Leapfrog Day Nursery - Peterborough

Leapfrog Day Nursery - Peterborough Inspection report for early years provision

p.1

EY221690 Unique Reference Number 12 July 2007 Inspection date Denise May Smith / Anna Davies Inspector

p.1

Hampton Hargate Primary School, Hargate Way, Hampton Hargate, Peterborough, Cambridgeshire, PE7 8BZ

p.1

Setting Address

01733 566321 Telephone number peterborough@leapfrogdaynurseries.co.uk E-mail Leapfrog Day Nurseries (Trading) Ltd Registered person Integrated Type of inspection Full day care Type of care

p.1

Setting Address

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000

p.1

ABOUT THIS INSPECTION

The purpose of this inspection is to assure government, parents and the public of the quality of childcare and, if applicable, of nursery education. The inspection was carried out under Part XA Children Act 1989 as introduced by the Care Standards Act 2000 and, where nursery education is provided, under Schedule 26 of the School Standards and Framework Act 1998. This report details the main strengths and any areas for improvement identified during the inspection. The judgements included in the report are made in relation to the outcomes for children set out in the Children Act 2004; the National Standards for under 8s day care and childminding; and, where nursery education is provided, the Curriculum guidance for the foundation stage. The report includes information on any complaints about the childcare provision which Ofsted has received since the last inspection or registration or 1 April 2004 whichever is the later.

p.2

The key inspection judgements and what they mean

Outstanding: this aspect of the provision is of exceptionally high quality Good: this aspect of the provision is strong Satisfactory: this aspect of the provision is sound Inadequate: this aspect of the provision is not good enough

p.2

The key inspection judgements and what they mean

For more information about early years inspections, please see the booklet Are you ready for your inspection? which is available from Ofsted's website: www.ofsted.gov.uk.

p.2

THE QUALITY AND STANDARDS OF THE CARE AND NURSERY EDUCATION

On the basis of the evidence collected on this inspection:

p.2

THE QUALITY AND STANDARDS OF THE CARE AND NURSERY EDUCATION

The quality and standards of the care are satisfactory. The registered person meets the National Standards for under 8s day care and childminding.

p.2

THE QUALITY AND STANDARDS OF THE CARE AND NURSERY EDUCATION

The quality and standards of the nursery education are satisfactory.

p.2

WHAT SORT OF SETTING IS IT?

Leapfrog Day Nursery is one of 88 nurseries run by Nord Anglia Education PLC. It opened in 2002 and operates from a large, purpose built premises situated within Hampton, a new township, to the south of Peterborough city centre. The nursery serves children living in both the local and wider catchment areas.

p.2

WHAT SORT OF SETTING IS IT?

A maximum of 118 children may attend the nursery at any one time. The nursery is open each weekday from 07.00 to 19.00 for 52 weeks of the year. All children share access to secure, enclosed outdoor play areas.

p.2

WHAT SORT OF SETTING IS IT?

There are currently 124 children aged from birth to under five years on roll. Of these, 51 children receive funding for early education. The nursery currently supports children with learning difficulties.

p.2

WHAT SORT OF SETTING IS IT?

The nursery employs 31 members of staff. Of these, 18 hold appropriate early years qualifications and two are working towards a qualification.

p.2

WHAT SORT OF SETTING IS IT?

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000

p.2

Helping children to be healthy

The provision is satisfactory. Children's health is generally well promoted. Most staff hold an appropriate first aid qualification and the first aid box is kept up-to-date. This means that the staff can respond appropriately should an accident occur. The recording of any accidents children may have is, centrally recorded in the office, these records are analysed and used to inform the risk assessments within the nursery. Routines are maintained so that children’s bedding is identified and cleaned as necessary. Older children are supervised as they independently access the toilet to ensure that they wash their hands. Younger children, at key times such as prior to eating, follow routines whereby staff ensure their hands are cleaned. However, some staff do not continue this level of hygiene at other times of the day. For example, a baby having had her nappy changed plays with the dirty bin lid while the member of staff washes her hands. The member of staff tells

p.3

Helping children to be healthy

her not to play with it because ‘It is dirty’ but does not go on to wash the child’s hands. Another member of staff sneezes into her hands but does not wash them before going on to hold a babies hands when supporting him in walking. This fails to consistently protect the children.

p.3

Helping children to be healthy

The cleaning routines of the premises, toys and equipment throughout the nursery are systematic and ongoing. Areas where children sleep and play are suitable and toys are in a hygienic condition. However, the sink and worktops in the milk kitchen are not routinely cleaned during the day as they become soiled. This does not promote children’s health.

p.3

Helping children to be healthy

Children are well nourished and enjoy a range of healthy food and snacks. Special dietary needs are recorded, and made known to all the staff to ensure that their individual needs are met. Children enjoy a range of healthy snacks such as apples and bananas together with water and milk. Older children freely access their water bottles throughout the day as they become thirsty ensuring they remain hydrated. All children are offered freshly prepared meals suitable for their individual needs. The meals are appealing, sufficient in quantity and enjoyed by the children. The management takes care to ensure that all food served in the nursery is suitable for all, any food a child may be allergic to is removed from the menu; this gives added protection to children.

p.3

Helping children to be healthy

Children are offered good access to physical play in the garden as they climb and slide on the large static climbing frame and use a range of wheeled vehicles to manoeuvre around the painted roadway. Indoors, young children enjoy dancing to music with the staff and clamber onto soft play shapes as they develop their skills at climbing. They use, with increasing control, a range of small equipment such as trowels as they dig in the soil and paint brushes to paint on banners in the garden.

p.3

Protecting children from harm or neglect and helping them stay safe

The provision is good. Children are cared for in a welcoming, secure and safe indoor and outdoor environment. Staff are deployed throughout the nursery to ensure that children are supervised at all times. Thorough risk assessments are in place and continually reassessed to ensure that the building, toys and equipment remain in a suitable condition. This contributes towards keeping children safe.

p.3

Protecting children from harm or neglect and helping them stay safe

Very good security arrangements are in place to prevent unauthorised access to the rooms where children are being cared for. The outside areas, in addition to the internal rooms, are monitored by the management via close circuit television. A separate monitor in the reception

p.3

Protecting children from harm or neglect and helping them stay safe

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000 area allows parents to view their children in their base rooms as they arrive and leave their children or as they collect them in the evening. This helps satisfy them that their children have settled and are engaged in activities.

p.3

Protecting children from harm or neglect and helping them stay safe

Toys and equipment are well maintained, clean and suitable for the children attending and effectively meet their individual needs. Young children sleep in identified cots, in a spacious sleep room or on sleep mats in their base rooms. Children have access to a sensory room within the nursery to further extend the range of opportunities available to them.

p.4

Protecting children from harm or neglect and helping them stay safe

Fire evacuations are practised, recorded and evaluated to inform the ongoing risk assessments and therefore develop effective practice. Children are protected from abuse or neglect. The manager takes the lead role for child protection and all staff are aware of the signs to look for and the procedure to follow if they have concerns.

p.4

Helping children achieve well and enjoy what they do

The provision is satisfactory. Children are happy, settled and enjoy their time in the nursery. They gain confidence through consistent routines and form appropriate relationships with the staff team. Staff use the ‘Birth to three matters’ framework to support the care, learning and play of the children in the baby, waddlers, pre-toddlers and toddler rooms. Planning across these rooms is balanced and provides children with a range of age-appropriate experiences. Staff assess the children’s development and identify next steps of learning for them. However, staff have not received training in this key area and do not have a firm understanding of this process. This results in them not effectively identifying appropriate next steps of development or learning. There is not a clear process for using observations and assessments to inform the short term planning which means that the planning is not tailored to meet their individual needs.

p.4

Helping children achieve well and enjoy what they do

Staff take time to sit on the floor with the children supporting their play such as, encouraging them to catch and pop the hundreds of bubbles created by the bubble machine; children delight as they pop on their hands. Staff in the baby and waddler rooms support the children as they develop their confidence in walking and encourage them to explore using both natural and man-made resources. Staff in the pre-toddler and toddler rooms sit with the children as they play and support them as they paint and engage them in stories as they sit and read stories together.

p.4

Helping children achieve well and enjoy what they do

Children progress through the nursery rooms depending on their age and stage of development. This ensures children are grouped appropriately. Staff operate a key care system so that children, wherever possible, are cared for by the same adult. This helps children to form relationships and become confident in the setting.

p.4

Helping children achieve well and enjoy what they do

The quality of teaching and learning is satisfactory. Staff working with the pre-school children generally have a sound understanding of the Foundation Stage and this ensures that children make satisfactory progress towards the Early Learning Goals. Most staff collate regular written observations of the children's play and learning and their progress is illustrated in the form of a written report twice a year. However, although observations are used to identify children's next steps of learning, these are generally too broad and are not used effectively to inform future planning. This results in missed opportunities to challenge or support children and is not completely effective in helping them to move on to their next stage in their learning. Staff

p.4

Helping children achieve well and enjoy what they do

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000 have reviewed their methods used for planning to ensure that children are offered a broad and balanced range of activities that cover the six areas of learning. Learning intentions for some activities are displayed. However, some staff are not sufficiently knowledgeable or experienced in the way that children learn. This results in missed opportunities to extend and develop individual children's knowledge through both planned and spontaneous activities.

p.4

Helping children achieve well and enjoy what they do

The rooms used by the pre-school children are clearly designated for different activities. However, the organisation of the free-flow system of play encouraged by staff between the rooms, is not implemented effectively. Children are told when they can and can't play in each room, according to how many children are already in there. This limits their ability to make independent choices and decisions about the activities that they wish to be involved in. Some resources such as writing materials and creative materials, are organised so that they are accessible to children. However, children do not routinely self-select these resources.

p.5

Helping children achieve well and enjoy what they do

Children separate confidently from their parents and carers and have good relationships with both staff and their peers, creating a positive environment in which to learn. They are developing their independence skills as they help to set the table for snack and mealtimes and serve their own drinks and food. Children are keen to take part in new activities such as matching games and mixing their own paints. They are confident speakers and love to share experiences from home such as, a recent trip to a theme park. However, some staff interrupt children's activities, for example, to call them for their snack, which does not help to promote children's self-esteem or demonstrate that they value what children have to say and do. Children independently promote the good behaviour and co-operation of others. For example, as children share items that they have brought in from home, they organise the children to look at them one at a time

p.5

Helping children achieve well and enjoy what they do

so that everyone gets a turn. Some children anticipate and appreciate the needs of others, spontaneously fetching chairs for adults to sit on and handling models made by other children, with care.

p.5

Helping children achieve well and enjoy what they do

Children show an appreciation and enjoyment of story books as they spontaneously visit the well-resourced book corner and read aloud to themselves and to others. They are generally beginning to learn to communicate through writing. They spontaneously use emergent writing as they draw and some letters are recognisable. They are able to draw detailed pictures and show delight when staff support their drawing activities and share their ideas with them. Some opportunities are available for children to use writing for other purposes. For example, children make their own pretend observations using a note pad and pencil. Children are beginning to link sounds to letters through the use of planned and spontaneous activities such as, looking at the letters that begin the staff's names on their badges.

p.5

Helping children achieve well and enjoy what they do

Children spontaneously use mathematical language and concepts in their play. For example, during sand play they discuss the sizes of their buckets and how much sand it takes to fill them. Some younger children count confidently, for example, up to sixteen. However, there are missed opportunities for children to extend their learning because staff do not always provide effective support during this play. Children are able to match and sort objects according to similarities and differences. For example, during a game of 'pairs' staff encourage children to shout out if two cards are the same. They calculate as they count backwards and forwards, taking away and adding one on each time, during songs such as 'Five Currant Buns'.

p.5

Helping children achieve well and enjoy what they do

Children are making good progress in their physical development. They are confident climbers on the large apparatus outside. They make good use of available space outside as they run around and pedal tricycles, cleverly avoiding obstacles in their path. Some staff enthusiastically use spontaneous opportunities outside to develop children's physical skills. For example, children

p.5

Helping children achieve well and enjoy what they do

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000 show much enjoyment as they march, playing musical instruments to 'The Grand Old Duke of York'.

p.5

Helping children achieve well and enjoy what they do

Children are beginning to understand the concept of time as they make connections between their own watches and the clock on the wall to describe at what time 'tidy up time' will take place. They show curiosity as they repeatedly travel toy cars down a small ramp during an activity that links to the current 'transport' theme. However, staff do not offer effective interaction to further develop their learning, for example, the concept of speed. Children are clearly enthusiastic when the settings computer is fixed and they can work together to complete simple programmes. Following the very recent development of the outdoor learning environment, children are keen to be outside and enjoy the many opportunities for natural exploration. They dig in the flower beds looking for worms and watch how water, sand and small balls travel down lengths of drainpipe.

p.6

Helping children achieve well and enjoy what they do

Children explore their own ideas of creativity through planned activities such as mixing colours of paint. They spontaneously paint their own hands and arms and make unique prints onto paper. However, ineffective staff support does not enable children's learning and ideas to be further extended. Children engage themselves and others in complex role play ideas. For example, they make dens behind furniture and experiment with their own 'fishing rods' that they have created. Some staff support and extend their learning during imaginative play as they ask 'Which room does the bed go in?' when children are organising the doll's house furniture. Children have an appreciation of music and rhythm as they sing and dance in circle times, for example, they are able to clap their hands and tap their knees in time to the singing.

p.6

Helping children make a positive contribution

The provision is satisfactory. Children are made to feel welcomed in the setting. Staff take time to greet the children as they arrive and settle them into their play. Comprehensive information is gathered from parents to ensure staff are aware of the children’s individual needs, especially with the babies, so that their feeding and sleeping routines can be followed. A system is in operation whereby children who have food allergies eat from a different coloured plate in order to ensure the food that they eat is suitable. However, in practice, as any food children may be allergic to is removed from the nursery menu. The food is all the same, it is cooked together and simply served in the kitchen on these special plates, children receiving this food do not have the opportunity to serve themselves as the others are encouraged to do, and cannot choose to have second helpings if they wish. This is not treating all children with equal concern and makes these children feel

p.6

Helping children make a positive contribution

General information about the children’s day is shared with parents on a daily basis as they arrive to collect their children. Parents spoken to during the inspection are generally positive about the care provided and they feel able to approach staff and management if they need to. A selection of the children’s work is displayed on some of the nursery walls and corridors which helps children to develop a sense of pride and promotes their self-esteem. Children across the nursery are developing positive attitudes towards others. They have opportunities to learn about their local community as they go for walks to the lake and around the local area. They gain an understanding of the wider world through using a range of multi-cultural toys and celebrating a variety of festivals from around the world. This helps them to understand and value the similarities and differences between themselves and others.

p.6

Helping children make a positive contribution

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000 All children are fully integrated within the setting. Procedures are in place to ensure any child who has learning difficulties and/or disabilities is appropriately supported. A co-ordinator is in place, who has received appropriate training. She oversees the staff to ensure these procedures are implemented. Staff have developed appropriate relationships with other relevant professionals. This means that children receive appropriate support.

p.6

Helping children make a positive contribution

Children are encouraged to develop positive relationships with each other. Staff use effective strategies to manage children's behaviour. For example, staff explain to children why they must not do things, such as throwing sand, so that children begin to understand consequences of their actions. Good manners are promoted as children are encouraged to say 'Please' and 'Thank you' and not to talk with their mouth full. Children’s spiritual, moral, social and cultural development is fostered.

p.7

Helping children make a positive contribution

The partnership with parents and carers of children who receive nursery education is good. They have access to a good amount of information regarding the Foundation Stage and how children are helped to make progress towards the early learning goals. Open days enable parents to participate in some of the activities that their children are offered, and understand their educational benefits. Planning is clearly displayed and newsletters detail the themes and suggested resources that can be brought in from home. This enables parents to share in their child's learning. Parents receive biannual written progress reports together with regular parent consultation opportunities. This enables them to discuss their children's progress and development. However, the next steps of learning recorded on the progress reports, are too broad and do not help parents to provide specific support to their children.

p.7

Organisation

The organisation is satisfactory. Children are cared for by adults who have submitted to a robust recruitment and vetting procedure to ensure that they are suitable to care for the children. Thorough induction procedures are in place for all new staff and regular staff reviews and appraisals generally identify training and development needs, supporting staff in their work. Staff are encouraged to attend training such as first aid but the lack of training in the ‘Birth to three matters’ framework and the Foundation Stage impacts on the quality of the learning opportunities provided. The safety and welfare of the children is given a high priority and many systems and procedures are in place to ensure staff perform required tasks. However, these do not take into account routine daily situations that arise such as the identified hygiene issues. The children progress through the many rooms and sub-groups within the nursery according to their individual

p.7

Organisation

needs and the premises are maintained to support their care and learning.

p.7

Organisation

All of the required policies and procedures are in place and maintained in a confidential manner. Overall the provision meets the needs of the range of children for whom it provides.

p.7

Organisation

The quality of the leadership and management is satisfactory. The manager is new in the post since the last inspection and has some effective systems in place for monitoring the provision of nursery education to ensure that children make satisfactory progress towards the early learning goals, for example, through regular meetings and discussions. However, these systems are not always effective in identifying weaknesses in the quality of teaching and learning. This means that children are not always able to meet their full potential.

p.7

Organisation

Action plans generally outline areas for improvement. However, whilst some improvements have been suitably actioned, other key areas such as the development of the outdoor provision,

p.7

Organisation

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000 have taken much longer to implement which has an impact on the quality of teaching and learning. Staff are well supported on a day-to-day basis. For example, they are generally offered sufficient time to plan activities and regular staff meetings ensure that they are aware of key issues that affect their daily practice. The manager has a clear, child-focussed vision of the future of the nursery and both he and the whole team of staff demonstrate a firm commitment to further improving the standards of care and education for the children in their care.

p.7

Improvements since the last inspection

At the last care inspection the provider agreed to devise and implement a system for monitoring and recording children's progress that is consistently maintained by staff to help children to progress to their next stage of development. The staff are now using the 'Birth to three matters' framework to plan for the younger children in the setting rather that the early learning goals. This is appropriate for these younger children and the planning provides a range of experiences for children. However, the use of assessment to effectively inform these plans is a recommendation resulting from this inspection. The provider agreed to review the organisation of the toddler rooms to enable children to free-flow and access a variety of different activities simultaneously. The toddlers now have access to all of their rooms, for most of the day, as they wish, providing them with greater access to a range of opportunities. The procedure for changing

p.8

Improvements since the last inspection

nappies has been reviewed so that it now meets children's individual needs. Overall, staff have developed their practice in line with these recommendations improving the outcomes for children.

p.8

Improvements since the last inspection

At the last nursery education inspection, three recommendations were made with regard to the maintenance and use of children's progress and assessment records, the outdoor play environment and the presentation of resources, particularly in the role play area. Children's progress and assessment records are generally consistently maintained by staff and next steps of learning are routinely identified. However, these are too broad and are not always used to guide planning and therefore does not ensure that children are sufficiently challenged. The provision of opportunities for natural exploration in the outdoor play area have taken a long period of time to be actioned. Consequently this has had an impact on the quality of children's learning in the outdoor environment up until this inspection. However, very recent improvements to the outdoor areas now ensures that there are plenty of opportunities for natural exploration,

p.8

Improvements since the last inspection

for example, digging in flower beds, exploring the properties of sand and water using lengths of drainpipe and pots and pans hung on the fence to stimulate musical experimentation. Extra resources are now taken into the role play area, such as a telephone and fax machine and further resources to support themed play, for example, travel and estate agents brochures. This effectively supports and enhances children's imaginary play. Overall, some improvement has been made to improve the quality of teaching and learning and further areas for development have been highlighted at this inspection.

p.8

Complaints since the last inspection

Since The last inspection Ofsted has received five complaints. On the 25th August 2006, the provision informed Ofsted that they had received a complaint regarding nursery hygiene, children being restrained and children being ill. This relates to National Standard 7: Health and National Standard 13: Child protection. Ofsted asked the provider to investigate and report back to Ofsted within seven working days. The provider reported that all staff will be refreshed in ‘good practice’ and the child protection policy. The formula milk/bottle log had been amended to include details of what happens to the bottle and teat following use. Ofsted is satisfied that

p.8

Complaints since the last inspection

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000 the registered person has taken appropriate steps to address the concerns, and the registered person continues to be qualified for registration.

p.8

Complaints since the last inspection

On the 4th January 2007, Ofsted received a complaint which raised concerns about safety at the setting, hygiene, staff deployment and behaviour management. Ofsted conducted an unannounced visit to the provision on the 16th January 2007 to consider these concerns in relation to National Standards 2: Organisation, 6: Safety, 7: Health and 11: Behaviour. During the visit a breach of National Standard 6 was identified and the provider took action to remedy this by removing unsafe play equipment from the baby room. The registered person continues to be qualified for registration.

p.9

Complaints since the last inspection

On the 19th March 2007, Ofsted received concerns about hygiene standards within the setting, and the level of learning and development provided to children through activities and resources. These concerns related to National Standards 3: Care, learning and play 4: Physical environment and 7: Health. There were also two additional complaints raised within the same timeframe that were also taken into consideration. On the 22nd March 2007, Ofsted conducted an unannounced visit to the provider to investigate these concerns. In relation to this case the provider was not meeting National Standards 4 and 7, at the time of the visit and therefore three actions were set as part of eight actions set overall. Under National Standard 4, the provider was told to provide evidence of how the premises were kept clean and maintained to a suitable standard, and provide evidence of the arrangements made to ensure that an adequate

p.9

Complaints since the last inspection

supply of clean bedding and towels were always available. Under National Standard 7, the provider was told to ensure that a record of all accidents was maintained. The deadline for all actions was 30th March 2007.

p.9

Complaints since the last inspection

On the 5th April 2007, Ofsted received a response from the provider detailing what actions had been taken to meet the National Standards. Ofsted also conducted a monitoring visit on 16th April 2007 to check that all actions had been met and were satisfied that the provider was meeting the National Standards. No further action was taken. The provider continues to be qualified for registration.

p.9

Complaints since the last inspection

The provider is required to keep a record of complaints made by parents, which they can see on request. The complaints record may contain complaints other than those made to Ofsted.

p.9

THE QUALITY AND STANDARDS OF THE CARE AND NURSERY EDUCATION

On the basis of the evidence collected on this inspection:

p.9

THE QUALITY AND STANDARDS OF THE CARE AND NURSERY EDUCATION

The quality and standards of the care are satisfactory. The registered person meets the National Standards for under 8s day care and childminding.

p.9

THE QUALITY AND STANDARDS OF THE CARE AND NURSERY EDUCATION

The quality and standards of the nursery education are satisfactory.

p.9

The quality and standards of the care

To improve the quality and standards of care further the registered person should take account of the following recommendation(s): • ensure that the systems in place to prevent the spread of infection are consistently applied to routine practice. This relates to the cleanliness of the food and bottle

p.9

The quality and standards of the care

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000 preparation area and staff's understanding of when it is appropriate to routinely wash their own, and children's hands • ensure that all children are treated with equal concern. This relates to children with identified health needs being given the same opportunities, being allowed to serve themselves and have second helpings if requested • develop further the staff's understanding of how to effectively use assessments to identify appropriate next steps of learning and use this information to directly influence the short term planning (also applies to Nursery Education).

p.9

The quality and standards of the nursery education

To improve the quality and standards of nursery education further the registered person should take account of the following recommendation(s): • improve the effectiveness of the free-flow system of play and the organisation of resources to promote children's learning, decision making and independence • continue to develop systems for monitoring and evaluating the provision for nursery education to ensure that children are consistently challenged and have access to good quality learning experiences • improve staff's knowledge of how children learn to ensure that opportunities for learning are not missed during both planned and spontaneous activities.

p.10

The quality and standards of the nursery education

set out in the leaflet Complaints about Ofsted Early Years: concerns or complaints about Ofsted's role in regulating and inspecting childcare and early education (HMI ref no 2599) which is available from Ofsted's website: www.ofsted.gov.uk

p.10

The quality and standards of the nursery education

This inspection was carried out under the provisions of Part XA of the Children Act 1989, as inserted by the Care Standards Act 2000

p.10