Inspection on 27/10/05 for Aashna House

This inspection was carried out on 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Aashna House 02/10/07

Aashna House 15/05/06

Aashna House 23/05/05

Aashna House 05/11/04

Aashna House 30/06/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Aashna House ASRA Greater London Housing Association 2 Bates Crescent, Off Abercairn Road Streatham London SW16 5BP Lead Inspector Mary Magee Unannounced Inspection 14th November 2005 09:00 X10015.doc Version 1.40 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 Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 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 Older People. 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. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Aashna House Address ASRA Greater London Housing Association 2 Bates Crescent, Off Abercairn Road Streatham London SW16 5BP 0208-765-0822 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) ASRA Greater London Housing Association Limited Mathini Navukkarasu Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0), Physical disability of places over 65 years of age (0) Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include the current service user aged 56 years Date of last inspection 23rd May 2005 Brief Description of the Service: Aashna House is a purpose built residential care home providing care and accommodation for frail elderly people of Asian origin. It is situated within a ten-minute walk of local shops and public transport. It is located in a residential road in Streatham, South West London. Asra Greater London Housing Association own and manage the home. It is a very pleasant and spacious two-storey building with the added advantage of enclosed wellmaintained gardens to the rear. The house is divided into five units, each having its own dining room and small kitchen. The large catering kitchen is located on the ground floor. A passenger lift is also provided. The gardens and the buildings are wheelchair accessible. The home has 31 single bedrooms and 3 double bedrooms. Each room has an abundance of space with attached kitchenette and en-suite shower facility. A CCTV is provided by the front door. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken during the daytime. It lasted over seven hours. An interpreter assisted with discussions between ten service users and the inspector. The inspector also met with the registered manager and the staff team of seven. A number of personnel records were viewed, these included those of service users and staff. A tour of the premises was conducted. This included all of the communal areas as well as ten bedrooms. What the service does well: What has improved since the last inspection? Improvements were found in care arrangements in place. Care plans were up to date and reflected the changes as they occurred to individual needs. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 6 Staff had received training from the district nurse on the management of those service users with insulin diabetes especially in recording blood sugars. Some areas of the home have been brightly redecorated. Service users reported that they were very pleased with the new pink colours in the corridors. 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. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Information is available for people interested on the services provided in the form of a service users’ guide. It has been translated into a number of Asian languages. EVIDENCE: The organisation has produced a service users’ guide in three languages, these are Guejarati, Urdu and English. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 789 The home promotes and supports service users to maintain their health ensuring that access is facilitated to health services. Members of staff are fluent in languages and act as interpreters for service user consultations with health professionals. Procedures that are more robust are needed for service users self-medicating. EVIDENCE: Service users health and personal care needs are set out in care plans. Three service users’ care plans were viewed. Staff had worked hard on updating the records especially care plans so that they reflected the current and changing needs of service users. Risk assessments were in place for service users at risk of falls. There was also guidance on managing service users with diabetes. One service user competent at taking her own blood sugar records it in Gujerati in a notebook. A care worker fluent in this language as well as English is always present so that records are made of the readings in English. This is necessary to assist the district nurse and to ensure that she is aware of the correct reading before she administers insulin. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 10 A service user spoken to said “ she was well cared for by gentle caring staff that related well to her”, she said that “there was a number of the staff that spoke in her mother tongue”. Senior members of staff have received training from the district nurses on completing blood sugar readings. Six monthly reviews for service users take place with the GP at the home. The manager or a senior member of staff also attends these reviews. There are currently no service users with pressure sores. Pressure relieving cushions were seen on some service users’ chairs. A service user with diabetes had experienced ulcers on her feet for some months. These had responded well to regular treatment from the district nurse and were healed. Service users are registered with a number of GP practices. The majority attend surgery appointments with the support of staff or family members. Service users’ weights are recorded and action is taken promptly to address any notable changes. Examples of staff vigilance and response include the following. A service user with a low body weight and poor appetite had been appropriately referred to the hospital consultant for investigation. Medication is supplied in an MDS system from a large dispensing pharmacy. Observations made were that procedures of the home were adhered to carefully. A service user recently took excessive amounts of a laxative. She had retained this medicine in her room but staff were unaware of this. For those service users self-medicating assessments were not completed. A senior member of staff spoken to said that staff were currently working on developing these assessments for self-medicating service users. The requirement has been restated with the timescale extended to allow for achievement. There were records of service users attending hospital appointments regularly. The home has experienced some difficulties when service users attend the A&E departments at hospitals. Staff escorts service users if relatives are unable to attend. There have been unnecessary long delays as members of staff remain at the A&E department to assist hospital staff with translation. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 14 Service users are offered the chance to exercise choices and to take control over their lives by participating in activities that they enjoy. Mealtimes are made pleasurable for people with service users fully involved in planning meals EVIDENCE: A characteristic feature of the home, observed and confirmed by staff and service users, is the way the home promotes a spiritual sensitivity and actively celebrates all religious feasts. Religious celebrations of note had taken place prior to the inspection. Service users had supplies and treats in their kitchens to serve visitors to their home at this important time. These were shared with the inspector and the interpreter. Other weekly celebrations such as Bhajans and Sai Babas take place at the home. Individual accommodation is very spacious and includes kitchens that have cookers and fridges. This enables service users retain a greater degree of independence using these facilities for entertaining visitors. Female service users found that it was important to have these facilities as “it helped them retain the role as mother”. Ten service users were visited in their rooms. Observations made by the inspector were that service users played a key role in deciding and influencing decisions about the lifestyle at the home. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 12 Television with Asian channels is available in the large lounge. When the inspector arrived a small number of service users were in the lounge enjoying a television programmes. It was tuned into an Asian channel. The home is divided into five units, each unit has it’s own dining room and kitchen. The dining rooms are important and service users meet there to chat with each other. Service users take exercise on the wide spacious corridors and in the sheltered garden weather permitting. The majority of service users spoken to are happy with the lifestyle offered. An area that is recommended for more consideration is regarding the development of more stimulating activities that take in to account individual lifestyles and interests. Many ways demonstrating how service users are offered the opportunity to exercise choice were seen. Service users take personal possessions and with pride display them in their rooms. Support is given to support service users with maintaining their financial affairs, bank accounts are held by service users. Their account books are held safely in the administrator’s office. Copies of care plans and records are held in service users’ rooms so that they are fully involved in the recording of information about the services they receive. Mealtimes are important at the home with efforts made to make them as pleasurable as possible. Dining rooms are small and intimate with tables grouped for two to four people to dine. The quality of the meals served continues to be of a high quality. The choice of food is excellent. Service users are fully involved in planning the menus. There are a minimum of two chefs employed every day to prepare food. The inspector was invited to share lunch. Available for lunch on the day were a number of choices. The following were on the menu: turdal; cauliflower curry; rice and chapattis; salad and lassi; and, egg curry. As well as catering for specific cultural needs there is provision made for those with additional dietary needs, such as food with reduced salt and spices. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has a robust complaints procedure. Service users’ views are listened to and responded to swiftly. EVIDENCE: Service users spoken to were satisfied with the approach by the home to encouraging service users to put forward their views. They found that if any areas of concern were raised regarding the home that these were dealt with appropriately and responded to promptly. Unit meetings are held quarterly for service users and their relatives to discuss any issues. On all dining room notice boards are copies of the complaints procedure. It is available in Guejerati, Urdu as well as in English. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 26 The home is pleasant and well furnished. Priority is not given to responding to repairs promptly and leads to service users being inconvenienced. EVIDENCE: The premises, now over ten years old, are purpose built and well designed. The home is located in a quiet close with enclosed well-maintained gardens. Gardens are accessible to wheelchair users. The home is pleasantly furnished inside and comfortable but the repairs system in place is very poor. Little priority and consideration is given to ensuring that repairs are responded promptly. A number of repairs that remain outstanding for some months and cause unnecessary inconvenience to service users. Although part of the planned maintenance programme had been completed, there are still a number of bedrooms requiring attention as well as dining rooms and corridors. This was the subject of a requirement in the previous Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 15 inspection report. Although some work has been undertaken several areas remain outstanding. It is restated as requirement with a new timescale. There are problems with water pressure in the building that affects the water flow in some service users’ bathrooms. There are variations in showers with some not receiving a good flow of water. A thorough check is needed to investigate the causes and rectify the problem. It has been causing problems for the past three months with repeated repair requests made. Hot water temperatures are controlled to safe limits since the installation of new valves to the boilers. Because of leaks from showers overhead there is damage to a number of ceilings on the corridors and stairways. Work in repairing these has not been done as water penetration is ongoing. The maintenance list viewed showed a list of repair requests repeated for the past four months. The organisation is reminded of its duty to keep the premises maintained to a safe standard. The home is kept clean and odour free. More attention is recommended to ensure that all areas are kept free from dust. Both dishwashers were out of action in the kitchen and should be repaired. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 30 A staff team from similar specific minority ethnic communities meets the needs and preferences of service users. The staff team have members that are able to communicate effectively with service users in their native tongue. More training and development is needed for the staff team to equip them with the skills and knowledge necessary to meet the specialist needs of older people. EVIDENCE: The cultural diversity and ethnic origin of service users is reflected in the staff team. Staff with many linguistic skills are employed enabling service users to communicate in their mother tongue. Staffing levels deployed are appropriate. During the day there are five care officers on duty. This allows one member of staff to be allocated to each unit, (a ratio of 1-6/7 people). At night there are two members of staff on waking night duty. A senior care officer is also available on sleepover duties. Members of staff have received a variety of training. The majority of this is mandatory training and includes first aid and manual handling. A number of senior care officers have participated in very little training and take responsibility for team leadership. The home has an induction training programme provided by the organisation, but this relates to generic housing issues. The home does not have an induction training and foundation programme that meets National Training Organisation specification, or that includes training on the principles of care, Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 17 safe working practices, the experiences and particular needs of the service user group. The registered provider must ensure that the care home is conducted so that staff are sufficiently trained to make proper provision for the health and welfare of service users. Although this was the subject of a requirement in the two previous inspection reports it has not been addressed. It is restated in new requirements. Regarding the NVQ programme there are four care staff taking part in programmes, two care workers are working on completing NVQ level 2 in care and two more doing Level 3. Staff have the right approach and relate well to service users. The staff team have the necessary linguistic skills and share similar cultural backgrounds. All ten-service users spoken to were complimentary about staff. They found that staff practice demonstrated that they were interested in their job and worked hard. There have been no new members of staff since the last inspection. Regular agency care staff are employed on the staff team giving continuity and consistency to service users. Some of these staff members have been engaged at the home for over twelve months. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 38 The management approach of the home has given stability to service users and staff. Staff are supervised and supported. Service users and relatives views are welcomed and considered. EVIDENCE: The registration of the manager has taken place since the last inspection. She needs to participate in regular management training keep her knowledge and skills updated. She has started to work on the Registered Manager’s Award. The organisation has not fully developed a quality assurance system. A number of methods are used to evaluate the service such as internal service user reviews, local authority reviews and unit meetings with service users and relatives. These initiatives need to be developed in order to evaluate fully how successful the home is in meeting its aims and objectives and to assist with future planning and development. This requirement remains unmet from the previous inspections. It is restated in new requirements. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 19 Staff spoken said that they were supported in the workplace. Regular team meetings take place. The role of the team leader/senior is providing support and guidance on the floor to the care staff. Service users hold individual bank accounts. These books are held in safekeeping by the home. Personal allowances are paid in as relevant for service users. Copies of Regulation 26 visit reports are forwarded to CSCI regularly. Handovers are completed thoroughly at change of shift. The inspector met with the staff team at the time of changeover. Staff were enthusiastic and interested in their role. Service users progress/changes and appointments are discussed at change of shift. Records of one to one supervisions were viewed. These should be more regular and at least six times a year. Health and safety checks of the premises are undertaken every three months. Records of maintenance and associated records demonstrated that essential equipment was serviced and maintained. The equipment serviced included the following, emergency lighting, fire equipment, lift and hoists. Weekly fire alarm tests are undertaken. Fire drills are undertaken regularly. The poor response to repairs has the potential to place service users at risk and must be addressed. Further development is required to the staff training programme. Staff need to receive induction and foundation training that includes topics on safe working practices. This is also detailed in Standard 30. Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 1 2 2 X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12 (1) a 18 (1) c Requirement Timescale for action 30/01/06 2 OP24OP19 23 92) b 3 OP38OP21 23 (2) j The registered person must ensure that a risk assessment is undertaken for any service user who takes responsibility for administering his/her own medication. Previous timescale of 30/08/05 not met. 30/01/06 The registered person must ensure that a programme of routine maintenance and renewal of the fabric and decoration of the home is produced and implemented with records kept. This is to include the dining rooms and all bedrooms identified as requiring it. A number of bedrooms have been refurbished as they become vacant. A number of bedrooms remain outstanding.(Previous timescales of 30/08/05 not met) 30/12/05 The registered person must ensure that the water system is checked thoroughly. The problem with the pressure of water supply to be resolved, an engineer must attend to this promptly. (Confirmation that this has been completed to be sent DS0000022715.V256488.R01.S.doc Version 5.0 Aashna House Page 22 4 OP20 5 OP24 6 OP36OP38 OP30 7 OP31 8 OP33 to CSCI) The registered person must ensure that the seals on the floors of shower units are attended to and repaired. Steps to be taken to prevent damage to ceilings underneath. 23 (2) The registered person must ensure that repairs are responded to promptly. All outstanding repairs including ceilings damaged by water penetration must be repaired. 12 (10 a b The registered person must 18 (1) b ensure that there is a staff training and development programme including induction and foundation training, which meets Sector Skills training targets and is tailored to the needs of the staff team including presentation in suitable formats for staff. Previous timescale of 31/08/05 not met. 10 (3) The registered person must ensure that the manager receives training for the role and responsibilities of the care home manager and the conditions affecting older people 24 The registered person must ensure that there is an effective quality assurance system is in place for the home to ensure that the home is successful in meeting its aims and objectives. 23 (2) g 30/01/06 30/01/06 30/03/06 30/01/06 30/03/06 Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 23 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 OP12 Good Practice Recommendations The registered person following consultation with service users should consider developing further activities that are stimulating and fulfilling and that match individuals changing needs and capacities. The registered person should ensure that the broken dishwashers in the kitchen are repaired. The registered person should ensure that all areas are kept dust free including skirting boards. The registered person should ensure that all staff at the home receive regular one to one supervision ( six times a year). 2 3 4 OP26 OP26 OP36 Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Aashna House DS0000022715.V256488.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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