Inspection on 05/07/06 for Buxton House

This inspection was carried out on 5th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buxton House 22/04/08

Buxton House 12/12/07

Buxton House 31/05/07

Buxton House 24/11/05

Buxton House 15/08/05

Buxton House 23/03/05

Buxton House 11/11/04

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

CARE HOME ADULTS 18-65 Buxton House 50 Barrow Road Streatham London SW16 5PG Lead Inspector Barbara Ryan Unannounced Inspection 5th July 2006 9:30 Buxton House DS0000041799.V303006.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 Buxton House DS0000041799.V303006.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. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buxton House Address 50 Barrow Road Streatham London SW16 5PG 020 8769 9667 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) janet-yeboah@uku.co.uk Buxton Healthcare Ltd Mrs Victoria Schandorf-Torto Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: Buxton House is a care home located in an end of terrace house on a residential road in Streatham, Southwest London. It was registered in July 2004 to provide care and accommodation for up to six people with mental health related issues. There are six bedrooms laid out over three floors, a lounge, dining room/kitchen and a conservatory. It is a short distance away from public transport facilities and the local shopping area. There are currently two service user vacancies. The service users are young adults all of whom are from ethnic minority backgrounds. Nursing care is not provided. The home provides information about its service in its statement for purpose and service users guide. People are invited to visit the home and the manager will answer any questions they may have. The home has a copy of the last report available. The home charges a minimum of £850 per week. This cost does not include toiletries or holidays but the home may pay a contribution to a holiday. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 5th July 2006 beginning at 9.30 and ending at approx 5.30. The method of inspection included a tour of the building, looking at four care plans and residents files, observation of a house meeting, discussion with three residents, discussion with the director of the organisation, as the manager was on annual leave, an inspection of the management of the medication and of the management of residents’ money. What the service does well: What has improved since the last inspection? What they could do better: The home needs to update their statement of purpose to reflect recent staff changes. Updates or changes to care plans need to be recorded clearly. All medication must be entered on the mar charts and a photograph of each resident should be kept with their mar chart. The home needs to provide information about how to contact an independent advocate. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 6 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. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome area is good. This judgment is made using available evidence including a visit to the service. Residents have information with regard to the home, but there is some updating to be done regarding staff qualifications. Residents’ needs are fully assessed and they are able to spend time at the home prior to admission. They are given contracts of term and conditions. EVIDENCE: The home has a statement of purpose, which gives full information about the aims and philosophy of the home and all the other information required in schedule 1. The home needs to update the information about the staff qualifications as this has changed recently. The home completes an assessment of residents’ needs and works closely with the mental health multidisciplinary team. Prospective residents are invited to view the home and there are opportunities for residents to spend a day at the home and then build up to a day and night or weekend prior to admission. This is done with the support of the multi-disciplinary team working with the prospective resident. Residents receive a contract of terms and conditions and there was evidence of this on residents’ files. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is good. This judgment is made using available evidence including a visit to the service. Residents assessed and changing needs are reflected in the care plans. These were up to date and comprehensive, although there were some gaps and some issues needed clearer recording. Risks are assessed and residents are supported to make decisions about their lives. EVIDENCE: Four residents’ care plans and files were looked at. All contained care plans, which identified residents’ needs. These are drawn up when the residents move to the home. Long and short term goals and objectives are identified and evaluated. The home has a keyworker system and keyworkers will meet with residents twice a week and will complete a monthly report. This is where goals are also evaluated and changed if needed. Care plan are updated and evaluated as residents’ needs change. There were some gaps in the recording of the keyworkers monthly updates. On one occasion an item on the care plan had been crossed out; it was not clear why and what the current situation with regard to this particular issue. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 10 Staff were able to explain this situation, why it arose and the present situation. The home needs to ensure that care plans are clearly written. The home records any restrictions in place for residents on their care plans. There was evidence that residents were signing their care plans and it was confirmed that they were provided with a copy. Care plans contained risk assessments; the home has its own format, and there was also evidence on file of more extensive risk assessments from the mental health team and other professionals to support staff in ensuring residents’ safety. Residents are supported to make decisions about their lives. Residents live fairly independent lives and have their own routines and make their own choices about how to spend their day. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgment is made using available evidence including a visit to the service. Residents have opportunities for personal development and to explore options around work and education. They are supported to maintain links with their families and are able to access leisure activities. Residents are able to access a healthy diet of their choice. EVIDENCE: Residents live individual and independent lives. The structure of the home is relaxed and has a flexible routine. Most of the residents have activities outside the home; two are working at part time jobs and residents are supported to enrol at local colleges or attend other facilities as they wish. If residents need more time to explore what they would like to do with regard to education and personal development they are given time to do this and the home works at residents’ pace and with their wishes in this area. Residents are able to access the local community and other resources. The home will monitor residents’ plans for activities as needed and support Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 12 residents if this is required. On the day of the inspection, residents were coming and going during the day, with one going to the cinema in the afternoon and another prepared to go the work that evening. All the residents have a key to their room and to the front door. The home has a routine with regards to residents doing their laundry and they will be supported with regard to doing housework and maintaining their room as needed. The level of support will depend on residents’ needs in this area. The home said that the rehabilitation aspect of the service aims to encourage residents to be as independent as possible with the view to moving on to more independent accommodation. The home will support residents to maintain links with family and friends. The home ask visitors to leave at 10pm; if visitors are staying to have a meal residents needs to give notice so food can be prepared. There are two house meeting a week, one of which was observed on the inspection. The residents make decisions with regard to what they would like to do at these meeting. On the morning of the inspection residents and staff were doing a script reading and exploring other activities that they might undertake. These meeting are also where residents work out their weekly menu for the evening meal and who would be doing the cooking. The residents and staff will cook a meal in the evening. This is seen is part of the support residents receive to move towards more independent accommodation in the future. Other meals are prepared on a more individual basis and residents supported as needed by staff. The planning of the menu was fully participated in by all the residents at the meeting, with staff encouraging residents who had not made a suggestion to join in the planning. The resulting menu plan was culturally diverse and healthy. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good adequate. This judgment is made using available evidence including a visit to the service. Residents are supported to maintain their physical and mental health and the home works closely with healthcare professionals to prevent relapse in resident’s mental well-being. All medication must be entered on residents mar charts and all charts should a photo on the chart. The pharmacist inspector has been forwarded a copy the home’s current mediation policy for review. EVIDENCE: Residents are supported with personal care if this is needed. This will be mainly around encouraging and prompting people. The home had drawn up prompt sheets for some residents to support them with personal care and maintaining their rooms. Residents are supported to maintain contact with mental health services and there was evidence on residents’ files of CPA meetings and contacts with a range of mental health and social care professionals. The director said that the home views close contact with the multi-disciplinary team as very important. There was information on files with regard to supporting residents to maintain their physical health via appointments at out patient’s clinics and monitoring of residents’ weight where this was appropriate. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 14 The management of the medication was looked at. There was one incident where medication prescribed by a hospital to use as required by the resident had not been entered on the mar chart. Although it had not in fact been used by the resident, it should have been entered on the mar chart. No residents are on self-medication programmes at present, although the home does have a risk assessment form to complete if residents are going to self-medicate. Not all residents had photo on their mar charts. The home’s policy with regard to medication has been forwarded to the CSCI pharmacy inspector to be looked at with regard to their recommendations. The home has arranged sessions with the Westbury Pharmacy, the last being in September 05. They also provided in house training. The home has supported residents when this has been appropriate to make known their wishes around illness, death and dying. However they have not undertaken this task with all residents, as this may not be something that residents wish to discuss. It should be raised as appropriate with residents and if this is not something residents wish to do this should be recorded on residents’ care plans. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgment is made using available evidence including a visit to the service. Residents concerns are listened to and there is a complaints procedure in place. Information about how to contact an independent advocate should be provided by the home. The home has a policy with regard to the protection of vulnerable adults and staff have received training in this area. EVIDENCE: The home has a complaints procedure and a complaints book. Both were looked at. Residents will raise issues with staff and these were being listened to and recorded. The complaints book had two complaints from residents since the last inspection, which were about an incident around cooking and the other pertained to a resident’s feelings of wellbeing rather that a complaint about the home. The complaint book should have a section next to the complaint to record what action needs to be taken and the outcome of the complaint. The home should provide information about how to contact an independent advocate if residents feel this would be something they would like to do. Residents spoken to said that they feel able to raise any concerns they had with staff, and can also raise issues at the house meetings The home has a policy and procedure in place around adult protection. It would benefit from having the multi-agency procedure at the home. Staff had in house training in January 06 as planned. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,30 Quality in this outcome area is good. This judgment is made using available evidence including a visit to the service. Residents live in a homely, comfortable and safe environment. Bedrooms are of a good size and can accommodate residents belongs. The home is clean and hygienic. EVIDENCE: The home is situated in a semi-detached house in a residential road. The home is comfortable and homely. On the ground floor there is a sitting room, dining room, kitchen and a conservatory with doors leading to the garden; there is also a small office off the entrance hall to the house. The communal areas are pleasant and well maintained, with up to date ornamentation and colour schemes. There are six bedrooms located on the ground, first and second floor. There is a roof terrace on the first floor with stairs leading down to the garden; there is also an outhouse at the end of the garden. The latter two places are the home’s designated smoking areas. Of the residents rooms seen all were pleasantly furnished and personalised. There is a pay phone on the landing. The hand basin in one of the bedrooms has a crack in it and needs replacing. One of the bedrooms at the top of the Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 17 house has one small window and in warm weather could get quite hot; a fan or some other form of ventilation should be considered for this room. Residents are supported to maintain their own bedroom and of those seem all had appropriate bedding. The home was clean and hygienic throughout. The home offers a well-maintained, homely and safe environment for residents Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35,36 Quality in this outcome area is adequate. This judgment is made using available evidence including a visit to the service. Resident’s benefit from a supportive and committed staff who receive regular supervision. The home’s recruitment procedures are appropriate. The home has increased the level of training. It has yet to reach is 50 target with regard to staff qualified to NVQ level 2. EVIDENCE: The home operates a keyworker system. Staff interaction with residents was observed to be relaxed, friendly and informal. Residents spoken to said that staff were supportive and helpful. The rota was inspected and there were sufficient staff on duty to meet residents’ needs. The manager was on annual leave on the day of the inspection and the director of the organisation was present to support staff. Due to staff leaving, the home now has three care staff on NVQ level 2 at present. They have one member of staff that is waiting to start their NVQ level 3. They now have ten care staff, several of whom work part time. The owner said that staff had waited so long time for places at the local college they have now paid to enrol staff on a privately run course. The home is below the target of 50 of the care staff being NVQ 2 qualified or above. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 19 The owner said that the home had set up various training sessions. She has purchased a training resource for care staff and will, with the home manager, be using this to provide in house training once a week. This resource includes opportunities to purchase training videos and CDs. All staff have now completed a course on dual diagnosis, half having done so this last year and half doing it this year. The home have also set up training sessions on Skill for Life with a local college to support staff. The home has a new inductiontraining manual and this covers topics to TOPPS standard. Two staff files were looked at and there was evidence of appropriate recruitment procedures being followed with reference and CRB checks present on the files. The home offers regular supervision to staff. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42 Quality in this outcome area is good. This judgment is made using available evidence including a visit to the service. The manager of the home has a background in mental health nursing and is registered with the Commission. The home is well run; it takes residents’ view into account as part of its self-monitoring and keeps appropriate records at the home. The home’s health and safely procedures are generally good, although fire drills need to be recorded in the correct place and done in accordance with the fire assessment. EVIDENCE: The home manager was on leave on the day of the inspection. She is now registered with the Commission. She has a background in nursing and mental health. The director, who is the registered owner of the home, was at the home on the day of inspection. The director was very familiar with residents needs and of issues around mental health. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 21 The home has completed an annual survey of residents and visitors. There are twice weekly residents meeting, one of which was observed on the day of inspection. Residents are able to raise issues here or with their key worker on an individual basis. The home has an adequate procedure to keep records in line with schedule 4. The home records fridge and freezer temperatures am and pm and these were within safe limits. The home test alarm points one a week and this was recorded. There was evidence of the last fire drill taking place on 28/06/06. This was written in the home’s diary, with information about how long it took. It was not recorded in the fire drill record; the last one recorded here was 25.1.2006. All fire drills should be recorded in the appropriate place and should be done in line with timescales in the fire risk assessment. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X 3 2 X Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 23 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 2 Standard YA6 YA20 Regulation 15(2)(b) Requirement Timescale for action 18/09/06 18/09/06 3 YA22 4 YA24 5 YA32 6 YA42 The registered person must ensure that changes to care plans are clearly written. 13(2) The registered person must ensure all medication is entered on the mar charts and that all mar charts have photographs of the appropriate resident attached. The registered person must ensure 22(2) that there is information available at the home about how to contact an independent advocate. The registered person must ensure 23(2)(b) that: and (p) i. The creaked hand basin in the top floor bedroom is replaced. ii. Appropriate air conditioning be fitted in the bed room with the small window The registered person must ensure 18(c) that the home reaches the target of 50 of care staff on or having completed training to NVQ level 2 23(4)(c)(v) The registered person must ensure that fire drills take place in accordance with their fire risk assessment and are recorded in the appropriate place. 18/09/06 18/09/06 30/12/06 18/09/06 Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 24 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 2 3 YA22 4 YA23 Refer to Standard YA1 YA21 Good Practice Recommendations The home should update it the statement of purpose and the service user’s guide to reflect changes to staff qualifications. The home should continue to work with residents around recording information about their wishes with regard to illness and death. The home should update is recording of complaints book to include information about what actions are needed to be taken to respond to the complaint and the outcome. The home should obtain multi-agency guidelines with regard to the protection of vulnerable adults. Buxton House DS0000041799.V303006.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 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 Buxton House DS0000041799.V303006.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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