Care Home: Croftside

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What the care home does well All prospective residents are fully assessed prior to a place being offered. The manager is always mindful of the needs of those already living in Croftside when the assessments are carried out and there is a trial period before the placement is made permanent. This is seen as a safeguard to all concerned. All those using this service have a full plan of care that is generated from the initial assessment of needs. These are updated regularly to meet any changing needs. Medication records are kept in an appropriate way ensuring the safety of those living in the home. Recreational activities are provided for those wishing to join in and a varied nutritious diet is provided. Environmental standards within the home have improved ensuring the home is safe, warm and comfortable.There is an experienced and well-trained staff team providing a good level of care and support. The recruitment policy means that those using this service are safeguarded at all times. Staff training is in place with training courses currently being organised by the manager. What has improved since the last inspection? New curtains have been purchased for the lounges together with new lounge chairs. Seven residents` rooms have been re-decorated and the home manager is hoping to be able to purchase new lounge carpet in Derwent unit to match that already laid in the dining area. A new care planning system has been introduced and the manager and staff are in the process of changing all the current records over to the new format. New garden fencing has been erected which has ensured the garden area is secure for any residents wishing to spend time outdoors. The garden area has been greatly enhanced by the planting of bushes and plants, which is greatly appreciated by the residents. CARE HOMES FOR OLDER PEOPLE Croftside Beetham Road Milnthorpe Cumbria LA7 7QR Lead Inspector Mrs Margaret Drury Unannounced Inspection 09th July 2008 09:30 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 Croftside DS0000036503.V367774.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. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croftside Address Beetham Road Milnthorpe Cumbria LA7 7QR 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) 015395 63325 www.cumbriacare.org.uk Cumbria Care Mrs Shirley Robson Care Home 35 Category(ies) of Dementia (35), Old age, not falling within any registration, with number other category (35) of places Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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 (maximum number of places: 35) Dementia - Code DE (maximum number of places: 35) The maximum number of service users who can be accommodated is: 35 Date of last inspection 31st July 2007 Brief Description of the Service: Croftside is owned by Cumbria Care, an internal business unit of Cumbria County Council. The home is registered to provide care and accommodation for up to thirty-five older people, including fifteen with various forms of dementia. Croftside is situated in a residential area of Milnthorpe and is close to all local amenities, shops and bus routes. It is purpose built and situated over two floors, the upper floor being serviced by a passenger lift. All rooms are single and personal to each resident. The ground floor of the home is used for the care of those residents with dementia. It is comprised of a large, airy lounge and a dining room with kitchen facilities, a small smoking lounge and residents’ bedrooms. There are also bathing and toilet facilities available. The first floor is spilt into two units caring for frail elderly residents. There is a lounge/dining room on each unit together with residents’ rooms. All bedrooms have wash hand basins and there are three with en-suite toilet facilities. The toilets and bathrooms on both floors are equipped to assist people with a physical disability. There are well kept gardens around the home for the residents to enjoy and car parking facilities are provided at the front of the building. The fees in this service range from £337.00 - £449.00 per week as at the date of the visit. There are extra charges for chiropody, hairdressing, newspapers, toiletries and taxi fares. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 5 This home does not provide intermediate care. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This site visit that forms part of the key inspection took place over one day in July and we (The Commission for Social Care Inspection - CSCI) were in the home for a total of 6 hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager • Survey questionnaires returned by residents, staff and family members. • Interviews with residents, visitors and staff on the day of the visit. • Looking at any information received from other professional agencies • Details of monthly visits made by the operations manager since the last inspection. We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Medication records were examined and staff training records and personnel files were also inspected. We had discussions with the manager about the running of the home, staffing and the dependency of those living in Croftside. What the service does well: All prospective residents are fully assessed prior to a place being offered. The manager is always mindful of the needs of those already living in Croftside when the assessments are carried out and there is a trial period before the placement is made permanent. This is seen as a safeguard to all concerned. All those using this service have a full plan of care that is generated from the initial assessment of needs. These are updated regularly to meet any changing needs. Medication records are kept in an appropriate way ensuring the safety of those living in the home. Recreational activities are provided for those wishing to join in and a varied nutritious diet is provided. Environmental standards within the home have improved ensuring the home is safe, warm and comfortable. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 7 There is an experienced and well-trained staff team providing a good level of care and support. The recruitment policy means that those using this service are safeguarded at all times. Staff training is in place with training courses currently being organised by the manager. 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. Croftside DS0000036503.V367774.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 Croftside DS0000036503.V367774.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): Standards 2, 3, 4 & 5 were assessed. Standard 6 is not applicable to this service so was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All those wishing to use this service are fully assessed prior to admission. This ensures their needs are recognised and fully met. EVIDENCE: Comprehensive needs assessments are completed before anyone is admitted to Croftside to ensure that the home is suitable and able to meet any requirements in an appropriate manner. When we were discussing the assessment procedure the manager confirmed that she always takes into account the needs of those already living in the home before finally offering accommodation. We looked at the assessments and care plans of six residents and found the documentation to be relevant and informative. This information is then used when drawing up the initial care plan after admission. Some of the care plans have already been transferred over to the new format recently introduced Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 10 throughout the organisation. The remaining plans will all be transferred as soon as possible. No resident is admitted without an assessment/care plan received from Social Services, after which the manager meets with the prospective resident and family members if this is considered appropriate. All residents have a contract with the home and with the Social Services Department. This home does not provide intermediate care. Croftside DS0000036503.V367774.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): Standards 7, 8, 9 & 10 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of health and personal care people receive is based on their individual needs, with the principles of respect, dignity and privacy maintained at all times. EVIDENCE: We examined the care plans for six residents, two of whom were admitted only a short time ago. The care plans were up to date and relevant to the individual. They identified the assessed needs and the assistance required whilst maintaining independence as far as possible. The care plans follow Cumbria Care’s corporate format, which has recently been completely reviewed and updated to include a more person-centred approach to social and personal care. This format will mean much more input from and discussion with those using this service when the plan of care is being drawn up. Although the staff Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 12 are finding writing the care plans a little difficult, each will be a working tool that will include an admission assessment, risk assessment and a full dietary and nutritional screening assessment tool. The plan puts emphasis on what is important to the individual and how best their needs can be met. As new residents are admitted the new format will be used. For those already living in Croftside the information will be transferred to the new documentation via a rolling programme. All records viewed during this visit indicate that people living at the home have access to health care professionals such as doctors, community nurses, chiropodists, opticians and are assisted to attend hospital appointments where necessary. It is difficult to locate dental treatment for any new residents but any treatment required is provided by the local hospital. There is a medication policy and procedure in place at the home. Staff have received training in safe handling of medication to help ensure that this is administered safely. Medicines are supplied in a monitored dosage system from Boots Chemist and the manager confirmed that the home receives an excellent service. The pharmacist visits to conduct an annual audit. We looked at a sample of medication records and found them to be correctly and neatly completed. All medication is stored correctly and any controlled drugs are recorded in the appropriate way. The manager conducts regular checks on the records and, is taking steps to reduce the amount of ‘as and when’ medication held as stock at the home. This will ensure the minimum amount of waste. Records of ‘homely remedies’ are held, together with documentation from the GP. All returned medication is recorded and signed for when collected by the pharmacy. Croftside DS0000036503.V367774.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): Standards 12, 13, 14 & 15 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are sufficiently flexible to meet changing needs and activities are available for those wishing to participate. EVIDENCE: There is no specific activities co-ordinator employed at Croftside but 2 of the supervisors take responsibility to organise outings whilst other members of staff organise, bingo, quizzes and the making of greeting cards. Some residents from the dementia care unit will join in those activities they are able to. The garden is very popular especially since one supervisor has taken responsibility for planting shrubs and flowers. Residents told us how much they enjoyed the flowers. The gardens are now completely safe for the residents to move around as new fencing has been purchased and erected. There is no set time for getting up or going to bed so those residents who wished were able to have their breakfast in their rooms and then get up at their leisure. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 14 Croftside welcomes visitors at any time and comments on the returned surveys confirmed that they are always made welcome. Some comments were concerned with the general care and support and included, “Mealtimes are an enjoyable experience, sociable, nice food and always an important part of the day” and “ Croftside gives my mother a clean, safe environment with excellent care”. During the visit we observed the way that staff interacted with those living in the home. There was a warm and friendly atmosphere and the staff were heard to laugh and joke with the residents in a respectful manner whilst still preserving their dignity. We spoke to residents during the visit and heard comments such as, “ the staff are great and I always enjoy a joke”, and “I love all the girls”. We also received survey forms from relatives that included other comments such as, “ The staff are very approachable and helpful”, “The staff involve residents in group activities and their scrapbook record of different things they are involved in is excellent work” and “Croftside provides a safe and caring environment”. There is a shop that the staff operate providing tights, basic toiletries and sweets and the residents told us this was useful if they could not get out to the shops. Meals are served on each unit and were observed to be a warm, social occasion with staff assisting those residents requiring help in a quiet unhurried manner. There is a choice at each meal and special diets are provided whenever necessary. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 & 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place with ‘protection of adults’ training provided. This helps to demonstrate that people are protected as much as possible from harm or abuse. EVIDENCE: Croftside has a complaints procedure in place and all concerns and/or complaints are recorded and dealt with within the stated timescale. We were able to confirm this by checking the written records. The residents we spoke with during the visit all confirmed that they knew who to speak to but had not had reason to complain about anything. We (CSCI) have not received any complaints since the last inspection. The home uses the corporate policy to deal with a suspicion or allegation of abuse and Social Services would always be notified of any incidents. We spoke to members of staff who were fully aware of the procedure to follow if there was any suspicion or allegation and training is provided via induction and supervision. The staff were confident in the process and would not hesitate in Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 16 speaking to the manager or supervisor if it was necessary. The home has a copy of Cumbria council’s multi disciplinary guidance available for staff to read. Croftside DS0000036503.V367774.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): Standards 19, 20, 23, 24, 25 & 26 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, hygienic and well maintained, helping to ensure that people live and work in a safe and comfortable environment. EVIDENCE: Croftside is a purpose built home set over two floors with access to the upper levels via a passenger lift. The ground floor contains the unit dedicated to the care of those residents with varying forms of dementia and is well suited to the high level of care and support required. There is a large lounge/diner, a second lounge at the other end of the corridor and a small quiet room. All the bedrooms are for single occupancy. There are bathing and toilet facilities available. There is access to the gardens and outside space. This unit has only recently been completed and is in a very good state of decoration. All the Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 18 communal areas are well furnished and there is plenty of space to allow the residents freedom of movement. Bedrooms are personal to each resident with pictures, ornaments and small items of furniture brought from home. There are handrails on the corridor to assist with walking around the building. The kitchen and laundry facilities are also situated on this floor, the laundry being well away from the kitchen area. On the first floor there are two units comprising two lounge/ diners, residents’ bedrooms and small sitting areas providing extra space for the residents to enjoy. There is also a small balcony that is used during the warm weather. The corridors are wide with handrails for ease of movements between the units. The home is quite well furnished and some new carpets, lounge chairs and curtains have recently been purchased. Since the last inspection seven of the bedrooms have been re-decorated and the manager works with the estates manager to ensure the building is as well maintained as the budget will allow. Croftside DS0000036503.V367774.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): Standards 27, 28, 29 & 30 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team have been correctly recruited and have the necessary skills and experience to provide a good standard of care to older people. EVIDENCE: We looked at the staffing levels in the home and found them to be sufficient to meet the daily needs of those living there. There are only 2 members of staff on duty during the night although the manager did advise us that should it be required at any time an extra carer would be brought in. It was recommended that consideration should be given to the number of night staff employed. Staff turnover is low and there is an experienced and well-trained team of staff who work closely with the manager and people’s relatives to ensure people receive a personalised and consistent service. Although there are a small number of staff hours vacant, these are covered by regular agency staff who are known to the residents and provide consistent care. Three new members of staff are in the process of completing their induction and we were able to speak briefly to one during the visit. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 20 We observed a warm understanding between the staff and residents and it was obvious the staff knew the residents well. The residents responded in a friendly manner and commented to us that, “the girls are lovely and so friendly”. There have been one new members of staff recruited recently and we checked their personnel files. These contained all the relevant documentation to meet the National Minimum standards including, an application form, references and a contract of employment. No new member of staff starts work until and enhanced Criminal Records Bureau (CRB) check has been completed. The recruitment process is completed at the organisation’s head office but the manager is hopeful that she will be more involved in the selection of her own staff in the future. There are 75 of the staff qualified to NVQ level 2 and any new staff will be given the opportunity to undertake the qualification. Training is ongoing with courses completed in the following, manual handling (trainer), Mental Capacity Act, Palliative Care, Equality & Diversity and Health & Safety. Training records are kept on the individual personal development files. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 21 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): Standards 31, 32, 33, 35, 36 & 38 were assessed. 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 efficiently and effectively and continues to provide an appropriate service that responds to people’s needs and preferences. EVIDENCE: The manager, Mrs Shirley Robson was appointed to Croftside last year and has recently been registered with CSCI. She has a wealth of experience in caring for older people, having previously managed another home within the Cumbria Care organisation. She has completed the Registered Manager Award and has started her NVQ level 4 in care. She has an open style of management and is Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 22 committed to ensuring those living in the home are provided with the highest possible standard of care. In discussion with staff and residents there was the general feeling that she is approachable and fair. The supervisor on duty during the visit told us how she appreciated all she has done since taking up her post and the support she has given to staff and residents. A comment made by one of the residents was “ Shirley, is wonderful and you can speak to her at any time, she is never too busy”. She has a warm and open style of management that is appreciated by those who live and work in the home. Croftside does hold personal monies on behalf of some of the people who live there and there are procedures in place with the records appropriately and adequately kept. All income and expenditure is recorded and signed by 2 members of staff with a monthly audit completed. Receipts for all expenses are held for each individual resident. Staff supervision is up to date with records held on file. All annual appraisals have recently been completed. All equipment is serviced via annual service level agreements and staff training is in place on respect of fire safety. The organisation’s health and safety officer completes an annual audit highlighting any work to be completed. All risk assessments are in place, which demonstrates the health and safety of those living and working in the home are always under review. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 23 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 3 3 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 3 3 X 3 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 24 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. 1. Refer to Standard OP27 Good Practice Recommendations It is recommended that consideration be given to increasing the number of waking night staff to deal with he increasing dependency of those living in the home. Croftside DS0000036503.V367774.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Croftside DS0000036503.V367774.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. 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