Inspection on 28/11/06 for Ashfield House

This inspection was carried out on 28th November 2006.

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

The inspector found 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashfield House 15/05/07

Ashfield House 13/06/06

Ashfield House 10/01/06

Ashfield House 21/06/05

Ashfield House 09/12/04

Ashfield House 28/09/04

Ashfield House 29/06/04

Ashfield House 26/05/04

Ashfield House 16/12/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Bell House 105 Ashley Road Ashley New Milton Hampshire BH25 5BL Lead Inspector Liz Palmer Unannounced Inspection 28th November 2006 9:15 Bell House DS0000012384.V320964.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 Bell House DS0000012384.V320964.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. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bell House Address 105 Ashley Road Ashley New Milton Hampshire BH25 5BL 01425 619256 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) Bell House Homes Ltd Mrs Jillian Ann Haughey Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2006 Brief Description of the Service: Bell House is a care home providing personal care and accommodation for service users with a learning disability who may also present challenging behaviours. It is owned by Bell House Homes Ltd, a subsidiary of Allied Care Ltd, which has a number of other registered properties in the area. The home is located on the outskirts of the town of New Milton, and with relatively easy access to the shops and other public amenities. The home comprises a detached, double fronted property with care parking for 4 vehicles to the front of the building and a well-maintained and accessible garden to the rear. All bedrooms are occupied on a single basis, and seven of these have an en-suite facility. There is a lounge with a television easily accessible to service users, and a separate quiet lounge and dining room. The home also has another room that is available for use by service users for recreational activities. The fees range from £954 to £2260 per week. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over seven hours. This was the second key inspection of the year 2006/2007 owing to the number of requirements made at the last inspection and the concerns over the health and safety of service users and management of the home. Improvements were noted in all areas highlighted for concern. All of the requirements had been addressed and all but one of the requirements was fully met. A partial tour of the premises was undertaken, all service users were met, two were spoken to about the home and three were observed during lunchtime. Care plans, risk assessments, policies, procedures and other documents were sampled. Over the course of the inspection, three staff, the registered manager and the area manager were spoken to. What the service does well: What has improved since the last inspection? There have been improvements in all the areas of running of the home. All care plans have been reviewed. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 6 Staff receive regular supervision. Improvements have been made to protecting service users. Improvements have been made to securing the laundry as this poses a risk to service users. An unused bedroom that had dangerous equipment left in it has been redecorated and is now occupied. All service users have a pictorial complaints procedure that has been explained to them. 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. Bell House DS0000012384.V320964.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 Bell House DS0000012384.V320964.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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring prospective service users’ needs are assessed to ensure they can be met before offering them a place in the home. EVIDENCE: There have been no new service users admitted to the home since the last inspection. The home currently has two vacancies and the manager has produced an admissions procedure file that contains all the relevant documents that would be used in the event of a service user applying to live in the home. For example, a statement of purpose, service user guide, and assessment forms. The manager stated that all prospective service users would be jointly assessed by the Community Learning Disability Team (CLDT) to ensure their needs could be met in the home and that suitable support was available for the home. Bell House DS0000012384.V320964.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 adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the reviewing of care plans and risk assessments ensure service users changing needs are identified. Risk assessments must be reviewed for all service users. EVIDENCE: Three service users’ care plans, risk assessments and daily logs were looked at. The manager has worked hard to review and update these as required at the last inspection. All the care plans looked at showed improvement since the last inspection. Each had a personal profile and details of service users individual needs and wishes. Goals and aspirations are recorded and action plans drawn up. An improvement in the recording of how these goals are to be met was seen although there were some gaps, the manager must follow these up. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 10 There was evidence of care plans being reviewed three monthly and staff signing to say they have read them. Although care plans reflect individuals’ wishes and aspirations they are not yet developed in a person centred model. Staff and the manager would benefit from training in person centred planning. Risk assessments were seen to be detailed and relevant to the individuals. Two of the three looked at showed evidence of having been reviewed three monthly. One service users’ risk assessments did not have any evidence of having been reviewed since June. They were said by the manager to be current although she was aware that they had not been updated. An annual review had taken place for this person but the care manager’s comments were not available for inspection. The manager was aware that this work was outstanding and was planning to action it. Evidence of service users being involved in decision making was seen. Service users have weekly meetings where they can suggest activities, outings and be involved in the running the home, for example choosing meals. Records are kept where decisions are made on behalf of people and where any restrictions to their rights are in place. There have recently been some issues with a service user who has restrictions around his smoking. There was evidence that these restrictions are part of his agreed care plan, however, there are times when he clearly does not what to stick to the care plan and this can result in him displaying negative behaviour when he is not permitted to change it. This was discussed with the manager who agreed that other ways of handling this could be looked into and discussed with him and the staff. Bell House DS0000012384.V320964.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. Service users benefit from the arrangements for educational, social and community activities. Healthy and varied meals are provided with the involvement of service users. EVIDENCE: Care plans, daily records and minutes from house meetings showed evidence of service users being supported to access a range of activities on an individual basis. For example, college courses are attended individually and evidence of service users choosing their courses was seen. Evidence of 1:1 support being given for household tasks, going shopping engaging in games and leisure pursuits within the home was also seen. Choices and preferences are recorded and taken into account when planning activities. There was evidence of service users accessing local shops and amenities and being supported to maintain contact with families. For example, one service user spoke about the Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 12 day he regularly telephones his mum. Another is supported to visit his sister on a regular basis. Service users spoke about a Christmas party they were planning, evidence of them having control of this was clear in what they were saying about who was coming, what the entertainment would be and what they would be eating. Records showed that trips out of the home are still being taken in groups. The manager and area manager stated that this was the choice of service users, some of whom had struck up a friendship and others because they felt they would be missing out if they did something different. Care plans seen did not reflect any particular friendships. New approaches to offering activities could be introduced, for example, asking people individually rather than in a group situation. Service users are supported to maintain a healthy and balanced diet. Individual dietary needs and preferences are recorded in care plans. One service users said the food was ‘good’, another said it was ‘very good’ and another said it was ‘lovely’. Care plans showed that those who wish to are involved in planning the menus and getting involved with the cooking while others choose not too. The main kitchen is locked, as per the risk assessments service user can access with supervision from staff. A smaller kitchen with the facility to make drinks is open to service users. One service user said he can have a drink whenever he likes, others were seen helping themselves or requesting drinks which staff would make for them. Bell House DS0000012384.V320964.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. Improvements to the approach to care planning ensures physical and emotional health care needs are better met. Improvements to the procedures for medication better protects service users. EVIDENCE: Care plans reflect the personal care needs of service users. Mostly they are clear and detailed and reflect personal preferences. One care plan to support someone shaving did not contain enough detail for the reader to be sure how to carry out this task. This was discussed with the manager who agreed that clearer instructions should be available to ensure consistency of care. Details of physical and emotional health needs are recorded in care plans. Deescalation techniques are drawn up for those service users who require that level of support. Staff are trained in these techniques and records showed they are used effectively. Each service user is supported to maintain their health and well being by having their own General Practitioner (GP). Support is given to keep GP’s appointments as well as dental and optician appointments. The requirement for ‘as required’ medication to be reviewed and a protocol Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 14 drawn up was made in respect of a service user not currently living in the home. This was discussed with the manager in respect of other service users where protocols are in place. Evidence of medication reviews were seen. Specialist healthcare professionals are involved when necessary. One service user is waiting for a health check due to concerns about his epilepsy, evidence of the manager chasing this was seen. One member of staff said there had been improvements to the way healthcare needs are followed up and another said they felt service users health needs were met by the home. At the last inspection concerns were noted about physical intervention techniques for one service user. The particular technique raising concern has been removed from their care plan, however physical intervention guidelines still remain. The manager stated these were never used but were there as a ‘last resort’ as the service user has a history (pre dating their move to Bell house) Medication procedures were looked at. Suitable storage and recording systems are in place. As a result of the recent internal audit some improvements to the procedures have been made. At the last inspection errors were found on the recording sheets, on this occasion no errors or omissions were found. A required for ‘as required’ medication to have a clear protocol has been met. The requirement for ‘as required’ medication to be reviewed has not yet been met however evidence of a referral being followed up the manager was seen. Bell House DS0000012384.V320964.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 good. This judgement has been made using available evidence including a visit to this service. Improvements to the reporting of incidents better protects service users. Improvements have been made to the charging for transport, however service users would benefit from a more equal arrangement. EVIDENCE: At the last inspection concerns were noted about the reporting of events which are detrimental to the well being of service users. An improvement in this area has been noted in the form of regulation 37 notices being received by the commission and incidents being reported to social services under adult protection. Records in the home were sampled and matched records sent to the commission. Staff have received training in Adult Protection and those spoken to were aware of their responsibilities for reporting events. A requirement for transport charges to be clearly recorded has been addressed. Changes have been made to how charges are made however there are still two systems for charging. Historical agreements are still in place whereas more recent service users have their costs included in their contracted terms and conditions. The manger said that they are looking into changing the historical agreements. In the mean time they have asked care managers to agree the current arrangements. Agreement has not yet been received from any care managers. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 16 All service users have been issued with a pictorial complaints procedure for which they have signed. A record has been made of those who named a person they would complain to. The manager was asked how one service user who could not verbalise their complaints would make their feelings known. She stated that his parents would speak up for him and staff would pick up if he was unhappy or unwell by his behaviour. No complaints have been made since the last inspection, therefore it is difficult to assess whether this is because no-one has any complaints or whether they are still not able to complain. This is an example of how service users would greatly benefit from person centred planning where they would have the involvement of friends and advocates. The procedures for supporting service users with their finances were sampled. Bank books, cash and records of transactions were looked at for three service users. All records were accurate and matched balances held. Receipts are kept for large expenditures and an audit trail for cash withdrawals from bank accounts was evident. Bell House DS0000012384.V320964.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. Service users benefit from a clean, safe and homely environment. EVIDENCE: A tour of the home was undertaken. There was adequate communal space and these areas were clean, homely and comfortable. Two service users bedrooms were seen and they were decorated and furnished to reflect individuals’ needs and preferences. Health and safety is maintained by staff training, risk assessments and regular cleaning and safety notices. Areas highlighted for improvement at the last inspection have been made safe. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Changes to the support and supervision of staff have improved the quality of care provided in the home. EVIDENCE: At the last inspection concerns were raised about the roles and responsibilities of staff. This was highlighted by poor communication in the home and a lack of formal supervision of staff. Regular supervision is now planned for all staff and three staff spoken to confirmed it takes place. One staff member said that their supervision was ‘very useful’, another said the manager was ‘very supportive’ and another said it was ‘very helpful and gets results’. Staff also said their staff meetings were useful and that they could be open and honest with their opinions and ideas. One staff member said their meetings were a good forum for getting service users’ requests implemented. Staff also commented on the new system for signing care plans to show they have noted any changes. There have been no changes to the ongoing training programme, which was looked at during the last inspection. Staff spoke highly of the training they had received recently, some of the courses included refreshers of mandatory Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 19 courses, Autism, Adult Protection and Makaton. These courses reflect the needs of service users on an individual and joint basis. Further specific training to meet individual needs can be requested. Training in person centred planning is required in the home. The manager stated this was being looked at by the company and someone had been earmarked to come and work specifically with the staff at Bell House. Training in physical intervention continues to be provided to staff by an external organisation although no physical intervention is currently used in the home. This training also covers de-escalation techniques which are used by staff. No new staff have been recruited since the last inspection and no changes have been made to the recruiting procedure. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. 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. Improvements to the management practices have been made to the running of the home. These better promote the health and safety of service users. Taking into account the history of this home a period of sustained improvement needs to be evident to ensure the long-term health, safety and welfare of the service users. Evidence of the manager sustaining her management of the staff through regular supervision and on going training also needs time to be proven. EVIDENCE: At the last inspection concerns were raised about the management of the home. Areas highlighted for improvement included, the reporting of events Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 21 detrimental to the well being of service users, reviewing of care plans and risk assessments, communication with staff and safety in the home. Since then Allied Care carried out it’s own internal audit where similar issues were raised and requirements made by the auditors. The auditors have returned to the home and stated all their requirements had been met. Improvements in all areas have been noted since the last inspection. For example, improvements to the reporting of incidents both to the commission and to social services, a programme for reviewing all care plans and risk assessments was seen and is being followed with the exception of one person’s risk assessments. This person has recently been involved in an event of high risk to him. Although the manager stated his risk assessments were still current, this needs to be closely looked at to ensure his safety at all times. The home is currently investigating this is and has reported it to social services under Adult Protection. Out of date material has been taken out of service users files and systems are in place to ensure staff are kept up to date with changes. Staff confirmed they have regular supervision and say there is improvement in the communication within the home. All areas deemed as a high risk were secure during the inspection, for example the laundry was locked and the alarm on the front door was active. The manager stated she is hoping to appoint a deputy in the home. This would be of great benefit to assist her with the paperwork as currently all the care plans and risk assessments are written and reviewed by her. Training for staff in this area would also ease the burden of this task. Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CONCERNS AND COMPLAINTS CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score Standard No 22 23 Score 3 3 3 3 X 1 x ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000012384.V320964.R01.S.doc LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bell House Score 3 3 3 X 2 X 3 X X 3 X Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The registered person must ensure that all service users have a ‘person centred’ care plan. The registered person must ensure that all service users have risk assessments that are up to date and kept under regular review. Issues relating to this have been raised at previous inspections on 28/09/04, 9 and 10/12/04, 13/06/06 and in a statutory requirement notice dated 12/01/05 Timescale for action 01/03/07 2. YA9 20 01/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Bell House DS0000012384.V320964.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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