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Inspection on 11/10/06 for Claybourne Residential Home

Also see our care home review for Claybourne Residential Home for more information

This inspection was carried out on 11th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Claybourne is a care home specialising in the care of older people with a dementia. The environment is cleverly designed to afford maximum opportunities for residents to wander freely and enjoy a high standard of comfort. There are spacious and attractive communal areas and all bedrooms are for single occupancy, with an en suite. The attractive and safe gardens extend around the entire building and are freely accessed from several points in the home. During this visit, which was a pleasant, mild autumn day, three or four residents, at different times, were observed walking in the gardens. Staff training has provided a specialist focus to enable staff to achieve a high standard of care for vulnerable, mentally frail residents. Observations of staff on duty confirmed to the Inspector that they were caring and competent in their varied roles, while extensive discussions confirmed their satisfaction with the training provided by the organisation.

What has improved since the last inspection?

The rolling programme of redecoration and refurbishment has continued. For example a new carpet has been provided on Churchill Lane. The home strives hard to maintain high standards throughout the environment and on the day of this inspection, the carpet in one of the lounge-diners was being cleaned. The commitment to NVQ training has been maintained and despite staff turnover, just over 40% of staff (25) have NVQ level 2, with 14 more at various stages of completion.

What the care home could do better:

The organisation of staff files still needs further attention. This had been a recommendation of the previous report and while some improvements are acknowledged, the absence of important records must be addressed. The Pre Inspection Questionnaire had stated that all staff had been CRB checked and senior staff on duty also believed this to be the case, so either information had not been filed, or had been misfiled. The recent reduction to staff cover in the home, during the afternoon, 2pm to 4pm and in the evening 9pm to 10pm, is a change for the worse and not for the better. Dependency levels have seen a steady increase at Claybourne and the reduction in the deployment of care staff hours, which means that on each unit instead of having three staff on duty at all times, there can often be two or occasionally one, at these times, is very concerning.

CARE HOMES FOR OLDER PEOPLE Claybourne Residential Home Turnhurst Road Chell Stoke-on-trent Staffordshire ST6 6LA Lead Inspector Unannounced Inspection 11 October 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Claybourne Residential Home Address Turnhurst Road Chell Stoke-on-trent Staffordshire ST6 6LA 01782 790500 F/P 01782 832642 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) home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Zoe McCallum Care Home 45 Category(ies) of Dementia (45), Dementia - over 65 years of age registration, with number (45) of places Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 45 DE(E) Minimum age 50 years on admission The Care Manager achieves the Registered Managers award by 31 March 2006 22nd November 2005 Date of last inspection Brief Description of the Service: Claybourne residential care home is a modern purpose built home, specialising in the care of older people who have a dementia. Opened in the autumn of 1997, the home is run by the Methodist Homes for the Aged, (MHA), which is a national voluntary organisation specialising in the care of older people. The ethos of the home is inspired by Christian values and is based upon providing a quality lifestyle for older people with dementia. Prospective residents do not have to be Methodist but can be from any religious denomination. The home is registered for 45 long stay residents with dementia, (DE(E)), and at the time of this announced inspection was occupied by 44 long stay and 1 resident was in hospital. The design and specification of Claybourne provides a high standard of environment and facilities for people with a dementia. The accommodation is divided into three wings, each of which is equipped with a large lounge/diner/kitchen. An additional quiet lounge, bedrooms, bathrooms and toilets are also located in each wing. Centrally there is a large open plan sitting area, used for activities and entertainment and throughout accommodation is light, spacious and comfortable. Residents are able to move freely throughout the home and have easy access to the enclosed gardens that surround the entire property and which are a particularly positive feature of the design. Claybourne is situated in Chell, near Tunstall and is well located to access a wide range of local community facilities. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Ms Norma Welsby carried out this unannounced key inspection on the 11th of October 2006 between 10.30am and 5.30pm. The Inspection was well received and the senior staff, all other staff on duty, residents and several visitors to the home, provided helpful assistance. The Registered Manager, Mrs Zoe McCallum was not on duty at Claybourne throughout this inspection as she was attending a MHA managers meeting in Stratford. The Inspection, which was based on the National Minimum Standards, found that the majority of standards, inspected at this visit, were satisfactorily met. There were, however, two areas of concern. Of the random sample of 3 staff files examined, while all had evidence of POVA First checks, only one contained proof that a CRB check had been received. The second area of concern found during this inspection, related to the fairly recent changes in the staffing of the home, which results in an inadequate number of staff on duty between 2pm to 4pm and 9pm to 10pm. The Inspector discussed these findings thoroughly during the inspection and also had a telephone conversation with the Registered Manager on the following day and these concerns are included as Requirements of this inspection report. What the service does well: Claybourne is a care home specialising in the care of older people with a dementia. The environment is cleverly designed to afford maximum opportunities for residents to wander freely and enjoy a high standard of comfort. There are spacious and attractive communal areas and all bedrooms are for single occupancy, with an en suite. The attractive and safe gardens extend around the entire building and are freely accessed from several points in the home. During this visit, which was a pleasant, mild autumn day, three or four residents, at different times, were observed walking in the gardens. Staff training has provided a specialist focus to enable staff to achieve a high standard of care for vulnerable, mentally frail residents. Observations of staff on duty confirmed to the Inspector that they were caring and competent in their varied roles, while extensive discussions confirmed their satisfaction with the training provided by the organisation. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 not applicable to this home. Quality in this outcome area was assessed as good. The Inspector found that the home has very detailed pre admission assessment procedures and was able to demonstrate that the needs of residents were being met appropriately. EVIDENCE: Claybourne has a very detailed pre admission assessment procedure that is well supported by comprehensive written records, samples of which were examined and found to be satisfactory. If the prospective resident lives many miles away and closer to another Methodist Home, then that Registered Manager/Senior Team may undertake the home assessment using the corporate model. At Claybourne, the Assistant Managers take the lead role in assessments, always with a second person, either the Registered Manager or a Care Assistant. Needs are identified and a plan of care is established which is developed further as the period of assessment reveals more information of individual needs and how these are to be effectively met. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 9 Every encouragement is given to prospective residents and their relatives to visit Claybourne prior to admission, to view the vacant room, to look round the home and see its range of facilities and to meet other residents and staff. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Quality in this outcome area was assessed as good. This judgement was made using available evidence, including observations and discussions during the inspection day, by consulting a range of health care professionals and by examining pertinent records kept by the home. EVIDENCE: The Inspector examined three random care plans in detail and found each of them to be of a very good standard. Information was kept securely in a modular file, which was well organised to facilitate ease of access. There was evidence of all aspects of the care plan being reviewed monthly by key workers, along with a monthly audit by senior staff. Risk assessments were in place and were reviewed. The Inspector had a good impression of the sample of care plans seen as being ‘live’ documents and felt that they were well maintained. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 11 During this unannounced inspection, the Inspector had the opportunity to observe the teatime medication being administered and found this to be done in an organised and careful manner by the senior on duty. Medication administration records were also examined and found to be satisfactory. The Inspector was satisfied that appropriate arrangements were in place to meet the personal and health care needs of residents. Observations on the day evidenced staff responding to the needs of residents in a caring and sensitive manner. Without exception residents were very well presented, with arrangements in place for hairdressing, eye, dental and foot care. Residents were registered with local GP practices and district nursing services and the Inspectors consultation with these services, prior to the inspection, confirmed that they had no concerns and indeed felt that Claybourne provided a high standard of care. During the inspection itself, the Inspection was able to consult at length with a visiting district nurse who was also very positive and complimentary in her comments. She commended staff for their hard work and commitment and praised the effective communication that existed between the home and her service. Extensive observations and discussions with residents, relatives and staff, confirmed to the Inspector that residents of Claybourne are treated with respect and their right to privacy is upheld. All of the residents are very dependent on staff for a wide range of daily activities and, without exception, staff were observed to conduct themselves in a calm, thoughtful and caring manner. Visitors too, confirmed to the Inspector that they were always satisfied, not only with the respect and dignity afforded to their elderly relative, but also with the general observations they made during their visits to the home. From the Inspector’s own observations and discussions throughout the day it was concluded that the dependency levels and range of complex needs of residents was steadily increasing. All 45 residents are considered to be ‘high dependency’, 42 needing help with washing, dressing and undressing and 36 are doubly incontinent. Throughout the day and night, 18 residents are assessed as needing two or more staff to undertake their care. Fifteen residents need varying degrees of help at mealtimes, 10 use a wheelchair, 7 exhibit extreme behaviour and up to 10 need to be hoisted. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area was assessed as good. This judgement was made using available evidence gathered through extensive observations and discussions during the inspection visit to the home. EVIDENCE: Claybourne deploys an Activity Co-ordinator for 25 hours each week. This member of staff was on leave during this inspection, but had put some arrangements in place to cover her period of absence from the home. During the morning of the inspection, many of the residents enjoyed a sing a long provided by a visiting entertainer, while in the afternoon a member of the care team did some gentle exercises with a group of residents in the central area. For the most part comments about the provision of social care opportunities and activities were very positive, although the Inspector also received comments of concern, from both relatives and staff, that due to the reduction in hours in the afternoon, care staff were less able to spend quality time with residents. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 13 The home produces a good quality monthly newsletter, which details planned events and other news of interest and which is freely available to residents and visitors. Posters advertising activities are also on display in each of the living areas. During this inspection, the Inspector had the opportunity to consult with several visitors, including a family of a former resident who was visiting the home to see old friends and thank staff for the ‘fantastic’ way in which their elderly relative had been cared for while living at Claybourne. Both these relatives and others, who visited the home during the inspection, confirmed to the Inspector that they felt very encouraged to visit the home and remain in close contact with their elderly relatives. Claybourne also hosts a Relatives Support Meeting, usually once each month and to which specialist speakers are invited. The purpose of these meetings is to provide support and information to partners and other relatives. From observations made during this inspection, the Inspector was very satisfied that residents are appropriately consulted and encouraged to make choices in their day to day lives. As well as observing direct examples of this, discussions with residents and relatives also confirmed this good practice. Three residents have an independent advocate and others have assistance from a solicitor. The Inspector was able to have lunch with a group of residents and this was much enjoyed. The mealtime was relaxed and unhurried and staff were discrete, but attentive, to the needs of residents. Tables were nicely set and one resident said grace. A hot cooked meal and pudding was provided and residents were given a choice of two alternatives, and other special provision could be made if needed, or requested. Without exception all residents who were consulted, along with visitors to the home, confirmed their satisfaction with the quality and variety of food and refreshments provided at Claybourne. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area was assessed as good. This judgement was made using available evidence gathered during extensive consultations with residents and relatives. EVIDENCE: Claybourne had received just one complaint from a relative of a resident during the past 12 months. The Assistant Manager on duty at the time dealt this with immediately and satisfactorily. No additional complaints have been raised directly with the CSCI during the past year. The home has comprehensive policies and procedures, including ones on the protection of vulnerable adults. All staff receive specialist training in the care of older people with dementia, included in this is abuse awareness and associated guidelines. Many staff had recently attended refresher training on dementia care. The Organisation also has a confidential reporting system, called ‘Speak Up’. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area was assessed as excellent. This judgement was made using available evidence gathered during an inspection of the physical environment at this site visit. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 16 EVIDENCE: Claybourne provides an accessible, safe and well-maintained environment that meets the needs of residents. There is a rolling programme of decoration and maintenance intended to ensure high standards are maintained. While Claybourne is a large home, its design, which consists of 3 separate living areas leading from a large central recreational area, provides a very attractive and homely interior. Throughout the period of this inspection, many residents were observed to be wandering freely and utilising many different areas of the home and garden. Observations on the day of this unannounced inspection confirmed that the environment was clean, pleasant and hygienic. Robust policies and procedures were in place for the control of infection and appropriate hand washing facilities and disposable gloves/aprons were provided throughout the home and staff were observed to be accessing these during this inspection. Staff confirmed that they were provided with appropriate training and guidance. Fire records were inspected, including the fire risk assessment and these were found to be satisfactory. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 29 Quality in this outcome area was assessed as adequate. This judgement was based on evidence gathered during an examination of records, consultation with the senior staff and observation of staff on duty. In addition three care staff were interviewed and three more consulted during the inspection visit. EVIDENCE: The Inspector was disappointed with the findings of this group of standards. Prior to the inspection the Inspector was alerted to issues about staffing levels through pre inspection comments received from relatives. These concerns were further highlighted during the inspection following consultation with relatives visiting the home, two of whom were very anxious about the recent reduction in staff cover between 2pm to 4pm and 9pm to 10pm. The Inspector was told that they had observed cover often reduced form three staff to two staff and occasionally one staff covering a unit. This information was confirmed via consultation with several staff and by an examination of recent working rotas. Discussions with staff revealed to the Inspector a feeling of low morale and anxiety about risks that they felt were being taken during periods of inadequate staffing. The only explanation for this reduction in care hours appears to relate entirely to budgetary considerations and does not reflect the changing dependency of residents, which, in fact is well acknowledged to have increased over recent years. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 18 The home has operated with three care staff on duty in each living area since opening in the autumn of 1997, (when it was originally registered for 36 residents), and to introduce a reduction of hours nine years later, when due to an increase in dependency levels, more not less care staff hours are desirable, is alarming. A discussion with the Registered Manager on the telephone on the day following this key inspection, confirmed that she was operating under an organisational directive. The Inspector expressed her concern about the current staffing arrangements, given the high dependency of residents, previously reported in Section 2 Health and Personal Care, and advised that a requirement would be made in this inspection report. An examination of a random sample of staff files revealed that of the three examined only one had evidence that CRB checks had been received, although all contained evidence of POVA First. The PIQ had indicated that all staff had been CRB checked, including the sample examined, and it was not clear why the evidence was not on their file. A senior member of staff rang through to the organisation’s personnel department, but they were not able to clarify the situation. It was advise during the inspection that a requirement would be made about this finding. Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not examined during this inspection. EVIDENCE: Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP27 Regulation 18 & 19 Requirement The registered person must, having regard to the size of the care home, the statement of purpose and the number and needs of service users –ensure that at all times, suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure evidence of CRB checks are filed securely on each staff file. Timescale for action 31/10/06 2 OP29 19 Schedule 2 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Claybourne Residential Home DS0000008219.V312420.R01.S.doc Version 5.2 Page 23 - 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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