Inspection on 07/09/05 for Cameron Road (51)

This inspection was carried out on 7th September 2005.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cameron Road (51) 28/01/09

Cameron Road (51) 23/02/07

Cameron Road (51) 17/01/06

Cameron Road (51) 07/03/05

Cameron Road (51) 10/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Cameron Road (51) 51 Cameron Road Seven Kings Ilford Essex IG3 8LG Lead Inspector Jackie Date Unannounced Inspection 07 September 2005 11.30 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 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 Stationary 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. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cameron Road (51) Address 51 Cameron Road, Seven Kings, Ilford, Essex IG3 8LG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 503 8219 Royal Mencap (Housing & Support Services) Mr Chee Ong Ngai CRH Care Home 5 Category(ies) of LD Learning disability (5) registration, with number of places Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 07 March 2005 Brief Description of the Service: 51 Cameron Road is home for five adults with severe learning disabilities and challenging behaviour. Residents have little or no verbal communication skills, and very limited ability to make decisions about their lives. They all need a lot of support and supervision from staff. The house is semi-detached and is in Seven Kings, in the London Borough of Redbridge, close to bus routes, the station and local shops. Each resident has their own bedroom. On the ground floor there is a lounge, kitchen, bedroom and shower room. The remainder of the bedrooms, another bathroom and the staff office/sleep-in room are upstairs. The garden has a range of garden furniture and is used by the residents. Some of the residents go to day activities outside the home and the others go out with staff. At the time of the visit four men and one woman were living at home. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted for about three and a half hours and took place during the late morning and early afternoon. It was the first of the two inspections that each home must have during the inspection year. The deputy, one member of staff and four of the residents were spoken to. The lounge, shower room and kitchen were seen and staff, care and other records were checked. What the service does well: What has improved since the last inspection? Staff have received training in intervention and restraint as required by the previous inspection and are aware that restraint should only be used as a last resort. Staff continue to use what they learnt on this course and on training about autism to assist them to manage the challenging behaviour of the residents. Some of these behaviours occur less often than before. Residents are being encouraged to do things for themselves and staff have said that some residents are doing more for themselves. For example one resident will now put his clothes on rather than staff dressing him. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 6 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. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 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 standard(s) 2 and 3 Information is available to enable the staff team to meet residents’ needs. If a vacancy arose the required information would be gathered on a prospective resident and they and their relatives could spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so. EVIDENCE: There have not been any new admissions for several years. The organisation has an admissions procedure that includes gathering of information and assessments. It also contains details of how a prospective resident would be introduced to the home. The staff are aware of this and would be able to assess and introduce a new resident to the home if needed. Each resident has a care plan that contains information about what they can do, their likes and dislikes and what help and support they need. The staff team know residents well and know what they can do, their likes and dislikes and what help and support they need to meet these needs. The residents are unable to comment on what it is like to live in the home, but they all appeared to be at ease with the staff team. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 9 Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 10 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 standard(s) 6, 7 and 9 Residents’ plans focus on their individual needs and abilities and contain detailed information so that staff can meet their needs. Assessments of risks are undertaken, but require information such as the dates of reviews, to evidence that they remain appropriate. EVIDENCE: Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 11 Each resident has a care plan. These are very detailed and give clear information about each person. They include details of what they can do, what they like, the support that they need and how they communicate. For example one persons plan says: I can help make my bed and hoover the floor, I like puzzles, going for a walk and going to the shop. I go to the centre three days a week. Another persons plan contained details of the events that they celebrate. The plans are supported by the use of photographs and pictorial symbols. The degree to which residents can be involved in the development of the plan is very limited due to their profound learning and communication difficulties. However the care plans are discussed with relatives and in some of the plans relatives had made notes and comments. The care plans contain information on how the residents communicate and this is used to enable staff to offer them choices and find out what they want as far as possible. Some examples of this are that one of the residents coughs or clears their throat if they want to draw someones attention to themselves. The same person will put on their shoes or their coat if they want to go out. The staff write daily notes about what each person has done and how they have been. The resident’s plans need to be reviewed and updated at least every six months in line with the National Minimum Standards for Care Homes for Younger Adults. Residents, their relatives and social workers must be invited to these reviews. Some of the residents’ reviews were overdue but in one case this was due to the ill health of a relative. Dates have been set for the outstanding reviews. There are risk assessments in place. These identify risks for the residents and indicate ways in which the risks can be reduced to enable the residents needs to be met as safely as possible. For example one of the residents has been known to kick and hit staff when they are assisting him to put his socks on. It is identified in a risk assessment and guidance is given as to how to lessen the risk of this when assisting him. Overall the risk assessments are very detailed but not all of them are dated and those that are do not show that they have been reviewed. The deputy said that the risk assessments are reviewed but that they are only altered if needed. She also said that many of the strategies to minimise risk had been in place for some time and continue to be used as they are still felt to be the most appropriate. All risk assessments must be dated and review dates recorded. If no changes are made to the risk assessment then this must also be recorded. This will mean the staff can be sure that they are working to the most current and applicable risk assessments. The residents cannot look after their own finances and staff have to help them. Some residents can indicate what they want to buy when given choices in the shop and staff support them to do this. The section on concerns, complaints and protection gives more information about residents’ monies. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 12 Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 The residents are encouraged to be as independent as possible, to take part in activities and to be part of the local community. Residents are supported to keep in contact with their relatives and relatives are welcomed at the home. Residents are given meals that they like and that meet their needs and individual preferences. EVIDENCE: Residents are encouraged and supported to develop their skills. For example one resident will take the rubbish out to the dustbin and another resident now puts his clothes on when they are given to him. Staff said that these were both improvements. Some of the residents go to day services for part of the week. Others have been excluded due to their challenging behaviour. As previously stated the residents’ care plans state what they like to do and the Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 14 staff team support them to do things that they like, both in the home and outside in the community. For example, one resident likes to go out on the bus or train and to eat out. Another resident likes to go to the pub. An additional member of staff is booked on duty to take one of the residents out on the day that his day service has been cut. All of the residents need support from the staff team when they go out and for some this must be one-to-one due to their challenging behaviour. Two residents went on holiday a few months ago and at the end of September are going to Center Parcs. A third resident usually goes on holiday with his family. The other two residents cannot cope with holidays and they have extra days out. The care plan seen indicated that these residents do not have any specific cultural or religious needs both in terms of activities and food. Four of the residents have regular contact with their families. One resident regularly goes home to stay with his mother for a few days and as previously stated another one goes on holiday with his family. Families will be contacted for feedback on the service prior to the next inspection. Menus are based on staff and families knowledge of residents’ likes and dislikes. Menus seen were healthy and nutritious. The inspector joined the staff and residents for lunch in the garden. Lunch was homemade burgers and salad. Staff said that the residents do have some ways to say what they want. For example, one will go into the kitchen and stand there and staff will know that he wants something either to eat or drink. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 and 21 Residents receive personal care that meets their individual needs and preferences. The staff team support the residents to get the healthcare that they need. Medication is appropriately administered by staff that have been trained to do this. The residents’ files contained information as to the arrangements to be taken into account, in the event of their death. EVIDENCE: The residents require support with their personal care and details of the help that they need and how they prefer to be supported are in their individual plans. The care plan of one resident states that they enjoy having a shower and that they become very agitated if shampoo gets in their eyes. Details of how to deal with this situation are also in the plan. There is only one female Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 16 resident and staff on duty confirmed that she is always assisted with personal care by female staff. All of the residents go to the local doctor and specialist help is received when required. Staff take residents to all of their medical appointments. Residents’ files have details of health care issues and show that residents have regular access to health care professionals. Records are kept of medical appointments and these show that residents have checks from the optician, dentist and when needed the chiropodist. One residents file says that they will go to the Dr but will not have their blood pressure taken and probably will not let the doctor listened to their lungs. The detail of this information ensures that residents get the support they need when attending medical appointments and that any risks associated with these visits is minimised. None of the residents can self medicate and staff are only allowed to administer medication when they have received training. The medication was securely stored in a separate locked cupboard and all the necessary medication administration records are kept. Medication records include photographs of each resident to lessen the chance of medication being given to the wrong person. Residents’ files contain details of the medication that they take and what this is for. Staff had recently received refresher training for the administration of rectal Valium and would therefore be able to administer this is the need arose. Each file contains information from families with regards to their wishes in the event of the death of their relative. Therefore the home would be quite clear of the arrangements they need to make in the event of this. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 There is a complaints procedure. However due to the degree of their disability is unlikely that any of the residents would be able to make a complaint without support. Staff are aware of issues of abuse and work to protect residents from abuse. EVIDENCE: There is a complaints procedure that would be followed in the event of any complaints being made. Mencap has produced a detailed adult protection policy that tells staff the actions to take in the event of abuse/suspected abuse being discovered. Staff have attended a course on protecting residents from abuse and are aware of their responsibility to residents. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 18 All of the residents need help with their finances and do not have the capacity to understand about the concept of spending or saving money. Records are kept of financial transactions. Daily checks are made to ensure that these are correct. Residents’ finances checked at the time of the inspection were correct and appropriate receipts were on file. Only the shift leaders are able to access the money. There are safeguards in place where large expenditures of personal money is being spent on behalf of a resident, and where the resident is not able to fully understand or contribute to the decision-making process. All of the staff have received training in intervention and restraint as required by the previous inspection. However staff on duty were clear that restraint would only be something that was used as the last resort. They discuss strategies to manage difficult behaviour and use these when necessary. These strategies are recorded in the care plans. For example one of the residents can become agitated and aggressive when staff are carrying out household chores. Clear guidelines are in place about this and this includes assessing the persons mood and asking the question does the chore have to be down at that time or can it wait until later. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28 and 30 The residents live in a clean home that is suitable for their needs. EVIDENCE: The house is near to the local shops and bus routes. The communal space consists of a lounge, kitchen/diner and a garden. These areas are clean and satisfactorily maintained and decorated. Each resident has a single bedroom but these were not seen during this visit. There is a bathroom and bedroom on the ground floor and the remainder of the bedrooms, more bathing facilities and the staff office/sleep in room are on the first floor. The garden has suitable garden furniture a barbecue and an outdoor heater. On the day of the visit the residents had lunch in the garden. There are enough baths, showers and toilets and these meet the residents’ needs. At the time of the inspection the home was clean and free from offensive odours Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 20 Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 36 Staffing levels are sufficient, and staff receive the necessary training, supervision and support in order to meet residents’ current needs and provide an appropriate service for them. EVIDENCE: The home is fully staffed and there have not been any new staff recently. Therefore the residents are receiving a service from a consistent group of staff. Staff on duty said that they had received training since they started work in the home. This has included training about autism and intervention and restraint. Staff found both of these courses helpful and relevant to the residents living at the home. Most of the staff have achieved NVQs, some at level 2 and some level 3. Staff have also had person centred planning training and some of them are hoping to do a facilitators course with regard to this. They were clear about their duties and responsibilities towards the residents. Two staff are on duty per daytime shift during the week and the manager is supernumerary. There is also an additional member of staff from 4pm to 8pm weekdays and from 10am to 8pm at weekends. Staffing levels are sufficient to meet the assessed needs of the residents with extra staff on duty at peak times. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 22 Staff meetings are held every two weeks and residents’ needs are discussed at these, as are strategies for dealing with difficult behaviour. In addition staff receive regular supervision. Both staff also confirmed that the manager is available to discuss problems with and encourages all staff to participate in staff meetings. Therefore the staff team have the opportunity to discuss what is happening in the home and also to share ideas and to develop skills. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 41 and 42 The home is appropriately managed and provides a safe environment for the residents. EVIDENCE: The manager has considerable experience of working with people with learning disabilities and of managing residential services. He is a qualified nurse of people with learning disabilities and is in the process of completing the Registered Managers Award. The home is appropriately managed. The quality of the service provided to the residents is monitored by the home manager and by Mencap. The service manager carries out monthly monitoring visits to assess how effectively the home is operating to meet its stated aims and objectives, and reports indicate the action to be taken when deficiencies are identified. The last report on file in the home was for a visit that had taken Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 24 place in April 2005. However the deputy confirmed that the visits have been taking place regularly. After the inspection the service manager provided copies of the missing reports to the home and to the inspector. He apologised for the oversight in sending them out. Quality assurance questionnaires that had been completed by relatives were also on file. A selection of records was seen at the time of the inspection. These included service user files, medication, accidents, complaints, health and safety and service users money. These were appropriately kept as required. All of the necessary health and safety checks are carried out and a safe environment is provided for the residents. Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cameron Road (51) Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 3 3 x G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 26 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 YA9 Regulation 13 Requirement All risk assessments must be dated and review dates recorded. Timescale for action 30 November 2005 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 Good Practice Recommendations Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU 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 Cameron Road (51) G55_S0000025891_Cameron Road_V248187_070905_Stage 4.doc Version 1.40 Page 28 - 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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