Inspection on 13/09/07 for Crann Mor Nursing Home

This inspection was carried out on 13th September 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

Crann Mor Nursing Home 25/07/06

Crann Mor Nursing Home 26/09/05

Crann Mor Nursing Home 14/06/05

Crann Mor Nursing Home 07/12/04

Crann Mor Nursing Home 02/07/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Crann Mor Nursing Home 151 Old Woking Road Pyrford Woking Surrey GU22 8PD Lead Inspector Sandra Grainge Unannounced Inspection 13th September 2007 09:45 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 Crann Mor Nursing Home DS0000017602.V347177.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. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crann Mor Nursing Home Address 151 Old Woking Road Pyrford Woking Surrey GU22 8PD 01932 344090 F/P 01932 344090 crannmor@hotmail.co.uk 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) Mr A M Emambux Mrs M Emambux Care Home with nursing 24 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (24) of places Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users may be admitted from the age of 60 years onwards. Date of last inspection 25th July 2006 Brief Description of the Service: Crann Mor is a large two storey detached property, which has been adapted to provide nursing care for up to 24 Older Persons. The home is situated in a residential area not far from the town of Woking. Accommodation is offered mainly in single rooms. There are communal areas consisting of a lounge/dining room and another small sitting area within the home. There are gardens to the front and rear of the property, and there is ample parking space within the grounds. Range of fees at time of inspection - £550-£700 per month. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of an unannounced key inspection including a site visit that was carried out by the Commission for Social Care Inspection (CSCI) using the “Inspecting for Better Lives” process. An Annual Quality Assurance Assessment (AQAA) was supplied to the home and this was completed and returned to CSCI. Information provided in the AQAA is referred to in this report. A number of CSCI survey forms were supplied to residents, their relatives and friends, and to healthcare professionals involved in the support of residents. The results of the survey forms were very positive and are referred to in the report. At the time of the unannounced site visit there were 22 Service Users living in the home; they were in the care of the Owner, an experienced nurse; the service was fully staffed. The Deputy Matron, who is currently undertaking the Registered Manager’s award, joined the inspection for most of the time. A tour of the premises was carried out; records and documents were sampled these included policies and procedures, residents’ individual files, medication records and staff recruitment and training files. A number of residents, visitors and staff were spoken with during the tour of the home. The care of selected individuals was “case tracked”. During the inspection the requirements resulting from the previous inspection were appraised and it was found that these had been addressed however further work is required. Incidents that had occurred during the previous year were reviewed and had been satisfactorily managed. The people living at the home prefer to be known as residents and that is the term that will be used throughout this report. What the service does well: The Home provides individual nursing care for residents in a small friendly family operated service. The accommodation is homely and the staff are welcoming. The service has a trained and permanent workforce; no agency staff have been required for a long time. Positive feedback was received from residents, their relatives and healthcare professionals about the standard of the care provided. Comments made on the completed surveys included: Care and support: - “always given”; “staff very helpful in all ways” “ Staff available when call bell used” Support: - “always given”; “happy in home” “Owner and staff always attentive and caring” Home “cares for mother with kindness and friendliness. Dresses her in colour coordinated clothes, checks with me (relative) if anything unusual crops up” Does well? : -“ Everything”; “looks after Mum”, “everything”. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 6 Improve?: - “ Don’t know- everyone does their best”; “ everything”; “ Cannot see that there can be improvement”. Respect of privacy and dignity: - “at all times; doors etc closed” Staff: -“very experienced; always give that little extra.” “ Crann Mor –lovely caring home, staff always on hand for residents, seeing to needs”; “Lovely home from home feel”; “Residents always happy”; “Home smells nice- wish all homes could be the same- 10/10”. 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. The summary of this inspection report can be made available in other formats on request. Crann Mor Nursing Home DS0000017602.V347177.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 Crann Mor Nursing Home DS0000017602.V347177.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): 1,2, 3, 4, 5, and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given up to date information about the home and the needs of prospective residents are fully assessed before they are admitted. A contract for delivery of care and provision of a service is provided for all. EVIDENCE: The updated statement of purpose and service user guide were available. The complaints procedure was attached to the document. The statement of purpose contained the philosophy of the home but did not give detail of the things that the home does well or the specialist care that it offers. This was discussed with Mrs Emanbux and the Deputy Matron. Each resident has a contract and copy of the complaints procedure on entry to the home; the relatives of the person most recently admitted to the home confirmed this. Residents’ needs are assessed either when a prospective resident visits the home or during a visit by the Proprietor or Deputy Matron to the resident’s own home or hospital placement. Staff use recognised tools for assessment of nutrition, pressure area risk, moving and handling, and continence. Evidence of assessment was found in each resident’s files that was examined. The Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 9 person most recently admitted to the home came from a hospital in London. Her relatives explained how the home’s staff had liaised with the hospital staff and social workers to receive a comprehensive assessment prior to transfer to the home. At this point the home’s staff had carried out their own assessment and written their own plan for her care in consultation with the resident and her family. The owner was able to demonstrate that the service is capable of meeting the assessed needs of the residents, as they prefer to be called. This included meeting needs of confusion, mild dementia, physical and sensory handicap, sexual preference, divergent ethnicity and religion or faith, all in accordance with principles of equality and diversity. Intermediate care is not offered in this service. Crann Mor Nursing Home DS0000017602.V347177.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, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed plans are available to guide staff in the health care and support needs of residents. Residents are very pleased with the level of that they receive. EVIDENCE: Each resident had an agreed comprehensive plan of care that set out the action to be taken by staff to provide good care. The plans were up to date and records seen were complete. There was evidence that the plans were reviewed and up dated on a regular basis. Comments in all the surveys returned to CSCI praised the care given by staff in the home and this was corroborated during the inspection In the survey one relative returned a comment that the care of some residents was “difficult” and some staff “seem abrupt.” No evidence of this was seen and residents who spoke to the inspector were surprised by the comment. There are some residents in the home who have communication problems due to a variety of reasons; staff were observed to approach them in an appropriate manner and to have the skills needed to manage difficult behaviour. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 11 A visiting professional commented that staff respect residents’ privacy and dignity. This was observed during the inspection visit and confirmed by several residents. Medication administration practice was observed at lunchtime; medication is stored securely in an appropriate fridge, or cupboard and trolley; it is kept locked safely and the keys are kept on the person of the nurse in charge. The prescribed medication was administered and recorded correctly. Records are signed and the receipt and disposal of medication is recorded. The Deputy Matron informed the inspector that the supplying Pharmacy gives a speedy delivery service, inspects systems and gives advice. Staff training is provided. No residents were assessed as able or wanting to be responsible for selfadministration of their medication. The home had a procedure and facilities for storage should these be required. The Deputy Matron reported that during evenings and at weekends the nursing staff have recently found it difficult to obtain medical staff to attend the home at the time of a resident’s death. Crann Mor Nursing Home DS0000017602.V347177.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. A range of social and leisure activities are offered to residents and they are supported in their daily lives to maintain contact with their families and friends. A well-balanced and varied diet is provided. EVIDENCE: Recently the home has provided more formal entertainment such as visiting players and musicians. This has been well received and there are plans to offer more. An occupational therapist visits regularly and a member of staff continues these activities on a daily basis. Many residents told the Inspector that they enjoy the visits of the dog from a “Pets as therapy” scheme. During the morning of the visit a Church Visitor had been to see one of the residents; this is a regular occurrence. The Owner explained how they make arrangements for residents to receive support to follow their own beliefs. The staff in the service is multi national and they hold a range of spiritual beliefs. They are aware of issues of diversity and equality and these principles are incorporated into the care practice I the home. The kitchen has been completely refurbished and is now fitted with Stainless steel units and has new flooring that can be cleaned to environmental health standards. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 13 Staff monitor each resident’s diet following a nutritional assessment of need and all residents are weighed regularly. Staff give help to feed those who require it in a discrete way and the home has equipment such as special cutlery for those who need assistance. One resident commented in a survey that there was “ not a lot of variety” in the menu; on follow up the Inspector found that the resident was very unwell at the time and has subsequently died. There was evidence in the home that there is a varied menu. Individual choice is given and both staff and residents acknowledged that the cook is very willing to meet specific requests. Crann Mor Nursing Home DS0000017602.V347177.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 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Few complaints had been received and these had been appropriately managed. Staff are aware of their role in the protection of residents. EVIDENCE: CSCI has not received any complaints concerning this service in the last year. The home’s complaints procedure was on display in the home and a copy was given to residents and their relatives. The relatives of the new resident in the home confirmed that they had a copy and had been informed how to use it. Residents who were spoken with stated that they were aware of how to make a complaint. Visitors who were in the home told the Inspector that they felt happy to speak to the Owner or Deputy Matron about any concerns and felt sure that any dissatisfaction would be resolved. An older resident stated that she “ feels safe here”. The Deputy Matron stated that in the event of a suspicion or allegation of abuse the home would follow the Surrey Multi-Agency procedure for Safeguarding Adults. An up to date copy of the procedure is kept in the home for staff to refer to if required and staff are trained in its use. The case of an allegation made earlier this year was followed. The records contained evidence that the situation had been managed in accordance with procedures and there had been no abuse. The care plan contains instruction for continuing management of the situation. All concerned had agreed this. Crann Mor Nursing Home DS0000017602.V347177.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well maintained, comfortable and clean home. EVIDENCE: A tour of the premises was carried out and it was observed that an on-going process of maintenance and improvement is in progress. All areas were fresh, clean and attractively decorated. Redecoration of the shared areas is carried out as part of a schedule and individual bedrooms are redecorated when empty and as needed. Residents’ individual rooms contained their favourite furniture, pictures, ornaments and possessions. Attractive grounds are available, with seating provided in sun and shade, there was access to the rear garden from the lounge. A garden is employed weekly and a relative enjoys using the garden and helping with it. Sluice rooms are provided on each floor, are equipped with clinical waste bins and a contracted clinical waste collection and disposal service has been arranged. Infection control practice was in place as in previous inspections. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 16 The house has been adapted for its purpose by the addition of a lift, handrails, easy access baths and aids. There is no designated hair dressing area and one of the surveys referred to “limited hair dressing facilities”. None of the residents who were asked had any objection to the current practice of washing residents hair in a cloakroom fitted with a hairdressing shower spray followed by the use of a drier in the small lounge. They enjoyed the coffee and magazines there. During the past year the Fire Officer has written to the home concerning fire safety practice. The owners had addressed this, which related to the opening mechanism of a fire door on the first floor corridor. Staff were trained in fire prevention and drills are held regularly in the home. In addition advice was sought from the fire safety management company employed by the service. It is required that the Owners confirm that the Fire Officer’s requirements are met concerning this issue. A window opening restrictor required for the safety of residents had been fitted to the first floor bedroom window as required in the previous inspection report. Crann Mor Nursing Home DS0000017602.V347177.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. 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. A full team of properly recruited and trained staff meets the needs of residents. EVIDENCE: In the previous inspection report a requirement was made that recruitment of staff was improved so that all safety clearance checks and references are obtained before employment of staff. This has been done and there was evidence in the staff files inspected that a thorough proper recruitment practice is in use and is being recorded. Staff training needs and planning are included in the supervision sessions. The workforce is stable; agency staff have not been used for some time and enough staff are receiving NVQ training to meet the target for numbers of NVQ trained staff. This was in accordance with the evidence supplied in the aqaa document. In the returned surveys residents referred to staff as “ very experienced; always give that little extra” “and staff always on hand for residents, seeing to needs”. One survey contained a comment that “some staff do not always understand i.e. sponge means cake.” The Owner was asked about the ability of staff to speak English and she replied that only once had they needed to arrange English lessons for a member of staff. During the inspection it was noted that all the staff were able to speak and comprehend very good English; residents confirmed that this was usually the case. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 18 From information supplied in the AQAA and records and documents seen at the inspection, it was clear that a full team of staff are employed to meet the needs of residents. The majority of the team are nursing and care staff, but catering, housekeeping and maintenance staff support them. It was positive to note that residents commented that they felt there are enough staff to meet their needs, and this included at the weekend. Crann Mor Nursing Home DS0000017602.V347177.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed, is run in the interests of residents and provides good outcomes for the people who live there. There is a need for the management to liaise with the fire officer to ensure that best practice is followed to comply with latest fire safety orders. In addition the management of the home must contact their local Primary Health Care Team to agree a protocol for the provision of out of hours medical cover. EVIDENCE: The Owner, who is an experienced nurse, manages the service as it has been for many years. The Deputy Matron is undertaking the registered manger’s award. Information supplied on the data set accompanying the AQAA had been supplied on a printed hand written copy. This led to the omission of some data Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 20 because the form was not clear. The omitted information concerning the review of policies and procedures and the review of arrangements for the management of services and equipment was all found to be available in the home. The service operates a quality assurance programme. Because of the last set of residents comments the Owners had reorganised the staff to ensure that a member of staff is always working in the lounge in the afternoons. Residents’ monies are not handled the Owners, as all residents have a representative to support them in dealing with their finances. Should the home have to pay for anything on a resident’s behalf, the expenditure would be invoiced to the resident or their representative so that the home could be reimbursed. Staff receive regular supervision sessions that are recorded and kept safely in their personnel files. Fire safety drills and training for staff had been carried out but the owners must confirm compliance with the requirements of the fire officer. Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 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 3 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 3 3 X 3 X X 2 Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 22 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. OP11 OP8 Standard Regulation 12 (1)(4) Requirement The provider to write to the PCT to put in place a protocol for the provision of a medical service in urgent situations such as unexpected death that occur during hours when medical cover is provided by a deputising service in the evenings and at weekends. The Provider to liaise with both the fire officer and fire safety management company to ensure compliance with fire safety regulations. Timescale for action 31/10/07 2. OP19 24, (schedule 4) 31/10/07 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 OP37 Good Practice Recommendations It is recommended that the data set is viewed and completed electronically to avoid omission and repetition. DS0000017602.V347177.R01.S.doc Version 5.2 Page 23 Crann Mor Nursing Home Crann Mor Nursing Home DS0000017602.V347177.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Crann Mor Nursing Home DS0000017602.V347177.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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