Inspection on 30/05/06 for 89 Grosvenor Avenue

This inspection was carried out on 30th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

89 Grosvenor Avenue 22/07/08

89 Grosvenor Avenue 04/12/07

89 Grosvenor Avenue 30/01/06

89 Grosvenor Avenue 25/11/05

89 Grosvenor Avenue 03/02/05

89 Grosvenor Avenue 04/10/04

Similar services:

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

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

CARE HOME ADULTS 18-65 Grosvenor Avenue (89) 89 Grosvenor Avenue Carshalton Surrey SM5 3EN Lead Inspector Deborah Yapicioz Key Unannounced Inspection 30th May 2006 13:00 Grosvenor Avenue (89) DS0000007134.V296348.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 Grosvenor Avenue (89) DS0000007134.V296348.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. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grosvenor Avenue (89) Address 89 Grosvenor Avenue Carshalton Surrey SM5 3EN 020 8647 3912 020 8647 3912 manager.grovesnoravenue@careuk.com 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) Care Solutions Limited vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30/01/06 Brief Description of the Service: 89, Grosvenor Avenue, Carshalton Beeches is owned, managed and staffed by Care U.K. The home is registered to provide residential care for up to five adults with Learning Disabilities. The home is a large semi-detached Edwardian property, which has many original features. There is a large lounge on the ground floor, a kitchen diner as well as an enclosed patio and a large garden. The home has a built on laundry room to the rear of the property. There are four bedrooms on the first floor and one bedroom on the ground floor. The home has an office/ staff sleep in room and storage space on the third floor. The house has its own transport and is well placed for public transport links and is close to Wallington, Carshalton and Sutton town centres Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes first inspection for the year 2006/2007 and was an unannounced visit, which took place on the afternoon of 30th May 2006. The home was inspected under the National Minimum Standards Care Homes for Younger Adults. Methods of inspection included meeting with the service users, a tour of the premises, observation of contact between staff and service users, meeting with the home manager. Records examined included service user plans, care manager assessments, risk assessments, medication records, complaints, staffing records, health and safety and fire records. The inspector would like to thank the service users, the staff team and the home manager for their help in facilitating the inspection. What the service does well: What has improved since the last inspection? The organisation has recently introduced service users meetings for the group of homes in the local area. The manager explained that the meeting is also a social occasion Service users choose the venue for the meetings and settings have included going bowling and to a fire station. The meeting also includes having a meal out as well as the consultation element of the session. The service users spoken to during the inspection had enjoyed the variety of places that they visited and liked to be involved in the meetings. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 6 The service users and their families (where appropriate) have been consulted on their wishes around death and dying and the record has been placed on their file. This includes a section on any religious or cultural choices. 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. Grosvenor Avenue (89) DS0000007134.V296348.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 Grosvenor Avenue (89) DS0000007134.V296348.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2.4 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home provides information and introduction opportunities for prospective service users and their families to make a choice about moving to the home. EVIDENCE: The home has a statement of purpose in place and is currently working on the service users guide. The home has a referral process for new service users, which includes having a full assessment of service users needs in place to ensure that the service users needs can be met by the home. All service users files looked at had a care manager’s referral on file as well as supporting information from other healthcare professionals and the homes own assessment records. No new referrals have been received since the last inspection. The home manager confirmed that cultural and religious issues were discussed at the time of referral to the home and ways of meeting these needs would be included in the service users care plans. Details of religious beliefs and cultural issues (particularly related to food) was noted on a service users files as part of their referral information, this was also detailed on the homes menus. New service users would have a gradual introduction to the home done at a pace to suit them. The details of each service users introduction to the home were seen on files. One of the newest service users spoken to during the inspection remembered that he had enjoyed coming for tea and visits before moving in. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users have comprehensive individual care plans with detailed information on their needs and personal goals. Individual care plans include consultation with service users and are regularly updated by the key-worker to reflect current needs and service users wishes. EVIDENCE: Each of the service users has an individual tailored care plan. The care plans are on the service users file and is a record of their aims and goals as well as their achievements. The care plans at the home have all been reviewed during the last six months and the staff team have made regular entries as an ongoing record of activities, health issues etc. The home manager also keeps a central record of when service users reviews have taken place as when the next meeting is due. The home operates a risk management strategy. Service users at the home have individual risk assessments depending on their needs and goals. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 10 The home has a key worker system. The residents are offered the opportunity to participate in the day to day running of the home through regular meetings and individual discussions with their key workers. Part of the role of the key workers at the home is to ensure the service user individual opinions are put forward. Regular service user meeting are held and service users are encouraged to attend. The organisation has recently introduced service users meetings for the group of homes in the local area. The manager explained that the meeting is also a social occasion Service users choose the venue for the meetings and settings have included going bowling and to a fire station. The meeting also includes having a meal out as well as the consultation element of the session. The service users spoken to during the inspection had enjoyed the variety pf places that they visited and liked to be involved in the meetings. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users at the home are offered the opportunity to engage in age appropriate activities with an emphasis on using community based facilities. The service users have a varied programme of social activities organised by the staff team to reflect service users individual interests. The home has an open visitors policy to ensure friendships and family links are maintained. EVIDENCE: There is an open visitors policy and the home just ask that visitors phone to ensure their family member is going to be in before they visit. Visitors can be seen in any of the homes communal areas as well as the service users bedrooms. Service users spoken to during the inspection have regular contact with their families and look forward to their visits. The house rules and daily routines are as flexible as possible, bearing in mind the weekday commitments of the service users. The home is supporting service users to access appropriate activities through day centres and colleges including The Cheam Centre, Orchard Hill further education unit and H.F.T where service users have individual schedules of activities. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 12 Details of the service users daily activities and commitments are kept on the service users file. The home has its own transport. The local parks, cafes, pubs, theatres, libraries, bowling alley, and shops are accessed. In house activities are also provided and one of the service users told the inspector that he really enjoys the aromatherapy sessions. Service users also attend clubs. The service users have the opportunity to attend religious services if they wish. The service users all have an annual holiday. The choice of destination is left to the service users. The home menus are based on the likes and dislikes of the homes service users. They also take into account the service users health issues, for example the home manager explained that one of the service users has diabetes and another has small portions on the advise of the dietician. They also include cultural/ religious choices. The company has a nutritional policy and the staff team attend basic food hygiene training. A record of the training was seen on staff files and the policy was accessible to the staff team. The home has a kitchen/diner with enough room for everyone to sit around the dining table although the service users can choose to eat wherever they wish. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. 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. Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Residents’ physical and emotional health needs are detailed in personal plans to offer consist care in this area. Residents’ medication is well managed to ensure good health. EVIDENCE: The service users need varying degrees of assistance with their personal care. Some service users just needs a prompt while others need more support. The level of personal support a service user needs would be detailed at their review and recorded in their personal file. Personal care is provided in private, and timings of this are flexible. The home provides consistency and continuity through designated key workers All service users are registered with a local General Practitioner. The staff team receive training on medication and a record of sessions attended was seen on staff files. Key workers at the home monitors the service users health and any health appointments are kept on service user files. The home has a policy and procedure in place for the receipt, recording, storage, handling, administration and disposal of medication. Medication checks are also in place. There has been an improvement in the level of Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 14 recording on the Medicine Administration Record Sheets since the last inspection and there were no gaps in the medication records at the tine of the inspection. The home manager completes medication audits to ensure compliance in this area The service users and their families (where appropriate) have been consulted on their wishes around death and dying and the record has been placed on their file. This includes a section on any religious or cultural choices. Grosvenor Avenue (89) DS0000007134.V296348.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 at least once during a 12 month period. 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. There is complaints policy and procedure, which facilitates good access to the complaints system for the residents, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable service users. EVIDENCE: The complaints procedure was clear and contained all of the elements required to meet standard 22 including a minimum response time of less than 28 days. There have been no complaints since the last inspection. The home has a copy of the local authority Adult Protection Policy on site. The staff team have attended training on adult protection issues and a record id kept on their files. The staff team are aware of the action they must take if they need to report an incident. Grosvenor Avenue (89) DS0000007134.V296348.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the home provides a comfortable, clean and safe environment for service users to live in, however some of the communal areas are in need of redecoration. EVIDENCE: The home is situated in a residential area between Wallington and Sutton There was suitable domestic lighting and ventilation, There is a large garden at the rear of the home which the service users spend time in during the summer months. The home’s premises are in keeping with the local community and were suitable for their purpose. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 17 The home manager stated that some areas including the communal hallway had been redecorated since the last inspection. However the communal lounge and the kitchen diner appear shabby and worn in some areas and should be redecorated. Each of the service users in the home has a single room. All of the rooms have been personalised and decorated to reflect their individual taste, with the help of the service users key worker. Two of the service users spoken to during the inspection said that they liked their bedrooms. The home has a pleasant garden to the rear of the house. There are sufficient numbers of bathrooms and toilet facilities situated throughout the home. The home has appropriate laundry facilities separate from the kitchen and the preparation of food. The washing machine is capable of washing clothes at high temperatures, which helps with the control of infections. The laundry has suitable flooring. There is a locked cupboard for the Control of Substances Hazardous to Health products. On the day of the inspection the home was clean, bright and well ventilated. The home has policies and procedures on the disposal of clinical waste. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team at the home have a range of skills and abilities, which enable them to meet the needs of the service users living at the home. EVIDENCE: The home ensues that there are at least two members of staff on duty at any one time. This does not include the home manager. At night there is one waking and one sleep in member of staff. The staff job descriptions looked at during the inspection were comprehensive in there content and linked to achieving service users goals, as set out in their individual care plans. The home offers training opportunities to staff at all levels within the home. New members of staff complete an induction programme covering various subjects including health and safety, fire drills, and introductions to service users and other staff. The induction programmes are signed, dated and kept on staff files. Criminal Records Checks are completed before a new member of staff can begin work in the home. The atmosphere in the home is friendly. The staff members spoken to felt they worked well as a team and would have no difficulties approaching the manager and senior members of the staff tram if they needed to. The staff team were observed to treat service users with dignity and respect throughout the course of the inspection. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 19 At the previous inspection it was noted that staff were not receiving formal recorded supervision as often as they should. Since then the supervision records at the home demonstrated that there has been a big improvement in this area and the home manager has introduced monitoring tools to ensure that supervisions are always carried out. The deputy manager also carries out supervisions. Staff members spoken to during the inspection felt that they would approach the manager to speak to them about any issues and would not wait for a formal supervision session. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management style appears to be transparent with clear lines of accountability, however the home manager must register with the Commission for Social Care Inspection. In the main health and safety arrangements are adequate to ensure potential risks to service users health and safety are so far as reasonably possible identified and minimised however fire drill records were not taking place as often as they should. EVIDENCE: Mr William O’Brian was appointed as the manager of Grosvenor Avenue in October 2005. He had been the acting manager of the since the previous manager left and has worked at the home in various positions since it opened in September 2001. Mr O’Brian is not yet registered with the Commission for Social Care Inspection he informed the inspector that sometime ago he submitted an application to register as the homes manager. Mr O’Brian must “chase up” the manager application as soon as possible. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 21 There was a clear line of accountability within the home and the manager demonstrated a good knowledge of the service users and the staff team. Many of the records required for the safety and well being of service users are in place including accidents, PAT testing, water temperatures, risk assessments, complaints, incidents, food records, service users case files, medication records and so forth. Fire records at the home demonstrated that fire drills are not taking place on a regular basis. Fire drills should take place at least four times a year in keeping with recommended good practise and the company policy. All staff members must attend mandatory health and safety training including moving and handling and adult protection, copies of attendance certificates for courses attended were seen on staff files. The home manager also keeps a central record of all training attended by the staff team. The home has a health and safety policy in place. Environmental risk assessments are in place. A first aid box and a fire blanket are situated in the kitchen. There are fire extinguishers throughout the house. Coloured chopping boards and knives were seen in the kitchen. Health and safety law posters issued by the health and safety executive were on display. The service users and staff made positive comments about the home and the management team. The home has self-monitoring systems in place such as a Quality Assurance audit carried out by “Care U.K.”, which takes place every year along. A representative of the registered provider visits the home on a monthly basis in keeping with the regulations and copies of the visit reports are sent to the Commission for Social Care Inspection, Croydon Office. Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 4 3 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 2 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 X 2 X X X 2 X Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 23 Yes 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 Standard YA24 Regulation 23. (2)(d) Requirement The home manager must ensure the communal lounge where wall paper is peeling and worn is redecorated The home manager must ensure regular fire drill are undertaken and recorded. The home manager must apply for registration by the Commission for Social Care Inspection, Timescale for action 28/10/06 2 YA42 23. (4)(e) 30/05/06 3 YA38 8. -(1)(a) 30/05/06 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 YA1 Good Practice Recommendations The service user guide should be put into a format suitable for the service users Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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 Grosvenor Avenue (89) DS0000007134.V296348.R01.S.doc Version 5.2 Page 25 - 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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