Inspection on 29/05/07 for Dalvey House

This inspection was carried out on 29th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dalvey House 30/05/06

Dalvey House 27/09/05

Dalvey House 11/04/05

Dalvey House 22/09/04

Dalvey House 24/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Dalvey House 35 Belle Vue Road Southbourne Bournemouth Dorset BH6 3DD Lead Inspector Chris Gould Key Unannounced Inspection 29th May 2007 10:00 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 Dalvey House DS0000052636.V341547.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. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dalvey House Address 35 Belle Vue Road Southbourne Bournemouth Dorset BH6 3DD 01202 423050 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) Norlington Care Limited Joanne Louise Smart Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: Dalvey House is a care home that provides personal care and support for up to nineteen older people. It is a large detached house that has been adapted to provide residential care. The service user accommodation is situated on two floors with a passenger lift providing access to the first floor. All service users at Dalvey House have single rooms, eight of which benefit from en-suite facilities. There are separate lounge and dining areas and an easily assessable rear garden with level pathways. The house is situated on a bus route and is within half a kilometre of shops and other community amenities including the cliff tops at Southbourne. Car parking space is available at the front of the house. Mrs Tempany and her son Gary Tempany are the registered Directors of Norlington Care Limited. Gary Tempany is the responsible individual for the home and Joanne Smart has recently been registered by the Commission for Social Care Inspection as the registered manager. The fees for the home as provided to CSCI at the time of inspection range from £450 to £460. Additional charges include hairdressing, chiropody and newspapers. See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection took place over six and a half hours on one day in May 2007. Joanne Smart the registered manager and Mrs Tempany a director of Dalvey House was present throughout the inspection. A tour of the premises took place and three staff files, three residents care records and relevant documentation of policies and procedures relating to the running of the home were inspected. Seven of the nineteen residents, two visitors to the home and the staff on duty were also spoken with during the inspection. One resident had gone out with a relative, one was attending a hospital appointment and one had been admitted to hospital. The Annual Quality Assurance Assessment form had been completed and has been provided to the Commission for Social Care Inspection prior to the day of inspection. New legislation has made it a legal requirement for all registered adult services to fill in an Annual Quality Assurance Assessment. The completed assessment is the main way that the Commission for Social Care Inspection will know how well the services is delivering good outcomes for the people using it. What the service does well: Dalvey House provides a clean and well-maintained home where residents personal, health and social care needs are met. The residents describe the home as a very homely, friendly place to live where the staff are cheerful and approachable. The staff treat residents with respect and provide encouragement to pursue their own lifestyle, where feasible, and to make choices about their daily lives. There is a varied activities programme for those residents who want to participate. The staff encourage friends and relatives to visit and to maintain contact with the home. Both service users and relatives say that visitors are made welcome. Residents are able to take their meals in the dining room or in their own room if that is their choice. All residents spoken with were very positive about the quality of the meals provided. Comments included ‘no complaints’, ‘excellent’ and ‘I always enjoy my meals’. Staff and residents agreed that Dalvey House was a good place in which to live and work with comments including ‘very happy here’, ‘everyone very nice’ and ‘Jo will always listen’. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dalvey House DS0000052636.V341547.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 Dalvey House DS0000052636.V341547.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): Standards Assessed - 3 The home does not provide intermediate care therefore standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions only take place when the home is confident that they are able to meet the assessed needs of the prospective resident. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 9 EVIDENCE: The file of a recently admitted resident contained an assessment that had taken place in hospital before they came to live at Dalvey House. Discussion with the registered manager demonstrated that a full assessment had been undertaken although all the details had not been fully documented. A letter had been sent to the prospective resident advising them that following assessment the home is able to meet their needs. When talking to residents they confirmed that they or a relative had been provided with the opportunity to visit the home before making the decision to move there. Discussion with staff confirmed that they were aware of the resident’s needs at the time of their admission. Dalvey House DS0000052636.V341547.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 7, 8, 9 and 10 The residents’ personal care needs are met and they have access to healthcare services however, shortfalls in the administration of medication and the completion of risk assessment documentation could potentially place them at risk. EVIDENCE: The care records of three residents were viewed. The care plans identify the resident’s needs and the actions required to meet the individual needs but would be improved by the provision of additional detail. One resident’s care plan includes the use of a cream and a pressure relieving cushion. The care plan does not identify the name of the cream to be used or the type of pressure relieving cushion in place. Discussion with staff and residents confirmed that the care plans reflected the actual care provided. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 11 One resident has been assessed as being at risks from falls. The care records did not provide a detailed falls risk assessment or plan of care to identify and minimise the risk of falling. One resident uses bed rails to manage the risk of falling out of bed. An assessment has not been undertaken. The Department of Health document Safe Use of Bed Rails was discussed with the registered manager. Two care records identified that the residents have diabetes. There are no clear care plans in place to inform how the resident is assisted to manage their diabetes including identifying and minimising potential problems. The residents sign to say that they have taken part in the assessment and agree with their care plan. The registered manager said that the resident’s care plans are reviewed monthly but this was not seen to be consistently recorded. The records identified that residents are visited by the district nurse and their General Practitioner as required. Residents spoken with confirmed that they receive foot care from a visiting chiropodist and one resident was attending an out patients appointment at the hospital on the day of the inspection. The home has a medication procedure in place and staff involved in the administration of medication have received training. The home has purchased a lockable refrigerator for the storage of medication as appropriate. The temperature of the refrigerator is recorded daily but needs to include the minimum and maximum temperature. The Medicines Administration Records (MAR) for a number of residents contained blank spaces on one day where medicines had not been signed as administered. The home uses a monitored dosage blister pack system so it was possible to confirm that the medication had been given. When residents are prescribed one or two tablets to be given there is no record of the number actually administered. The care records did not always provide clear guidance to indicate when prescriptions marked ‘as needed’ or ‘prn’ should be given when the resident is unable to request the medication. Staff induction includes respecting residents privacy and dignity. This was confirmed when speaking with staff. Staff were seen knocking on doors and waiting for an answer before entering residents’ rooms. Residents spoken with said that they were always addressed in the way they had requested and the staff are always polite. Dalvey House DS0000052636.V341547.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 12, 13 14 and 15 The flexibility of the home and the varied programme of activities provided enable residents to retain control over their lives where feasible and take part in social activities that meet their expectations. EVIDENCE: Dalvey House offers a varied programme of activities including entertainers, crafts, games and chair exercises. The residents have recently been involved in modelling with salt dough. These are now drying ready to be painted. On the day of inspection the residents enjoyed the afternoon’s entertainment provided by a piano accordion player. The home is actively fund raising with the aim of purchasing a mini bus to enable them to provide more outings. Photographs record the many activities, outings and celebrations that have taken place. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 13 The registered manager has identified that further work is required to record a resident’s social history as a full picture of the person’s past family, work and social history will further assist with planning for their future care. Residents confirmed that activities are provided but it is their choice to decide if they wish to participate. In the home’s completed Annual Quality Assurance Assessment it is identified that as part of their improvement plan they aim to spend more time with residents who wish to remain in their own room. Residents receive visitors whenever they wish. A record is maintained of all visitors to the home. The home encourages friends and relatives to keep in contact. Residents are able to go out on their own if able or with a member of staff, relative or friend. A resident had gone out with a relative on the day of inspection. Visitors spoken with confirmed that they are always made welcome by the staff. The majority of residents spend the greater part of the day in the lounge with a small number choosing to remain in their bedroom. Residents spoken with confirmed that they were able to make choices about such matters as what they ate and when they got up in the mornings and went to bed at night. Residents are able to “personalise” their bedroom with additional items of their choice. This was confirmed when visiting residents’ bedrooms. The home has a four-week rolling menu that is flexible to take into account the weather and in season produce. At least five pieces of fruit or vegetable are offered every day. The likes, dislikes and dietary needs of service users are known and are taken into account. Residents eat their meals either in the dining room or in their bedroom. The lunchtime meal was served and eaten in a very relaxed manner at the resident’s own pace. Hot and cold drinks are available at all times. Residents generally spoke very positively about the quality of the meals provided commenting ‘no complaints’, ‘excellent’ and ‘I always enjoy my meals’. Dalvey House DS0000052636.V341547.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 16 and 18 The systems in place provide residents with the confidence that their complaints will be listened to and acted upon and they are protected from abuse. EVIDENCE: The home has a comprehensive complaints procedure including the address of the CSCI and timescales. Residents’ and visitors spoken with said that they were aware of the procedure and what to do if they had a complaint. No complaints have been received by the home or CSCI since the last inspection but residents and visitors spoken with agreed that if a situation did occur then they were sure that they would be listened to and action taken. The home has an adult protection procedure that has been amended in line with the multi agency ‘No Secrets’ guidelines. Staff training has been provided. Dalvey House DS0000052636.V341547.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 19 and 26 The standard of the environment is good providing the residents with a comfortable, clean and well maintained place to live. EVIDENCE: The home is well decorated and comfortably furnished. Residents spoken with agreed that it was a very homely, friendly place to live where the staff are cheerful and approachable. A full time and a part time person are employed to ensure that the home is well maintained and to assist with implementing the ongoing refurbishment plan. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 16 An assessment has recently been undertaken by an occupational therapist and the home has started working through the recommendations that followed. These include the provision of additional handrails to enable residents to move safely around the home and gardens. A fire risk assessment is in place together with an action plan. The home is actively working towards meeting the recommendations. One resident commented ‘my room is very comfortable just as I like it’. All areas that were seen during the tour of the home were in a clean condition and free from unpleasant odours, residents and visitors confirmed that this is always the case. Residents confirmed that their bedroom was regularly cleaned. Dalvey House DS0000052636.V341547.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 27, 28, 29 and 30 Dalvey House has systems in place for the recruitment and training of staff to support the people living at the home. However shortfalls in the actual practices within the home have the potential for care to be provided by staff that do not have the relevant skills to meet the needs of the residents. EVIDENCE: Talking to residents, staff and viewing staff rotas confirmed that the number of staff on duty meets the needs of the present dependency levels of the residents at the home. There is additional ancillary staff to cover, cleaning, maintenance and gardening. A cook works from 9am until 3pm to provide the lunch and prepare the evening meal. The laundry is managed by the care staff. The staff files viewed included an application form, proof of identity, a health questionnaire, a job description and contract. A satisfactory enhanced Criminal Records Bureau check or Protection of Vulnerable Adults (POVA) check had been received prior to the member of staff commencing employment. Two files contained two written references but not including one from the most recent employer and one included a reference addressed to whom it may concern. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 18 The records available did not include any information relating to an interview having taken place. The registered manager agreed that in future the files would be audited on a regular basis to ensure all appropriate information and checks have been obtained. Seven of the eleven care staff have obtained an NVQ level 2 in care or equivalent and three staff are undertaking NVQ level 2 at the present time. The home has introduced an induction programme based on the Skills for Care induction standards. The training files of two recently recruited care staff were viewed, one contained documentation to demonstrate that they were undertaking an induction programme. In the second file there was no information available to evidence that an orientation programme had been provided and induction training commenced. The care staff have received manual handling, infection control, abuse in the care home, food hygiene and health and safety training. The registered manager and senior carer are manual handling trainers and have recently updated their own training. Dalvey House DS0000052636.V341547.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 31, 33, 35 and 38 The management arrangements at Dalvey House and the quality assurance system ensures that the residents live in a home that is well managed and the service provided meets their needs. EVIDENCE: Joanne Smart who was recently registered as the manager of Dalvey House by the Commission for Social Care Inspection has achieved an NVQ level 4 in care and the Registered Managers Award. June and Gary Tempany, directors of Dalvey Care Home are closely involved in the management of the home. Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 20 Staff and residents agreed that Dalvey House was a good place in which to live and work with comments including ‘very happy here’, ‘everyone very nice’ and ‘Jo will always listen’. The views of residents are obtained by using survey forms and holding regular residents meetings where minutes are recorded. When the results of the surveys have been collated action has been taken to address any issues identified. A recent family/friends meeting proved very successful and these will now be held six monthly. A monthly newsletter is produced. The registered manager completed and has returned the Commission for Social Care Inspection, Annual Quality Assurance Assessment and will now use the document as part of the home’s quality monitoring programme. Family, friends or professional advisors assist all residents to manage their financial affairs. Pocket money is held for a number of residents and clear records are maintained. The money is kept in secure facilities. Residents confirmed that the home keep some money for them to pay for hairdressing, chiropody and anything else they may want to buy. The home has now implemented a structured staff appraisal and supervision programme. All staff have now taken part in an annual appraisal and most have received their first supervision. This was confirmed when talking to staff who thought appraisal and supervision ‘a good idea and ‘very helpful’. All gas installations, central heating, electrical wiring and appliances and equipment used to meet service user needs has been checked. Policies and procedures are available relating to health and safety, Control of Substances Hazardous to Health (COSHH), infection control, manual handling and first aid are in place. Fire training, drills and fire safety checks have been completed as required. A record of all accidents is maintained. The record does not consistently provide sufficient detail of the accident. An accident to a resident resulting in admission to hospital had been reported to the Commission for Social Care Inspection. Dalvey House DS0000052636.V341547.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13(4)(c) Requirement The registered person must ensure that all risks to residents are identified and appropriate measures put in place to minimise any risk including the use of bedrails and of the resident falling. The registered person must ensure that: • Staff accurately record the administration of medicines at the time they are given. • When residents are prescribed one or two tablets to be given there is a record of the number actually administered. • Records always provide clear guidance to indicate when prescriptions marked ‘as needed’ or ‘prn’ should be given when the resident is unable to request the medication. The registered person must ensure that the persons employed to work at the care DS0000052636.V341547.R01.S.doc Timescale for action 30/09/07 2 OP9 13(2) 30/09/07 3. OP30 18(1)(c)(i ) 30/09/07 Dalvey House Version 5.2 Page 23 home receive training appropriate to the work they are to perform including structured induction training. A record of all training undertaken including induction training must be kept in the home. There should be evidence that all staff have an individual training assessment and profile. Timescale of 31-12-05 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Dalvey House DS0000052636.V341547.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Dalvey House DS0000052636.V341547.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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