Care Home: St Joseph`s

Similar services:

• The Shelley
• Springfield House
• Sutton Lodge Nursing Home
• St Helier`s Residential Hotel
• Ridgemount
• Wingham Court
• Old Hastings House
• Anchorstone Services Limited

What the care home does well There is a comprehensive system to assess the needs of prospective residents before they move into the home. This gives people clear information about the services provided and assurance that their needs can be met. People`s assessed needs are clearly set out in comprehensive care plans. Support is provided for people to access the health services they need and people are treated with dignity and respect. The home provides excellent support for people to take part in a wide range of activities they enjoy. Family and friends are made welcome and encouraged to use the guest accommodation. People are confident any complaints will be taken seriously and responded to and action is taken to protect people from abuse. The home provides excellent facilities, which ensures people`s needs are met in a comfortable and homely environment. The high staffing numbers, staff recruitment procedures and excellent staff training programme helps to ensure that all residents` needs are met. The home is managed by a qualified and committed manager, who ensures that people are kept safe. There is a programme of continuous improvement, which is based on the views and experiences of residents. What has improved since the last inspection? There were no areas identified as necessary for improvement in the last inspection report. The home has created a new therapy room, where qualified staff provide therapies, including Indian head massage and aromatherapy. What the care home could do better: There are no areas for improvement identified in this report. The home has a development programme based on continuous improvements and the manager should continue to implement the identified actions. CARE HOMES FOR OLDER PEOPLE St Joseph`s Albert Road Bognor Regis West Sussex PO21 1NJ Lead Inspector Craig Willis Unannounced Inspection 20th June 2007 09:45 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 St Joseph`s DS0000014734.V339822.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. St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Joseph`s Address Albert Road Bognor Regis West Sussex PO21 1NJ 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) 01243 864051 Grace & Compassion Benedictines Sister Mary Breslin Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: St Joseph’s is a care home registered to provide accommodation for up to 22 people, whose primary need for care is due to their age. The establishment is a large detached house, which has been further extended to provide accommodation on three floors, all of which are served by a vertical lift. All rooms are for single occupancy, are of generous proportions and have en-suite facilities. There is an area for car parking to the front and a private and well-tended garden to the rear. There is additional accommodation for residents’ visitors and a quiet dining room where residents can entertain their relatives and friends. There is an independent building (the Jubilee Room) in the garden, which is used as a venue for parties and other gatherings and any entertainment or activity being provided. It is also used to house the home’s extensive library of books, DVD’s and CD collection. There are independent catering and toilet facilities adjacent. A facility for charging wheelchair batteries is available. Situated in a quiet residential road in Bognor Regis it is approximately half a mile from the town centre and approximately 50 metres from the seafront. The registered provider is the Grace and Compassion Benedictines and the registered manager is Sister Mary Breslin. The manager reported during the site visit that the fee for a room in the home is £500 per week. St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to the Commission for Social Care Inspection (CSCI), including an annual quality assurance assessment, and a site visit to the home on 20th June 2007. Comment cards were received from all twentytwo service users, two GPs and a chiropodist. During the site visit the inspector spoke with service users, observed the interactions between service users and staff and spoke with the manager and staff on duty. A tour of the building was made and documents relating to the running of the home were inspected during the visit What the service does well: There is a comprehensive system to assess the needs of prospective residents before they move into the home. This gives people clear information about the services provided and assurance that their needs can be met. People’s assessed needs are clearly set out in comprehensive care plans. Support is provided for people to access the health services they need and people are treated with dignity and respect. The home provides excellent support for people to take part in a wide range of activities they enjoy. Family and friends are made welcome and encouraged to use the guest accommodation. People are confident any complaints will be taken seriously and responded to and action is taken to protect people from abuse. The home provides excellent facilities, which ensures people’s needs are met in a comfortable and homely environment. The high staffing numbers, staff recruitment procedures and excellent staff training programme helps to ensure that all residents’ needs are met. The home is managed by a qualified and committed manager, who ensures that people are kept safe. There is a programme of continuous improvement, which is based on the views and experiences of residents. St Joseph`s DS0000014734.V339822.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. St Joseph`s DS0000014734.V339822.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 St Joseph`s DS0000014734.V339822.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): Standards 3 and 6. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive system to assess the needs of prospective residents. This gives people clear information about the services provided and assurance that their needs can be met. EVIDENCE: Prior to admission to the home the manager or one of the deputies completes a full assessment of prospective residents to ensure that their needs can be met. This covers personal history, medical conditions, social and family information, mobility, nutrition, skin condition, weight, pain, personal care, sensory impairments, emotional needs, personal safety, spirituality and religion and a specific section on equality and diversity. Information is obtained from the person themselves during a visit to their home. This initial assessment includes an action plan of how these needs could be met and St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 9 whether any equipment or environmental changes are required. Following the assessment, the manager decides whether or not the home can meet the needs of that prospective resident. The needs identified during this assessment are reviewed after a month and form the basis for the care plans that are written when the resident moves into the home. The assessments were seen in residents’ care files for the four people whose care was tracked. People spoken with said they visited the home before deciding whether to move in and were provided with clear information about what services the home provides. The home has a video available for prospective residents and their relatives, which gives further information about what people can expect if they move into the home. Residents are given a satisfaction questionnaire approximately a month after they move in. This asks how the process of moving in went and whether their expectations had been met. All of the four questionnaires seen had been answered very positively. Comment cards were received from twenty-two residents, all of whom said they received sufficient information before they moved into the home. The home does not provide intermediate care and therefore standard six is not applicable. St Joseph`s DS0000014734.V339822.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): Standards 7, 8, 9 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The details recorded in care plans, involvement of people in planning their care and support to access health services ensures that people are treated with dignity and respect and their needs are met in an holistic way. EVIDENCE: The care plans of four residents were inspected during the visit. These documents set out how the assessed needs of people should be met and were reviewed monthly, or sooner if needs changed significantly. Residents are involved in writing and reviewing plans and those spoken with said their plans contained accurate information. In addition to the written information, care plans include a photographic diary, which provides information on the activities people have taken part in. Staff spoken with demonstrated a clear understanding of people’s needs and how they should be met. St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 11 All residents are registered with a local GP practice and people spoken with said they were able to see their GP and other health services when they need to. Two GPs completed a CSCI survey and reported that the home always meets people’s health care needs. Additional comments included “I would confidently recommend St Joseph’s as an excellent and caring care home” and the home cares for people in a “kind, considerate and effective manner”. People’s records showed that they were supported to attend regular health appointments, both in the home and the community. The records included any advice that was given by the practitioner. There is an efficient recording system, which ensures people are supported to attend follow up appointments where necessary. Medication is securely stored in a locked trolley and most is supplied in a monitored dosage system. The administration records were inspected and were fully completed. All staff administering medication have received training and regular internal and external audits are completed of the medication storage and records. Records were available of medication that had been returned to the pharmacist to be destroyed. Several people administered their own medication, following an assessment of their ability and consultation with their GP. The manager reported that she encouraged people to keep control of their medication where possible, as it helps people to maintain their skills. None of the residents are currently prescribed any controlled drugs, however, there are systems in place for their storage and administration should it be necessary. People spoken with said that staff treated them well and provide support in a manner that maintains their dignity. Twenty-two CSCI comment cards were received from residents, all of whom said staff listen to them and act on what they say and they always receive the medical support they need. Throughout the visit, staff were observed interacting with residents in a friendly and respectful manner. St Joseph`s DS0000014734.V339822.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): Standards 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides excellent support for people to meet their lifestyle expectations, exercise control over their lives and maintain contact with family and friends. EVIDENCE: The home organises a very wide range of activities including shows by visiting groups and staff, quizzes, films, bingo, music and movement. Regular trips are arranged, including visits to local theatres and gardens. On the day of the visit, several people were supported to have a walk down to the seafront. Since the last inspection the home has developed a therapy room. This room provides a relaxed and comfortable environment where qualified staff provide treatments such as aromatherapy and Indian head massage. People’s interests are recorded as part of their initial assessment before moving into the home, including their spiritual and cultural needs. The home provides specific support St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 13 for Roman Catholics to practise their religion, both in the home’s chapel and at the parish church. The manager reported that there are no current residents who are members of other faiths, but support has been provided in the past for people to practise other faiths. People spoken with said that they enjoyed the wide range of activities that were available and confirmed that they were able to choose whether or not to participate. The manager reported in the annual quality assurance assessment for CSCI that she plans to obtain a greater variety of large print books and provide more personalised outings for individuals and small groups of residents. These plans followed suggestions in the residents’ meetings. People spoken with said their friends and relatives were able to visit at any time and were made to feel welcome. The home has guest accommodation for visiting relatives who wish to stay. These rooms have a separate small kitchen, lounge and dining area. The manager reported that they have equipment available for the use of families with small children, such as pushchairs, cots and toys. This enables families living abroad to visit and helps residents maintain contact with the younger members of their family. Each year residents are given copies of a personalised calendar, which they can send to relatives and friends. This provides a photographic record of events that were of interest to people during the year. The home has a pleasant and welcoming dining room and emphasis is placed on the social aspects of meals. There is a choice of meals, which are presented in a large print menu. People spoken with said that the food was very good and there was a choice of meals. Snacks are available at all times if people require them. One member of kitchen staff spoken with during the visit demonstrated a good understanding of the people’s dietary needs and preferences. St Joseph`s DS0000014734.V339822.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): Standard 16 and 18. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home’s procedures, staff knowledge and practice provides assurance to people that any complaints will be taken seriously and responded to and ongoing action is taken to protect people from abuse. EVIDENCE: The home’s complaints procedure is supplied to residents and their relatives with the service users’ guide. This is available in large print, audio and Braille formats. People spoken with said that they were aware of the home’s complaints procedure and were confident that any complaints would be taken seriously and responded to appropriately. All twenty-two of the residents who completed a CSCI survey said they know who to speak to if they are not happy and how to make a complaint. No complaints have been received by the home or CSCI since the last inspection. There is a system in place for annually auditing complaints received by the home to ensure they have been appropriately responded to and actions identified have been implemented. The home has procedures in place covering safeguarding adults and “whistleblowing”. All staff working in the home have completed safeguarding adults training. Staff spoken with during the visit demonstrated a good understanding of types of abuse, signs that someone may be being abused and what action they should take if abuse is reported, witnessed or suspected. The manager has collated information made available by CSCI and other St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 15 organisations concerning current legislation around safeguarding adults and good practice and made it available to all staff. Residents have been given information and contact details of local advocacy services. St Joseph`s DS0000014734.V339822.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): Standards 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides excellent facilities, which ensures people’s needs are met in a clean, comfortable and homely environment. EVIDENCE: All of the communal areas of the home were inspected during the visit. Communal facilities include a large lounge, a dining room that can accommodate all residents, a chapel in which Mass is celebrated each day, a function room with separate toilet and kitchen facilities and a large, well maintained garden. Since the last inspection a garage has been converted into a therapy room, known as the Amethyst Room. This provides a calm and St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 17 relaxed environment, where qualified staff provide therapies including head massage and aromatherapy. All twenty-two residents who completed a CSCI survey said the home was always clean and fresh. The manager reported that they employ contract cleaners and regular meetings are held with the company to ensure they are providing a good service. Most of the bedrooms have an en-suite bath or shower, however there are additional shared bathrooms that are available for residents. Suitable mobility aids and equipment have been fitted throughout the home to meet the specific assessed needs of residents. These have been fitted in a discreet manner and do not compromise the homely nature of the building. The home has infection control procedures in place and there is a separate laundry room. There are suitable hand washing facilities throughout the building. St Joseph`s DS0000014734.V339822.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): Standards 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The high staffing numbers, staff recruitment procedures and excellent staff training programme helps to ensure that all residents’ needs are met. EVIDENCE: The home has a staff rota, which indicates there are at least eight care staff on duty during the day and evening and two overnight. In addition to the care staff there are kitchen, administrative and management staff and an activities co-ordinator. The rota is managed to ensure there is a qualified first aider working at all times. The manager reported that this high level of staffing was necessary to ensure residents are supported to undertake the activities they enjoy. The manager reported in the annual quality assurance assessment for CSCI that all staff in the home have achieved the National Vocational Qualification (NVQ) at level 2 or above. One member of staff has been employed in the last year. This person’s recruitment records were inspected and demonstrated that the manager had obtained a Criminal Records Bureau disclosure and written references in St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 19 respect of them. Evidence was seen that work permits were obtained for staff where necessary. The manager expressed her strong commitment to staff training and there is a comprehensive training programme in place. As well as general courses on aspects of providing a care service, there are specific courses on sensory impairments, equality and diversity, challenging behaviour, cultural awareness and prevention of falls. One member of staff spoken with said she was going to complete training in dementia care mapping through Bradford University in order to improve support for residents who may have the early stages of dementia. The manager has a training plan that tracks all staff, giving information on what training they have completed and when any refresher courses are required. The home’s training programme is planned in conjunction with the development plan to ensure staff have received training related to improvements in the service. St Joseph`s DS0000014734.V339822.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): Standards 31, 33, 35 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is managed by a qualified and committed manager who ensures that the service is safe and continuous improvements are based on the views and experiences of residents. EVIDENCE: The manager has worked at the home for almost 30 years and has completed the NVQ levels 4 and 5 and the registered managers award. The manager is also a registered nurse and takes part in regular training and development to keep her skills up to date. The home has three deputy managers, two of whom have completed the NVQ level 4 and one who is currently undertaking it. St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 21 Staff spoken with said they felt the manager did an excellent job, in an open and supportive manner. The home has a comprehensive quality assurance system, which includes internal assessment and external audits as part of a recognised national system. The system has been amended to incorporate guidance from CSCI about how judgements are made about the quality of service provided. The views of residents and their representatives are sought throughout this process by means of questionnaires, and group and individual meetings. Regular audits are completed, including a review of accidents and complaints to identify any patterns and ensure that they were appropriately responded to. Following the various assessments a development plan is written to ensure that the service continues to develop and improve. The manager reported in the annual quality assurance assessment for CSCI that a staff member is completing a dementia care mapping qualification as a result of the identified need to more fully involve residents who are confused in the running of the home. The manager reported that the home does not hold any money for residents or operate bank accounts on their behalf. The manager reported in the annual quality assurance assessment for CSCI that equipment in the home such as the gas boiler, fire system, lift and electrical appliances are regularly serviced and maintained. These records were sampled during the visit and confirmed the manager’s report. A fire risk assessment has been completed and fire safety policies and procedures have been updated following recent changes in legislation. Staff regularly complete fire safety training. There is a dedicated member of staff in the home who takes the lead on health and safety issues and has completed nationally recognised training. St Joseph`s DS0000014734.V339822.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 I am surCHOICE 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Joseph`s DS0000014734.V339822.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!