Care Home: Drakelow House

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What the care home does well The atmosphere in the home was warm, welcoming and friendly. People living in the home said that they enjoyed living there and that they were well looked after and staff were very good. One resident told us, "I am very happy in the home. I am well looked after. The food is good. The staff are friendly and caring". The home is maintained and furnished to a high standard that adds to the comfort and well being of the residents. Each resident has a plan of care that staff use to provide support and help to that individual. These plans are person centred and focus very much on what the resident is saying they need, not what the home thinks they need. This helps the resident to maintain a good quality life in which they take an active part in making decisions for themselves. What has improved since the last inspection? When staff are recruited to work in the home the manager now ensures that all relevant pre-employment checks are carried out before the person starts working in the home. This minimises the risk to residents from unsuitable people being employed to work in the home. A new cook has been employed which has reduced the pressure on care staff to prepare meals every day. This allows care staff more time to spend with the residents. What the care home could do better: The manager does not routinely notify the Commission for Social Care Inspection of events that affect the wellbeing of residents in line with regulations. This must be addressed. CARE HOMES FOR OLDER PEOPLE Drakelow House 64 Parsonage Road Heaton Moor Stockport Cheshire SK4 4JR Lead Inspector John Oliver Unannounced Inspection 19th February 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 Drakelow House DS0000008553.V358239.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. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drakelow House Address 64 Parsonage Road Heaton Moor Stockport Cheshire SK4 4JR 0161-432 4033 NO FAX 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) Miss Gloria Dawn Patten Miss Gloria Dawn Patten Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 18 OP. Date of last inspection 26th June 2006 Brief Description of the Service: Drakelow House provides residential care for up to 18 service users over the age of 65. The home is owned and managed by Gloria Patten. Drakelow House is situated in a residential area of Heaton Moor, approximately a quarter of a mile away from shopping facilities and the local health centre. Stockport town centre is approximately a mile away. There is off-road parking for up to four cars, with further parking on Parsonage Road. There are mature gardens to the front and side of the house where, in good weather, service users are able to sit out. Accommodation is provided on the ground and first floors. Access to the first floor is by stairs and passenger lift. The home has been extended to provide single bedroom accommodation to all service users and nine bedrooms have en-suite toilet facilities. The home has a statement of purpose and service user guide which were reported to be given to prospective service users or their families when they visit the home to look round. Copies of these are also within service users’ bedrooms. The fees for staying at the home were reported to be between £364 and £374 per week. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We came to this quality rating at the last key inspection. The inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Commission for Social Care Inspection) in relation to the home prior to the site visit. This visit, which the home did not know was going to happen, took place over the course of six hours on Tuesday, 19th February 2008. During the course of the site visit we spent time talking to the residents, the registered manager (owner) and staff on duty to find out their view of the home. Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information about the service they provide. This was returned before the visit took place and contained some information that helped to us to assess the service being offered by the home. We also spent time examining various files and written information and spent some time looking around the building. What the service does well: The atmosphere in the home was warm, welcoming and friendly. People living in the home said that they enjoyed living there and that they were well looked after and staff were very good. One resident told us, “I am very happy in the home. I am well looked after. The food is good. The staff are friendly and caring”. The home is maintained and furnished to a high standard that adds to the comfort and well being of the residents. Each resident has a plan of care that staff use to provide support and help to that individual. These plans are person centred and focus very much on what the resident is saying they need, not what the home thinks they need. This helps the resident to maintain a good quality life in which they take an active part in making decisions for themselves. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 6 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. Drakelow House DS0000008553.V358239.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 Drakelow House DS0000008553.V358239.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents are provided with information regarding the service prior to admission and receive a full assessment of their needs. EVIDENCE: We saw that copies of the service user guide and statement of purpose were on display in the reception area of the home. These documents provide relevant information about the home and the service that is offered and provided at Drakelow House. The manager told us that both documents had been reviewed and updated since the last inspection visit. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 9 The manager told us that all prospective residents are assessed prior to being admitted into the home and we looked at the file of one recently admitted resident. We saw that an assessment of need had been carried out by social services and by the manager of the home. This information was then used when developing an initial care plan for the resident. Wherever possible, all prospective residents are invited to visit the home on a trial visit to meet other residents and to have an opportunity to look around and ask any questions they may have. The manager told us that the home did not provide an Intermediate Care service. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Care plans were in place that detailed the needs of the individual resident and medication was handled safely, although some improvements could be made. EVIDENCE: Each resident living in the home had an individual care plan on file. These plans have been developed from the initial assessments carried out prior to moving into the home and then further developed on an ongoing basis. Those care plans we looked at included information relating to health and personal care needs, mobility, social interests and risk assessments, and were reviewed by the manager on a monthly basis. Information was very person centred and clearly identified what the individual person expected and chose to do, for example:; ‘… gets herself up independently. … Likes to get up around 9am. … Will bring herself down to the dining room for her breakfast. … goes to bed between 10pm & 11pm…” Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 11 We also saw evidence where staff in the home are managing a difficult situation between two residents. Relevant advice has been sought from other healthcare professionals and details and information were in place to support staff in the management of the situation. Daily records were detailed and concise and gave a full picture of how the home was meeting the residents’ care needs and how residents spent their day. We spoke with a number of residents and comments included, “Good staff, beds are changed and made every day and your clothes are kept clean”, “You can see the doctor when you need to”, “You come and go virtually as you please – I’ve got a television in my room” and “We are well looked after”. Evidence was available in records to show that residents had access to other healthcare professionals, such as district nursing services, general practitioner support and optician and chiropody services. Medication is administered via a monitored dosage system provide by a local pharmacy. Medication Administration Records (MAR’s) had been completed appropriately and each record contained a photograph of the resident for ease of identification. At the time of this visit the manager told us that no resident was prescribed controlled drugs or homely remedies. Prescriptions are collected by the pharmacy and medication is then dispensed directly to the home. It would be better if the manager arranges for the prescriptions to be delivered directly to the home so that she can check what has been prescribed for each resident for the month and to check for any errors that may have been made. We saw that some medication, such as eye drops, were not individually labelled with administration instructions, only the outer container was. This increases the potential risk for errors to occur should the outer container be misplaced. The manager said that she would contact the pharmacy and arrange for actual eye drop bottles to be labelled. We also saw that some discontinued medication was still appearing on the monthly MAR for some residents. This has the potential to confuse staff when administering medication and such directions should be removed from the MAR. The manager told us that all staff with the responsibility for administering medication had received appropriate training, although no formal assessment of the individual staff’s competency had been carried out. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Daily routines in the home demonstrated that residents were encouraged to maintain control over their lives, were encouraged to maintain contact with the community and are provided with a wholesome and well balanced diet. EVIDENCE: The day-to-day routine of the home enabled residents to spend time in their rooms or the lounge areas. Residents told us that they could get up and go to bed at a time that suited them and they could spend the day how they chose. We saw that activities take place but are fairly limited. However, residents spoken to said that they were happy with the activities that are available. A number of relatives returned survey questionnaires to us and comments about activities in the home included: “I have observed activities and the efforts made by the staff to engage the residents in activities. However, many resist taking part so it is very hard for the staff to do this”. In one survey returned to us by a resident it stated, “Do not wish to take part in activities – prefer to stay in room”. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 13 One resident we spoke to said, “We go out when the weather is fine. Harry Ramsdens (restaurant) and then a trip on the canal. Last summer we went to Liverpool and Southport. I occasionally play bingo but the activities we do get are enough for what we want”. Residents told us that visitors were made welcome at the home and that they were enabled to keep in touch with family and friends. One resident told us, “My friend visits every weekend”. The manager of the home sees meal times as a ‘social interaction’ time and, as such, ensures that residents can enjoy their meals in a relaxed and comfortable atmosphere. Since the last inspection visit to the home the manager has recruited a cook onto the staff team, which has reduced the pressure on care staff to prepare meals every day. The manager told us that both she and the cook had completed in-house training called ‘Safe food better business’ which is supported by the Food Standards Agency. A record is kept on a daily basis of the meals each resident has to enable the staff to monitor that appropriate nutritional intake is being maintained. Residents spoken to told us, “I enjoyed my lunch – had meat pie and chips”, “I like stew and always get offered more”. “You can have more food if you want”. One resident likes to order his own fruit and vegetables from a local supermarket that then delivers the order to the home. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People using the service felt that their complaints and concerns would be taken seriously and acted upon but staff would benefit from training in this area. EVIDENCE: There is a complaints procedure in place that was readily accessible to both residents and visitors to the home. The procedure encourages people to make their views and opinions known so that if there are any concerns, however slight they might be, the staff team can try to address them. Residents spoken to were very clear about who they would speak with should they have any worries or concerns and residents told us, “I would go to Gloria (manager)”, “I would speak with one of the girls” and “I know I would never have to complain – but if I did I would speak with one of the staff”. Seven resident survey questionnaires were returned to us before this inspection visit and all confirmed that people knew who to speak to if they were not happy or needed to make a complaint. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 15 Records were maintained of concerns raised by residents, which were mainly around food likes and dislikes and that sometimes you get too much! The format used to record concerns/complaints did not detail sufficiently enough the processes used when investigating a complaint and did not record a final outcome from any investigation that may have been carried out. This was fully discussed with the manager. The Commission for Social Care Inspection had received no complaints about the service since the last visit to the home. The manager told us that no safeguarding referrals had been made since the last inspection of the home took place. Discussion with the manager demonstrated that she understood the principles of adult protection and the procedures to follow should an allegation be made. One member of staff spoken to said that she would “inform the manager” if she had any concerns regarding abuse, but was not clear what she would expect the manager to do should she report an incident. It is important that all staff know the procedure that should be adopted in the event of an allegation of abuse being made. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The environment was extremely clean, tidy and comfortable with systems in place to protect and monitor the health and safety of those residents living there. EVIDENCE: The home is set in attractive, well kept gardens and grounds that provide suitable outdoor space for residents should they wish to us it. On entering the home the atmosphere was found to be very homely and welcoming. We looked around most of the premises, which we found to be extremely well maintained throughout, and provide appropriate and very comfortable accommodation for those people living in the home. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 17 Furnishings such as lounge chairs and dining tables and chairs were domestic in their style and are of good quality, adding to the comfort of residents. All parts of the home were clean, tidy, bright and airy and were totally free from any unpleasant odours. Those bedrooms seen had been personalised to varying degrees and reflected the character of the person whose room it is. We saw that a number of residents liked to spend time in their own rooms watching television or listening to the radio. Residents also had the choice of having a key to lock their rooms for added privacy. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Sufficient numbers of staff are employed in the home and a robust recruitment and selection process is in place that helps protect residents from unsuitable people working in the home. EVIDENCE: Drakelow House employs a small but consistent group of staff and a rota was available to show which staff were on duty at any one time. Staff and residents spoken to during the inspection said that they felt there were usually enough staff on duty, although in one survey returned by a relative it said, “If there is an issue about quality of care it would be about staffing levels”. We looked at the files of two most recently recruited members of staff. All had relevant pre-employment documents in place, including an application form, two appropriate written references, an enhanced Criminal Record Bureau (CRB) disclosure or POVA First and a job description. Further discussion with the manager demonstrated that she was clear about checking any gaps in employment details and in making sure relevant information was obtained to verify an applicant’s details, such as a copy of a birth certificate, driving licence and a photograph. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 19 New staff completed a period of induction training at the commencement of their employment and this also included ‘shadowing’ an experienced member of staff but no written confirmation of any induction training carried out was on file. Each member of staff had a training record on their individual personnel file but these were not all up to date with training staff had completed. The manager told us that she was in the process of auditing all staff training. On completion, she said that she would then be arranging updated and refresher training for individual members of the staff team. At the time of this inspection visit, three members of the care staff team were working towards obtained a National Vocational Qualification (NVQ) at Level II. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is well managed for residents and care staff are appropriately supervised. The health and safety of residents and staff is, in the main, safeguarded. EVIDENCE: The manager is also the registered owner of the home and has many years’ experience of caring for older people. She told us that both she and her deputy had recently completed the National Vocational Qualification (NVQ) Level 4 in management and care (Registered Manager’s Award). Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 21 A clear record is maintained of any accidents involving residents and a monthly analysis is completed to monitor individual residents, for example, increase in number of falls. This sort of information has resulted in changes being made to care plans and support routines to help minimise any identified risks. Further discussion with the manager highlighted that she was not completing Regulation 37 notifications when accidents or injuries to residents were occurring and especially those requiring hospital treatments. It is important that the Commission for Social Care Inspection is notified of all such incidents in order that an accurate record of information about the home can be maintained and regulatory requirements met. Staff received regular supervision to support them in their work and records of such meetings were seen to be on staff files. Regular staff meetings are held and these create opportunities for staff to contribute and share ideas and opinions about their work in the home. The manager told us that she had no involvement in managing residents’ finances; this remained the responsibility of the resident and/or their relatives/ advocate. Small amounts of money were held for residents to purchase small items and systems were in place to ensure the safe handling and storage of residents’ monies. Regular residents’ meetings are held and the majority of residents attend and contribute to the meeting, sharing their views and opinions. The manager told us that the maintenance and servicing of equipment used in the home had been carried out and a random selection taken from the service records during our visit confirmed this. Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 37 Requirement Regulation 37 notifications must be sent to the Commission for Social Care Inspection when necessary. Timescale for action 19/02/08 Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations a) Monthly prescriptions should be seen by the management of the home prior to being sent to the pharmacy for dispensing. b) The manager should contact the pharmacy to ensure that all medication is suitably labelled and not just the outer container, e.g., eye drops. c) The manager should contact the pharmacy and request that all details relating to discontinued medication be removed from medication administration records. d) The competency of staff with the responsibility for administering medication should be assessed on a regular basis. The way in which complaints are recorded should detail the processes used during investigating the complaint and also record the final outcome/conclusion. All staff should receive training in the protection of vulnerable adults. Staff training records should be brought up to date and training/refresher training be arranged for individual staff where required. 2 3 4 OP16 OP18 OP30 Drakelow House DS0000008553.V358239.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Drakelow House DS0000008553.V358239.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. 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