Inspection on 21/01/09 for Bath House

This inspection was carried out on 21st January 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Bath House 26/11/06

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

CARE HOME ADULTS 18-65 Bath House Links Resource Centre 21 Cromwell Road Eccles Gtr Manchester M30 0QT Lead Inspector Sylvia Brown Unannounced Inspection 22nd January 2009 09:30 Bath House DS0000066573.V374196.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 Bath House DS0000066573.V374196.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. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bath House Address Links Resource Centre 21 Cromwell Road Eccles Gtr Manchester M30 0QT 0161 707 8856 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) Abbotsound Limited Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD The maximum number of people who can be accommodated is: 3. Date of last inspection 12th March 2007 Brief Description of the Service: Bath House is a residential care home for three service users with a learning disability and/or hearing impairment. It is located in a building which also provides, day services to people with a learning disability and or a physical disability, some supported living tenancies and a separate registered care home for nine people with a learning disability/physical disability. People living in Bath House can access the day service. The home is situated close to the centre of Eccles, local bus routes and public amenities. The provision is owned by Abbotsound Ltd. The cost of the service varies dependant on the persons individual requirements for support. Fees are arranged through the Local Authority once the criteria for a service has been met. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the 26th October 2006. This was a key inspection which included a site visit to the service. The site visit was unannounced, which means the manager and staff were not told that we would be visiting. The manager who is also the manager of The Hamlet was not on the premises when we arrived, however he made himself available throughout the site visit and met with us to receive feedback at the end of the visit. As part of the inspection process we gathered information from a number of people which included, where possible, talking with and seeking the views of service users during the site visit. Prior to the site visit we also sent out surveys to service users and members of staff. This gave them an opportunity to tell us about their opinions on the services provided at Bath House. We did not receive any completed surveys at the time of writing the report. We case tracked one person living at the home, this means we looked in depth at their care support which included looking at their records in detail. We spent some time with service users and observed their day-to-day routines as they received care support from care staff. This helped us get a better view about how people living at Bath House are looked after and supported. In December 2008 the manager completed a self-assessment form, which is called an Annual Quality Assessment Audit (AQAA). This document should tell us in detail what the manager has done since the last key inspection to meet and maintain the National Minimum Standards. It should also tell us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. Unfortunately the AQAA was not completed in enough detail to give us all the information we required. As a consequence we spent time with the manager to gain additional information. We also gathered information through general contact with the home; through their reporting procedures which are called ‘Notifications’ and through information we received from other people, such as the general public and professional visitors. We have not received any complaints about the services provided at Bath House within the last twelve months. The AQAA identified that the manager had received one complaint within that time which was investigated under the homes complaints procedure. One allegation of abuse Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 6 has been made which was fully investigated under the Local Authority Safeguarding procedures. Since the last key inspection which was completed in February 2006, we have monitored the service by completing a random inspection in March 2007 to specifically look the management of medication. In February 2008 we completed an Annual Service Review (ASR) which means we gathered information about the service and made an assessment about if we thought it was continuing to maintain a good standard of care. The outcome of the ASR was that we felt their was no need to alter our inspection programme and that service users were continuing a good standard of support. What the service does well: What has improved since the last inspection? Medication administration record keeping has improved and records looked at were maintained to the required standard. This means medications could be accounted for and identified when administered. Repairs have been made to the kitchen areas and the standards observed at the time of the site visit were good. Some health and safety records are now maintained for Bath house which are separate from The Hamlets. This means we were able to see how some health and safety issues are monitored by the manager and what actions are taken to safeguard service users. Bath House DS0000066573.V374196.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. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 8 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 Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 9 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. Prospective service users have their needs assessed and information is provided to the service. This means that service users needs are known and that the manager can confirm the service users needs can be met by the service before decisions about moving in are made. EVIDENCE: There have been no new admissions made since the last key inspection. The admissions process for the two current service users living at the home have been looked at a number of times at previous inspections. Previous inspections have assessed the pre admission process as good and have identified that service users are consulted about their needs and have the opportunity of visiting the service before making any decisions about moving in. The home has a vacancy which means there is an opportunity for a new service user to move in. Because the AQAA did not detail enough information, we are going to request that the new manager completes a review of the pre admission and the admissions procedure and if necessary make any amendments to reflect any changes in practice which he wishes to make. This will enable us to make a more accurate evaluation at the next inspection about Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 10 this managers practice regarding assessment , re admission and admissions process. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 11 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 Service users are involved in the development of their care plans and are able to influence how care support is provided to them. This means their care needs are known and that they have some control to how their needs are met. EVIDENCE: Inspection of care plans identified that service users continue to be involved in the development of their care plans and ongoing assessment processes. Information is detailed but not in a format which can easily be understood by service users who have a learning disability and who are without hearing. Care plans detailed service users received health care checks , appointments and treatments when required. Records were signed and dated and were in enough detail to enable the reader to know what support had been provided to service users each day and evening. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 12 Service users are supported by staff who can communicate through the use of British Sign Language. During the site visit we met with one service user and a member of staff, there appeared to be no communication difficulties with the service user being able to express themselves without difficulty and be understood by the staff member. Each service user had a daily timetable which ensures their daytime occupation is planned for. Timetables include general support to promote service users independence, complete small tasks around the home and some self caring routines. They also include activities inside and outside of the home which the service users have been consulted about and chosen to do. At the time of the site visit one service user was out of the home completing an activity which was detailed within the timetable. Service users are able to take everyday risks and face challenges as other people do, however where risks are identified assessments are completed and plans put into place which encourages service users to make their choices and decisions for themselves whilst at the same time reducing as far as possible the risk of harm. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 13 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service users individual needs are recognised and they receive support to live fulfilling and meaningful lives as they desire. This means they receive the support they require to follow their own personal interests and activities. EVIDENCE: Records were detailed enough to identify service users daily routines particularly their activities. From reading those records and talking with the staff members and manager we were able to tell that service users have opportunity to meet with others both within the home , at the Links Centre next door and when going out in the community. The manager has links to community services which are able to support people with a learning disability to continue with their education and learning if they desire and are able. We saw a number of photographs where staff had supported one service user to have experiences which were both enjoyable and promoted confidence Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 14 building. The manager stated within the AQAA that financial restrictions have meant that he has not been able to develop a wider selection of external activities for service users as he would have like, however he feels that whilst this may be restrictive it does not hinder service users from having hobbies and interest which they enjoy. Friends and family are invited to the home and service users are able to spend time privately with them within the home and visit friends and family outside of the home. One the day of the site visit one service user was spending the day away from the home shopping and having their lunch out in the community, this was identified within their care plan as something they enjoyed and which had been planned for on that day. Whilst there was a menu within the home, we were informed that it was a flexible menu and that due to the small numbers of service users they could chose each day what they liked. We advise that an accurate record is kept of meals prepared and taken, including when outside of the home. This will enable an accurate assessment to be made in future of a service users diet. Service users and staff members shop together for food supplies which enables service users to be aware of the cost of food and how shopping has to be planed for, also this gives service users the opportunity of seeing new foods which come into shops and make their own decisions about trying new foods. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 15 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 Service users receive support in the way they would prefer, this means their health and emotional needs are individually recognised and met to ensure that as far as possible they remain healthy. EVIDENCE: Each service users has a care plan in place which they have signed their agreement to. These plans detailed health care assessments and personal care support requirements. Service users abilities were recognised and where support was required records indicated that service users had been consulted about how that should be provided. From reading records we were able to tell that service users had their own daily routines for rising and going to bed and how they occupied themselves. Both service users at Bath House were at the time of the site visit, receiving one to one support which meant they were able to go out of the home or stay in as they desired. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 16 Both service users were registered with a general practitioner and records confirmed that healthcare checks were in place and that service users were supported to attend healthcare appointments and receive annual check ups and appointments when required which included dental, optical and chiropody. Service users received support to take their medication, records were kept for all medication administered. The records we looked at kept properly and recorded all medicines administered. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 17 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and safeguarding procedures are in place which the staff have been trained in. This means that service users have the appropriate support to keep safe and have their complaints recognised. EVIDENCE: Bath House has a written complaints procedure which is detailed within the Service Users Guide and Statement of Purpose. Both are provided at the time of admission and again upon request from the manager. The AQAA identified that the complaints procedure has been reviewed by the current manager and that one complaint had been received at Bath House within the past 12 months. The CSCI has not received any complaints regarding this service. Whilst Bath House does have a procedure for dealing with and reporting all allegations and suspicions of abuse they also follow safeguarding procedures which are put into place by the Local Authority. This ensures that appropriate action is taken in a timely manner by the correct people, makes sure service users are protected and that investigations remain objective. Since the last key inspection one allegation has been made at the home which was investigated under the Local Authority Procedure. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 18 Accounting systems were in place which means that monies held on behalf of service users are monitored and kept safe. Personal possessions lists were in place, however fixtures and fittings which have been purchased by the service user or their family were not included, nor were other items such as music centres, bedding and other fixtures and fittings. Accurate records should be maintained of all service users personal belongings on their behalf which will in the event of theft, damage or loss enable an accurate evaluation to take place. Such records should also be in place to make sure service users who are short stay and or who move on to alternative placements are able to have all their own belongings accounted for. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bath House offers service users a homely environments which is comfortable and safe. EVIDENCE: Bath House does not offer spacious accommodation, however it is of a suitable size for the registered numbers. On the day of the site visit Bath House was found to be clean, tidy and homely. The lounge area and kitchen had fixtures and fittings which were of a good standard and suitable for a homely domestic environment. We were told that service users are able to influence how the home is developed in respect of decoration and are consulted when new items of furniture are to be purchased. Service users rooms were individually decorated according to the service users own taste and preferences. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 20 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): 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by staff who have been correctly recruited and trained. Because of this they can be confident that they will receive the support they require. EVIDENCE: The home has written recruitment and selection procedures which are followed when new staff are recruited. Inspection of staff files confirmed that the manager continues to ensure application forms are completed and that all statutory checks and references are made and received before staff are offered a position. Face to face interviews are conducted and successful staff have induction procedures to complete within their probationary period. The manager confirmed within the AQAA that the induction training programme for staff meets the required standard set by Skills for Care. The AQAA identified that there are seven staff who work at Bath House six of whom are permanent. All six staff have achieved National Vocational Training at level 2 or above which exceeds the required minimum standard. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 21 There has been minimal changes in the staff team since the last inspection. The staff team has both male and female members of staff whose age range is varied, this means service users receive support from people they can relate to and who they are familiar with and trust. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 22 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): 37,38,39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users get the support they receive because the manager runs the service correctly, however the manager is not known to us and is not yet registered as a fit person to manage the service. EVIDENCE: Since the last inspection there has been a change in the management of the service, and as stated within the summary we were not kept informed of the current managers appointment. The registered provider has not kept us informed of developments of the service or of the appointment of the current manager. An application for registration of the manager has not been submitted, therefore we have minimal information about the manager and have not made an assessment regarding his fitness to manage the service. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 23 Once we were informed by the previous registered manager of their resignation we contacted the service to confirm the information and gather information about the initial management arrangements. Since that time the registered provider has not kept us informed and has not notified us of any changes regarding longer term management arrangements or the appointment of this or any other managers appointment since the previous registered manager left. We have not received any information regarding the homes annual quality assurance outcomes or of any action taken as a consequence of feedback from seeking the views of service users, staff, relatives and other relevant stake holders. The registered provider is aware that this should be completed each year and a public report made of the outcome, a copy of which should be supplied to us. We were provided with and inspected a number of health and safety records and identified that they were adequately maintained. The AQAA confirmed that appropriate servicing of equipment and services were completed by professional outside agencies and that health and safety standards were maintained. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 24 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 3 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 3 23 2 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 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 2 2 X X 3 X Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 25 No 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 YA37 Regulation 7 Requirement An application for registration of the manager of the service must be submitted without delay. This will ensure that the regulatory process will be followed which ensures as far as possible care homes are run and managed by people who are fit to do so. The registered person must ensure that they keep us informed of all significant events within the service , including managerial appointments. Timescale for action 27/03/09 2 YA43 37 & 38 27/03/09 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 YA2 Good Practice Recommendations A review of the pre admissions and admission procedure should be completed and where required amended to DS0000066573.V374196.R01.S.doc Version 5.2 Page 26 Bath House 2 YA6 3 4 YA17 YA13 5 YA39 reflect best and current practice. A copy of which should be supplied to us. All information which service users have access to, should be in a suitable format so that they can be understood by the service user they individually relate to. Where required specialist advise should be sought to ensure the individual needs of service users have been considered. Accurate records should be kept about the meals served and eaten by service users. This will enable precise monitoring of nutritional intake and diet when required. All service users belongings should be recorded, this includes any fixtures, fittings, bedding, furniture and other items which have been purchased by them or their family and friends. Such records should be kept under review and accurate. The registered provider should ensure that a quality assurance audit is carried out for the services of Bath House and a public report made available of the outcome, the details of which should be provided to us. Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Bath House DS0000066573.V374196.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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