Inspection on 02/11/06 for Alexandra House

This inspection was carried out on 2nd November 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra House 31/03/08

Alexandra House 06/01/06

Alexandra House 12/09/05

Alexandra House 10/02/05

Alexandra House 08/07/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Alexandra House 87 Alexandra Road Addiscombe Croydon Surrey CR0 6EZ Lead Inspector Margaret Lynes Key Unannounced Inspection 2nd November 2006 09:45 Alexandra House DS0000025810.V318280.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 Alexandra House DS0000025810.V318280.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. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra House Address 87 Alexandra Road Addiscombe Croydon Surrey CR0 6EZ 020 8656 2232 020 8656 2232 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) Mr James Emmanuel Kwabena Safo Mrs Bernadette Joan Redmond Mrs Celia Ann Gurney Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th January 2006 Brief Description of the Service: Alexandra House is a semi-detached building set in a residential area of Croydon and is indistinguishable form any other house in the street. It provides for a family type dwelling for its five service users who have a past or present mental illness. Each service user has their own bedroom, all of which are of an acceptable standard of décor and furnishing. The home is situated within easy reach of Croydon town centre, and near to bus routes and local amenities. The stated aim of the home is to provide a safe and suitable environment that is friendly and homely, and to base its service on a service users right to respect, dignity, independence and flexibility for choice rights and fulfilment. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 5 hours and consisted of examination of documentation, a tour of the communal areas of the home, and discussion with all of the service users, the manager and one of the staff. All of the aforementioned are thanked for their assistance. The previous key inspection, carried out in September 2005, had resulted in 9 new requirements being made. It was also identified that there were two requirements that still remained outstanding from previous visits. A follow up visit in January 2006 found that almost half of these requirements had been met. Those not met related to medication administration, staff training and the refurbishment of the premises. This visit revealed that action had been taken with regard to the medication charts, and the refurbishment of the residents’ bathroom and the staff toilet. Staff training remains an ongoing issue, but some improvement has been made, while refurbishment of the kitchen is due to take place this month. This visit has resulted in 11 new requirements and 1 recommendation being made. The vast majority of these relate to record keeping and as such should not be difficult to achieve. Evidence to support the comments below was gathered from a range of sources – the service users themselves, members of staff and inspection records. What the service does well: What has improved since the last inspection? It was noticeable on entry into the home that the hallway and stairs carpet had been replaced, which immediately made the home lighter, more welcoming and homely. Service users are also able to benefit from a refurbished bathroom. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Alexandra House DS0000025810.V318280.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 Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (it was not possible to assess Standard 2 as there have been no new admissions since the last inspection) Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. While it had been demonstrated that the home has the capacity to meet the needs of service users who are in the younger adult category, it must now indicate that it has the ability to also meet the needs of one of its residents who now falls into the older person category. EVIDENCE: On examination of the service user files it was noted that one of the residents has recently celebrated their 65th birthday. This means that they now fall into the older person category and, as such, fall outside the registration status of this home. The manager was advised that she must contact the Commission and apply for a variation to the home’s registration. In so doing she must demonstrate that the home can continue to meet the needs of the service user in question. This application must be supported by the Placing Authority. Alexandra House DS0000025810.V318280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. It was felt that the service user plans were satisfactory, that service users were enabled to make decisions about their lives and that they were supported to take risks as part of an independent lifestyle. EVIDENCE: All of the service user plans were examined. Each one was relevant to the individual and, where appropriate, was supported by CPA documentation. The plans were reviewed six-monthly and this was recorded on a re-assessment form and/or a care plan review form. The files showed evidence of good liaison between the home and the community mental health teams. The Inspector was pleased to be able to spend half of the inspection sitting with the service users and discussing with them their opinion of the home and the service provided. They were clear that they felt involved in the planning of Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 10 their care, that they were enabled to make decisions about their lives, and that where necessary, staff assisted them in the decision making process. They were similarly positive about the action taken by staff to minimize identified risks and hazards, and while they might not always be in agreement with the proposed action, appreciated the need for some safety measures. The manager must ensure, however, that the risk assessments are reviewed at regular intervals and updated where necessary. Alexandra House DS0000025810.V318280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff encourage residents to participate in appropriate activities, to integrate into the local community, to maintain family links and friendships where appropriate, to participate in the day-to day decision making in the home and to help prepare, plan and serve meals. This means that service users are enabled to live as ordinary and meaningful lives as possible. EVIDENCE: Two of the current service users attend day centres while another works part time in a charity shop. One attends regular art/painting classes. All residents are encouraged to participate in activities, with staff assistance where needed. Monthly keyworker sessions are held with each service user and these are recorded. There is also a general residents meeting every 6 months. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 12 Four of the five residents are able to go out into the community independently, and do so on a regular basis. The fifth resident needs much encouragement to leave the house, but on rare occasions, with staff support, will do so. Staff assist residents to familiarise themselves with the local area, so that they become competent and safe to use local transport, and to enjoy community based facilities. Some of the service users have family contact, and go out to visit them regularly. Staff encourage the residents to bring family and friends to the house to visit. There are no restrictions in place for any of the current service users. There is only one house rule – which relates to the ban on smoking in bedrooms. Almost all of the residents do smoke, but all accept this house rule and will only smoke in the dining room or the rear garden. The daily routines are very much set around what each service user wishes or has planned to do that day. Individual choice and freedom of movement is greatly encouraged. While the manager does ensure that a menu is on display, frequently the advertised meal will be changed because the service users wish it. They are at liberty to choose something different to the menu choices, and encouraged to assist in its preparation. A record of food provided is being maintained to a satisfactory standard. Alexandra House DS0000025810.V318280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. From discussion with the service users and observation of the interaction between residents and staff it was apparent that the service users received support that was flexible, consistent and reliable. This means that their preferences are being taken into account and their physical and emotional needs are being met as much as is possible. EVIDENCE: Each of the service users receive as much support with personal care as they require. Due to the ability of most of the residents, this support will often only consist of guidance regarding personal hygiene and dress. All of the residents are registered with local GP’s. The staff team enjoy a good relationship with the local mental health professionals such as the psychiatrists and CPN’s. Staff will accompany a resident to health appointments if the resident wishes it. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 14 The medication administration records were examined and found to be in order. The previous requirement regarding the medication records has been met. None of the current residents are able to administer their own medication at present. Should they be able then this would be encouraged. Alexandra House DS0000025810.V318280.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. From examination of the complaints records it was felt that the recording was incomplete. This means that it is possible that issues raised by service users and/or their families may be overlooked or not adequately dealt with. The home has appropriate information for staff regarding the protection of vulnerable adults from abuse. It was felt, therefore, that service users were as protected as possible from abuse, neglect and self-harm. EVIDENCE: The home maintains a record of all complaints made – in fact two records were found and it would be helpful if just one log were to be maintained. The records showed that two complaints had been made since the last inspection visit. Unfortunately staff had not entered into the log the action taken with regard to each of these matters, or the outcome. It was also noted that while the home had notified the Commission of a separate complaint, it had not been entered into the log. Even if a complaint is ultimately investigated under different procedures (such as adult protection), there should still be an initial entry into the home’s complaints log, with a comment indicating how the matter is being processed. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 16 At the last inspection the home was unable to produce an adult protection procedure. On this visit, however, the appropriate policies and procedures were in place and were supplemented by the Local Authority multi-agency procedure and the guidance produced by the Department of Health with regard to POVA referrals. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. From a tour of the communal areas of the home it was evident that the home was hygienic, clean and provided a homely, comfortable and safe environment for the service users. EVIDENCE: It was pleasing to note that some refurbishment of the communal areas had taken place since the last inspection visit. The hallway and stair carpets have been replaced, creating a much lighter, welcoming atmosphere. The residents’ bathroom had been nicely refurbished while the refurbishment of the kitchen is scheduled for later this month (November). The staff toilet was in the process of being re-decorated. A maintenance book is kept in the home however it was difficult to determine if problems were attended to promptly as not all entries had been signed off. It would be helpful, therefore, if staff could enter into the record the date that each problem was resolved. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 18 Although none of the service users’ bedrooms were inspected (as they did not wish it), they all commented that they were satisfied with their room. Only one new requirement has been made with regard to these Standards and this relates to the need for the three-piece suite to be replaced. It is now well worn and it is possible to feel the springs when sitting on it! Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Due to some gaps in recruitment documentation it was not felt that service users were as adequately protected and supported by the home’s recruitment policy as they should be. While some progress has been made it was still not felt that the training programme for staff was sufficient to ensure that they received adequate training so as to enable them to fulfil the aims of the home and meet the changing needs of the residents. EVIDENCE: Just one new member of staff had been recruited since the last inspection visit. While it is acknowledged that they have since left employment in the home, the manager must nevertheless ensure that all recruitment documentation is complete before new staff start work. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 20 The file of the aforementioned carer was incomplete as it did not contain a full employment history, with an explanation of any gaps, and did not explain why the individual had left previous employment working with vulnerable people. The manager was also advised that where a home wished to start a new carer without waiting for the full CRB to be returned, then they must seek and obtain the agreement of the Commission first. Some staff training has taken place during the last 12 months, including fire safety, health and safety, food hygiene, medication and mental health issues. This is promising however not all of the staff were enabled to attend all of the courses. The manager has identified where training is still needed, and submitted a list to the proprietor. The Commission expects prompt action by the proprietor as this requirement has now been raised on a number of occasions. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager is in the early stages of the NVQ level IV award, and is keen to learn and improve the quality of both the service offered in the home and her own management skills. From discussion with service users it was apparent that they felt the home was well managed, and the majority of the findings from this inspection support this. Other requirements notwithstanding, the Inspector was satisfied that generally the home was being run with the best interests of the service users in mind, as a number of quality assurance checks were in place (albeit some improvement is needed), and most of the records examined were being appropriately maintained. The Inspector felt that in the areas that were inspected on this visit (risk assessment/health and safety), the home was not always being maintained to Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 22 an appropriate level of safety, thus failing to ensure that service users were not subject to unnecessary risk. EVIDENCE: The manager has recently successfully applied to be Registered and, as mentioned overleaf, is currently undergoing the NVQ level IV course. She was spoken of with high regard by the service users, and it is felt that she has the competencies to foster an atmosphere of openness and respect. A quality assurance audit system is in place. It includes quality checks on, for example, employment records, staff training, inspections and requirements, room by room risk assessments, the house maintenance plan, health and safety and the home’s annual development plan. It also involves seeking feedback from residents and relatives, staff and stakeholders. On looking through the audits, it was evident that while some parts of it were reviewed as planned, others aspects were not. There is a need, therefore, for the manager to ensure that audits are carried out regularly and that this is documented. Regulation 26 visits are part of the quality audit however it was not possible to evidence that they had been carried out as required, as a number of reports were not available in the home. Maintenance checks of the fire detection system and fire fighting equipment were up to date, as were the maintenance checks on the electrical installation, gas installation, portable electrical equipment and the water system re Legionella. Although there was a chart available for staff to record checks of the temperature of the hot water, this record had not been completed for almost a month. It was of concern to note that after consistent regular weekly checks of the fire alarm (following a previous requirement), no such tests had been conducted for 4 weeks. The last fire drill was carried out in May and one is therefore overdue. Risk assessments re the premises were in place, but they were not being reviewed regularly. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 23 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 x 3 X 2 X X 2 x Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 24 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 YA35 Regulation 18 Requirement The proprietors must ensure that the staff team are provided with training specific to meeting the needs of the service users. The previously set timescale has again not been met. The kitchen requires refurbishment. The previously set timescale has not been met. (it is acknowledged that this work is scheduled to start shortly) The registered person must apply for a variation to registration for the service user who now falls outside the registration category of the home. The registered person must ensure that all service users have up to date and regularly reviewed risk assessments on file. The registered person must ensure that all complaints are appropriately logged and that the action taken and outcome are recorded. DS0000025810.V318280.R01.S.doc Timescale for action 31/12/06 3. YA24 23 30/11/06 1 YA3 14 31/12/06 2 YA9 13 15/11/06 3 YA22 22 02/11/06 Alexandra House Version 5.2 Page 25 4 5 YA24 YA34 16 19 6 7 YA39 YA39 24 26 8 YA42 13 9 YA42 13/23 10 YA42 13/23 11 YA42 13 The three-piece suite in the lounge must be replaced. The registered person must ensure that all new staff supply the documentation listed in the Regulations. The registered person must ensure that quality assurance audits are kept up to date. The registered person must ensure that the home is visited monthly, that a report is written and that this report is available in the home. The registered person must ensure that staff conduct regular checks of the temperature of the bath hot water. The registered person must ensure that the fire alarm system is tested on a weekly basis and that this is recorded. The registered person must ensure that fire drills are carried out at regular intervals and that this is recorded. The registered person must ensure that health and safety risk assessments are regularly reviewed and that this is recorded. 02/02/07 02/11/06 02/12/06 02/12/06 02/11/06 02/11/06 30/11/06 30/11/06 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 YA24 Good Practice Recommendations It would be good practice to indicate in the maintenance book when specific repairs/problems have been repaired/ rectified. Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra House DS0000025810.V318280.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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