Care Home: Sharon House

Similar services:

• Cowden Road, 52 - 54
• Norbury Crescent (30)
• Chatsworth Care - Tudor Lodge
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House

What the care home does well People living at Sharon House say they like living there, that they get on well with the staff and are well cared for and supported. The staff team has been consistent and stable for a long time and know the people living there very well. Staff and residents have good relationships, which enable the residents to feel secure. The house is kept clean and comfortable for benefit of the people living there. People are encouraged to keep in touch with their family and friends. The home is small, homely and intimate. It feels like a real home to the residents, who said they value the atmosphere. What has improved since the last inspection? Requirements made at the last inspection have been actioned. Improvements are being made to the written risk assessments for residents and a staff member is booked to attend risk assessment training. Residents now have health care plans in place. Staff training gaps in food hygiene and diabetes awareness are remedied. Staff photographs are up to date . Pharmacy advice on secondary dispensing of medication has been obtained. Supervision records are retained on file. CARE HOME ADULTS 18-65 Sharon House 24 Sharon Road Enfield Middlesex EN3 5DQ Lead Inspector Margaret Flaws Unannounced Inspection 10th July 2008 11:00 Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 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 Sharon House DS0000010653.V367298.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 Adults 18-65. 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. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharon House Address 24 Sharon Road Enfield Middlesex EN3 5DQ 020 8804 5739 F/P 020 8804 5739 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) Mr Chandra Jootun Mr Chandra Jootun Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as either of the specified service users vacates the home. 8th November 2007 Date of last inspection Brief Description of the Service: Sharon House is situated on a quiet residential road in Enfield, a short walk from Brimsdown train station. Residents can reach Enfield Town by bus or train. The home is registered for 5 adults aged between 18 and 65 years who have a learning disability. There is a condition allowing the home to continue to care for two people who are now over the age of 65. The home is owned and managed by Mr Chandra Jootun. The cost of placements was reported by the registered manager to be £570680 per week. Following Inspecting for Better Lives, the provider must make information available about the service, including inspection reports, to residents and other stakeholders. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over one day. During the visit, we spoke to two staff team members and three residents who were at home. The inspection also comprised a tour of the grounds and the building, a review of written records including the care files of two residents and records of health and safety, medication, residents’ activities and the food served in the home. The Registered Manager was spoken to by phone on the day after the inspection. A basic Annual Quality Assurance Assessment (AQAA) was completed and returned to CSCI. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. What the service does well: What has improved since the last inspection? Requirements made at the last inspection have been actioned. Improvements are being made to the written risk assessments for residents and a staff member is booked to attend risk assessment training. Residents now have health care plans in place. Staff training gaps in food hygiene and diabetes awareness are remedied. Staff photographs are up to date . Pharmacy advice on secondary dispensing of medication has been obtained. Supervision records are retained on file. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 6 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. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living in the home have had their individual aspirations and needs initially and regularly assessed. Prospective residents can be confident that their needs and mutual suitability would be fully assessed prior to admission. EVIDENCE: No new residents have moved into the home for over four years. The standards about the admission process were not inspected in depth. There is a clear referral and assessment procedure in place to ensure that the needs of any prospective residents are appropriately assessed. The home had one vacancy at the time of the inspection. In the two care files we examined, thorough assessments had been completed. Reviews by placing authorities were done annually and were positive about the care provided at the home. Internal review and reassessment of people’s needs and aspirations are ongoing and documented. Sharon House is a small, family-like home and staff demonstrated a positive approach to review and ongoing assessment. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 9 Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living in the home are involved in making decision making about the home and their own lives. People have individualised, accessible care plans that set out their needs and are regularly reviewed, in consultation with them. Improvements have been made to make these plans more understandable to the people living in the home. Written risk assessments are improving, incorporating the knowledge that staff already have of the risks and opportunities for each individual. EVIDENCE: We reviewed the care files of two residents. Each person’s file included written care plans, which had been reviewed regularly. They were of a good standard and addressed relevant areas of people’s lives. One staff member described how person centred accessible plans had been developed over the previous few months. We examined one Person Centred Plan. It was written in clear English, in an accessible format and contained good visual Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 11 illustrations. The plan was comprehensive. The residents we spoke to described how they were involved in planning their goals and how staff supported them to achieve these goals. Both staff members on duty demonstrated an excellent knowledge of the individual needs of each person living in the home and this was reflected in the quality of the care plans produced. The care plans were up to date, thoughtful and practical. The residents had signed off the plans, which were developed during their one to one sessions with the staff. Because the home has had a stable staff team, with no changes over several years, there is continuity of support. Financial arrangements for the residents are clear and evidence seen indicated that the residents were protected by these arrangements. One resident has recently been supported to make a will. Throughout the day, in the interactions we observed, the residents appeared confident and comfortable in expressing their wishes to staff and to each other. Menu planning and discussions about outings were interactive, animated and positive. Cultural and spiritual choices were discussed and these are documented, for example, in Person Centred Plans. Staff spoken to had a good understanding of the value of independence and choice for the residents. One person said that the reason the staff worked in the home was to understand each resident, listen to and respect them, to be clear about each person’s needs and meet them – “that is why we’re here and that is why they’re here”. Three people are accompanied when they go out of the home and one resident goes to the shops and into the local community on his own. At the previous inspection, the scope of the risk assessments were discussed with the Registered Person. The previous inspector noted at the time: “A lot of the practice around working positively with residents with the risks in their lives has evolved over time and is known to all staff, thus the risk assessments are very brief”. Since the last inspection, some improvements have been made to written risk assessments and one staff member is booked on risk assessment training, meeting the previous requirements. Staff were very clear about how they manage risks and how they support people living in the home to develop and stretch their capacity. For example, staff described how they had worked with one resident to increase his confidence and skill in walking. Another example given was the way in which a resident, who came from an older peoples’ home in poor condition, was helped to improve his wellness and his engagement with the world. He is now a very mentally and physically active man. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 12 Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living in the home have the opportunity to develop as people and maintain important personal and family relationships. Individual rights and choices are supported by the home and the home’s ethos. People living in the home are involved in meaningful daytime activities of their own choice, which match their individual interests and capabilities. They are also involved in the domestic routines of the home, taking responsibility where they are able. Food is varied, balanced, interesting and chosen by the residents. EVIDENCE: The inspection took place during the day and three out of the four residents were at home. One person was at day centre. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 14 Activities are an integrated part of the resident’s daily lives. There are good written records and plans for activities. There are individualised pictorial materials from the day centre showing activities to choose from. We reviewed two care files, checked the activity folders and planning tools and talked to the residents about how they spent their time. They said that they enjoyed going out, for example, to college, and felt supported to do so. Regular activities include baking, games, arts and crafts, puzzles, gardening, walks, cinema, trips to Enfield Town, domestic activities and contributing to the running of the household. One resident said that he loves reading and writing. Most residents attend colleges and day centres during the daytime. Residents are supported and encouraged to maintain contact with relatives and friends. One resident often stays with a relative and they sometimes go on holiday together or for day trips. Visits by friends were recorded in the visitors’ book. Two people living in the home are brothers. One said he was very pleased to be able to continue living with his brother after their parents had died. Food in the home appeared to be healthy and of good quality. There was plenty of fresh fruit and vegetables in the fridge and the freezer and the cupboards were well stocked. Lunch was a nicely cooked meal of vegetables and a liver casserole, followed by dessert. The residents said that they enjoyed the food and said there is a good variet always available. During the inspection, the residents and a staff member discussed and planned the menu for the next few days based on what the residents said what they would like to eat. Staff are updating food and hygiene training, meeting a requirement from the last inspection. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living in the home have their physical and emotional healthcare needs met through good quality planning and supportive intervention. Staff encourage people to be independent and to take responsibility for their own personal care needs. Medication policy and procedures are sound and protect people living in the home. An issue around secondary dispensing has been safely addressed. EVIDENCE: Because the residents are generally quite independent, staff generally just prompt them for personal care. This support is well documented in the care plans. The residents spoken to said that the staff respected their privacy. The two written records examined had very good information on people’s health care needs and how they are monitored. There was evidence of regular check-ups and appointments, for example, with dentists, doctors and opticians. The chiropodist was due to visit on the day of the inspection. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 16 Health care plans are now in place, meeting a requirement from the last inspection. These are clear and easy to follow. The residents we spoke were able to describe how some of their health care needs are met. Two residents in the home are diabetic and their care needs are managed with support from health care professionals. Staff are updating training in this area, meeting a requirement from the last inspection. Medication policies and procedures in the home are safe and protect eh people living there. Medication is stored appropriately in a locked cupboard in the office. The Medication Administration Records (MAR charts) were good, with no gaps or errors noted. One staff member showed us the records of medication received into and leaving the home. These were clear and accurate. Medication cupboard temperatures were monitored and recorded. In response to a requirement on secondary dispensing made at the last inspection, the home consulted with their pharmacist to explore alternatives to staff putting the medication in a dossett box. The pharmacist advised that they were not able to make up the medication packs for a person who goes to stay with a relative because the visits are not planned in advance and the pharmacist would need longer lead times to prepare the medications in this way. The home has a procedure of two staff checking and signing for the medication they organise for these visits. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has an open culture that supports people living there to express their views and concerns in a safe and understanding environment. People living in the home say that they are happy with the service provision, feel safe and well supported. People living in the home are protected by the home’s safeguarding adults policies and procedures. EVIDENCE: There have been no complaints received by the home since the previous inspection. The inspector spoke to three residents, who said they knew how to express their views and concerns. The residents discussed concerns as they arose throughout the day and the staff addressed these proactively. Safeguarding adults policies and procedures are in place. Staff are generally trained in safeguarding adults but, for some staff, this needs updating. A requirement is given under the Staffing Section of this report. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is a comfortable, homely and well-maintained environment suitable for the residents’ needs. Sharon House is well lit, clean, tidy and fresh. EVIDENCE: We made a tour of the home with one resident. The home has a wellequipped kitchen, two bathrooms, a laundry and a spacious, comfortable lounge with television with Sky TV, DVD player and small library. There is also an activity area in the lounge. There is a big private garden, which appeared well maintained. Two residents have television and DVDs in their rooms. During the inspection, residents spent time in their rooms, in the lounge or the garden, as they wished. Each person has their own bedroom. One resident showed us his bedroom, which was comfortable and personalised. This resident said that he liked his room very much. Others residents commented that they liked the home environment and had good quality personal spaces. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 19 The house was clean, fresh and well maintained. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is staffed by sufficient skilled staff who know the residents and their needs very well and can support them knowledgeably on a daily basis. The staff team has been the same for several years. Staff are generally well trained but the home needs to maintain an ongoing, planned training programme to help staff support the residents knowledgeably. EVIDENCE: There were two care staff on duty at the time of the inspection. The rota reflected that this was the normal staffing level for the home. The Registered Person normally works at the home during the week, but was not available on the day of the unannounced inspection. We spoke to him on the following day. All of the staff have worked in the home for several years and have formed a good team. There have been no new staff for over four years but there is a sound recruitment procedure in place should new staff be needed. The staff have very solid relationships with the residents and know their strengths and needs very well. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 21 Recent photographs of staff have been obtained, meeting a requirement from the last inspection. Staff supervision takes place regularly and is recorded. Most staff have NVQ 2 qualifications and several staff have or are working towards NVQ 3. Staff have been undertaking training in infection control and medication. Requirements made at the last inspection for staff training to be put in place in food hygiene, diabetes awareness and risk assessment have been met. However, in discussion with staff and reviewing their training information, it was clear that there are several areas where staff training needs to be updated. Staff need to receive updated training in first aid, safeguarding (protection of vulnerable) adults and fire safety. Requirements are given. The service generally trains its staff well but must provide CSCI with an annual training plan to demonstrate continuous staff development. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The service is well planned and well focused on the needs of people living in the home. People’s views are formally and informally assessed and their health and safety needs protected. EVIDENCE: The Registered Person is also the Registered Manager and runs the home on a day-to-day basis. Staff spoke positively about the management. Staff meetings are a regular and constructive forum for discussing good practice and considering the needs of the residents. Staff said these meetings were a useful venue for open discussion and service development. We discussed the basic Annual Quality Assurance Assessment (AQAA) with the Registered Person and how next year’s AQAA could be improved. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 23 A rudimentary quality assurance process is in place, with a simple survey of relatives, residents and care professionals. However, informal residents’ meetings are regular and flexible, in keeping with the ethos of the home. Health and safety practices in the home protect the people living there. Equipment and health and safety certifications are up to date, according to the Annual Quality Assurance Assessment (AQAA) provided by the Registered Person. The home has a fire safety risk assessment and took advice from the local fire safety authority in October 2007. Fire safety compliance is internally assessed each month. Fire drills are carried out quarterly; alarms are generally tested weekly and fire equipment checks done and annual testing was due within this month. Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 YA35 Regulation 18(1) Requirement The Registered Person must ensure that all staff receive updated training in safeguarding adults. The Registered Person must ensure that all staff received updated training in first aid. The Registered Person must ensure that all staff received updated training in fire safety The Registered Person must provide the Commission for Social Care Inspection with a schedule of the annual training programme for the service. Timescale for action 30/09/08 2. YA35 18(1) 30/09/08 3. 4. YA35 18(1) 30/09/08 30/09/08 YA35 18(1) 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 Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 26 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 Sharon House DS0000010653.V367298.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!