Inspection on 06/06/08 for Church Green Lodge

This is the latest available inspection report for this service, carried out on 6th June 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Church Green Lodge 22/12/05

Church Green Lodge 15/06/05

Church Green Lodge 11/01/05

Church Green Lodge 27/07/04

Church Green Lodge 12/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Church Green Lodge Church Lane Sprowston Norwich Norfolk NR7 8ET Lead Inspector Debra Allen Unannounced Inspection 6th June 2008 10:30 Church Green Lodge DS0000035060.V366073.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 Church Green Lodge DS0000035060.V366073.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. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church Green Lodge Address Church Lane Sprowston Norwich Norfolk NR7 8ET 01603 411855 01603 411855 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) www.norfolk.gov.uk Norfolk County Council-Community Care Mr Brendan O`Brien Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Six (6) service users may be accommodated of either sex who have a learning disability and are aged between 18 and 65 years. The length of stay of a service user shall not exceed 28 days. Where there is a need for this condition to be waived, the provider will consult with the Commission, in advance, to agree and give reasons for any extension. 8th June 2006 Date of last inspection: Brief Description of the Service: Church Green Lodge is a six bedded purpose built home offering short-term care for up to six adults with learning disabilities. It is located in a residential area in the suburbs of Norwich. All of the accommodation is located on the ground floor and there is car parking to the front of the home, with a sizeable enclosed garden to the side and rear. This resource is operated by Norfolk Learning Difficulty Services and guests will generally stay for a few days, a weekend or a full week, although some stays may be longer. The fees for the respite service vary, depending on individual circumstances of guests and their families. Church Green Lodge DS0000035060.V366073.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 stars. This means the people who use this service experience good quality outcomes. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This inspection was carried out over a period of three and a half hours, during which time a discussion was held with the registered manager, records and files were checked and a tour of the premises was made. One guest was observed during the course of the inspection. Meanwhile, the registered manager of Church Green Lodge completed an Annual Quality Assurance Assesment (AQAA) and submitted it to The Commission prior to this inspection. Additionally, The Commission completed an Annual Service Review (ASR) for Church Green lodge in November 2007. Four requirements have been made as a result of this inspection. Four relatives returned completed questionnaires about the service, all of which contained mostly positive comments such as: …[name] is always made very welcome and is very comfortable going there. …staff are very friendly and caring. …sometimes they are a bit short-staffed, more staff would help. …Church Green Lodge is perfect for [name]s needs and for when we need a break. …excellent care. “ …the care and the food is brilliant.” Four surveys were also completed and returned by staff members. These contained generally positive comments as well as some constructive feedback, which should also be given some consideration, such as: “Good training is provided to us.” “We have regular 1:1 supervision sessions, although they could be more formal and organised.” Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 6 “We provide a homely environment, enable personal choice, independence and creative activities in a safe and supportive way.” “We could be better staffed.” “We could do with more resources.” “Its not just a job, most of the staff really do care.” “We offer a good range/choice of meals.” “Care plans could be updated more regularly.” “We could do with more time for proper hand-overs.” “Generally staffing is ok, but the rotas are sometimes chaotic, leading to mistakes being made.” “We could make better use of staff meetings to discuss service users and procedures. Six Questionnaires were also completed and returned by some of the people who have stayed at Church Green Lodge, which also contained additional comments such as: “Church Green Lodge is a wonderful place, I like everybody at the Lodge.” “I like coming to Church Green Lodge but I don’t like it if other people come in my bedroom when the door is shut.” “I’d like more activities, especially with my friends.” “I like coming when my friends are here.” “I like going out on the mini bus.” “The beds are nice and comfy.” “I like the food and listening to music.” ”The staff are nice and friendly.” “I like being with other people and making new friends.” “I think the Lodge is a nice place to stay – it’s better than the hostel that used to be here.” “I like coming to stay at the Lodge but I don’t feel so safe if I don’t know the other guests.” “I like staying when my best friend is here.” “It’s lovely at Church Green Lodge.” What the service does well: Church Green Lodge provides a homely and comfortable environment for respite guests. All new guests are properly assessed before staying at Church Green Lodge and regular guests have their assessment information reviewed and updated before each visit. Each person staying at Church Green Lodge has a personal file, which is reviewed and updated on a regular basis. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 7 Healthy meal options are offered and guests are involved in choosing the menu. There is an excellent range of activities available at Church Green Lodge and there are regular outings, which guests are able to help choose and organise. The people staying at Church Green Lodge receive personal care and support in the way they prefer. 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. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 8 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 Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 9 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): 2 & 4 Quality in this outcome area is excellent. All new guests are properly assessed before staying at Church Green Lodge and regular guests have their assessment information reviewed and updated prior to each visit. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A discussion with the manager, and the records looked at, confirmed that individual needs assessments are carried out – usually by the manager, in conjunction with each individual, social workers, relatives and carers. Good evidence was seen in people’s care plans by way of questionnaires and other information recorded or gathered during previous stays. The manager also explained how new guests are invited to come to the service and look around, followed by an afternoon/evening visit (which can include staying for dinner) and finally an overnight stay, in order to ensure that people will be happy staying at Church Green Lodge and confirm that the service can fully meet each person’s needs. Information held in individual files showed that regular visitors have their information reviewed and updated before each stay. Church Green Lodge DS0000035060.V366073.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, 9 & 10 Quality in this outcome area is excellent. Each person staying at Church Green Lodge has a personal file, which is reviewed and updated on a regular basis. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans and personal files were looked at for four people, two of which were for people currently staying at Church Green Lodge, while the other two were for people who had visited before. New assessment forms and questionnaires were seen to include clear and detailed information with regard to people’s ‘self-help’ skills and very good examples were seen of previous records having been reviewed and relevant information added where necessary to show changed needs or requirements in areas such as personal care/hygiene, dietary requirements and work/leisure interests. As the people staying at Church Green Lodge are guests and not permanent residents, their involvement with regard to decision-making was noted to be Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 11 focussed much more around work and leisure activities, meal choices, what to do in the evenings and where to go for ‘outings’. Daily notes were also looked at, which gave further evidence of how people had made decisions and choices. The care plans/personal files that were looked at also contained very detailed risk assessments covering areas such as going out, traffic awareness, moving and handling, individual challenging behaviour, medication and personal hygiene. Each assessment was seen to be very individual and personal and good explanations were given for risks that were assessed as being too great, although on the whole the risk assessments were of a very empowering nature, with evidence of staff encouraging people to do as much as possible for themselves, rather than doing things for them. All personal information, relating to guests, was seen to be stored securely in the office, thereby ensuring confidentiality. Church Green Lodge DS0000035060.V366073.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, 14, 15, 16 & 17 Quality in this outcome area is excellent. Guests have opportunities to be part of the local community, maintain appropriate personal relationships and engage in appropriate leisure activities, if they choose to. Healthy meal options are offered and guests are involved in choosing the menu, to help ensure meals and mealtimes are enjoyable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An excellent range of activities and leisure facilities were seen to be available within different areas of Church Green Lodge such as Sky TV, music, videos, DVDs and Jigsaws in the two lounges, an organ, karaoke machine and ‘soft’ mats/boxes in a communal area and various equipment such as Giant Connect 4, music, television, computer, pool table, jigsaws and assorted games/board games in the games room. In addition to the above, daily notes provided good evidence of external activities and outings such as attending day services, trips to the pub, Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 13 shopping trips, trips to Wroxham or the beach and meals out although one guest stated in their questionnaire: “I’d like more activities, especially with my friends.” It was apparent from daily notes and personal files that people are able to maintain appropriate personal relationships and engage in appropriate leisure activities. Additionally, some of the other comments received from people who have stayed at Church Green Lodge were as follows: “I like staying when my best friend is here.” “Church Green Lodge is a wonderful place, I like everybody at the Lodge.” “I like coming when my friends are here.” “I like being with other people and making new friends.” “I like coming when my friends are here.” “I like going out on the mini bus.” “I like the food and listening to music.” In addition to the above some of the comments in the staff questionnaires stated: “We provide a homely environment, enable personal choice, independence and creative activities in a safe and supportive way.” “We could do with more resources.” “Its not just a job, most of the staff really do care.” “We offer a good range/choice of meals.” And some of the relative’s comments included: …Church Green Lodge is perfect for [name]s needs and for when we need a break. …excellent care. “ …the care and the food is brilliant.” Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. The people staying at Church Green Lodge receive personal support in the way they prefer, their physical and emotional healthcare needs are met and they are protected by the home’s medication policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans and personal files that were randomly inspected contained good evidence of people being able to choose the way they receive personal care and support. Detailed information was seen in respect of last appointments with healthcare professionals and there were clear guidelines and information for staff with regard to individual requirements in areas such as mobility, diet, leisure and interests, personal abilities, sleep patterns, significant medical requirements, Guests wishes regarding urgent medical treatment and funeral arrangements. Medication was seen to be stored in a locked cabinet in the manager’s office and the manager confirmed that all tablets are counted in and out when Guests arrive and depart. Medication administration sheets were noted to be kept in each individual’s personal file and initialled by staff at the point of medication being given. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. Respite guests feel their views are listened to and acted on and they are protected from abuse, neglect and self harm as much as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information supplied by the manager in the Annual Quality Assurance Assessment (AQAA) stated that five complaints had been received since the last inspection and the information and records looked at confirmed that none of these were of a serious nature. All of the complaints were seen to have been dealt with appropriately, with confirmation of the outcome and any action taken put in writing to the person making the complaint, in line with the service’s complaints procedure. All six Guests who returned completed questionnaires said they knew who to talk to if they were unhappy and three out of four relatives/carers confirmed that they knew how to make a complaint if necessary. One relative/carer stated that they didn’t know how to make a complaint but they did confirm that the service had always responded appropriately if any concerns were raised. Other records looked at confirmed that staff are well trained in areas relating to adult abuse and protection. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is excellent. Church Green Lodge provides a homely, comfortable and safe environment for respite guests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection all the communal areas were seen to be clean and tidy and the whole environment had a very comfortable and homely feel to it. No safety hazards were identified during a tour of the premises. In addition to private single bedrooms, all of which have televisions and overlook the back garden, there is choice of communal areas such as the two lounges and the games room. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good. Church Green Lodge has a robust recruitment procedure and a good training programme, although staff need to receive formal supervision sessions on a regular basis. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were looked at and found to contain application forms, copies of employment contracts, job descriptions, evidence of identity, clear enhanced Criminal Records Bureau (CRB) disclosures and written references. Training records and personnel files confirmed that staff are also well trained in a number of areas such as moving and handling, health and safety, medication, first aid, fire safety, food hygiene, challenging behaviour and adult protection. Copies of rotas were also looked at during the inspection and these showed which guests were staying at Church Green Lodge and which staff were on duty at what times. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 18 The staff team is made up of a combination of full time, part time and relief staff, most of who have worked at Church Green Lodge for some time, and the rotas are created according to the number of guests staying at Church Green Lodge and their individual/personal requirements. The records looked at in respect of staff supervision were found to be quite irregular and formal supervision sessions must be carried out and documented on a regular basis. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is good. Church Green Lodge is generally a well-run service and respite guests benefit from the ethos, leadership and management approach, although a documented quality assurance process still needs to be put in place, Regulation 26 visits must be carried out and recorded on a monthly basis and evidence of weekly fire equipment checks must be available for inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has successfully completed his registration with the Commission since the last key inspection and appears to be managing the service very effectively on the whole, with mostly positive comments having been received in questionnaires from guests, relatives/carers and staff members. However, evidence of a formal ‘in-house’ quality assurance process was still not available, although comments in personal files and daily notes showed that Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 20 feedback from guests was invited and the manager confirmed that he was in the process of compiling questionnaires to be sent out to guests, relatives/carers and relevant professionals such as doctors, tutors and social workers etc. This requirement has therefore been repeated. Health and safety is generally promoted at Church Green Lodge and records looked at confirmed that servicing of the fire system and equipment takes place regularly, cleaning materials/hazardous chemicals were seen to be stored appropriately and staff training in areas relating to health and safety was seen to be up to date. However, although the manager confirmed that a specific member of staff now carries out the weekly fire alarm and equipment checks, records providing evidence of this were not available during the inspection. Therefore, this requirement has been repeated. Guests generally only bring small amounts of money with them during their stays at Church Green Lodge, to cover things like outings but good records were seen of any money that is looked after on behalf of individuals, receipts are kept in individual guests’ files and clear records are maintained of all expenditure. Monthly Regulation 26 visits have not been taking place recently. Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 21 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 X 2 4 3 X 4 4 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 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 3 LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 2 X Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA36 Regulation 18 Requirement It is required that staff are formally supervised on a regular basis as determined in the National Minimum Standards. Repeat Requirement. It is required that weekly checks of the fire system are carried out and recorded. Repeat Requirement. A process for reviewing the quality of care must be developed and put into place. Repeat Requirement. Monthly visits by a representative of the County Council must be carried out and a copy of the report sent to the Commission. Timescale for action 31/10/08 2. YA42 23 30/06/08 3. YA39 24 31/10/08 4. YA39 26 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Church Green Lodge DS0000035060.V366073.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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