Inspection on 23/04/07 for Coldwells House and The Stables

This inspection was carried out on 23rd April 2007.

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

The inspector 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

Coldwells House and The Stables 18/05/06

Coldwells House and The Stables 10/01/06

Coldwells House and The Stables 23/08/05

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

CARE HOMES FOR OLDER PEOPLE Coldwells House and The Stables Coldwells Lane Holmer Hereford Herefordshire HR1 1LH Lead Inspector Wendy Barrett Key Unannounced Inspection 23rd April 2007 09:10 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 Coldwells House and The Stables DS0000064831.V332806.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. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coldwells House and The Stables Address Coldwells Lane Holmer Hereford Herefordshire HR1 1LH 01432 272414 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) Ms Karen Anne Rogers Ms. Karen Evans Care Home 28 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25), Old age, not falling within any other category (25), Physical disability (3), Physical disability over 65 years of age (25) Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 Brief Description of the Service: Coldwells House is a detached late nineteenth century period house on the outskirts of Hereford city. The Stables is a modern detached house separated from the main building by a small courtyard/patio area. Although the home is close to the main A49 road it is in a small, rural lane and there are good views of the surrounding countryside from many windows. The main building has been adapted for its current use and a purpose-designed extension was built in 1995. The service has twenty eight registered places, although only 25 places were in use at the time of this inspection due to refurbishment work. The service caters for people over the age of sixty five years who have care needs arising from the general ageing process, dementia, physical disability or mental disorder. Three places may be used for younger adults with a physical disability. All the bedrooms are single occupancy and thirteen have en-suite facilities. There is information literature that describes the service and this is available at the home. Each bedroom has a copy of a service user guide and potential residents and enquirers are offered a copy. From 1st April 2007 the fees ranged from £420 to £460 per week. There are additional charges for hairdressing, chiropody, external activities and newspapers. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written with reference to information held by the Commission, feedback survey responses from health care professionals and relatives. A sample of resident survey forms was also supplied but these responses had not been returned when this report was written. The Care Manager completed a pre-inspection questionnaire and an unannounced visit to the service was undertaken. What the service does well: What has improved since the last inspection? Staffing levels have been increased in response to a higher number of residents accommodated at the home. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 6 The Care Manager is keeping good records of all concerns received at the home, and action taken to put things right when this is necessary. Night staff have received training in medication administration so there is always someone on duty to give out medication when necessary. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Coldwells House and The Stables DS0000064831.V332806.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 Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Care Manager carefully assesses the suitability of potential residents so that she only admits those people who have care needs and expectations that the service can meet. Potential residents and their families are given the information they need to help them decide if the home will suit them. EVIDENCE: When people are considering going to live at Coldwells House they are able to visit the home and are given written information about the service so they can decide if it will suit them. A resident’s written records referred to a preadmission visit by the potential resident and her daughters. The Care Manager visits all prospective residents in their own home so that she can ask them about their care needs and their expectations of the home. She will only admit residents when she has enough information to be sure their Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 9 needs can be met and that they will be able to receive the support they need to live in the way they prefer. This assessment work involves contact with relatives or other health or social care professionals, when appropriate e.g. social work staff, hospital staff. Written records of pre-admission assessments were inspected at the home. These included details of unsuccessful referrals and confirmed the care given to making sure each placement has every chance of being successful. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff keep comprehensive records of the way they plan, provide and review the care each resident receives. This includes attention to any identified risks. The resident, or their relatives are consulted about this work. Residents, their relatives and visiting health care professionals are happy with the staff go about this work. EVIDENCE: The staff keep written records for each resident. The Care Manager and a Senior Care Assistant described how these documents work and they clearly understood how to use them in the best interests of each resident. The records show that residents and/or their relatives are consulted when care is being planned or when difficulties arise e.g. a ‘Care Plan Consultation sheet’ referred to discussions with a resident and her daughter, a risk assessment record for Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 11 one resident stated ‘J refused to sign’. When the staff are worried about a resident’s wellbeing they consult health care professionals appropriately so they can get more advice e.g. the Provider told the Commission about a very ill resident’s wish to remain at the home. She had spoken to the district nurses to be sure they could meet the resident’s nursing needs and she made sure the home’s staff could continue to meet his personal care needs. Because of this work, the resident was able to stay comfortably and safe in the place of his choice during his last days. Feedback from health care professionals confirms their confidence in the staff- ‘I have never had cause for complaint, or seen anything I have not been happy with’. Most residents prefer that staff manage their medication for them. This means that secure storage, reliable handling procedures and accurate records must be kept. A sample of records were inspected at the home. These were satisfactory and the medication was being stored securely. There was also an example of specific guidance given to staff when they have to administer medication prescribed ‘as required’. This is good practice because it is important that medication is only used when really necessary and all staff work consistently when making these decisions. Staff who handle medication receive training so they know how to work safely. Night staff had received training since the last inspection so that there would always be a competent staff member at work through the night period should any medication need to be given out. The residents are happy with the way the staff treat them –‘they treat me well’, ‘they’re all very good’. Feedback from a relative did mention concern over attention to shaving and laundry. The Care Manager was aware of this problem and had altered staff routines to ensure the resident would be given a shave as soon as he got up rather than later in the morning. Laundry is attended during each evening and night period so there is a quick turnover of clothing. This may have led the relative to feel the resident’s clothes had not been changed. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to follow their chosen lifestyle and they feel satisfied with their life at the home. When they need help or guidance with this the staff offer it. The meals are varied and each resident’s dietary needs and preferences are taken into account. EVIDENCE: Residents who were met during the inspection visit were happy with their life at the home –‘we don’t get bored’. Breakfast was observed being served at a leisurely pace – some residents had finished, others were being served, some were not yet ready for their breakfast. The residents were eating in various areas of the home – some at dining tables and others in their bedroom. There were a variety of dishes being served – porridge, bacon, eggs, toast etc. and a resident commented ‘we can have what we like’. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 13 An activity organiser was at work in the home during the inspection visit and she described how she helps residents enjoy their days. Sometimes there are trips out e.g. local garden centres and sometimes entertainment is brought in e.g. a harpist had recently come in for a musical session. For those resident who prefer one to one time the activity organiser sets aside some of her day to work with them. When residents have sight or hearing difficulties they need special help and this was being offered e.g. one lady who has multiple sensory disability was being funded for additional one to one time. Another lady was recovering from a cataract operation and was enjoying being able to play dominoes with the activity organiser. Written records of the activity organiser’s work with each resident were available. Sometimes residents don’t feel they want to take part in the opportunities offered to them. It is a good idea to keep a record when this happens so it is clear what is actually being made available. The records gave examples of trips out with family members, community based activities and one to one activities e.g. escorted walks. When residents make lifestyle choices that may increase personal risk the staff consult the resident and other professionals e.g. a younger resident had left the home on a number of occasions without letting staff know where he was going. The written records of this work demonstrated a balanced approach to assessing the resident’s ability to make his own choices but offering guidance to help him consider his safety. Relatives were seen at the home. They visit regularly and were satisfied with everything. One would be staying to have lunch with her husband. The cook was met as she prepared the lunch. Fresh carrots and broccoli were seen ready for cooking and a piece of boiling bacon was already cooking. The cook was also observed serving breakfasts to individuals out in the home. This direct contact gives the residents a chance to comment on the meals and the cook can ask them for menu ideas for the future. Records of meals were being kept in the kitchen to confirm a choice of dishes being prepared each day. The staff assess each resident’s dietary needs and ask them about their preferences. The Provider explained that she had purchased a meal supplement when it was noticed a resident was not eating a well balanced diet. The G.P. had been consulted and had agreed the supplement could be offered. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents concerns are listened to and action taken to put things right when this is necessary. The staff understand how to recognise potential abuse and they take appropriate action when they are worried about a residents safety. EVIDENCE: A complaints procedure is displayed in the main entrance to the home and every resident receives a copy when they are admitted. The Commission hasn’t received any complaints about the service since the last inspection. The Care Manager maintains a record of all complaints received at the home. This was inspected during the visit. There had been a few minor concerns raised and the record showed how staff took appropriate action, when necessary, to put things right. Staff have received abuse awareness training since the last inspection and there has been a recent example when they used their knowledge in identifying and reporting an incident to a local multi agency group of Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 15 professionals who work together in ensuring the safety of vulnerable adults. This open approach helps to protect the residents. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from comfortable and well maintained accommodation that has been completely refurbished with their needs in mind. The staff follow working practices that maintain a hygienic environment. EVIDENCE: The home was clean and tidy when the unannounced inspection visit took place. The main building has been completely refurbished over the past 2 years so that residents now benefit from accommodation that is good quality and suited to their needs. There has been some work to The Stables area – new carpets, redecoration. A lounge has been made into bedroom accommodation for a resident who previously lived in the main building. This is particularly suited Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 17 for him as he enjoys gardening and now has his own ‘plot’ directly outside his room. Two residents did not recall being asked if they would like a key to their bedroom door. Although they said they would not want one it is recommended that their wishes be clarified at the point of admission so that all residents have the opportunity to lock their room and secure their personal possessions. The Care Manager has supplied details of regular maintenance and servicing arrangements and a Fire Safety consultant was due to visit the home the week after the inspection visit to review the home’s fire risk assessment. It was noted that a few bedroom doors are not linked to the fire system and some bedroom doors were being held open by wedges or other items e.g. a footstool. Residents sometimes put things in place to keep their doors open but this does stop the door closing in the event of an alarm. Wedges may also warp fire doors. The Care Manager had addressed this situation i.e. written risk assessment for individual situations was seen. She was advised to consult the Fire Safety consultant further when he visits. Warning notices e.g. slippery floors, hot water, were seen in position during a tour of the building. There were also supplies of liquid soaps and paper towels throughout the building. Care staff were wearing protective clothing to maintain infection control when handling food. A cleaner completed a cleaning rota report following her duty to confirm she had done all her required tasks. She felt that her working conditions had improved with the arrival of the new Provider and Care Manager –‘yes, it’s better now’. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the needs of the residents. Residents are kept safe through careful selection of new staff and good training programmes. EVIDENCE: At the start of the unannounced inspection visit staff were serving breakfast and helping residents to get up and dressed. There was a relaxed atmosphere with evidence of prompt attention to each resident e.g. a lady arrived at the breakfast table and was quickly served with her cooked breakfast. A senior carer and two care assistants were at work. The activities organiser was also at work. These staff were being supported by a cook and two cleaners. The Care Manager felt staffing levels were adequate to meet the needs of the residents and observations throughout the visit supported this view. Two relatives’ feedback forms referred to inadequate staffing levels. However, the evidence does not support this view and without more specific details it is not possible to assess the reasons for these comments. Two cleaning staff confirmed they had received appropriate health and safety training e.g. annual manual handling, annual fire safety. They had also Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 19 received training in adult protection and legislation regarding the safe handling and storage of cleaning materials during 2006. Both held an up to date food hygiene certificate. 11 out of the 15 care staff hold a national vocational qualification and there is ongoing involvement to increase this number and to help some staff obtain a higher level qualification. Care staff are also being offered care practice training e.g. dementia care, palliative care, continence management and stroke care. There are only 3 staff with a first aid certificate but the Care Manager was already planning additional training so that there will always be a first aider on duty at the home. This should receive priority attention so that there will always be a first aider at work in the home. The way that the Provider selects new staff to be sure they will be safe to work with vulnerable adults was satisfactory at the last inspection. It was not reviewed during this inspection. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed by competent people in a way that protects the best interest of the residents. EVIDENCE: The Provider has considerable experience and understands how to fulfil her responsibilities. The Care Manager has recently been registered with the Commission so she is considered competent and suitable to hold this position. She also benefits from regular meetings with the Care Managers of the Providers other two care homes. This contact allows them to share knowledge and ideas and to discuss any difficult areas of their work. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 21 Residents and relatives are encouraged to comment on their experience of the service so that it can be run in a way that meets their needs and expectations e.g the home sends out feedback questionnaires annually and regular residents’ meetings are held. When ideas are received they are listened to e.g. foam was fitted to doors after comments about the noise at night, book shelves are being arranged. Residents are appropriately encouraged to ask relatives to help them manage their financial affairs although the staff have a little money for 5 residents held in safekeeping. Records are kept to show how this money is managed e.g. receipts, expenditures, invoices. It is recommended that residents are encouraged to sign the record when they are handed some of their money. When this isn’t possible it would be a good idea to get two staff to sign the record to confirm money has been handed over. To make sure the residents live in a safe, healthy environment the Provider and Care Manager make sure they understand what is required of them under health and safety law. When they need further advice they seek it from other professionals e.g. fire safety consultant. The staff have policies and procedures that tell them how to go about their work. They also receive health and safety training with refreshers at recommended intervals although there are not yet enough staff with a first aid certificate. The Care Manager has already identified this shortfall though and is making arrangements. In order to make sure all this is working as it should there are regular audit exercises by management staff. Records of these checks were seen at the home and covered things such as the premises, cleaning routines, care practices. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 x 3 3 3 x 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP12 OP19 OP35 OP38 OP38 Good Practice Recommendations Refusals to take up social activity opportunities should be recorded so that the overall picture is clearer. New residents should be offered a bedroom door key and this exercise should be recorded in admission records. Residents should be encouraged to sign as receipt for money held in safekeeping. When this is not possible, two staff should sign the record to confirm the transaction. Additional first aid training should be organised as a priority to ensure there is always a qualified first aider at work in the home. The Fire Safety consultant should be consulted about the acceptability of bedroom doors that are either not fixed to the fire alarm system or a regularly held open by residents during the days. Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Coldwells House and The Stables DS0000064831.V332806.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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