Inspection on 21/03/07 for 26 St Barnabas Road

This inspection was carried out on 21st March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

26 St Barnabas Road 26/01/09

26 St Barnabas Road 05/02/08

26 St Barnabas Road 21/02/06

26 St Barnabas Road 20/09/05

26 St Barnabas Road 02/02/05

26 St Barnabas Road 22/06/04

26 St Barnabas Road 24/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 26 St Barnabas Road Emmer Green Reading Berkshire RG4 8RA Lead Inspector Andy McGuckin Unannounced Inspection 21st March 2007 12:00 26 St Barnabas Road DS0000011047.V331221.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 26 St Barnabas Road DS0000011047.V331221.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. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 26 St Barnabas Road Address Emmer Green Reading Berkshire RG4 8RA 0118 946 1775 F/P 0118 946 1775 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.milburycare.com Milbury Care Services Limited Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. Service users not to be admitted over 65 years of age. Date of last inspection 21st February 2006 Brief Description of the Service: 26 St. Barnabas Road is part of Milbury Care Services Ltd. and registered to provide support and care for six adults with learning disabilities, between 18 and 65 years of age. The home has 5 permanent residents and one respite placement , which is used by a single service user. The home is situated in a suburb of Reading. It consists of six bedrooms, lounge/dining room, kitchen, shower room and bathroom. The aims and objectives of the home are to provide a secure and comfortable home; encourage and support residents to make decisions and choices in their lives; support and assist service users to make and maintain satisfying relationships; assist service users to develop their skills; and enable service users to engage in valued day time occupation and use the community facilities. The cost of care is calculated on an individual basis dependant on the care needs of the individual. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “Key Inspection”. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that the CSCI has received about the service since the last inspection. The inspection took place on a weekday afternoon and involved a visit to the home. The inspector looked at core documentation relating to the regulations and standards. The inspector spent some time with the manager and staff and had informal contact with 3 residents. The inspector toured the building and was shown residents’ living accomodation. The inspector had informal conversations with staff and residents. The home’s medications systems were tested and found to be safe. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The inspector would like to thank the manager, staff and residents for their assistance in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The manager needs to be freed up from providing care due to staff shortages, to enable him to manage the current recording systems and staffing issues. The home is carrying four full time vacancies at present but is about to appoint a deputy manager. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 6 The previous inspection highlighted the desire to involve service users in a more meaningful manner; this is still outstanding due to the issue raised above. The manager should be freed up to develop personal development plans and new systems of recording. 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. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are encouraged to visit the home to “test drive“ it for suitability. EVIDENCE: The home provides information about the home to prospective purchasers of the service. Information about the suitability and decisions are usually made in a one to one situation giving residents time to gain a good understanding of what is on offer and available to them. The manager is hoping to develop pictorial communication methods to enable service users to be more fully involved. The last resident to join the home transferred from another home within the organisation. The resident had several day visits to the home and overnight stays to assess suitability on both sides. Existing residents are consulted to the extent of their ability and willingness to make an opinion. Residents’ files evidenced that residents are being consulted and informed about, where possible, changes and challenges which are available to them. All residents have an appropriate weekly timetable which involves a good mix of work and leisure. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 9 New residents are encouraged to visit the home prior to making a final decision as to the suitability of the home. This also enables the home to assess its suitability to meet the residents’ care needs. Regular reviews take place to ensure that this is still the case. Service users have individual written contracts and terms and conditions. Relatives or advocates are involved in the contracting process to assist the individual resident to be safeguarded. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Evidence was found at inspection that individual needs and choice are promoted. Information held on file needs to be updated. EVIDENCE: All six service users’ care plans and associated documentation were seen. They included information about personal care routines/how much support individuals need, and how to give it. Parts of the care plans are produced in user-friendly formats to assist service users to understand as much of it as they are able. Individual Lifestyle support plans include a short life history, what is vital for staff to know, likes and dislikes, achievements, level of support required, the best way to get to know me, what I like and don’t like and “what worries me” are all included in the resident’s file. The future needs are noted on reviews which service users are supported and encouraged to attend. Families also attend reviews and sign the review notes. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 11 Service users’ care plans are very detailed and include all the necessary information to ensure that staff can meet their individual personal support needs. Some information however needs to be updated and some forms had not been filled in for some time. The manager accepted that due to pressures of working as a carer as well as a manager things had slipped. The inspector did not feel that this had a significant impact on the quality of the care being provided but was more of a reflection of the current staffing situation. There is a description on individual files of the service user’s ability/limitations with regard to decision making and how to ensure that they are given appropriate choices, such as sampling different activities before being asked what they want their daytime activities programme to consist of. There are weekly group meetings held at which various subjects are discussed, including activities for the week, the rotas, complaints, health and safety and any other issues arising. These meetings are recorded and were seen to be appropriate at this inspection. Staff use a variety of activities to keep service users interested and occupied. All residents are limited in their ability to communicate their needs. However staff are trained in identifying the needs of the residents by the use of body language and facial expression. Any specialist communication need is identified and recorded on file. Staff are informed of these needs and any areas of training are identified. All residents are encouraged to have contact with family and friends with some going home regularly at the weekend. One resident attends for one day per week respite and has her own room which is not used when she is not there. Confidential information is kept confidential. Risk assessments seen were detailed and reviewed. 26 St Barnabas Road DS0000011047.V331221.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): 11,12,13,14,15,16,17. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents have a range of activities. All residents had a range of activities both within the home and outside of it. One resident assists and has training provided through a local garden centre for which he receives a small payment. Many residents attend the local church and attend activities provided through this organisation. Currently no residents attend full time paid work or attend college. On the day of the inspection three residents were in the home and two were out on activities. The local and wider community are used to provide leisure activities which include visits to pubs, restaurants, cinema, swimming pool, shops and social clubs. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 13 Specialist activities such as horse riding and trampoline are available following risk assessment. All residents have a schedule of activities. In house entertainment includes TV, video games and arts and crafts. A neighbour has donated a computer to the home for use by the residents. The home is not able to use this equipment at the present time as they have no money to buy the appropriate software to enable the residents to use it. The inspector would recommend that this generous gift be enabled by the provision of money to buy the appropriate software. Service users have choice in what they want to do and what they do not want to do. Personal space is respected and the choice not to be involved is also accepted. All service users have their own room, which they have the choice of locking if they so wish. Staff knock and wait before entering a resident’s room. Residents are not allowed in each other’s rooms except by express invitation. The manager has just taken delivery of a software package aimed at making communication easier and will start off with the selection of meals and food from a pictorial menu. The manager should be freed up to develop this programme. Evidence was found on the day of the inspection that residents were enjoying a balanced and nutritious meal using fresh ingredients which were being cooked from fresh. 26 St Barnabas Road DS0000011047.V331221.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): 18,19,20,21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of the residents were found to be met. EVIDENCE: Residents’ preferred method of address and how they can be best supported are clearly noted in the plans. One resident smokes and is usually encouraged to smoke outside but in colder or wet weather a designated smoking area is available for his use only. This is a small room, which was used as a toilet at one stage. The toilet has been removed. Organisational discussion needs to take place as to what will happen to this post June 2007 when the smoking ban comes into force in public places. It may be this situation is exempt but it may not be as it is a complex area. Health records are well kept and accurate, service users are supported to have regular health checks and attend the GP/specialists as necessary. Residents also have access to alternative therapies. Incidents and accidents are recorded and immediate action is taken if necessary and appropriate. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 15 The medication administration system is robust and all staff receive training to administer it. The system has very good built in safety procedures involving a second member of staff counter-signing. At present one resident has been prescribed medication, which requires specialist training to administer. The home is having difficulty in accessing this training so the resident has to stay on the previously prescribed medication. The resident’s parents are aware of this situation and are in agreement with the home to maintain the current medication until such time as the staff can be trained. Evidence was found in residents’ files that information on what should happen in the event of serious illness or death is being recorded and would be acted on in the event. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate methods of enabling service users or their advocates to comment on the quality of the service. EVIDENCE: The complaints procedure is produced in service user-friendly format and is up-to-date. The home has a complaints book, one minor complaint regarding a fence that had blown down has been recorded and dealt with in a timely and satisfactory manner The Commission for Social Care Inspection has received no information about complaints or safeguarding adults issues. All staff have received Protection of Vulnerable Adults Training and staff members were fully able to describe the action that they would take if they had any concerns about the safety or well being of service users. The inspector was assured that residents’ finances are appropriately managed and monitored by external agents on a regular basis. The Commission for Social Care Inspection has received no information about complaints or safeguarding adults issues. All staff have received Protection of Vulnerable Adults Training and staff members were fully able to describe the action that would be taken if they had any concerns about the safety or well being of service users. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 17 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,26,27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of the home need improving. EVIDENCE: The home is situated in an area of similar properties. The home presents as needing some updating in places and the inspector was informed that a rolling programme of redecoration was underway but the process can be lengthy due to the fact that two separate organisations are involved. The kitchen was spacious and well equipped. The lounge was a good size with appropriate furnishings and fittings. The garden was laid mainly to lawn with fencing round the perimeter. The fence was uneven and did not match in places. It did however provide a secure external environment. With residents’ permission the inspector was shown all six bedrooms on two floors. The home has sufficient toilet and bathroom areas to meet the needs of 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 19 its residents. On the day of the inspection the downstairs bathroom smelt very damp and lacked ventilation. The manager informed the inspector that the bathroom was awaiting some work to be done which would include the removal of a sink to enable a wheelchair user better access to the sink and the installation of modesty screens. The inspector would recommend that the damp problem be investigated at the same time. All bedrooms were individually furnished and reflected the resident’s hobbies and personality. All residents have their own room. Specialist equipment is provided to those who require it. Toilets and bathrooms in the home offer privacy and comfortable safe areas in which to bathe. This will be further enhanced with the addition of screens in the downstairs bathroom. On the day of the inspection the home was clean and hygienic. The home is able to provide sufficient space to enable quiet private areas where residents can be quiet or alone. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 20 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): 31,32,33,34,35,36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to recruit staff to bring it up to full complement. EVIDENCE: The inspector was informed that the home had four staff vacancies including a deputy manager’s post. The inspector was informed that this was not impacting on the residents, as they were able to cover these vacancies with staff doing overtime or by the use of agency which are known to the service users. The manager has also been providing cover and hands on care, which has taken him away from some of the day-to-day management issues. This situation will be addressed by the appointment of a deputy manager. The post had been filled on the day of the inspection and a start date has been identified. Staff files showed that regular support is provided to staff informally but regular recorded staff supervision has not been taking place due to the situation outlined above. Regular recorded supervision must take place at least four times per year for all staff. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 21 Staff were seen to interact with residents in a relaxed and cheerful manner. On the day of the inspection there were three staff on duty in the morning and two in the afternoon; this appeared to be sufficient to meet the needs of the current residents. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 22 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): 37,38,39,40,41,42,43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager needs to be freed up from providing care to be enabled to manage. EVIDENCE: As previously mentioned in this report the manager has had to spend time working as a carer to cover for vacancies, absence and holidays. This has resulted in some of the records not being kept up to date and staff supervision not taking place on a regular basis. A deputy manager has been appointed and the inspector would expect to find these issues rectified in the near future. A requirement has been made that the organisation inform the commission in writing when this has been done 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 23 The organisation has a senior manager responsible for quality assurance. The quality assurance system consists of regular Regulation 26 visits, an annual audit by managers, formal annual reviews of service user care plans. A recent survey of users and advocates, including professionals, was undertaken and the result was an 82 satisfaction with the service. All health and safety records and checks were up-to-date. Staff have updated health and safety training. Accidents and incidents occur and are in the main properly recorded and any remedial action necessary is taken promptly. The inspector found one incident had not been recorded on the correct file although it had been recorded elsewhere. The home has smoke alarms, which are checked weekly. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The home’s finances and that of its residents are regularly monitored by independent auditors. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 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 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 2 3 Standard YA6 YA24 YA33 Regulation 17 23 18 Requirement Timescale for action 14/04/07 Information held on residents must be up to date. The home must be maintained to 14/04/07 a good standard. The home must recruit to bring it 14/04/07 up to full complement. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA14 Good Practice Recommendations The home should be provided with finance to enable residents to use the computer, which was donated for their use. 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 26 St Barnabas Road DS0000011047.V331221.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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