Inspection on 12/07/05 for Cathedral View Residential Home

This inspection was carried out on 12th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cathedral View Residential Home 04/04/07

Cathedral View Residential Home 10/11/05

Cathedral View Residential Home 27/01/05

Cathedral View Residential Home 26/04/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Cathedral View Residential House Kenwyn Church Road Truro Cornwall TR1 3DR Lead Inspector Lynda Kirtland Announced 12 & 13 July 2005 0930 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 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. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cathedral View Residential House Address Kenwyn Church Road Truro Cornwall TR1 3DR 01872 240974 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) Cathedral View Limited Mrs Lynde Gilbert Care Home 34 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (15), Old age, not falling within any other category (34) Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to Service users to include up to Service users to include up to (MD(E)) Total number of service users 19 adults of old age (OP) 15 adults aged over 65 with dementia (DE(E)) 15 adults aged over 65 with a mental illness not to exceed a maximum of 34 Date of last inspection 27 January 2005 Brief Description of the Service: Cathedral View Limited owns two registered care homes. These are Cathedral View Residential Home and the other is Cathedral View Nursing Home. Both homes are located on the same site. Cathedral View Residential Home is registered to accomodate 34 elderly service users in need of personal care, some of whom may be suffering with a degree of mental disorder or dementia. The home provides single bedrooms for the majority of service users although two rooms are registered for shared accommodation. Bedrooms are situated on three floors and there is a lift. There are two lounges, a large dining room and a conservatory for service user use. All facilities for service users are accessible for those who may have limited mobility or in need of specialist equpment such as wheelchairs. There are extensive accessible gardens for service users use. There is sufficent parking outside the home. The home is situated near to the centre of Truro city which has good transport links into the main town and surrounding areas. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited Cathedral View Residential Home on the 12 July 2005 and spent eight hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 27.01.05. In addition the inspector focused on the following key areas of care: choice of home, care planning, health care, leisure, complaints, staffing and some management areas. On the day of inspection 33 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, staff, the registered manager and registered provider to gain their views on the services that Cathedral View offer. The registered manager also completed the pre inspection questionnaire, which is similar to a survey asking for information on what services/facilities the home provide. Completed comment cards from two residents and two relatives in gaining their views on the home were received and assisted in the inspection process. Cathedral Views records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well: Residents commented that Cathedral View provides good quality care and accommodation. Residents are provided with information to assist them in making an informed choice before making a decision to live at the home. A ‘welcome pack’ and introduction to the home is planned with the resident. Residents commented that the welcome to the home was a positive experience and ‘relieved anxiety’ about moving into a care home. The home undertakes pre admission assessments and care plans ensuring that care needs are identified and plans how to address them. All residents said that they felt that they were consulted about their care needs which staff met. Residents commented that they have access to health care and felt that all their health needs were met to a ‘good’ standard. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. An activity coordinator visits the home four days a week and offers a programme of activities. This is displayed to promote this service and encourage others to participate. Residents felt their visitors were welcomed to the home. Residents were ‘very satisfied’ with the quality and provision of food. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 6 Residents and staff stated that if there were any issues they felt able to approach the registered manager directly and that their ideas would be listened to and where appropriate acted on. The home actively seeks resident’s views by holding a three monthly residents meeting. Residents and staff commented that there are sufficient staffing levels on duty. In the main residents made various comments about staff such as, they are ‘kind’ and ‘caring’. The registered manager ensures that appropriate recruitment checks are carried out before a person is employed at the home. Staff supervision occurs on a regular bases. Staff have attended training and the registered manager has taken active steps to develop this area further. The registered manager and registered provider ensured that all residents, relatives and staff were aware of the forthcoming inspection. They prepared relevant information to assist in the inspection process. The inspector felt welcomed to the home. What has improved since the last inspection? What they could do better: From this inspection two requirements were identified to improve the standard of accountability whilst managing residents money and to forward a copy of the homes quality assurance survey to the commission The previous Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 7 requirement to ensure that 50 of staff have gained the NVQ level 2 training remains within target for compliance. Residents and staff could not think of any improvements that Cathedral View could make. This inspection highlighted that Cathedral View Residential Home provides a good standard of care to residents. The inspector would like to thank the residents, staff and management team for their assistance during this inspection process. 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. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Cathedral View has detailed information, which informs service users and their representatives about the services that they provide. The home completes an assessment of prospective residents to make sure they are able to meet the person’s needs. Cathedral View provides a planned trial period of stay at the home. Staff are experienced and competent to meet resident’s needs. EVIDENCE: Cathedral View Residential home Statement of Purpose and Residents Guide has not needed to be amended since the last inspection as the services the home provides has not altered. Some residents confirmed that they had seen these documents and found the information in them to be useful. The registered manager agreed to review the presentation of these documents so that they can be accessible to a larger audience. Financial expectations and accountability are clearly stated in the residents contract with the home, which has been signed, by the resident or their representatives and the home, or referring local authority. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 10 From discussion with residents they confirmed that they were consulted about their care needs prior to admission to the home, but it is recommended that their involvement be recorded. From inspection of four residents files it was evident that pre admission assessments occur. Care needs identified by the referring professional assessments were incorporated in the assessment process and transferred to care plans. This assessment identifies the residents individual physical, emotional, social, educational and leisure needs and how the home would aim to address them. A months trial period is offered to all new residents after which a review is held with all parties present to consider if the placement is appropriate and if so a long-term placement will be provided. From records inspected and in discussion with residents they commented that the preadmission and ‘moving in period’ are carried out sensitively by staff and could not see how this process could be improved. They also stated that this was undertaken with their participation and that their care needs were identified accurately. From observations of staff, plus inspection of forthcoming training programme and records it was evident that the staff team are experienced in the area of older peoples care and receive training to update their knowledge in this area. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to residents. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10, Residents and their representatives are consulted in the implementation and subsequent reviews of their individual care plans. Health care needs are met to a good standard. The staff at the home builds positive relationships with residents that are based upon the residents dignity and privacy. EVIDENCE: From discussion with residents, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of residents files, and in discussions it is evident that Cathedral View encourage residents to express their views in the formation of their care plans. The care plans clearly identify service users care needs and from this specifies what actions staff should take to ensure that the care need is approached in a consistent manner. The inspector recommended that the home also consider what current skills residents display and promote this in the home. The registered manager agreed to incorporate this in the care planning process. Residents commented that health needs are met by the staff at the home and by external professionals to a high standard. Detailed records of all health professional visits to individual residents further evidenced this. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 12 All residents spoken with stated that staffs display a high standard of respect in their daily interactions. Residents stated that staffs ensure that their privacy and dignity is maintained and could not see how this area of care could be improved. The inspector noted that the atmosphere of the home and residents appeared to be relaxed. Residents commented staff ’ were ‘kind’. Residents confirmed that they have a choice as to when to rise/ retire to bed, receive their mail unopened, have access to a private phone and can receive visitors in private. In addition the inspector observed staff interacting with residents in a professional manner at all times, alongside a sense of humour when appropriate. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 Cathedral View provides a programme of activities to promote and encourage the pursuit of residents social, educational and leisure needs. Flexible visiting arrangements are in place and visitors are welcomed at the home. EVIDENCE: From discussions with residents the majority commented that there is ‘enough to do’ during the day. The inspector noted on the day of inspection a variety of activities taking place; socialising in the conservatory and the garden areas, music and receiving visitors. Cathedral View employs an activity coordinator who provides a variety of activities on daily bases. The inspector observed this occurring during the inspection and saw paintings, art and crafts that residents had made. The activity coordinator is keen to encourage as many residents to participate by advertising what the week’s activities are to take place. Some residents commented that they prefer to spend time in their own company and this is respected. Residents were able to recall a list of activities that occur such as exercises, monthly communion, games, mobile library, talking books to name a few. Individual interests are recorded in service user pre admission information and their ‘life story book’. There is a flexible visiting policy and residents determine where they meet with their guests. Residents felt their visitors were welcomed to the home positively and could not think of improvements in this area. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 14 Residents confirmed that they were aware of advocacy groups and could access age concern, solicitors, family or ask the home staff for advise. Residents made positive comments to the inspector in the variety and quality of food provided. As the food is prepared in the nursing home that shares the same site as the residential home this was not inspected in detail on this occasion. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17, Cathedral View has an appropriate complaints and whistle blowing policy. Residents, their representatives and staff are confident to raise any concerns. Residents are aware of advocacy groups to ensure that their legal rights are protected. EVIDENCE: Cathedral View has completed policies in respect of the complaints procedures. Cathedral View and CSCI have not received any complaints about the home. From the inspectors discussions with residents all stated that they had no concerns about the care or facilities that were provided by the home. Staff likewise commented they had no current concerns. The majority felt able to approach the management team if they had any concerns. Resident names are placed on the electoral role in order that they can participate in the political process, if they wish. Residents are aware of independent advocacy groups, solicitors or may use family members to represent them if they wish. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not inspected. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Suitable trained and experienced staffs are employed in sufficient numbers at all times to meet residents care needs. Robust recruitment procedures are put into practice to ensure that residents are protected in the home. The level of training in the home has increased to ensure staff are trained to undertake their work. EVIDENCE: On the day of inspection five care staff, an officer in charge, domestics, handyperson, kitchen staff, laundress and registered manager were on duty. In the afternoons the ratio of carers reduces to three but with the same level of management cover. The registered manager stated that the staffing ratio during waking hours is aimed to be 1:5. At night there are two waking night staff plus an officer in charge sleeping in and the registered manager on call. The registered manager stated that the home has not needed to employ agency workers recently and there are no staff vacancies. The registered manager has increased domestic hours since the last inspection to allow carers to spend more time with residents. The home also employs an activity coordinator. Residents were satisfied with the level of staffing in the home and all were complimentary about the care and approach they receive from the staff team. From discussion with staff they all commented that they felt that there is sufficient staff on duty and that they ‘work as a team’. The registered manager stated that if care needs become more complex then she would review staffing Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 18 levels and increase where needed. The inspector observed staffs that were competent in their work. Twenty five percent of staff has achieved a minimum of NVQ level 2 or above. Some staff are currently aiming to complete their NVQ level 2 by the end of 2005. When this has occurred the staff team will have reached the target of 50 of the staff group gaining NVQ qualifications. All staff has completed first aid training. The registered manager has liaised with a training company to assist in the training of the staff team. This programme was inspected and is up to date with recent legislation and in line with TOPPS and the national minimum standards. This process has just commenced with all staff. The registered manager wants to place a higher emphasis on staff training and is achieving this. From inspection of recently recruited staff files they evidenced that appropriate employment checks have been completed. Cathedral Views Limited recruitment policies were not inspected on this occasion. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,37 The registered manager is competent in her role to manage the home. The management approach creates an open, positive and inclusive atmosphere for residents and staff. Financial accounts are maintained to ensure viability of the home. EVIDENCE: The registered manager has experience in social care setting for 20 years and has officially managed cathedral View homes for the last 2 years. She has undertaken relevant training to update her knowledge in the area of older persons care. The staff team and residents spoke positively regarding the accessibility of the manager to voice any ideas as to how to improve/change the service. Some comments made were that she is a ‘good leader’. The registered manager also commented that she felt supported by the registered providers who are in regular contact to ensure that all that is needed for the home is in place. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 20 Staff stated that they meet with the management team approximately 3 monthly, minutes were inspected. Staff felt that these meetings were beneficial. Residents hold a ‘residents meeting’ that is independently chaired approximately three monthly, minutes were inspected and demonstrated comprehensive discussions in gaining their views on the service provision. The registered manager has completed a quality assurance survey with residents, and relatives, and stakeholders. The results were overall satisfaction with the care provided. The registered manager agreed to send a summary of a copy of the findings to CSCI and any actions that she intends to take. The registered provider confirmed that Cathedral View limited is financially viable and has relevant insurance in place. Cathedral View limited does not have policies in the management of residents’ money and agreed to implement this. This will be inspected further in the next inspection. A requirement to this effect has been identified. The registered manager, confirmed by records and discussion with some staff stated that all staff receives at least six supervision sessions per year. Records held by the home are stored in a confidential manner and in the main are in line with the Data protection Act. Following discussion with the registered manager and some staff the officers’ handover book has been reviewed to ensure that it is in line with the Data Protection Act. This was immediately rectified during the inspection. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 2 3 2 x 3 x Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 22 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 OP33 Regulation 24 (2) Requirement A summary of the Quality Asurance survey, with the actions that the home intends to take must be sent to CSCI. A policy in respect of the , administraiton and procedure in handling service users money must be implemented. All staff must then be made aware of the proceedures . 50 of staff must be qualified to NVQ 2 or equivilent. Timescale for action 30/11/05 2. OP35 20(1)(3) 16(2)(l) Sch4(9) 30/11/05 3. OP28 18 31/12/05 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 OP7 Good Practice Recommendations Care plans should be expanded further to identify service users skills and actively promote these. Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Cathedral View Residential House D52-D04 S46330 Cathedral View Residential House V226939 120705 Stage 4.doc Version 1.30 Page 24 - 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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