Care Home: The Granleys

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What the care home does well People who may wish to move into the home will be supplied with information via the Service User`s Guide to support them in making a decision. The needs of the people living in the home have been assessed and this enables the care plans to be developed to meet those needs. Risk assessments are in place to identify and minimise potential risks to people living in the home. People have access to a range of leisure activities and staff support them to complete them as required. People`s personal care needs have been assessed and the care plans developed as a result are excellent providing staff with comprehensive information to enable them to meet people`s needs consistently. The maintenance plan completed to date has improved the quality of the accommodation provided to people living in the home. The home`s recruitment procedures minimise potential risks to people living in the home. What has improved since the last inspection? Since the previous inspection there have been a wide range of improvements to the service which include; record keeping, activities, staff training and the environment. What the care home could do better: People`s goals need to be made clearer to enable staff to work towards them consistently and be able to measure progress. Care plans need greater detail to ensure that staff are able to work with people consistently. The notes made by staff have improved but require further work to ensure that all of the information relating people`s needs, their progress and deterioration in some cases is noted. CARE HOME ADULTS 18-65 The Granleys 21 Griffiths Avenue St Mark`s Cheltenham Glos GL51 6SJ Lead Inspector Mr Paul Chapman Unannounced Inspection 30th July 2008 09:00 The Granleys DS0000016610.V369318.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 The Granleys DS0000016610.V369318.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. The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Granleys Address 21 Griffiths Avenue St Mark`s Cheltenham Glos GL51 6SJ 01242 521721 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) Mrs Brenda Tapsell Miss Tracy Ashleigh Green Care Home 17 Category(ies) of Learning disability (17) registration, with number of places The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate 3 named service users who are over the age of 65yrs. This condition will be removed once the named service users no longer reside at the home. 30th January 2008 Date of last inspection Brief Description of the Service: The Granleys is a detached property approximately 1 mile from the centre of Cheltenham. The home provides care and accommodation to 17 adults with learning disabilities. The house is set in large grounds and is a listed building. The accommodation is arranged over two floors and all of the rooms have en suite facilities. A copy of the Statement of Purpose and Service User Guide are kept in the main office and are available upon request. The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place in August 2008. The registered manager was in attendance throughout the visit. Time was spent observing the care of people and their interactions with staff. All of the people at home during the site visit were asked if they wished to speak with us and two spoke did. A tour of the premises was completed with the manager and people’s bedrooms were seen on their invitation. The care of 5 people was looked at in depth that included looking at their financial, medication and personal records. Other records examined included staff files, health and safety information and quality assurance records. What the service does well: What has improved since the last inspection? The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 6 Since the previous inspection there have been a wide range of improvements to the service which include; record keeping, activities, staff training and the environment. 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. The Granleys DS0000016610.V369318.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 The Granleys DS0000016610.V369318.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Service User’s Guide provides people living in the home and people who may wish to move in with essential information about the service they can expect to receive. The home’s admission policy provides guidance to staff about the steps required to minimise the risk of people being admitted to home whose needs cannot be met. EVIDENCE: The previous inspection made a requirement against standard 1. The manager was required to review the home’s Service User’s Guide to ensure that it meets the criteria of the regulations. At this site visit we were able to examine a newly reviewed Service User’s Guide that now meets the criteria of the regulations. All of the people living in the home now have a copy of the new document. The manager stated that they have also sent copies of the new Service User’s Guide to all relatives/representatives. This came as a result of a questionnaire sent to relatives/representatives where they stated they wished to know more about the home. The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 9 The manager stated that they intend to create a Service User’s Guide making use of pictures and symbols. This becomes a recommendation of this inspection report. There have been no new admissions to the home since the previous inspection was completed. The manager stated that since the previous inspection was completed they have written an admissions policy for the home. The Granleys DS0000016610.V369318.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and PCPs have been reviewed but a number of goals are confusing and make it difficult to confirm that people’s current needs are being met. People living in the home are able to make choices about their lives and staff support people where it is required. Potential risks to people are identified and minimised where possible. EVIDENCE: The previous inspection report made a requirement for person centred plans (PCP) to be reviewed and re-written, and to ensure that they were all reviewed regularly. We looked at the care plans and PCP’s for 5 people living in the home. In each of the files we saw that an assessment of that person’s needs had been The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 11 completed. From the assessments care plans had been written to address identified needs and goals. Staff have written notes identifying how people are progressing towards meeting goals, and there were some good examples of detailed notes. Since the previous inspection there has been significant progress in the staffs approach to meeting people’s needs and goals. The best example of this is the care plans to meet people’s personal care needs (see Personal and Healthcare support section of this report). We discussed the progress with the manager and it was agreed that people’s goals need to be made clearer, that the manager should adopt the method of care plan writing used for personal care needs for other care plans and goals, and that all staff need to record daily notes in greater detail to enable the reader to accurately review what the person has done and whether their needs are changing. This becomes a requirement of this inspection report. The manager has arranged or completed annual reviews for each of the people living in the home. These reviews will be completed with other professionals (where possible) and other parties invited by each person. The daily notes we saw provided evidence of people being given more choices about their day-to-day activities. The home employs an activities co-ordinator. All of the people who were at home at the time of the site visit were asked whether they would like to speak to us, 2 people said they would like to speak with us. Both of the people were very positive about the home making comments that included “the staff are really helpful”, “I am able to decide what I would like to do”, “we go out quite a lot now”, “I am able to choose what I want to eat”. Since the new manager has been in post people living in the home have been encouraged to take a more active role in and around the home. This has included people being involved in preparing their meals and other foods. This has led to people setting goals around preparing meals, baking cakes. A requirement of the previous inspection report was the manager must ensure that all of the people in the home have risks assessments to cover all areas of their lives and provide strategies to minimise potential risks. All of the files we examined contained risk assessments that had been completed since the previous inspection. A good practice identified with 1 risk assessment was that the staff had included conversations they had with 1 person explaining the potential risk to them. The Granleys DS0000016610.V369318.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): 12, 13, 15, 16, 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are able to choose from a range of leisure activities and staff support people to complete these where it is required. People are able to choose what they like to eat and people are encouraged to be involved in the preparation. EVIDENCE: As identified earlier in this report the home has an activities co-ordinator. From examining peoples daily notes and speaking with people it is clear that there is a wide range of activities now available to people. The staff have created a photo album of recent activities that people have completed and this is kept in the hallway for people to browse through. At the time of this site visit there was a large banner in the lounge/diner wishing a person happy birthday. The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 13 The person had celebrated their birthday on the previous day and as a group they attended a local restaurant for a meal. People spoken to said that it had been a “great evening”. People use a range of local day services. People have the choice as to whether they attend the local church and staff support them to do this as required. 4 people have recently returned from a holiday in Blackpool supported by the staff. The manager said that another group is due to go to Blackpool in the near future. In September a day trip on a canal boat has been organised, some recent day trips include visiting Boughton on the Water and Cotswold Wildlife Park. Other activities that have taken place since the previous inspection include going to the town hall to watch concerts (ABBA and the Blues Brothers). Other regular activities people are involved in include going shopping, recycling, visiting a local Pub for lunch, swimming and attending various social clubs. Where people have hobbies staff support them to continue them. An example of this is a person being supported to attend a steam train rally. Around the home people like to play cards and board games, draw and paint and watch TV. Staff have also been supporting people to do some gardening and there were numerous pots that people have planted during the summer. We examined the previous menus for food provided in the home. This showed that there are choice of food for breakfast including a range of cereals, and a cooked breakfast at the weekend. Menus showed that at lunch and dinner times people have a choice 2 meals. Since the previous inspection the manager has been taking pictures of the meals provided and plans to create a picture menu for people in the future. This becomes a recommendation of this report as it will also be useful to help people choosing meals. Speaking with 2 people living in the home they commented that they thought, “the food is really nice”. The Granleys DS0000016610.V369318.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, 21 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Comprehensive guidelines to meet people’s person care needs enable staff to work consistently with each person. Where people require the input of specialist health care they are supported appropriately by staff. People’s needs around increased mental and physical frailty are being addressed in care plans to ensure that as and when required peoples wishes/needs are followed. EVIDENCE: A requirement of the previous inspection report was that the manager should review and re-write the care plans detailing peoples individual personal care needs. Since the previous inspection the manager has completed a review and the guidelines seen to meet peoples personal care needs were excellent. They provided staff with detailed guidelines about a person’s needs and wishes to enable them to support people consistently. A shortfall identified with this process is the recording of the staff’s input, this was brought to the attention of the manager and it was agreed that they would review this practice. The The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 15 staff should record exactly what their input was, what the person’s input was, whether there has been skill improvements, or any deterioration. The files we examined contained good evidence of people in the home accessing the support of other health professionals to meet their needs as required. Evidence showed that people had been supported to attend annual health checks with a practice/doctor. In addition to this the manager has also completed/reviewed people’s health care assessments. Medication administration was examined at the previous inspection and seen to be managed effectively and not causing unnecessary risk to the people in the home. The previous inspection report made a requirement that each person in living in the home has a care plan that identifies people’s wishes around increased mental and physical frailty. Examining people’s files there was evidence that either plans were now in place, or work was in progress to create the plan. The Granleys DS0000016610.V369318.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. If people are unhappy about the service they receive there is a complaints procedure in place to enable them to voice those concerns. Training in safeguarding vulnerable adults helps to minimise potential risks to people living in the home by raising the awareness of staff. EVIDENCE: The home as a complaints procedure. There have been no complaints made to the home or the CSCI since the previous inspection was completed. At the time of the site visit people spoke about being able to make a complaints if they were unhappy. A requirement of the previous inspection report was for the staff team to complete training in the safeguarding of vulnerable adults. Records of staff training showed that this had now been completed. The Granleys DS0000016610.V369318.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, 25, 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is now maintained to a good standard and provides people with a homely, comfortable environment that meets their current needs. EVIDENCE: The previous inspection report made 2 requirements relating to the maintenance around the home. Firstly the redecoration of the home’s communal areas must be completed, and that the redecoration of people’s bedrooms must also be completed. As part of this site visit we completed a tour of the premises and with the permission of some people in the home we saw a couple of the bedrooms. Since the previous inspection the re-decoration of communal areas has been completed. The manager explained that they were in the process of purchasing The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 18 pictures for the front room. In addition to the re-decoration new dining furniture has been purchased. Communal areas are now decorated to a good standard. Whilst completing a tour of the premises the manager stated it is planned for the kitchen to be decorated and re-fitted where needed. The bedrooms we saw with people’s permission were decorated to a good standard and personalised with their possessions. Speaking to 1 person they stated that they were asked how they wanted their bedroom decorated. At the time of this site visit the home was clean, tidy and hygienic. The Granleys DS0000016610.V369318.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): 34 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s recruitment and selection procedures minimise potential risks to people living in the home. EVIDENCE: The previous inspection report made a requirement for staff files to be reviewed to ensure that they contain the correct documents to meet the criteria of the regulations. We examined the staff files for 5 staff employed in the home, all of which were seen to contain the documents required by the regulations. All of the files we examined contained a number of training certificates for recent training courses that had been completed. Examples of these courses included; manual handling, food safety, safeguarding adults and dementia awareness training. The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 20 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, 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Quality assurance systems are being developed by the manager to empower people living in the home to have a greater say in the future development of the service. Potential risks to people in the home are monitored through regular checks completed by staff. EVIDENCE: Since the previous inspection was completed the manager has successfully completed their registration with the CSCI. A requirement of the previous 2 inspection reports has been for the proprietor of the home to complete monthly visits to meet the criteria of regulation 26. The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 21 Since the previous inspection was completed these visits have been completed and the reports have been sent to the CSCI. A requirement of the previous inspection report was for the manager to establish a system for evaluating the quality of the service provided, taking into account the views of the people in the home. The manager explained that since the previous inspection she has sent questionnaires to the relatives of people in the home asking them for their opinions about the service. The completed questionnaires seen by us spoke positively of the service provided in the home. A shortfall identified in the questionnaire was that the relatives did not know how to make a complaint, and what the qualifications the staff team held. Responding to this the manager has supplied all relatives with a complaints procedure and a list of staff’s qualifications. People living in the home have also completed questionnaires with the support of staff. In the questionnaires we saw people commenting on how much they liked the new decoration and the food available in the home. A discussion took place with the manager about investigating the use of an advocate to support people completing questionnaires in the future, as currently staff have to support the majority of people when completing questionnaires. This becomes a recommendation of this inspection report. We looked at using the service user meetings as a forum for enabling people in the home to comment on the quality of the service and plan for the future. The minutes seen provided some good details about what people wished to do, but did not follow through tasks to show that people’s wishes had been completed. It is recommended that future minutes summarise the agreed actions of the previous meeting to ensure that actions are not missed, or forgotten about. A requirement of the previous inspection report was for the manager to ensure that all of the home’s hot water outlets were tested each month. Records showed that this is now being done. Since the previous inspection was completed the manager has reviewed the home’s fire safety risk assessment, staff have completed fire safety training with a fire officer and all of the fire safety checks are being completed. The Granleys DS0000016610.V369318.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 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 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 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 X 3 3 X 2 X X 3 X The Granleys DS0000016610.V369318.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. 1. Standard YA6 Regulation 15 Requirement Goals to meet people’s needs must be clearly identified enabling staff to work with them consistently. Care plans developed to meet people’s needs must provide staff with sufficient detail to meet people’s needs consistently. Greater detail in care plans will allow future reviews to be more accurate about people’s needs. The notes made by staff need to provide greater detail to the reader about what actually happened when supporting a person with their care plan. The notes made by staff need to provide greater detail to the reader about what actually happened when supporting a person with their care plan. Timescale for action 03/10/08 2. YA6 15 03/10/08 3. YA6 12(1) 05/09/08 4. YA18 12(1) 05/09/08 The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA1 YA17 YA39 Good Practice Recommendations The manager should develop a Service User’s Guide making use of symbols and pictures. The manager should continue to develop pictures of meals/food to enable people in the home to have greater choices. The manager should investigate the use of an advocate to support people living in the home when completing future quality assurance questionnaires. The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Granleys DS0000016610.V369318.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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