Care Home: The Pines

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What the care home does well The Pines provides a caring homely environment in a pleasant setting on the edge of Ashington. Everyone spoken to enjoys living in this home and many positive comments were received about the good support provided by the staff team. There is a varied range of activities for residents to enjoy. All complaints are taken seriously and addressed. Staff are well trained to enable them to support residents appropriately. What has improved since the last inspection? The manager and her staff team have addressed a range of requirements made at the last inspection: Sitting scales are now available for residents with poor mobility so that they can be accurately weighed more easily. Medication storage and processes have been improved and good practices are promoted. Further work is still to do to make sure residents are maintained safely. The kitchen has been refurbished to promote good hygienic practices. Health and safety of residents and the promotion of privacy and dignity has been improved. Staff numbers and quality through training and supervision has been improved. The manager has been registered, which shows her ability to manage a home for older people. Quality monitoring is being introduced to further identify practices that can be further improved. What the care home could do better: The safe handling of medicines must be further improved to ensure the wellbeing of people who live in the home. Continue improving the home`s facilities. Consider improving the bathing facilities and other areas identified in the home`s own improvement plans. CARE HOMES FOR OLDER PEOPLE The Pines 1 Woodbine Terrace Ashington Northumberland NE63 8PP Lead Inspector Allan Helmrich Key Unannounced Inspection 20th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Pines DS0000065947.V370442.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. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Pines Address 1 Woodbine Terrace Ashington Northumberland NE63 8PP 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) F/P01670 816349 F/P01670 816349 pines@talktalkbusiness.net Mr Sunny Okukpolor Humphreys Suzanne Denise Hudson Care Home 28 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (17) of places The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th August 2007 Brief Description of the Service: The Pines was originally a domestic residence that has been extended and now provides accommodation with personal care for 28 older people, 11 of whom may have a dementia. It has accommodation on two floors with 24 single bedrooms, 10 bedrooms have ensuite toilet and hand basin and 2 double bedrooms without ensuite. At the front of the home is a large, well-maintained, secluded garden with lawns and a sitting area and a rear concrete patio with a small garden area and seating. There is level access into the home and into the rear yard area and a passenger lift to support people whose bedrooms are on the first floor. Information about the home is readily available on request. Weekly charges range from £415 - £430 per week. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Visit: The inspection was unannounced and was undertaken by the link inspector for the service. The inspection started at 10:00am and lasted 7.5hrs. During the visit we: • • • • • • • Talked with people who use the service. Talked with the home manager and staff on duty. Looked at information about the people who use the service and how well their needs are met, Looked at case records for three residents and other records that must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Also surveys were sent to residents and staff. Responses were received from three residents supported by relatives and four staff members. Information from these sources is used in this report. What the service does well: The Pines provides a caring homely environment in a pleasant setting on the edge of Ashington. Everyone spoken to enjoys living in this home and many positive comments were received about the good support provided by the staff team. There is a varied range of activities for residents to enjoy. All complaints are taken seriously and addressed. Staff are well trained to enable them to support residents appropriately. The Pines DS0000065947.V370442.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. The Pines DS0000065947.V370442.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 The Pines DS0000065947.V370442.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): 1, 3, 6. People who use the service experience good quality outcomes in this area. Comprehensive pre admission assessments and clear pre-admission information for residents are in place. This is so they can make an informed choice and know their care needs will be met before moving into the service. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Everyone is given the opportunity to spend time in the home prior to admission. The manager has recently improved the information available to prospective service users, which gives people information about the home and the service it provides. There is a statement of purpose, service user guides and a copy of the most recent inspection report available to anyone on request. Two of the three questionnaires stated that sufficient information was provided before a decision was made to move in. One resident stated that they The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 9 made an unexpected visit and found the home to be homely with pleasant staff. Another resident stated they made a couple of visits before moving in. The home receives an assessment from the persons care manager prior to admission. This information is looked at by the manager and a pre admission visit is made by management when other information is collected to ensure the home can meet the person’s needs. Each of the case records reviewed contained an assessment of the person’s needs and other appropriate supporting information. Within a short time of admission each resident has a plan of care constructed by senior staff in the home. These plans identify any special needs the individual may have such as religious or cultural requirements as well as personal care needs. The manager stated the home does not provide a rehabilitation service but short-term respite beds are available. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. Overall, health & personal care needs are well supported by good care planning, regular involvement from other professionals and clear recording. However, medication recording is not always consistent and prevents an accurate audit of medications refused/not given. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Shortly after admission a range of assessments to determine the physical and mental needs of the resident are carried out and any identified needs are included in the person’s plan of care. However, it was not always evident that staff using these assessment tools were provided with clear instructions following an assessment. For example, a nutritional assessment for one resident identified a moderate risk but didn’t outline what actions should be taken, if any, to reduce this risk. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 11 Care plans are produced and these are much improved from the last inspection. The home now uses a tool called ‘all about me’ to obtain the information to provide a person centred approach. The care plans are reviewed by key staff each month. This ensures that staff are considering the individuals needs are wishes on a regular basis. Each of the three questionnaires returned from residents stated they ‘Always’ receive the care and support they need. Comments included; Staff are always on hand to help. Always get the help and support off them all. All staff very friendly and helpful. The files are regularly reviewed by the manager for quality. One file was identified as having a fluid monitor in place that was poorly described. The manager was aware of this a showed how she had identified this problem and addressed it with the staff member to ensure a better level of support for the resident. Records demonstrated that residents regularly see healthcare professionals to promote their good health with details of health checks, visits to their GP and hospital appointments being recorded in the individual files. A set of sit-on scales has been purchased to better monitor the weights of residents. Three residents spoken to all stated the home provides a good standard of support and staff were observed throughout the inspection talking to residents and involving them in ad-hoc activities. The manager is concerned that all residents are treated individually. She and her deputy have recently completed equality and diversity training and this was then passed on to other staff. Other staff are to be given this training to ensure residents are well supported to live a life of their choosing. In one residents case record there was a specific plan of care to promote decisionmaking. All senior staff that dispense medicines have had training in the safe handling of medication. The following areas of practice were identified to ensure residents health and well-being is maintained. Medicines must be dispensed exactly as described. If a medicine is described as four times a day the medical administration record must have four areas for recording, not three. When a medicine is described as 1 or 2 the actual dose must be recorded. When a medicine is prescribed as 1 twice a day it should not be administered as 2 once a day. Also staff should use the correct legend when medicines have been refused. Storage of medicines was appropriate, the temperature of the store is regularly monitored and storage facilities are good and safe. Appropriate procedures that promote the safety and well-being of residents are in place. These should be re-introduced to staff administering medicines. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience good quality outcomes in this area. Residents take part in regular activities of their choice. Visitors are made welcome. A good standard of healthy food is provided. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: A social activities co-ordinator has been employed to promote activity for older people. Residents also benefit from regular visits by Mind Active, a company that is funded to promote activities in the local area for residents of care homes. Two of the responses to a questionnaire stated the home ‘Always’ arranges activities to take part in and one response stated this ‘Usually’ happens. One comment was; ‘they have Xmas parties, bingo sessions, flower arranging and painting. Staff are always looking at ways to stimulate residents. In each of the files reviewed, there was a list of activities the resident had been involved in and the activities person was further developing this into a care plan. Residents are encouraged to be active in the home by assisting with The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 13 some domestic chores of their choice. Where appropriate risk assessments have been produced to promote safe fulfilment. Staff stated that residents have left the home recently to visit shops within the nearby town centre and also to visit a local museum. Also following a recent resident meeting another bingo session has been added to the activities calendar. One visitor spoken to briefly on her way home was happy with everything the home does and stated she could not be happier. The manager is aware of diversity issues and has introduces systems to find out about residents specific needs and wishes. She stated that currently people in the home are from the local area and have no needs that cannot be met within the community. The lunchtime meal was overseen. Residents are given a choice as to where to eat their meals and people were seen in three separate areas of the home. Two men chose to have a meal together in a lounge and three women in another lounge. They all stated they enjoyed their meal. In the dining room staff were supporting the majority of residents. Lunchtime appeared a very relaxed occasion. The manager stated that menus have changed recently following a discussion with residents. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use the service experience good quality outcomes in this area. The home takes complaints seriously and staff are well trained to ensure everyone is protected from abuse. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home provides a copy of the complaints procedure to new residents in the Service User Guide and a copy is on the wall near the entrance for the benefit of visitors to the home. One complaint has been received since the last inspection. The manager recorded details of the complaint in a log and the detail demonstrated it was addressed appropriately. The three residents who responded to a questionnaire all stated they were aware of how to complain and one resident commented that any problems are dealt with straight away; the manager is always available and does her utmost to help you. The manager and several staff have been trained in an awareness of issues that affect vulnerable people and the staff spoken to were confident they would The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 15 always support the rights of residents in the home. Training is arranged for the remainder of the staff team. The home has policies and procedures to protect residents and the Department of Health guidance (NO SECRETS) dealing with the protection of vulnerable adults. This guidance is available to all staff to promote abuse awareness. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. People who use the service experience good quality outcomes in this area. The home provides a clean pleasant environment to live. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home is clean and ongoing maintenance work is improving the environment for residents. The windows to the front of the house have been replaced with new double-glazing. The kitchen was refurbished and redecorated to improve standards of hygiene in the home and the communal areas have been re-carpeted. Also in addition to improved decoration in some bedrooms, requirements made at the last inspection to improve residents’ dignity have been addressed. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 17 The front garden is well maintained and staff and residents are improving the rear yard area with some planting to make it a more pleasant place to sit. To improve safety within the home, the paint around intumescent seals in the doors has been removed. The front door has also been fitted with a keypad that disables in the event of a fire for easy egress. There are sufficient bathrooms in the home, although these would benefit from upgrading and in one bathroom the water was too cool for bathing and there was no thermometer to check water temperatures. The manager stated this bathroom was not used as residents prefer to use other bathrooms. Also ensuites in some bedrooms have no natural or mechanical ventilation to ensure the comfort of residents in these rooms. Each of the responses to a questionnaire were positive about the environment with a comments made that ‘the home is always clean with nice clean bedding and well maintained’. Residents spoken to stated they are content with their personal accommodation and that they enjoy living at The Pines. The manager has introduced new cleaning schedules in the home. The tasks described in these schedules should be made clearer to promote good hygiene. The laundry contains suitable equipment to aid the control of infection within the home, however the laundry floor would benefit from a repaint. All rooms containing combustible materials were locked to promote safety in the home. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use the service experience good quality outcomes in this area. There are sufficient staff to meet the needs of each resident and recruitment procedures ensure people who live in the home are safe. Staff get regular training and supervision to ensure the necessary skills are available to provide the people who live at the home with good care. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Information provided by the home manager showed that over 85 of the staff have an appropriate vocational qualification. The records showed that a regular training programme is in place to ensure staff receive the training they need to care for older people and people with a dementia. The range of training provided this year includes; first aid, fire, infection control, mental health, equality and diversity, caring for people with a dementia and training dealing with the safeguarding of vulnerable people. During the inspection sufficient staff were on duty to meet the needs of the residents and the staff rota demonstrated that the normal care staffing levels in addition to the manager who normally works Monday to Friday and a deputy, there is a senior care and two care staff through the day with two care staff on duty through the night. Also an activities person, domestic and kitchen The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 19 staff are employed to complete the staff team. The company employs a maintenance person to work between the homes in the group. The files of recent recruits were reviewed and found to contain appropriate information in the form of application forms, references and Criminal Record Bureau (CRB) checks to ensure residents can live in a safe environment. A system is in place to ensure all new staff receive an induction that demonstrates they are able to care for people living in the home. Details of this is recorded in a workbook and signed by the manager on completion of a demonstration of competency. Also each new staff member is provided with a handbook providing information regarding codes of practice for care workers. Returned surveys from residents were full of praise for the staff team and each resident who expressed an opinion complemented the staff team on the quality of support they provide. Four questionnaires were returned from members of the staff team. The responses identified good training is provided. The main issue for staff was the pressure created by staff sickness and holidays. Staff spoken to stated that training is available and that management provide regular support for them in their work. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. People who use the service experience good quality outcomes in this area. The Pines is a home that is well run for the benefit of the people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager, who is recently registered by The Commission, is aware of the needs of older people. She has made many improvements to the home since being employed and is continuing with these improvements in a structured way to ensure sustained benefit for the people who live and work in the home. Staff stated in a questionnaire that they are well supported, staff meetings are regular, as is supervision and appraisal sessions to promote good practice. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 21 There is a quality monitoring system being introduced. The proprietor visits the home regularly and provides a report of his findings to the manager. The home holds frequent resident and visitor meetings and questionnaires have been developed by the home. The manager stated that any suggestions are acted on. Currently no feedback is given out, it is suggested that issues identified and any actions taken should be included in the home’s newsletter. The home has procedures in place that make sure resident’s finances are safeguarded. The manager demonstrated that regular servicing of equipment takes place, that staff, through training, promote safe working practices to ensure the safety and welfare of people who live in the home. The certificate demonstrating the gas heating system has been maintained and that electrical tests are done were reviewed and found to be in order. A fire risk assessment has been produced. Staff have received fire instruction and fire drills take place to ensure residents are maintained in a safe environment. Recently a company has been employed to revise health and safety practice in the home and introduce new systems of monitoring. This system is not fully in place yet so the manager is also maintaining the current systems. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Pines DS0000065947.V370442.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 OP9 Regulation 13(2) Requirement The manager must ensure that: Medicines are dispensed exactly as prescribed. The legend, as detailed in the administration records to identify medicines not given is used. Staff record and dispense medicines in line with the home’s policies and pharmacist guidance. Timescale for action 30/09/08 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. Refer to Standard OP10 OP18 Good Practice Recommendations Continue with the provision of equality and diversity training for the staff team. Continue with the provision of safeguarding training for the staff team. DS0000065947.V370442.R01.S.doc Version 5.2 Page 24 The Pines 3. OP19 4. 5. 6. OP26 OP27 OP33 Continue with the improvement and upgrading of the home. Bathrooms should be improved, ensuites should be ventilated, the laundry floor should be painted and bath water temperatures should be within the comfortable range of 37-43 deg. C. Review the cleaning schedule descriptions given to domestic staff. Consider staff comments regarding pressure created covering sickness and holidays. Consider using the home’s newsletter to inform people of issues raised and actions taken. The Pines DS0000065947.V370442.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Pines DS0000065947.V370442.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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