Inspection on 21/06/07 for Bluebell Court

This inspection was carried out on 21st June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bluebell Court 16/04/09

Bluebell Court 12/12/08

Bluebell Court 11/06/08

Bluebell Court 14/01/07

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

CARE HOMES FOR OLDER PEOPLE Bluebell Court Stanley Road Grays Thurrock Essex RM17 6QY Lead Inspector Helen Laker Unannounced Inspection 21st June 2007 10:00 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 Bluebell Court DS0000067279.V342037.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. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebell Court Address Stanley Road Grays Thurrock Essex RM17 6QY 01375 369318 01375 369346 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) Primrose Care Home Limited Manager post vacant Care Home 80 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (80), of places Physical disability over 65 years of age (10) Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home should appoint a registered manager for the home, within three months of the homes premises registration, who should obtain a suitable qualification equivalent to NVQ level 4 - care and management by 2007. Following initial registration, no persons requiring nursing care must be admitted until a Nurse Manager is appointed. 2. Date of last inspection Brief Description of the Service: Bluebell Court is a purpose built three storey care home with Nursing for older people who have physical disabilities and dementia and is registered with Commission for Social Care for the continuing care of 80 residents in total. The Home is located centrally in the town of Grays within walking distance of local amenities. The M25, the A13 and Grays railway station are in close proximity. The building has been adapted to provide three purpose built floors, to provide a homely atmosphere for the service users and families. Trained nursing staff and carers are available for the provision of personal and nursing care. Parking is available to the front of the building. The home was registered in July 2006. The Service User Guide and Statement of Purpose are available and are updated as required. The residents and their representatives are provided with this information, also the manager stated that latest Commission for Social Care Inspection reports must also be available. At the time of this report the manager confirmed that the fees ranged from £395.43 to £709.00 per week and a completed pre inspection questionnaire was provided. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection, which took place over one day with one inspector in the home. There was a tour of the premises and grounds and an inspection of records and documentation. Time was spent discussing the care of the service users. The acting manager in charge of the day to day management of the home and staff and relatives were spoken with. Further feedback was also received from service users and care staff through survey and discussion. Responses have been included in the relevant sections of the report. A pre-inspection questionnaire and other reports and correspondence provided by the manager and staff on duty were also used as evidence to inform this report. Twenty one National Minimum Standards were inspected on this occasion, sixteen overall outcomes were met and there are five requirements and one recommendation detailed in this inspection report. Discussion of the inspection findings took place with the acting manager in charge of the day to day management of the home and guidance was given. Key standards as identified in the intended outcomes sections of this report are inspected at least once every twelve months during a key inspection. What the service does well: What has improved since the last inspection? There have been significant improvements since the last inspection. Risk assessments are in place and contain adequate information overall Records are kept regarding any complaints made or concerns raised verbally or informally. These records indicate whether the complaint was upheld and what action was taken to address the issues raised. Staff have received training in POVA. The employment policies and procedures adopted by the home and its induction, training and supervision arrangements have improved overall Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 6 It is recognised that the requirements at this inspection have decreased and the home has made efforts to ensure that they provide a consistent professional service to current residential service users. 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. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 7 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 Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 8 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&6 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 supporters have adequate information about the home so that they can make informed choices. The admission procedure does now include an adequate assessment, which ensures that service users needs can be met. The home provides a caring environment where visitors are made welcome. EVIDENCE: A pre-admission assessment is generally carried out by the manager or identified senior staff member. Pre admission assessments were reviewed for the homes most recent admissions and were found to be adequately completed and improved since the last inspection however some attention to detail is still required. For example one service user on zopiclone had nothing recorded for sleep patterns. Dating and signing documentation any assessments at the time of completion to ensure accurate information is maintained has improved. Wherever possible it is advised that residents or their relatives are involved in the assessment process and the home was reminded that following the Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 9 assessment they must confirm in writing whether they are able to meet the prospective residents’ health and welfare needs. Bluebell Court does not provide intermediate care. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using available evidence including a visit to this service. Each service user has an individual plan and service users are generally supported to take risks as part of an independent lifestyle via a process of assessment. The health needs of service users are generally met. Medication storage and recording issues were noted to require attention. Personal support is provided in a way that promotes dignity. EVIDENCE: Evidence of four service user care plans indicated that their basic health, personal and social care needs are recorded within an individual plan of care. Instructions for staff to meet service users’ care needs are improved but still need to be clear and comprehensive. Care plans did not always evidence service users’ or relatives’ involvement and those seen were not all reviewed on a regular basis. Daily recording has improved but repetition should be avoided and staff should detail fully the welfare of the service user, how they spend their day and the progress of the care plan. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 11 Risk assessments have also improved and are available for service users. Care plan training is planned and ongoing now in the home. There was evidence to show that the home ensures that residents are supported to access all the community health facilities. The inspector was informed that only trained staff administer medication. Completed drug histories should still refer to dose changes on the form. All individual entries on the drug sheets should be signed by the transcriber and checked for accuracy with a countersignature. The dose form and strength and time of medication were overall recorded on treatment charts inspected. Minor shortfalls were noted with the maintenance of records in respect of room and fridge temp recording and all of the three drug storage rooms were noted to still have no ventilation despite the last report highlighting this issue. The home has purchased air conditioning units but not enough for all three drug rooms and there needs to be adequate temperature control in all of the drug rooms. The nursing floor clinical/drug room was noted to be somewhat smaller that the other two floors presenting storage problems. The home must adhere to the procedures for the receipt, recording, storage, handling, administration and disposal of medicines. The manager stated on the day of inspection that these issues would be addressed. Residents and relatives spoken with expressed their satisfaction with the care they received and felt that staff generally respect their privacy. Observations throughout the day indicated that staff treat residents in a caring and unhurried manner. The manager stated that most residents open their own mail, those that are not able to usually have their relatives’ assistance. The home provides visitors areas, including a small café in the main reception foyer. This enables service users to see their visitors in privacy, if they do not wish to use their bedroom. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 12 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. A wider range of meaningful pastimes is being developed to promote the residents mental and physical wellbeing. Links with families are good and contacts are maintained. Choice in the routine of the day can be adapted to ensure resident’s rights are maintained. The home provides good food in ample quantities and is served in a congenial setting. EVIDENCE: At the last inspection it was confirmed that the home presently employs one activities co-ordinator for 25 hours a week for potentially 80 service users when at full capacity. A discussion was held regarding an increase in this provision in hours as occupancy increases. The manager has been actively recruiting but without success yet. The home does now have a set activities programme. Residents spoken to stated that they play cards, bingo, listen to music, and have sing-along; they also told of the regular visits by the clergy. The home held a fete the weekend previous to this inspection and had arranged a party to celebrate the homes first birthday in July. A quiz night is planned and a mobile sensory box initiative is being implemented. Two residents at the last inspection spoken with stated that a mini-bus/car would allow them to go out. The manager confirmed that an application had been Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 13 sent to a local company who provides transport to enable residents to go out. The manager confirmed that the home still had no transport of their own. Information about resident’s choices and preferences for activities of living are not consistently recorded for the people living at the home but social diaries are completed. It is accepted that a number of people living at the home may not wish to or be capable of participating in activities. However records in respect of meaningful occupational and stimulating activities should be kept. A display of activities, which are planned on a day-to-day basis, is now available. Improvements are being made slowly and more is being done in respect of the social and leisure activities provided by the home. Relatives spoken with said that they can visit when they wish and are always made welcome and can speak to the manager. Residents described the food provided by the home as “very good”. The home employs a cook who is prepared to cook any meal to accommodate individual residents needs. Another cook is also employed. Residents spoken with said the food at the home is good and that they get three courses. The dining areas are spacious and clean. The food was well presented and served in sufficient quantities. Visitors spoken with again commented on the quality and the quantity of the food served. A small café is available in the main foyer reception area for relatives to order from a menu snacks and drinks. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 14 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 an appropriate complaints policy, which informs complainants of their rights, in the event of any informal or formal complaint documentation is maintained appropriately. Staff receive relevant training relating to the protection of vulnerable adults and updates are planned. EVIDENCE: The home has a complaints policy and procedure and people may raise concerns formally or discuss any issues in a more informal way with the homes manager and operations director. A suggestion book is also in place. There has been a notable decrease in the amount of complaints the home has received since the last inspection in January. Informal and verbal complaints are now logged in a manner, which records the outcomes, and the home is endeavouring to attend to areas where services could be improved. The home has an Adult Abuse Policy and Whistle Blowing procedure. Most staff have now attended “Protection of Vulnerable Adults” training. The manager stated the home continues to ensure that all staff receives training and updates in the protection of vulnerable adults and ensure through the home’s supervision procedures that all staff are fully aware of what is expected of them. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 15 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. Bluebell Court is bright and airy and provides the service users with homely and comfortable surroundings. EVIDENCE: The home Bluebell Court remains presented in an attractive and comfortable way and adequately meets the current needs of the resident’s. The premises are generally well maintained with a garden area to the rear. The home was clean and hygienic on the day of inspection with no isolated odours. The home has a smoking room, which is for residents use, but the inspector received feedback from service users and relatives that it’s purpose would be better served as something else as it is not used. The conversion of one room to a consulting room for the doctor is also planned. The proprietor may wish to review storage systems within the home, as they are limited. Appropriate systems were in place to control cross infection. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels are currently maintained to meet the needs of service users. Recruitment practices have improved since the last inspection but still have some areas to address. Staff training is being addressed and more prominence paid to appropriate updates being undertaken to provide a competent work force. EVIDENCE: Staff rotas continue to indicate that appropriate staffing levels are maintained. Staff on duty during the inspection matched those stated on the duty rota. Some staff stated that dependency levels sometimes necessitated an increase in staff for tasks such as feeding residents. The registered manager is a qualified nurse and there are now nursing staff on duty at all times as the nursing floor had opened and to enable admissions. One nursing resident was admitted on the day of inspection. The first floor had been empty and was designated for nursing service users. The home previously had some staff problems since registration but these have now subsided and general good working relationships in the present staff team are improving the general running of the home overall. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 17 The home is ensuring that more of the staff team undertake NVQ training. Of the staff records reviewed at the last inspection it was noted that shortfalls were evident and documentation was missing. Although recruitment processes have improved the home must ensure all CRB checks are completed and received prior to staff taking up their post. Criminal Record Bureau checks are now available to inspect for existing staff. NMC PIN checks for qualified staff are not yet being done and must be implemented. The manager was advised that staff members must not start work at the home until all relevant recruitment checks have been completed. Although new staff have an induction to the home at the beginning of their employment, this could be evidenced more predominantly and the mandatory training carried out as part of the Skills for Care, TOPSS induction; specialist training is being identified according to the resident’s needs. Staff spoken with said that training is provided by the home. A plan was discussed previously and has now been implemented and training certificates for recently attended courses were seen for some staff. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 18 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. There is guidance and direction to staff and the home does overall have in place practices that will promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: At the time of this inspection the acting manager had been in post for approximately six months. She is appropriately qualified and is a qualified nurse. An application for registration must still be made and the inspector discussed with her the need to still seek guidance on how her present qualifications equate to NVQ level 4 in management. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 19 Service users, staff and visitors who were spoken with all confirmed that the home was managed in a manner which was open and promoted free exchanges of views, comments and suggestions. A resident’s meeting was planned for 27/06/07 and the last one documented was on 23/5/07 The acting manager works at the home most days in a supernumerary capacity and oversees the day-to-day running and provision of care and treatment. Residents and their relatives can discuss care and any issues with the acting manager informally or formally when they visit. Records in respect of the service were noted to be stored appropriately. A random selection of resident’s monies were checked and found to balance. Certificates in respect of service and maintenance of gas, electric (including portable appliance testing), lifting and fire safety equipment at the home were noted to be satisfactory. Fire drills are being regularly documented and undertaken and attendees’ names documented. The acting manager is aware of her duties under health and safety. Some fire doors predominantly to lounge areas, were noted to require automatic closure devices to enable them to be left open facilitating the manoeuvring of wheelchairs. The manager should consult with the proprietors and the fire authority to enable this. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 20 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) 17(1)(a)( b) Requirement A detailed service user plan of care must be drawn up including consultation with service user families and significant multidisciplinary personnel, to be reflected in the care plan and be completed sufficiently and reviewed comprehensively monthly. The registered person must ensure that there is a policy and staff adheres to the procedures for the receipt of recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. This with specific reference to the appropriate transcription of medication with evidence of two signatures, documentation of omissions, recording room and fridge temperatures. The proprietor should also ensure that all drug storage areas are adequately ventilated DS0000067279.V342037.R01.S.doc Timescale for action 14/09/07 2. OP9 13 (2)17 (1)12 (1) (4)13 (4)14 (2) 14/09/07 Bluebell Court Version 5.2 Page 22 3. OP12 16 (2) m &n (This is a repeat requirement from the homes last inspection timescale of 5/03/07 not met) The routines of daily living and 14/09/07 activities made available must be flexible and varied to suit service user’s expectations preferences and capacities. This with a view to increasing hours via an activities coordinator covering adequate hours for 80 residents when home full to capacity and the documentation of the same. (This is a repeat requirement from the homes last inspection timescale of 5/03/07 not met) The registered person must operate a robust and thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. This includes ensuring CRB and checks are received prior to staff taking up their posts within the home. (This is a repeat requirement in part from the homes last inspection timescale of 19/02/07 not met) The registered person must ensure that the home has a registered Manager. (This is a repeat requirement from the homes last inspection timescale of 5/03/07 not met) 4. OP29 7, 9, 19 (1) to (7)Schedu le 2 14/09/07 5. OP31 8(1&2) 9(1&2) 14/09/07 Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 23 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 OP3 Good Practice Recommendations The home must confirm in writing that they are able to meet the resident’s needs in respect of their health and welfare. Bluebell Court DS0000067279.V342037.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Bluebell Court DS0000067279.V342037.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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