Inspection on 07/08/07 for Ashley Park Nursing Home

This inspection was carried out on 7th August 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashley Park Nursing Home 25/05/06

Ashley Park Nursing Home 27/10/05

Ashley Park Nursing Home 17/05/05

Ashley Park Nursing Home 17/11/04

Ashley Park Nursing Home 15/06/04

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

CARE HOMES FOR OLDER PEOPLE Ashley Park Nursing Home The Street West Clandon Guildford Surrey GU4 7SU Lead Inspector Mavis Clahar Unannounced Inspection 7th August 2007 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashley Park Nursing Home DS0000017588.V348175.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley Park Nursing Home Address The Street West Clandon Guildford Surrey GU4 7SU 01483 222296 01483 211099 frenchla@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited 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) Mrs Ladan Roxanna French Care Home 47 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (47), of places Physical disability (1) Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate service users from the age of 60 years Up to one (1) service user may be a person with physical disability from the age of 50 years One named service user with dementia may be accommodated at the home. 25th May 2006 Date of last inspection Brief Description of the Service: Ashley Park is a large, attractively presented detached property set in pleasant grounds in the village of West Clandon. The home is owned by BUPA and the service is registered to provide care, accommodation and facilities for up to 47 older persons requiring nursing care. The accommodation and facilities are set over three floors with a passenger lift access to all floors. However, there are two bedrooms that require service users to negotiate two sets of four stairs from the lift to the rooms. These rooms are reserved for respite care or people who are independent and mobile. The communal areas are all found on the ground floor and consist of a sun lounge, a drawing room, a large dining room and a very large activities room that is also used as the hairdressing salon and physiotherapy room. The home has very large gardens that run down to the neighbouring golf course. The grounds closest to the home are well maintained, with many seating areas around the house and a sun gazebo in the grounds. There is plenty of parking to the front and around the side of the home. Fees at this home are in the range of £850 to £1300 per week. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit, which forms part of the first key inspection undertaken by the Commission for Social Care Inspection, (CSCI) was completed by Mrs Mavis Clahar on the 7th August 2007 and lasted for six hours and forty-five minutes; commencing at 10:15 hours and concluding at 17:00 hours. The first part of the visit was spent in discussion with a registered nurse updating her about the improvements and changes to the inspection processes under inspecting for better lives. This was followed by discussions with the registered manager around training needs of the care workers and how these needs were being identified and met, and employment of new care staff were discussed. A review of residents’ files and care workers records was undertaken and all found to be in good order. The second part of the visit was spent reviewing residents care notes, which were up to date and sampling selected policies and procedures. The information contained in this report is gathered from residents’ notes and records kept by the home, from discussions with residents, from direct observation by the inspector, along with discussions with care workers present on the day of the visit. The third part of the inspection was spent visiting and discussing with residents and observing lunchtime activities. Residents were enthusiastic about their home and the service they receive. Residents spoken to said they enjoyed their lunch, which was prepared freshly in the home’s kitchen. Time was spent observing the presentation of the meal, care workers and residents’ interactions and to obtain feedback on the meal, its suitability, taste, texture and amount. The inspector observed that portions were varied to suit the appetite of the residents and that they all ate their meal in a very social gathering, all sitting at tables which were laid for four, with a small vase of flowers and condiments. Residents commented positively on their meal, and the food served at the home in general. Many residents spoke highly of the choice of beverages they were offered during the mid-day meal, and it would appear that the glass of wine with their meal was very much appreciated. A tour of the home was undertaken and it was observed that residents’ bedrooms were kept in very good condition, both decorative and clean and tidy. The bedrooms are attractively presented. Generally, the home presents as clean and tidy. No requirement or recommendations for good practice was made on this visit. The inspector would like to thank all the residents and care staff that made the visit so productive and pleasant on the day. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 6 The final part of the visit was spent giving feedback to the manager about the findings of the visit. What the service does well: What has improved since the last inspection? All requirements issued on the last inspection have been actioned within the given timescales The home continues to be proactive in meeting the training needs of the care workers in order that seamless care can be offered to the residents. All members of staff have undertaken the Equality and diversity course. The home continues to refurbish bedrooms and replace worn carpets as per their annual refurbishment plan. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 7 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. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives have the information needed to choose a home, which will meet their needs and respite care service users are assured their independence will be maintained EVIDENCE: A selection of service users files were reviewed and it was noted that residents received a needs assessment prior to moving into the home. Furthermore, the first four weeks is used as a trial period for both new resident and the older residents, to ensure the new resident is comfortable on all counts in the home. It was also noted that all residents are given a contract of residency, and this contract is signed either by the resident or their representative. The manager gave examples of times she has visited prospective residents in their home to get to know them and their families before the resident is moved Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 10 into the home. This was verified by the documentation reviewed of the newest admission to the home and in discussion with the resident. The manager told us that a more comprehensive assessment as reviewed in resident’s file is obtained, once the service user has settled in the home. The manager or the deputy who are both trained in the art of assessing residents care needs usually carries out this assessment. Standard 6 does not apply to this home. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good and clear care plan in place for residents, which also includes appropriate risks assessments. This forms the basis for care based on the agreed care needs of the service users and demonstrated that health and personal care needs were met. Care staff receives training to meet the assessed care needs of the residents ensuring that competent staff supports residents and their health and care needs are met. The home’s medication policy on receiving, storing and administering and return of medication was in place and being adhered to thereby ensuring the safety and protection of the residents. Residents are treated with respect and are encouraged to maintain their dignity and privacy when delivering personal care. EVIDENCE: Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 12 The randomly selected care plans were signed by residents/relative, clear and easy to read, identifying potential and actual risks to residents with risk assessments completed as required. The daily work sheet along with discussion with residents demonstrated that residents’ care needs are identified and are being met. Residents spoken to, rated the personal care they receive at the home as very good; they said they were contented, they had enough to eat and can do as they like. Each service user is registered with a General Practitioner, and is able access the wider health care provision, as their care needs demand. No resident at the time of inspection was responsible for their medication, but the manager was knowledgeable about what to do should this situation arise. Good clear records are kept of medication receipts, storage, administration and returns. There is a list of staff trained and assessed as competent to administer medication. In discussion with care workers assessed as competent to administer medication it was evident they were working within the home’s policy and procedure on administration of medicines, which include using the Medication Administration Record (MAR) Sheet. Residents said the staff treated them very well. One resident said, “the staff are so kind. They will come to you as soon as you ring the bell, and they are always kind and wanting to help. Yet, I can have my privacy when I want”. Care workers were observed interacting with residents in a friendly but respectful manner. In discussion with care workers it was apparent they enjoyed their work. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lifestyles matched their needs and preferences and where possible they are able to maintain contact with family, friends and the local community. Service users are able to make choices in accordance with their abilities and were provided with a balanced diet in pleasant surroundings and in an unhurried way. EVIDENCE: The home employs an activity coordinator who plans the week’s activities following discussions with the service users. Thereby ensuring the activities needs of the service users are met, and care workers are encouraged to engage residents in their choice of activities. The activities programme is posted on the notice board so that relatives and visitors to the home are able to see what is planned for the residents. We observed that future activities planned for the residents such as Candle lit dinner in September, Trip to Southsea. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 14 In discussions with residents we were told that regular religious services were held at the home. Also that visiting was open and relatives and friends are able to visit whenever they like and can have a meal with their relative for a small fee at the home. The manager in discussions supported these statements. In discussions with residents they all said they were happy in their home and they were able to exercise choice and control over their lives in their home. One resident told us “I feel very protected in this home”. Catering facilities are managed and carried out by the home’s chef, who had a good knowledge of the dietary needs of the service users. On the day of the visit there were two main menus with various alternatives for service users who had made their choices. The inspector did not sample the meals, but the service users all said the food is good, the texture just right and the amount was what they ordered. We observed that there was a choice of beverages ranging from squash through lemonade, various fruit juices to wine and residents were able to make their choices. We further observed that there was an air of being in a restaurant with the care workers being very professional and polite whilst serving and helping residents with their meal. Also the food was presented in an attractive way to stimulate resident’s appetite. One resident told us “I have always had a glass of wine at mid day and do not know how I would mange if it was stopped now”. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints policy and procedure and training in place that evidenced that residents and relatives concerns are listened to and acted upon. Robust Safeguarding adults’ policies are in place to protect the service users from abuse EVIDENCE: There are a number of thank you notes and letters of appreciation from grateful relatives to the whole staff team praising their work with their relatives. All staff as evidenced in the training record and substantiated in discussion with care staff, have completed the Safeguarding Adults Course which is based on the local authority (Surrey multi-agency Policy) The Policy is up to date, dated 2005. CSCI received no complaints about the home. No current complaints were logged at the home, and the manager told us she is in touch with residents on a daily basis and issues raised are dealt with immediately; nine complaints over the last twelve months were dealt with satisfactorily within the agreed Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 16 time frame. Residents spoken to said they have no need to complain, as they are able to discuss everything with the manager. The home has a complaints procedure and policy, and the care workers spoken to were aware of the homes’ policy and procedure on Safeguarding Adults and felt secure in the knowledge that if they had to use the whistle blowing procedure the manager/ Owner of the company would support them. A random sample of care workers training record demonstrated that care workers are being trained to undertake the duties of meeting the service users assessed needs, thereby protecting them from abuse Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables service users to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The manager told us that the management and staff encourage residents to see the home as their own home. It presents as a comfortable, attractive homely home, which has all the specialist adaptations, needed to meet the service users needs. It was observed that care workers were interacting with the residents both in the lounge and dining area, so that residents’ needs are quickly attended to. The home has attractive gardens, which are well maintained and there is good access to the gardens from various parts of the Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 18 home. Some residents told us that they try to go out daily weather permitting to enjoy the gardens and watch the various birds visiting the garden. We observed that adverse weather would not stop residents enjoying the garden, as the windows are low enough to allow them to view the gardens from their armchairs, whilst sitting in their bedrooms. It was observed that some resident’s bedrooms were personalised with small items of furniture, paintings on the wall and many family photographs. Generally, the home presents as clean, safe, pleasant, hygienic and tidy and free from offensive odours. Random review of care workers training record demonstrated they have had training in infection control and this was evident in the storage of waste. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of the service users. EVIDENCE: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to service users for any twenty-four period was adequate to meet the assessed care needs of the service users. The home has a programme of planned training in place and all members of staff have an individual training record. A number of care workers have attained the L2 NVQ with more staff undertaking NVQ L2 course. Staff are encouraged and enabled to undertake developmental training as well as the mandatory training. . All newly appointed staff undertakes an induction programme. The home ensures that staff undertakes the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties. This was evidenced through discussion with the manager and care workers. The manager was knowledgeable about equal opportunities and how this relates to recruitment and retention of staff. At the moment there isn’t any one undertaking the Equality and Diversity training but this is being remedied as soon as they can obtain a place on a course. We were told that Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 20 the recruitment of staff are in line with Government and the homes policies based on equal opportunities, and that the current staffing team mirrors the area in which the home is based. It was noted that staff turn over at the home is relatively low. All staff are Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checked prior to commencing employment, and they are in receipt of terms and conditions of employment as evidenced in their randomly selected files. It was evidenced that staff files contain the necessary documents as per Schedule 2 of the Care homes Regulation 2001. The manager informed the inspector that supervision record were up to date and this was verified during random sampling of care workers files. The manager discussed with us her planned programme of improvements and training and development of staff. The home employs an education development officer to cater for the educational needs of the care workers. Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the experience to run the home and works to continuously improve services and provide an increased quality of life for the service users. There is a strong ethos of being transparent and open in all areas of running the home and the views of service users and their relatives are actively sought. Service users financial interests are safeguarded and the health, safety and welfare of service users and staff are protected and promoted by the homes’ policies and procedures. EVIDENCE: Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 22 The manager has demonstrated that she has kept herself updated on issues relating to care of the service users and staff in her charge. She has attained the Registered Managers Award and also the National Vocational Qualification Level 4 in management. In discussion with the manager it was evident she was knowledgeable about the care needs of the service users and the training needs of the care workers to meet these identified needs. There are clear lines of accountability within the home, each member of staff spoken to on the day of inspection aware of their role and responsibilities. Regular residents meetings are arranged and minutes of the meetings are passed to the owners who will action requests as soon as possible. The senior management on the behalf of the owners are in attendance on a daily basis and are able to monitor the running of the home through interaction with service users, relatives and care workers. The home does not become involved in service users finance. Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day was properly maintained. Records indicated that fire drills, fire alarm, water temperature fridge and freezer recordings were regularly checked. Random sample of care workers’ training files demonstrated that up to date and relevant training were carried out by care workers to protect service users’ health, welfare and safety. In discussion with care workers they discussed their understanding and implementation of appropriate procedures to safeguard service users. Further more they spoke about their understanding of promoting safe working practices based on their health and safety training. Ashley Park Nursing Home DS0000017588.V348175.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Ashley Park Nursing Home DS0000017588.V348175.R01.S.doc Version 5.2 Page 26 - 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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