Inspection on 22/10/08 for Abberdale House

This inspection was carried out on 22nd October 2008.

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

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

Other inspections for this house

Abberdale House 11/02/08

Abberdale House 13/10/06

Abberdale House 30/11/05

Abberdale House 12/09/05

Abberdale House 10/06/04

Abberdale House 30/03/04

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abberdale House 165-169 Hinckley Road Leicester LE3 0TF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Cowley     Date: 2 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Abberdale House 165-169 Hinckley Road Leicester LE3 0TF 01162915660 F/P01162915660 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shankar Leicester Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 24 24 24 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Abberdale House is a converted property in a residential area on the Hinckley Road, on the outskirts of Leicester city centre. It is easily accessible by car or public transport and there is limited parking available on the road outside. It is a care home providing personal care and accommodation for 24 older people with a physical frailty and/or mental health needs. The home is owned by the Registered Provider Mr Arun Sharmar and is one of three homes that he owns in the area. There are three lounges, one of which is used as an activities room, and a large pleasant dining room. The bedrooms are on the first and second floors, which can be accessed by the stairs or the passenger lift. There is a paved seating area with chairs and table where the residents may sit in the better weather. There is a well-used bird table and feeding area, that Care Homes for Older People Page 4 of 28 Brief description of the care home the residents enjoy watching. The current registration certificate from the Commission for Social Care Inspection is displayed in the reception area. The latest report is available in the manager?s office. The home can be contacted by telephone or fax. The current level of fees is within the Local Authority bands and is negotiated on an individual basis. There are extra charges for hairdressing, chiropody, newspapers and personal items. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted six and a half hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them; talking with the staff Care Homes for Older People Page 6 of 28 who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to four other residents, the Registered Manager, and three carers. Because people with dementia are not always able to tell us about their experiences of the service, we used a formal method of observation called the Short Observational Framework for Inspection (SOFI). This involved spending a period of one hour within the dining area of Abberdale House observing the care of three people. The observation period gave an indication as to how the service supports people living with dementia. What the care home does well: What has improved since the last inspection? What they could do better: Care plans for residents with dementia must provide more detail so staff can provide effective and consistent care. One relative suggested a key worker system should be put in place to help individual residents with their personal care. The Registered Person should give consideration to this suggestion. At present only a limited number of activities are organized for residents. This was discussed with the Acting Manager who agreed to take steps to improve the activity Care Homes for Older People Page 8 of 28 programme. The homes safeguarding procedure should be improved so staff know what to do and who to tell if they become concerned about a residents well being. Staff files must be updated so they all contain photos of the members of staff in question. The staff rota should be reviewed to ensure the home is properly staffed at all times. The home has now been without a Registered Manager for some time. The Acting Manager should be put forward for registration as soon as it practicable. Three staff members said they would like more support and positive feedback from the Owner. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents needs are assessed prior to admission to ensure the home is suitable for them. This judgement has been made using available evidence including a visit to this service. (Standard 3 was inspected.) Evidence: People who are interested in coming to Abberdale House are invited to visit prior to making a decision. The Manager assesses all prospective residents in their own homes, in hospital, or during a visit to Abberdale House. The assessment process helps to ensure the home is suitable for residents who are considering living there. Records relating to three admissions were examined. All were of a good standard and Care Homes for Older People Page 11 of 28 Evidence: included the views of relatives. Assessments carried out by health and social services staff had also been taken into account. Standard 6 was not inspected, as this home does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Staff in the home, and in the wider community, meet residents health and personal care needs. Care plans for a resident with challenging behavior are in need of improvement. This judgment has been made using available evidence including a visit to this service. (Standards 7, 8, 9, and 10 were inspected.) Evidence: Care plans are begun once a resident comes into the home and continually reviewed and updated. Those we looked at were well organized and most gave clear instructions to staff on how to meet residents needs. One was in need of improvement in that it described a residents challenging behavior, but did not state what triggered it and how staff should respond when it occurs. This information must be provided so staff can provide effective and consistent care. One relative said, I think the management should make sure all the residents have a Care Homes for Older People Page 13 of 28 Evidence: key worker who is responsible for their hygiene as some days some residents need a bit of attention. On the whole the staff are very caring but a bit more resident hygiene would be good for morale. The Registered Person should investigate this issue and give consideration to the relatives suggestion. Since the last inspection photos have been added to all residents care plans and medication records. This helps with identification, should agency staff be used or if a resident ever goes missing. All residents receive appropriate health care services and health problems are addressed and dealt with by GPs, District Nurses, and other health care professionals. One relative told us, The staff always inform me if my relative needs a doctor. Another said, When my relative went to the home he could not walk but they had a physio in and he was soon walking again with a frame. Records showed that moving and handling has improved in the home. The Acting Manager is a moving and handling trainer and told us she has been working closely with staff to ensure they use the correct procedures. A new sling have been purchased for the hoist so it is more comfortable for residents to use. Sit down scales have also been purchased so it is easier for staff to weigh residents. We observed staff caring for residents and saw they were respectful and polite. Residents were addressed by their first names or Mr/Mrs/Miss and their surnames, depending on their preferences. Residents have choice in their daily routines. One told us, I go to bed when I want. When I start getting tired I go up. The staff dont tell me when to go - its up to me. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. The homes activity programme needs to be improved and extended. Varied and wholesome meals are provided. This judgment has been made using available evidence including a visit to this service. (Standards 12, 13, 14, and 15 were inspected.) Evidence: At present a limited number of activities are organized for residents including visiting entertainers, films, and hairdressing. Staff occasionally take residents out to the shops. A priest comes to the home to visit some of the residents. A member of staff is teaching one resident to play a musical instrument. One relative said they were pleased with the activities and told us, The residents have a lovely garden fete, an excellent Xmas party, and a special meal when the Owner comes round and chats to everybody. The home also celebrates festivals and birthdays. However three relatives felt residents needed more to do. Their comments included: Care Homes for Older People Page 15 of 28 Evidence: It would be good if there was a bit more to stimulate residents although I realize this is not easy as a lot of the residents have varying degrees of dementia. I think it would help if there were more things to do during the day. I feel the residents are under-employed and at times, bored. There are not enough staff on duty to meet their social and intellectual needs. There should be more trips into and beyond the local community. This was discussed with the Acting Manager who agreed that the activity programme was in need of improvement. The Acting Manager told us that visitors are welcome to come to the home at any time. A resident told us, When we have visitors the staff look after them and offer them a drink. A relative said, The staff are kind and welcoming to visitors. All the residents we spoke to praised the food. Their comments included: In the morning the staff come round at about 10 am and ask what we want for lunch. Theres always two choices at mealtimes. They feed us pretty well and we always have a good choice. The other day we had beef casserole, peas, sweetcorn, and mashed potatoes. I enjoyed that. I also like the fish and chips we have on Fridays. Weve got an excellent cook. A relative told us the residents were provided with Good fresh home cooked food. We met the cook and discussed the menus with him. He said, I go round and have a chat with the residents about the food. If they ask for different dishes I provide them. For example a few residents like curry, so I occasionally make it and give the residents who dont like curry something different. We looked at the menus and saw that the food served was varied and appeared wholesome. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents and their representatives are encouraged to talk to staff about any concerns they might have. The safeguarding procedure is in need of improvement. This judgment has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) Evidence: All the residents we spoke to said they would speak up if they had any concerns. One told us, The staff are always asking if everythings OK so I could tell them if I ever had a complaint. A relative said, If I had a complaint I would just talk to the staff who are always ready to listen and would do their best to sort out the problem. And a member of staff commented, If a resident or relative has concerns we sit and listen to them and talk about what would be best. The homes complaints procedure is displayed in the entrance hall so it is accessible to residents and visitors. Some residents, because of their confusion, would not be able to use this procedure so staff ask them if they have any concerns, or observe them to see if there are any signs they are unhappy in the home. Since the last inspection a Complaints Book has been put in place. Staff use this to record any complaints made and what action has has been taken to resolve them. In Care Homes for Older People Page 17 of 28 Evidence: addition a Comments Book is now kept in the entrance hall so visitors can share their views about the home. The home has a safeguarding procedure in place which explains what staff should do if they have concerns about the way a resident is being treated. This procedure should be improved, as at present it is difficult to follow, and unclear about the role of social services as lead agency during any safeguarding investigation. Improving this procedure will help to ensure that staff know what to do and who to tell if they become concerned about a residents well being. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents live in an environment that is safe, comfortable, and well maintained. This judgment has been made using available evidence including a visit to this service. (Standards 19 and 26 were inspected.) Evidence: Abberdale House provides homely and comfortable accommodation to residents. All the areas we inspected were well decorated and maintained. The bedrooms we saw were personalized, as residents are encouraged to bring their own belongings and items of furniture when they move in. One resident told us, I think my rooms smashing. There are three lounges on the ground floor which gives residents a choice as to where they sit. There is also a dining room which was well laid out for meals with flowers on each table. There is a secure secluded garden at the rear of the home. One resident said, I like to walk round the garden every day to get some fresh air. Since the last inspection substantial improvements have been made to the premises including: Care Homes for Older People Page 19 of 28 Evidence: New carpets in all the lounges Improved access to the rear garden with handrails for residents to use The creation of an outdoor covered smoking area New furniture purchased for all three lounges New dining room furniture A door and gate fitted at the bottom of the stairs at each end of the home to reduce the risk of accidents All areas of the home we inspected were clean, tidy, and fresh. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. An established staff team meets residents needs. Relationships between staff and residents are warm and caring. This judgment has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) Evidence: The staff we met were friendly and helpful. We saw they got on well with the people who live in the home. All the residents and relatives we talked to praised the staff team. Residents comments included: The staff are very pleasant. The staff keep us active. The staff look after us very well. The staff are always helpful and caring. And relatives told us: The staff do a very good job in difficult circumstances. The management and staff are very friendly from senior to junior including the chef and the maintenance man and the owner and his family. The staff are kind and understanding. However one relative thought there were not always enough staff on duty. They said, Care Homes for Older People Page 21 of 28 Evidence: I dont want to be critical of the staff because I feel they do a great job but at times I feel they have too much to do and are overworked. This tends to delays in changing incontinent patients. Comments in staff surveys also indicated that the home is occasionally short staffed. One respondent wrote, We can cope most of the time with two staff per shift but could sometimes do with another pair of hands. As concerns are being expressed about staffing levels the staff rota should be reviewed to ensure the home is properly staffed at all time. All new staff are subject to CRB and POVA First checks and references are obtained. Records were examined and showed that no one is allowed to start work in the home until all the necessary background checks have been done. This will help to ensure residents are safeguarded. One of the staff files we looked at did not contain a photo of the member of staff in question. It is a requirement that photos of staff are kept in the home for identification purposes. The Acting Manager agreed to make sure this was done. Staff receive good training opportunities including a comprehensive induction. Since the last inspection a programme of staff appraisal and supervision has been put in place. The training and support provided helps to ensure staff have the knowledge and skills they need to carry out their work. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents live in a home that is safe and well managed. This judgment has been made using available evidence including a visit to this service. (Standards 31, 33, 35, and 38 were inspected.) Evidence: Since the last inspection a new Acting Manager has been employed. She has substantial experience in caring for older people, has NVQs 2, 3 and 4 in Care, and is currently completing the Registered Managers Award (a recognized qualification for people who run care homes). She is already established in the home and has built up a good rapport with all those involved with the home. She told us, Staff and residents and relatives know that if they have a problem they can come and see me at any time Staff comments about the new Acting Manager included: Care Homes for Older People Page 23 of 28 Evidence: The Manager ensures high standards of care are met and is always there for advice and support. The Manager is always there to give help if needed. The Manager and Deputy are very supportive. They run the home very well and deal with any issues which may arise. The Acting Manager told us that the Owner is supportive and call into the home every day to talk to residents and make sure they are being looked after properly. However the three staff members who completed our survey all said they would like more support and positive feedback from the Owner. Consideration should be give to their request. The home has now been without a Registered Manager for a considerable amount of time. To provide continuity to staff and residents and to comply with Regulations it is recommended that the Acting Manager is put forward for registrations as soon as it practicable. Residents meetings are one of the ways residents are involved in the running of the home. We looked at the minutes of the most recent one and saw that action had been taken in response to residents suggestions. For example, residents had asked for more regular hairdressing. In response the Acting Manager arranged for two hairdressers to come in once a fortnight. This shows that residents are listened to and their views taken into account when decisions are made about the home. Arrangements for residents finances were inspected. Most residents have their money looked after by their families. For those who have no family members able to do this, there is a bank account kept by the Owner that can be used. The Acting Manager will look after small amounts of money for residents on request, for example if they want cash for hairdressing or chiropody. Appropriate financial records are kept when this happens, which show that residents money is being properly looked after. The Acting Manager confirmed that appropriate health and safety checks and maintenance are carried out to help to ensure the home is safe for residents and staff. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be put in place for residents with challenging behavior. This will help to ensure that residents with dementia are properly cared for and staff use a consistent approach when caring for them. Following consultation with residents, a suitable programme of activities must be provided. This will help to ensure residents are occupied and stimulated. 22/11/2008 2 12 16 22/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 The safeguarding procedure should be rewritten so it is easier to follow and gives clear information about the role of social services as lead agency during any safeguarding investigation. Page 26 of 28 Care Homes for Older People 2 3 4 27 29 31 The rota should be reviewed to ensure there are enough staff on each shift. Staff files should be audited to make sure all the required documents are in place including a recent photograph. A Registered Manager should be put in place as soon as is practicable. This will help to provide continuity for staff and residents. Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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