Inspection on 17/11/09 for Siloam Lodge

This is the latest available inspection report for this service, carried out on 17th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Siloam Lodge 03/12/07

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Siloam Lodge 75 Bushgrove Road Dagenham Essex RM8 3SL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Legg     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Siloam Lodge 75 Bushgrove Road Dagenham Essex RM8 3SL 02085923977 02085923977 siloamlodge@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Siloam Carehomes Ltd care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 2 The Registered Person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Siloam Lodge is a small domestic style care home which provides accommodation and care for up to two people with mental health needs. The service is situated in Dagenham residential area. The home is semi terraced new build house. Off street parking is available for two vehicles at the front of the building. Public transport is near by. 0 3 1 1 2 0 0 8 2 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was undertaken by Mrs Julie Legg the lead inspector for the service and took place over one day. the manager was present for the inspection and was given verbal feedback at the end of the inspection. The inspection involved a tour of the premises, discussions with the manager and one of the service users. A health care professional also gave verbal feedback on the service provided. We looked at service user and staff files as well as other written records and we took information from the Annual Quality Assurance Assessment (AQAA). Care Homes for Adults (18-65 years) Page 5 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 7 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have the information they needs to determine whether the home is right for them. Evidence: The homes Statement of Purpose is specific to the home and the service user group they care for. It clearly sets out the aims, objectives and the philosophy of the service that can be provided. The Service User Guide is written in plain English and supports the Statement of Purpose, it states the services that can be provided, the quality of the accommodation and how to make a complaint. A copy of the most recent inspection report is also available; this allows the prospective service user to decide as to whether the home is right for them. All prospective service users receive an assessment prior to moving into the home. This assessment is carried out by the manager and involves the service user, families or representatives and other professionals. The assessment focuses on achieving positive outcomes for the service users and a placement is only offered of the manager is confident that the staff have the appropriate skills to meet the needs of Care Homes for Adults (18-65 years) Page 8 of 26 Evidence: the prospective service user. Admissions would normally be on a transition basis; that is prospective service users visiting the home and then staying overnight and possibly a weekend. This will assist the prospective service in getting to know the other service users and staff. Through these visits the service is able to identify as to whether they can meet the needs of the service user. Care Homes for Adults (18-65 years) Page 9 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to take control of their lives and are encouraged to make their own decisions and choices. Evidence: We looked the files of the two service users, spoke to one service user, staff and a health professional who all told us that service users are encouraged and supported to make their own informed decisions and that they also have the right to take risks in their daily lives within the bounds of their discharge sections under the Mental Health Act. Both service users have care plans and both have been involved in their development. The care plans are based on their individual assessments and cover in sufficient details all aspects of their life and address any needs identified around gender, disability, age, sexual orientation, religion or belief. Each service user has their own key worker who actively provides one to one support when required and keeps the care plan updated. Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: Care plans include risk assessments and any limitations on freedom or choice are always in the persons best interest and discussed with them. This is particularly important as the service is for male adults with a mental health illness who have a forensic history. The management of risk is positive in addressing safety issues whilst aiming for improved outcomes for people. However some of the risk assessments were too generalised and need to be more specific to an individual need. Care plans are used as a working tool and are regularly reviewed. Both service users care plans are in line with the Care Programme Approach (CPA) and are reviewed in accordance with the CPA procedures by the service users consultant psychiatrist. The manager has developed good working relationships with other agencies and this ensures that there is effective and well coordinated mental health care for service users. One service user told us staff dont tell me what to do but ask me what I want to do. One health care professional felt that the service users needs were being met and did not have any concerns. Both of the service users are able to and are encouraged to participate in the running of the home and regular meetings are held to ascertain their views on activities, menu planning and the domestic chores within the home. Care Homes for Adults (18-65 years) Page 11 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have the opportunities for personal development and to develop thier life skills. Evidence: Service users care plans identify choices such as leisure activities, day services, activities within the home, family contact and friendships. Daily records show when and where these activities have taken place. Both of the service users have opportunities for personal development within the home and in the community. Both of the service users attend a day service as well as a drop-in centre and other activities within the community such as cinema, church, tennis, football and shopping. Some of these activities service users undertake on their own and others they receive the support of their key worker. Day trips have included Kew gardens, Richmond Park and one service user went to France on Eurostar. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: There are no set house rules and a service user was observed going around the house freely. At the time of the inspection one of the service users was attending a day service supported by a member of staff and the other service user was initially playing music in his bedroom and then eventually went out. Both of the service users have keys to their rooms and one service user has the key to the front door. Both of the service users have family who are in regular contact and one of the service users has access to an advocate. One service user regularly visits his family and has friends who visit him at the home. Staff have the overall responsibility for the cleaning of the home, however service users are encouraged to participate in these activities particularly in keeping their own bedrooms clean, putting their washing in the washing machine and putting their clothes away. The home does not employ a cook therefore care staff plan, shop and cook the meals with some involvement of the service users. Staff are very aware of service users dietary needs and this was evidenced in their care plans. Menus that were seen showed that staff encourage service users to eat a healthy diet. On the day of the inspection there were adequate quantities of food available including fresh fruit. Service users are able to help them selves to snacks and drinks during the day, though there is limitations for one service users during the night. One of the service users told us that there was enough to eat. Care Homes for Adults (18-65 years) Page 13 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive support in a way they prefer which ensures that their physical and emotional needs are met. Evidence: Through the care planning process the service is able to identify the support required for each of the service users with regard to their personal and health care needs. Currently both of the service users are independent with their personal care but require prompting and encouragement. A service user was seen to be dressed in clothes that were appropriate for the time of the year and which suited their personality. Service users are able to buy their own clothes with some support from staff. Records showed that service users have access to all health professionals such as GP, dentist, optician and specialist nurses. Service users are encouraged to attend appointments on their own so that they develop their communication and planning skills. Because of the complex and varied mental health needs of the service users, staff ensure that they attend the meetings and reviews required under the Care Programme Approach (CPA) or if they are under a section of the Mental Health Act. Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: Because of the nature of the service to people with mental health needs staff are very alert to changes in mood, behaviour and general well being and know how to respond and what action to take. A health care professional told us that staff had been very supportive regarding a service users particular health need. There are policies and procedures regarding the storage, administration and recording of medication within the home. Staff have received medication training and this is documented in their files. Medication records that were seen have been complete appropriately, however we would recommend that where handwritten entries are made (change in medication) that two signatures are obtained to verify that the transcribed information is correct. This will act as a safeguard to both staff and service user. The aim of the service is for service users to become self medicating, this is done in consultation with other professionals, the service user and staff. Service users that are self medicating are closely monitored and this is an area that is discussed during monthly evaluation meetings. Where appropriate service users are encouraged to become involved in ordering their repeat prescriptions as part of their self medicating regime. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an effective complaints procedure,are able to express their views and are protected by the policies and procedures of the service. Evidence: In discussion with service users it was evident that they knew how to make a complaint . The home has an open culture that allows people to express their views and concerns in a safe and understanding environment. One of the service users had a complaint with the home. This had been discussed with the manager who was working with the service user and their health care professional to resolve their current concern. Both of the service users are in contact with day services and relatives, as well as an advocate, friends and health and social care professionals visiting the home. The complaints procedure is given to everyone living at the home and is displayed in a number of areas within the home. The service keeps a record of of any complaints and this includes details of any investigations and actions taken. The service views complaints in a positive manner and uses outcomes to improve the service to people living at the home. The service has safeguarding policies and procedures; these include the local authority policy and procedure. The manager was clear in what incidents needed to be reported to the local authority as part of the safeguarding procedures. There was signed Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: evidence that these documents had been read by staff and staff files indicated that members of staff have attended appropriate training in safeguarding adults. The Commission has not received any complaints regarding the service and to our knowledge the local authority has not been involved in any safeguarding referrals/investigations. The service has policies and procedures for the safekeeping and expenditure of service users money but the service users choose to manage their own finances with assistance from relatives. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in an environment that meets their needs and is clean, safe and homely. Evidence: The home is in keeping with the community setting and it does not stand out as different from other houses in the road. There is good access to community facilities and services. We undertook a tour of the premises and found that all communal areas were clean and well maintained and is appropriate for the lifestyle and needs of the servcie users. The decoration and furnishings are also maintained to a good standard. The domestic style kitchen/diner was clean and food was being stored appropriately and there are sufficient toilet and bathing facilities. There is a spacious lounge that was more than adequate to meet the needs of the two service users. Service users have there own bedrooms however on this occasion it was not possible to to view these rooms. Service users have keys to their bedrooms.At the last inspection it was noted that bedrooms were personalised to suit their taste and choice. Service users with support and encouragement of staff are responsible for ensuring that their bedrooms are kept in a reasonable state of cleanliness. The home does allow smoking in the service users bedroom or the back garden of the Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: home and the appropriate smoke detectors are in place. The rear garden is reasonably maintained and does provide a seating area for the service users. There was evidence that all necessary health and safety checks are being undertaken such as fire drills, water temperatures and room checks (Home Office restricitive order). Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by staff who are sufficient in numbers who have the skills and qualifications to meet their needs. Evidence: The manager confirmed that the home is fully staffed and that mostly permanent staff are used to cover for emergencies, sickness and annual leave; this affords the service users continuity of support by staff who are known to them. The staff team is small and culturally diverse and this reflects the local community in which the house is situated. We were able to speak to one of the service users who told us that generally staff were supportive and approachable. Obviously, there are times when there are tensions between staff and service users due to the nature of the service however staff understand and are able to deal with these difficult situations. Staff rotas are placed in the kitchen which allows service users to see who is on duty. The rota correlated with the staff members on duty and on the day of the inspection there where sufficient staff on duty to meet the needs of the service users. On a random sample two staff recruitment files were seen and we found that all appropriate recruitment procedures were being followed; application, interview, satisfactory references and Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been undertaken. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: On recruitment staff undertake an induction programme that includes all mandatory training such as safeguarding of vulnerable adults, first aid, health and safety, food and hygiene, fire safety, communication and administration of medication. Staff are encouraged to undertake formal training and staff are currently undertaking NVQ 2 and Level 3 Leadership and Management. The manager is completing a training profile for each member of staff that shows what further training is required. Staff files indicated that supervision is regularly taking place. Annual appraisals are currently being organised by the manager. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run and managed appropriately and in the best interests of the service users. Evidence: The manager of the home has many years experience of working with people with mental health issues. She has a Masters award in Train the Trainer and is currently undertaking a Leadership and Management course at Level 4 and the A1 assessors course which will enable her to assist staff with their NVQ training. Other courses that have been undertaken include; Mental Capacity Act, mental health workshop, supervision and appraisal, medication and record keeping and business of care and caring. This is a small home and therefore the needs of the service users are well known to the manager and staff. the service is flexible and service users get up and go to bed when they wish, they are able to eat at times that suit them and they have some 1:1 time with their key worker. The Annual Quality Assurance Assessment (AQAA) was completed and the information gave a picture of the current situation at the home and described where the home has Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: improved during the past twelve months and areas where improvement is still needed and how they plan to achieve this. The manager was able to demonstrate a clear understanding of the key principles and focus of the service. She and her staff want to continue to improve the quality of life for the service users and there is a strong focus on person centred thinking. Policies and procedures are sound and the service is aware of health and safety legislation. The manager and staff work within the health and safety policies and procedures, however as has been reported on earlier in this report risk assessments need to be more specific. records are of a good standard and are routinely completed. Wherever possible service users are supported to manage their own money plus assistance is given with budgeting skills and one of the service users is self medicating with prompting from staff. These skills will assist the service users to lead more independent lives. The service is in the process of introducing a quality monitoring system that will also encompass stakeholders views. The manager stated that she has an open door policy and this was confirmed by a service user who stated that he could go to her with any complaints or concerns. The home has the necessary insurance cover to enable it to fulfill any loss or legal liabilities. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered provider must ensure that the risk assessments are specific to an individual need Some of the risk assessments were too generalised 26/12/2009 2 20 13 The registered provider shall 26/12/2009 make arrangements that two signatures are recorded when there are handwritten entries on the MARs. This will help to safeguard both service users and staff when transcribing information Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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