been appropriately trained. Those not yet trained, are scheduled to receive the training during September 2008. The home has the appropriate policies and procedures in place. Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well designed, decorated, equipped and furnished, and one that is mostly clean and safe. EVIDENCE: Since the previous CSCI inspection, the hairdressing room, staff room and laundry have been relocated, and an additional secure unit for 9 residents with ‘early-stage’ dementia has been created on the ground floor. The later has resulted in the loss of one bedroom, which is now an additional dining room. Further building work is under way to create a café area where residents and relatives can purchase food and drinks and mix with staff in an informal environment. When this project has been completed, the Manager reports that further improvements will be made to the upstairs of the home by replacing additional worn and soiled communal carpets. Other improvements already achieved include the creation of a bar-be-que within the secure garden, the replacement of some carpets in communal areas with wooden laminate flooring, the installation of air-conditioning in upstairs lounges and improved ventilation in upstairs corridors. Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 18 Other than some soiled carpets, the home was seen to be clean, hygienic and free of malodours. Infection control has been enhanced by the installation of liquid soap and paper towels throughout the home. However a check of hot water temperature records demonstrated that at two wash-hand basins used by residents, the ‘hot’ water was being supplied at only 24 degrees instead of the required 42 degrees Centigrade (plus or minus 2 degrees). Coppermill Care Centre DS0000038202.V367936.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents’ needs are well met by a carefully recruited and excellently trained workforce. EVIDENCE: We examined a current staffing rota and observed that sufficient staff were on duty throughout the home. The Manager reported that the home currently had no staff vacancies, but that occasionally temporary agency staff have to be used. A third social activity co-ordinator has been recruited, which is commended. The Manager reports that 70 of the care staff have NVQ awards in care. This is commended. We examined in detail a recent recruitment file and found that all the necessary checks had been fully undertaken. The recording of information within the recruitment files was seen to be excellent. Staff training records are also excellently kept and demonstrate that mandatory training has been completed by staff members together with, for example, training in dementia care, NICE guidelines on pressure sores, the Mental Capacity Act, and infection control. All the care staff are scheduled to undertake Equality and Diversity training in September 2008, which is commended. Everyone has an individual training and development plan. Coppermill Care Centre DS0000038202.V367936.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is excellently managed, is operated safely, and residents’ best interests are well safeguarded. EVIDENCE: The Manager has obtained the Registered Manager’s Award, and this qualification has also been achieved by one of the home’s Floor Managers, which is commended. The Manager has been at the home for 4 years and has been very successful in driving up standards and meeting the requirements we have made previously. The home has an annual business plan for the year ahead, split into monthly action plan sections in order to plan its implementation. Quality Assurance surveys are undertaken annually and we saw the analysed results of the previous survey. Relatives meetings are held annually to further ascertain their views. We observed a suggestion box in the foyer of the home. The Manager has plans to establish a forum with relatives acting as Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 21 representatives for residents of the dementia care units, which is commended The home also produces a newsletter, and use is made of advocates. We examined sample financial records of monies held by the home on behalf of residents. The money had been spent appropriately by residents and only on ‘luxury’ items. Residents’ financial or legal advisors are automatically sent copies of the expenditure, which is commended. In terms of health and safety, we examined hot water temperature records and ascertained that the water was mostly at the correct temperature. A requirement has been made under the Environment Outcome Group. We also examined fridge and freezer temperature records, lift maintenance records, and we tested the call-bell system. Risk assessments were seen to be in place. Coppermill Care Centre DS0000038202.V367936.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 4 x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 4 x x 3 Coppermill Care Centre DS0000038202.V367936.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 OP7 Regulation 17(1)(a), Sch 3(2) Requirement Timescale for action 01/10/08 2 3 OP26 OP26 23(2)(d) 23(2)(j) The home must have a photograph of every resident including those receiving respite care in order to aid in their identification especially when medication is being administered. Soiled and worn carpets in 01/05/09 upstairs communal areas must be replaced with new flooring. The temperature of hot water 01/10/08 dispensed at wash-hand basins used by residents must be 42 degrees plus or minus 2 degrees. 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 Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Coppermill Care Centre DS0000038202.V367936.R01.S.doc Version 5.2 Page 25 - 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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