Care Home: Stepping Out (38 Hawthorne Rd)

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What the care home does well The service works very hard and effectively with regard to supporting people to regain their independence and move on into their own homes. The service uses a very detailed service user induction/introduction checklist for new service users upon admission. Service users are encouraged to be self-catering as part of their move to independent living and each person has a designated fridge, freezer and cupboard area in which to keep their provisions. Detailed risk assessments are in place with regard to people retaining and administering their own medication and the service has an eight week self medication programme to help people work towards self medicating where necessary. Risk assessments are carried out in respect of the appropriateness of discussing death and people`s wishes in the event of their death. Where deemed appropriate, service users` wishes are recorded on their file. Care plans include personal assessments, risk assessments and crisis strategies. Where necessary, crisis/relapse prevention plans are also completed to help ensure that people are kept safe. The service has a good quality assurance process in place. What has improved since the last inspection? The whole house is now `non-smoking` but a sheltered area in the garden has been made available to enable service users who smoke to do so safely and comfortably. Bathrooms/shower rooms and toilets have had new floor coverings, been decorated and mixer valves have been installed. Mixer valves have also been installed to the wash basins in service users` bedrooms. Other areas have also noted been redecorated such as the kitchen and one of the lounges. A new floor covering has been laid between the kitchen and utility room and radiator covers have now been fitted. What the care home could do better: It is important that the service holds some form of checklist or has copies of documentation to show that an appropriate recruitment process has been followed in respect of new staff. This information was not evident during the inspection and the manager confirmed that most of the recruitment information is held by the personnel department at County Hall. The manager must complete the NVQ4 Registered Manager award. CARE HOME ADULTS 18-65 Stepping Out (38 Hawthorne Rd) 38 Hawthorne Road Gorleston Norfolk NR31 8ES Lead Inspector Debra Allen Unannounced Inspection 26th June 2007 12:45 Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.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 Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.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. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stepping Out (38 Hawthorne Rd) Address 38 Hawthorne Road Gorleston Norfolk NR31 8ES 01493 440325 01493 442531 mark.blunt@norfolk.gov.uk www.norfolk.gov.uk Norfolk County Council-Community Care 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 Mark Alexander Blunt Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Seven (7) Service Users who have a Mental Disorder, excluding learning disability and dementia, may be accommodated. 30th January 2006 Date of last inspection Brief Description of the Service: 38 Hawthorn Road is a care home funded by a Norfolk Mental Health Trust, but run by Norfolk County Council Social Services Department. The home provides short to medium term residential accommodation for a maximum of 7 people of either sex who are between the ages of 18 and 65 years and have experienced mental health problems. It is the aim of the care home to provide support and guidance within a comfortable residential setting and to encourage the revival or development of skills and confidence with a view to the ultimate achievement of independent living. The care home is a large detached house located on a quiet residential road within the Shrublands Housing estate in Gorleston on Sea. It has eight single bedrooms that all contain a washbasin and service users have communal use of a bathroom and toilets on each floor, two lounges, utility room and a kitchen/dining room. There is a large garden that surrounds the home, off street parking to the front of the property and a small number of local amenities that are accessible on foot and the main bus route into Great Yarmouth that passes nearby. The fees currently range between £40 and £95 per week. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This inspection took place over a period of four hours, during which time the manager, staff and three service users were spoken with. A tour of the premises was also carried out and care plans, staff files and records required for regulation were examined. The home was found to be clean and tidy and provides service users with a comfortable and homely environment. Four service users’ and one relative’s questionnaire were returned prior to the inspection. What the service does well: The service works very hard and effectively with regard to supporting people to regain their independence and move on into their own homes. The service uses a very detailed service user induction/introduction checklist for new service users upon admission. Service users are encouraged to be self-catering as part of their move to independent living and each person has a designated fridge, freezer and cupboard area in which to keep their provisions. Detailed risk assessments are in place with regard to people retaining and administering their own medication and the service has an eight week self medication programme to help people work towards self medicating where necessary. Risk assessments are carried out in respect of the appropriateness of discussing death and people’s wishes in the event of their death. Where deemed appropriate, service users’ wishes are recorded on their file. Care plans include personal assessments, risk assessments and crisis strategies. Where necessary, crisis/relapse prevention plans are also completed to help ensure that people are kept safe. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 6 The service has a good quality assurance process in place. 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. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.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 Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.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): 1, 2, 3, 4 & 5 Quality in this outcome area is good. Prospective service users receive the information they need to make an informed choice about where to live and have the opportunity to visit the home before moving in. Prospective service users have their individual aspirations and needs assessed and know that the home they choose will meet these. Each service user is given an individual written contract, together with the service user’s guide and statement of purpose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most people come to Stepping Out following a referral from their social worker, and/or a stay in hospital and the main aim of the service is to support people to regain their independence and move on into their own homes. On the day of inspection, three care plans were looked at and each contained detailed information confirming that a full assessment had been carried out prior to each person moving into the home. Each person was also noted to have been given a copy of the statement of purpose and service user guide and the ‘resident’s contract and conditions’ was Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 9 seen to have been completed and signed by the service user, with a copy kept on file. One person spoken to confirmed that they had visited the home before they had moved in. In addition to this a checklist was seen to be in use for new service users upon admission, this was divided into five areas as follows: Before new resident arrives, On arrival, During the first 72 hours, First two weeks and Ongoing. This checklist provided further evidence that prospective service users had their individual aspirations and needs assessed and they could be assured that the home would meet them. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.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, 8, 9 & 10 Quality in this outcome area is good. The assessed needs and risk assessments for service users are shown in individual care plans. Service users are invited and encouraged to be actively involved in all aspects of life in the home and their views are taken into consideration. Service users’ information is secure so that confidentiality is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three care plans that were looked at contained good evidence of people’s changing needs and personal goals. As mentioned earlier, the service is intended to be a short-term placement, with the primary aim being to help re-enable people and risk assessments, together with detailed action plans, were seen to be a vital part of this process. Some of the risk assessments looked at were based around cooking, shopping, budgeting, paying bills, personal health and taking medication. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 11 Evidence of people making decisions about their lives was also seen, for example, one person’s care plan contained information in an ‘action and review’ sheet which outlined things they wanted to do such as deciding where to live, paying the bills and jobs to be done before moving into a new house. House meetings were noted to take place regularly and the purpose of these meetings was seen to have been explained to service users within the first two weeks of moving in. Additionally, new service users were noted to receive an induction style meeting to discuss group living and respecting other people and be shown the chores rota, which would be adjusted in order to include them. All personal information, relating to service users, was seen to be stored securely in the office, therefore ensuring confidentiality. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 12 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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. Service users are provided with opportunities for personal development and are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community and are supported to have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are supported to have a healthy and balanced diet. This judgement has been made using available evidence including a visit to this service. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 13 EVIDENCE: Discussions and observations with service users on the day of inspection confirmed that they were encouraged and supported to be as independent as possible and there was substantial evidence available of service users leading quite varied lifestyles, according to their personal needs, wants and choices. One person was noted to go Salsa dancing during the afternoon of the inspection and notes in another person’s care plan stated that, although the service user did not want any formal daily activities, they had regular visits and contact with family members during the week. A further person was also seen to have a friend visiting that afternoon. The ‘new resident checklist’ and further information seen in the care plans showed that people were supported with maps and local bus routes, especially if they were unfamiliar with the area. In addition to this, service users were also seen to be supported to plan activities and set up weekly programmes. Service users are encouraged to be self-catering as part of their move back to independent living and each person was seen to have designated fridge, freezer and cupboard areas in which to keep their provisions. Each person therefore does their own shopping and chooses what they want to eat on a daily and individual basis. During the inspection, it was noted that although one person currently prepares their own breakfast, lunch and snacks, they do require assistance with regard to cooking their main meal. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 14 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 & 21 Quality in this outcome area is excellent. Service users receive personal support in the way they prefer and require and their physical and emotional health needs are met. Service users are protected by the home’s policies and procedures for dealing with medication. The ageing, illness and death of a service user are handled with respect and as the individual would wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person was seen to have a clear and comprehensive care plan, which outlined how they like to be supported and what their individual needs are. Daily care notes were written in an appropriate and respectful manner and showed that service users’ wishes were being respected. Records looked at also showed various involvement from professionals such as Occupational Therapists, Community Nurses, GPs, Dentists, opticians and chiropodists. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 15 Detailed risk assessments were seen to have been completed with regard to people retaining and administering their own medication and the service was noted to have an eight week self medication programme to help people work towards self medicating where necessary. Risk assessments are also carried out with regard to the appropriateness of discussing death and people’s wishes in the event of their death. Where deemed appropriate, service users’ wishes have been recorded on their file. One person was noted to have a death policy in their room and notes on their file also confirmed what their wishes were regarding urgent medical attention. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. Service users feel their views are listened to and acted on and they are protected from abuse, neglect and self harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When a new service user moves into Stepping Out, part of the introduction process was noted to include explaining the suggestion box, how to make complaints and who to speak to if they wish to just talk things over. Included within the care plans looked at were personal assessments, risk assessments and crisis strategies. Where necessary, crisis/relapse prevention plans were seen to be completed, therefore helping to ensure that people are kept safe. Staff records looked at also confirmed that staff are well trained in areas relating to adult abuse and protection. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 17 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, 28 & 30 Quality in this outcome area is good. Stepping Out provides a homely, comfortable and safe environment for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information received from the manager’s pre-inspection questionnaire and observations made during the inspection confirmed that bathrooms/shower rooms and toilets have had new floor coverings, been decorated and mixer valves have been installed. Mixer valves have also been installed to the wash basins in service users’ bedrooms. Other areas were also noted to have been redecorated such as the kitchen and one of the lounges. A new floor covering has been laid between the kitchen and utility room and radiator covers have now been fitted, in accordance with previous requirements. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 18 The whole house is now ‘no-smoking’ but a sheltered area in the garden has been made available to enable service users who smoke to do so, safely and comfortably. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 19 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, 35 & 36 Quality in this outcome area is adequate. Service users are supported by a competent and qualified staff team, who receive regular support and supervision. The service lacks evidence that the recruitment procedure has been followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records looked at during the inspection were found to contain some evidence that staff had been police checked and received clear, enhanced Criminal Records Bureau (CRB) disclosures. However, evidence of the full recruitment process was not clear, as the manager confirmed that most of the recruitment information is held by the personnel department at County Hall. Other records seen did demonstrate that staff members had a good mix of experience and skills, undertook induction, foundation and regular training. The manager confirmed that most staff had completed or were in the process of completing their NVQs and, from information seen, it was evident that the service is meeting the 50 Government target. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 20 Discussions with staff, training records and certificates confirmed that staff have received training in areas such as moving and handling, fire safety, food hygiene, first aid and adult protection. The staff spoken to on the day of inspection, and records seen, confirmed that they received regular one-to-one support and supervision sessions. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 21 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, 38, 39 & 42 Quality in this outcome area is good. The service is well run but the manager must complete the NVQ4 Registered Manager’s Award. Service users are confident that their views underpin all self-monitoring, review and development by the home. The health, safety and welfare of service users are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Stepping Out has many years of experience in the care industry and holds a Masters Degree in Social Work. However, although the NVQ4 Registered Manager’s Award was started in September 2005, this still needs to be completed and is a repeated requirement. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 22 It was evident on the day of inspection that the manager runs the home with an ‘open door’ policy and is very approachable. Staff spoken to also said they felt very supported by the manager. It was commented that staff and management meet with the service users on a daily basis, as part of an ongoing quality assurance process, and discuss ‘life in general’. Evidence of service users’ views was seen in the records kept. Exit interviews are held with service users when they move on, which is also part of the quality assurance process. Results of the staff and service users’ quality questionnaires, (completed in December 2006), were also looked at and the overall scores from the staff questionnaires stated that the service was of ‘good quality and moving in the right direction’. Three service users had completed their questionnaires and the overall scores stated that the service was ‘borderline, with lots of scope for improvement’. The action plans that were compiled after the results had been analysed were seen to have addressed each of the issues raised by staff and service users. The regulated checks for fire, environmental health, water and electric were found to be satisfactory. Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 2 3 3 3 4 3 5 3 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 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 4 2 3 3 X X 3 X Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 24 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 YA37 Regulation 9(2) Requirement The manager must complete the NVQ4 Registered Manager award. (Previous timescale not set and requirement has not been met) Timescale for action 31/01/08 2. YA34 17 The responsible person must 30/09/07 ensure that the service is able to demonstrate that an appropriate recruitment process has been followed in respect of new staff and that records are available, at the service, for inspection. 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 Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Stepping Out (38 Hawthorne Rd) DS0000035106.V344317.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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