Inspection on 10/10/06 for Crowstone Manor

This inspection was carried out on 10th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Crowstone Manor 05/09/07

Crowstone Manor 06/03/06

Crowstone Manor 10/10/05

Crowstone Manor 21/02/05

Crowstone Manor 14/06/04

Crowstone Manor 08/12/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Crowstone Manor 38 Crowstone Road Westcliff On Sea Essex SS0 8BA Lead Inspector Mrs Nikki Gibson Key Unannounced Inspection 10th October 2006 10:10 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 Crowstone Manor DS0000015429.V315747.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. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crowstone Manor Address 38 Crowstone Road Westcliff On Sea Essex SS0 8BA 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) 01702 333594 01702 333594 manager@crowstonemanor.fsnet.co.uk www.crowstonemanor.fsnet.co.uk Mrs Angela Murray Sally Faulkner Care Home 13 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (13) of places Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Accommodation and personal care to be provided to no more than 13 older people over the age of 65 years (OP). Accommodation and personal care to be provided for up to 3 service users with dementia over the age of 65 years (DE). Total maximum number of service users to whom accommodation and personal care is to be provided shall not exceed 13. 6th March 2006 Date of last inspection Brief Description of the Service: Crowstone Manor is registered to provide accommodation and personal care for up to thirteen older people over the age of sixty-five, of whom up to three may have a diagnosis of dementia. The home has a separate lounge and dining room and bedrooms are situated on the ground and first floor. A passenger lift gives access to both levels. The home is well maintained throughout. Crowstone Manor is an attractive and spacious property, built in 1912 as a family home in a pleasant residential area. Many of the original features are still in place, such as an oak panelled hall and dining room with parquet flooring. There are nine single rooms of which two have en-suites and two shared rooms both with en-suite facilities. Crowstone Manor is close to local shops, public transport and local amenities. There is a garden and small area to the front of the building for parking and an attractive and secure garden at the rear with seating and tables for the use of the residents. Residents and staff who smoke are required to do so in the garden. The most recent inspection report was available in the office and staff room. In August 2006 the fees ranged from £369 32 to £644. Residents paid additionally for hairdressing, chiropody, newspapers, toiletries and outings. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which covered all the key National Minimum Standards. The site visit took place over nine hours by one regulation inspector. During the visit there was a tour of the premises and a selection of records and documents were studied. Time was spent in the lounge and dining room observing practice, and with residents in their own rooms. The inspection process also included discussions with the proprietor, manager, staff and visitors. Surveys were sent to the District Nursing team, GPs and social workers linked to the home. A pre-inspection questionnaire and other reports and correspondence provided by the proprietor were also used as evidence to inform this report. Discussion of the inspection process and findings took place with the proprietor, manager and staff throughout and at the end the inspection and guidance was given. There is a tendency for the home to be defensive and negative about the inspection process. Staff said that the proprietor worked very hard to provide a good standard of care and they saw guidance on developing further good practice as criticism. The home would benefit from developing a more open and receptive approach. What the service does well: What has improved since the last inspection? Some progress has been made in involving residents and relatives in the running of the home. Care was taken by management at this inspection with regard to the terminology used to describe residents’ behaviour which maintained their dignity. Care plans are developing well and are providing a wider picture of the residents’ needs and how they are to be addressed. Staffing levels remain the same, however deployment has changed and residents felt that there were sufficient staff to meet the present residents’ needs. A list of options are included on the reverse of the set menus to assist residents to be aware of the choices available to them. Vast surveys are Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 6 taking place which can be used as part of the home quality monitoring system. The proprietor states that a major overhaul of the electrics within the home has taken place. 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. Crowstone Manor DS0000015429.V315747.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 Crowstone Manor DS0000015429.V315747.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): 12346 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good level of information so that residents and relatives can make informed choices. Sufficient information is gathered about a prospective resident before a place is offered. Staff have the skills and abilities to care for the residents who are admitted. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide which is given to relatives of prospective residents when they visit the home. The home also has a web site with photographs and information including inspection reports. A relative said that when they came to visit staff were very polite and, ‘explained about the home exceptionally well’. The manager said that each resident has a contract and this was confirmed by a new resident. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 9 A comprehensive assessment is undertaken by someone competent to do so before a place is offered. Crowstone Manor caters for the more able resident, although if able they aim to offer a ‘home for life’. Residents’ experience of life at Crowstone Manor is generally positive. A visitor had written in the comments book, ‘although Crowstone Manor is professionally managed, the staff are still able to provide the residents with a homely atmosphere’. Another relative said that they had seen a marked improvement in their relative in the short time they had been in the home. The home does not provide intermediate care. Crowstone Manor DS0000015429.V315747.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are developing although there is little evidence of resident and relative involvement. The system for storing and administering medication is safe. Residents receive the medical care they require and their privacy is maintained. EVIDENCE: The home does not have the belief that it is essential to involve residents in the planning of care. They said that no relatives and only one resident was interested in reading their care plan. Each resident has a care plan which contains basic information and some risk assessments. Care plans are developing and are being regularly updated. One member of staff said she enjoyed being involved in care plans and she found them particularly helpful when she had had a few days away from the care of the residents. Recordings are made twice daily on the welfare of the residents. These varied in value and there was an over use of the term ‘no problems’. A resident said that she had seen staff writing the daily notes but she did not know what was written. One relative said he would like to read the daily notes when he visited as it Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 11 would reassure him and would inform him of his mother’s welfare on the days he did not visit. Residents have access to health care services and on the day of inspection two residents were taken to the GP surgery for ‘new patient’ check ups accompanied by a carer. A survey response from one GP did not highlight any concerns and showed a good level of satisfaction with the service that the home provided. Weighing and nutritional screening is not undertaken routinely, but action is taken if a change is noted. The home has introduced a Malnutrition Universal Screening Tool (MUST) and contacted the GP when a resident failed to pick up after having an infection. Residents are assessed to highlight who may be at risk of developing pressure sores. Care plans are put in place for those most at risk. The processes in place for the administration of medication are safe and well maintained. Protocols for the administration of medication prescribed ‘when required’ were in place in care files. Some were vague as to when the medication may be needed and this was discussed with the manager. Residents spoken to said they were treated with dignity and respect by the staff. A written comment by a visitor said residents were treated as individuals. One resident said all the staff were good and she only had to ask and staff get it for her. Staff are to be commended for sewing discrete labels in residents clothes rather than using a laundry marker which can be degrading. One resident said that a member of staff had spoken to her kindly and had helped her with practical ways to manage her slight incontinence. Crowstone Manor DS0000015429.V315747.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 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range of social activities is developing. Relatives and friends receive a warm welcome and contact is maintained with the local community. The food provided is nutritious and there is a choice at each mealtime. EVIDENCE: Changes have been made to the times staff are deployed to be of most benefit to residents. An additional member of staff works during the middle part of the day when residents are most receptive. Views on the range of pastimes available varied. One resident said she got very bored and she would like daily exercises, she said, “I can’t stand much but I can still use my hands!” A social worker reported that a resident said she had done more in the short time she had been in the home than she had done for years living at home. Two people commented on the poor quality of the television picture in the lounge. Residents are taken on occasional trips and are enabled to attend day centres in the community. Visitors are welcome at anytime. The home does not believe that residents would enjoy or benefit from a residents/relatives meeting and they are advised to review this decision. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 13 Residents are aware that they can bring small items of furniture and personal possessions into the home. The home does not have a designated cook and meals are prepared in the night and cooked by care staff during the day. The quality of ingredients is good and there is generally a frozen and fresh vegetable each day. Each resident had a copy of the planned menu with possible alternatives and they are encouraged to mark the foods they do not like. Residents’ views on the food varied between good and adequate. Presentation of food was an area which residents were less satisfied with. Crowstone Manor DS0000015429.V315747.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 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s rather defensive approach does not encourage residents and relatives to raise concerns or make suggestions on improvements. Staff have received training and understand the principles of protection of vulnerable adults. EVIDENCE: The Manager and proprietor work hard to run a home which is of a very high standard and in many areas they are successful. However, the home does not have an open outlook and is reluctant to discuss incidents or concerns with external bodies. The home received a complaint/concern which the proprietor investigated and closed. Full details of the complaint, the investigation and outcomes were not available for inspection. Staff spoken to had received training in the protection of vulnerable adults and were aware of the different forms of institutional abuse. They were aware of the appropriate action to take. The need to make POVA referrals if allegations are made was discussed with the Proprietor. To protect vulnerable people the home must refer allegations and allow experts in the field to make the decision as to who is the most appropriate person to investigate. Crowstone Manor DS0000015429.V315747.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 21 22 23 24 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Crowstone Manor provides care in a homely and hygienic environment. Suitable adaptations and aids at available and environmental risks are kept to a minimum. EVIDENCE: Crowstone Manor is conveniently situated in a residential area close to local amenities. It is Manor is well maintained and provides a safe environment in which to work and live. Communal space is sufficient and comfortable. Visitors said that they found it homely and appreciated the lack of offensive odours. The home has the necessary aids and adaptations to meet the care needs of the residents. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 16 Residents spoken to said they were very pleased with their rooms. One resident said the home was ‘spotless’ and another said her room was cleaned daily and ‘spring cleaned’ weekly. A relative said he had brought an electric fan into the home and he had been surprised how quickly it was checked for safety and made available for use. One resident in a double room said she was happy to share and a mobile screen was used when they went to bed. One relative said they were happy with their mother’s room although they did consider it small. They said they had been promised a larger room when one became available. Hot water that was tested during the inspection did not pose a risk. Despite the home having arranged for a fault in the heating system to be repaired, residents had been protected and said they found the home to be maintained at a comfortable temperature. The lighting in the home was adequate and homely. The laundry which is situated in an outhouse was clean and well organised. Residents said the laundry service was good and clothes were returned nicely ironed. Facilities are in place to prevent the spread of infection. Liquid soap, paper towels, and lidded bins were provided appropriately. Crowstone Manor DS0000015429.V315747.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 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate to meet the needs of the present residents. Training is promoted by the home and staff are well trained in the care of the elderly. The recruitment process is adequate to protect residents. EVIDENCE: The staff rota was studied. The home maintains a minimum of three staff in the mornings and two in the afternoon. An additional member of staff works from 10 am to 2 pm. In addition there is 3 hours of domestic chores covered seven days per week. At night there is one awake and one asleep member of staff. A new resident said that she found the staff ‘wonderful and nothing was too much trouble’. One resident said staff do have times to sit a chat for five minutes. Another resident said, that staff do not look hurried and residents are not rushed. Staff are undertaking NVQ in care at levels 2 and 3. The home has a good training record and staff are encouraged to progress and develop their knowledge. The recruitment process was generally robust and protected residents except in one incident. The proprietor was reminded that all staff should follow the same recruitment process to ensure that equal opportunities are maintained and there are no gaps in the thoroughness of their recruitment process. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 18 New staff are supernumerary during their early induction period and are supported by more experienced staff. Crowstone Manor DS0000015429.V315747.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 36 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is adequately managed and provides care in a safe environment. The home is slowly developing ways for residents and relatives to influence the care provided. EVIDENCE: The manager is qualified, experienced and competent to run the home and has obtained the Registered Managers Award. She continues to develop and update her knowledge through further training. The home would benefit from being more open and identify ways of working more positively and closely with the Commission for Social Care Inspection. Support and advice should not be seen as criticism. Staff meetings take place on an adhoc basis and minutes are maintained. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 20 The home has introduced monthly questionnaires as part of the Quality Assurance system. A recent one for residents was on the subject of food. This highlighted that there was a little dissatisfaction on the presentation of meals. This was also raised by residents at the time of the inspection. As yet the home has not put in any strategies to address this. The home may like to consider how food is presented and try a system where residents who wish can serve themselves from tureens on the tables. The home has yet to supply the Commission and residents with a report on this reviewing and improving of their service. It is pleasing to note that the home plans to introduce relatives meetings. The proprietor said she did not initially intend to invite residents to these meetings. Residents’ money is held securely within a safe in the home. Clear records are maintained and receipts filed for each transaction. Residents’ money is held together so the balance of individual accounts could not be checked. The manager said that staff supervision takes place on alternatives months and recorded. Records were not studied at this inspection. Working practices in the home provide a safe environment. Staff are appropriately trained in moving and handling, fire safety, food hygiene, first aid and infection control. Bedroom doors are fitted with ‘Dorguards’, which close at the sound of the fire alarm. Fire notices are placed strategically throughout the home. Certificates for Gas and Electricity safety were studied and showed that remedial action has been taken to address safety shortfalls. Risk assessments for unrestricted windows are in place on individual files. A resident said that staff put her in her wheelchair in the lift alone and then they use the stairs. This practice needs to be reviewed and risk assessments put in place on an individual basis. Crowstone Manor DS0000015429.V315747.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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 3 3 Crowstone Manor DS0000015429.V315747.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 Standard OP16 Regulation 17(2) Requirement The Registered Person must ensure that complaints are fully investigated and the outcome and any action taken is recorded and available for inspection. The Registered Person must notify the CSCI of any allegation of misconduct by any person who works at the home. The Registered Person must ensure that the recruitment process is robust for all staff employed or reemployed. The Registered Person must maintain a quality assurance system for reviewing and improving the quality of care provided. Copies of the report which covers the changes made following QA to be sent to the CSCI with copies available for residents. Timescale for action 24/11/06 2 OP18 37 24/11/06 3 OP29 19 24/11/06 4. OP33 24(2) 24/11/06 Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 23 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 OP7 OP12 OP14 OP32 OP35 Good Practice Recommendations Care plan development should continue with increased involvement of residents and relatives. Staff would benefit from further training in providing a wider range of pastimes and hobbies particularly for those with impaired understanding or dementia. Sensitive ways to increase residents autonomy and enable them to influence their care and the routines of the home should be explored. A more open and positive relationship with the CSCI should be fostered. It is recommended that residents’ money is stored in a manner which allows for individual accounts to be audited separately. Crowstone Manor DS0000015429.V315747.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Crowstone Manor DS0000015429.V315747.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. Re-publishing this information is in breach of the terms of use of that website. 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