Inspection on 20/02/07 for Duchesne House

This inspection was carried out on 20th February 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

Duchesne House 16/01/06

Duchesne House 08/08/05

Duchesne House 19/08/04

Duchesne House 06/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Duchesne House Aubyn Square, Roehampton Lane London SW15 5ND Lead Inspector Sharon Newman Unannounced Inspection 20th February 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 Duchesne House DS0000010188.V329954.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. Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Duchesne House Address Aubyn Square, Roehampton Lane London SW15 5ND 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) 020 8878 8282 020 8876 2758 Society of the Sacred Heart Mrs Julie Murrin Care Home 22 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (22) of places Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Duchesne House is a single storey purpose built care home. It is situated on Roehampton Lane, near Queen Marys Hospital and within driving distance of Richmond Park. The home benefits from its own grounds. All accommodation is provided in single rooms, which have a washbasin. Toilet and bathroom facilities are provided within close proximity to all rooms. The home is currently undergoing renovation to improve upon the facilities and will provide ensuite facilities to the new bedrooms. Service users at Duchesne House belong to the Order of the Sacred Heart and are admitted by referral from the Province. Fees are not charged by this service as it is a registered charity. Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 20th February 2007 and was conducted by one Regulation Inspector. The manager was present during the inspection visit. Documentation examined included care plans, medication records and health and safety information. A tour was also taken of the premises. Surveys were left at the home for residents, relatives and staff to complete. Two staff surveys and seven residents surveys were returned prior to completion of this report. The manager was very welcoming and informative and is very committed to her work and to the residents. Staff were helpful and open throughout the inspection visit and they continue to demonstrate a conscientious and caring attitude towards residents. The building and renovation work is now complete and provides eleven new bedrooms with ensuite facilities and a new kitchen. The sensory garden has also been completed. As stated in the previous inspection report this home has a strong religious ethos as it provides care for residents belonging to the Order of the Sacred Heart. One resident commented ‘my family and friends are jealous of me living here – you would have to search the country to try and find another home like this one.’ Another said ‘You can be yourself here, I am very happy.’ What the service does well: As stated in the previous inspection report staff at the home are caring and continue to demonstrate a good rapport with residents and to respect their dignity, choice and privacy. Residents are well supported and encouraged to be as independent as possible. Resident’s health and spiritual needs continue to be well met and their psychological needs addressed. There is a good standard of cleanliness at this home, it is well maintained and has a pleasant relaxed atmosphere. There are two lovely gardens which are accessible to residents and visitors and are well maintained. One of these gardens was built as a ‘sensory garden’ to help meet the needs of those with dementia or failing eyesight. The home provides many different adaptations to help meet the needs of those with different disabilities. Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 6 Residents commented about the ‘good food’ at the home and the choices they are offered in relation to meals and day-to-day activities. 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. Duchesne House DS0000010188.V329954.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 Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given good information to enable them to make an informed decision about the service offered at this home. Full and detailed assessments of need are carried out and ensure effective care plans can be drawn up. The residents continue to be looked after in a caring environment. Intermediate care is not offered at this home EVIDENCE: As stated in the previous inspection report there is a Statement of Purpose in place at the home which emphasises that this is a home for a religious Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 9 community and is designed to meet their needs. It gives information about the admission procedure, daily life, pastoral care and spiritual support. The Service Users Guide contains information about the philosophy of care, accommodation provided, catering arrangements, social and physical activities and GP and medical services provided. This information helps prospective residents to decide if the home will meet their needs. Full assessments of need were seen in the residents files looked at during this inspection visit. This enables detailed care plans to be drawn up to help meet the needs of the residents. Residents spoken to were all very positive about life at the home, one said ‘it is lovely here and I am very happy.’ Another commented ‘This is the ideal place for me, I feel at home here.’ A resident wrote that ‘physical, mental, and religious needs are met.’ Duchesne House DS0000010188.V329954.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 good. This judgement has been made using available evidence including a visit to this service. The health and emotional needs of residents continue to be well met and there is evidence of good multi-disciplinary working with community healthcare professionals. Staff have a good knowledge of residents support needs. Medication is administered, stored and recorded appropriately. EVIDENCE: The care plans looked at were detailed in content and contained a lot of information. They cover areas including: social, psychological and physical care and were closely tailored to individual needs. Care plans were observed to address issues such as continence, wound care and medication and each resident has a ‘medical file’ in place. However there was not enough evidence to show that care plans are being updated regularly. Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 11 This needs to take place monthly to ensure that any change in residents needs is documented. Also signed agreements need to be in place for bedrails and wheelchairs to indicate the consent of the residents/relatives. Also evidence needs to be available to show that appropriate health and social care professionals have been consulted in relation to this. It was discussed with the manager at the time of inspection that the residents care plans need to contain evidence of the involvement and agreement of the residents. The manager reported that this would be addressed. Evidence in the care plans sampled demonstrated that health needs are well met. Records of hospital, health, social contact and GP visits are kept. Health action sheets are in place and document any issues that arise, the action taken and the outcome. One resident reported that the doctor visited the home regularly and was ‘very good.’ During the inspection visit staff were seen talking to and supporting residents in a kind manner. The medication administration records seen were fully completed with no omissions. A medication policy is in place and the home has a copy of the Royal Pharmaceutical guidelines to refer to for information. The medication cabinet was locked securely. One staff member is responsible for ordering and checking the medication to help to ensure that this important area is not overlooked. All staff receive training in handling medication before they give medication to residents at the home. Areas such as death and dying are addressed sensitively in the care plans and residents’ wishes in this area are respected. The manager reported that she was looking at approaching the subject of living wills with residents. Duchesne House DS0000010188.V329954.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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice and control over their lives and family and friends are encouraged to visit. Religious and social needs are well met. A wholesome diet is offered in pleasant surroundings. EVIDENCE: Daily mass and afternoon prayers take place at the home. Also, many residents like to participate in reunion each day where they discuss religious matters. A lovely wheelchair accessible garden is available to all the residents. Residents were observed to be using the main garden during the inspection visit. Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 13 There is a private area with a telephone for the residents use and mobile phones are also available. Many residents were also seen to have telephones in their rooms. There is a range of television and music equipment available for the residents. Also most residents have televisions and music equipment in their rooms. A resident said that the new rooms have all been set up with wireless access so that they can use laptops. She reported that she uses a personal computer in her room and other residents prefer to use laptops. The manager reported that she would like to introduce Tai Chi classes at the home for any residents who are interested in participating in this pastime. Some of the residents are taking recycling very seriously and have introduced water butts and a compost heap to the gardens. Many residents enjoy watching films and said that they are starting up a small film club, where they make an occasion out of this. They said that they enjoy watching a variety of films. One resident reported that they enjoy playing music on the keyboard in one of the new sitting rooms. Another said that they ‘love to knit and listen to classical music.’ They also said they enjoyed the ‘armchair exercises’ provided weekly at the home. The dining area is large, bright and spacious. The lunch looked appetising, nutritious and well presented. Residents were seen to be offered a choice and those spoken to reported that they can choose whatever they like. Vegetarian options are offered. Desserts are available daily and drinks are served with the meals. Residents were seen helping themselves to water from the jugs on the tables. Residents were seen sitting at tables chatting to each other in a relaxed, informal atmosphere. Comments from residents about the meals served were largely positive. However, one commented that food portions were not enough to always meet their needs. They said ‘there never seems to be enough in the main dishes for four people.’ One resident wrote that the cook was ‘good’ and that ‘those with special needs and wishes are given them. Residents can choose to make themselves breakfast, snacks and drinks whenever they wish as there are two well-stocked kitchenette areas at the home. One resident said that if they wished to make a snack at night they could do so. They also reported that they can rise in the morning when they wish and retire to bed when they want to go. They said ‘I can have a bath whenever I wish.’ Duchesne House DS0000010188.V329954.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 good. This judgement has been made using available evidence including a visit to this service. There is an appropriate complaints procedure and systems are in place to protect service users from abuse. However, not all staff have received training in abuse awareness and adult protection and this can place residents at risk. EVIDENCE: An organisational abuse policy is in place and the home follows the Wandsworth Local Authority Protection of Vulnerable Adults Procedures. A whistle blowing policy is also available at the home. Staff spoken to stated they would report any issues immediately to ensure that residents are not placed at risk of harm. A complaints procedure is in place at the home and there were no complaints documented in this since the previous inspection. The manager reported that there have not been any formal complaints to the home. Evidence from looking at staff files and talking to staff demonstrates that training in the protection of vulnerable adults and abuse awareness is not upto-date for all staff. This training needs to be organised for all staff as this helps them to be aware of the importance of reporting any concerns immediately and helps to protect the residents. Duchesne House DS0000010188.V329954.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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is comfortable and homely. The environment at this home continues to be clean, and hygienic. Bedrooms are well decorated and residents have their personal possessions with them. The new extension compliments to existing facilities. There is a pleasant atmosphere at the home which benefits the residents. EVIDENCE: As stated in the previous inspection report this home is purpose built and all accommodation is provided on ground level which is easily accessed by wheelchair. The home has many facilities including a library, chapel and two sitting rooms with small kitchenette areas where residents can make hot drinks and snacks. Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 16 The kitchen has been refurbished and the dining area is large, bright and welldecorated. The new extension is now complete, apart from the snagging list and provides eleven new bedrooms all of which have ensuite facilities. There is also a new laundry room, sluice and two sitting rooms. Ecological principles have been applied where possible. The bathrooms all have sun pipes to allow light without the use of electricity. The bedrooms in this extension are all large, bright and airy. Bedrooms were seen to be well personalised to individual residents taste. Residents spoken to commented that they liked their bedrooms. The new sensory garden for those with dementia and disabilities has been completed and just needs to establish it self. The manager reported that it has been designed along the principles of feng shui and is lit up at night. The lovely main garden is well established and is wheelchair accessible, wisteria climbs up the surrounding pergolas, creating a haven for wild birds. One resident reported that she loved to feed the birds and squirrels. The home has a range of equipment to meet peoples needs such as adapted baths, wheelchairs, magnifiers for reading and adapted computers. The home was clean and hygienic at the time of inspection. Duchesne House DS0000010188.V329954.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. Staff continue to be enthusiastic and committed to delivering high standards of care, they have a good knowledge of residents’ needs and a conscientious attitude to their work. Staff training has improved, however the lack of staff supervision could mean a lack of support and direction for staff in their roles. The staff contribute towards a relaxed atmosphere at the home which benefits the residents. EVIDENCE: The manager reported that they have just advertised for two new members of care staff and were interviewing that week. She said that the home is maintaining staffing levels at present by using bank and overtime staff. Staff were observed to be supportive of residents and to treat them in a considerate and caring manner. The staff files sampled contained evidence of pre-employment checks including two references and criminal record bureau (CRB) checks, this helps to keep residents safe from harm. Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 18 Evidence in the staff files demonstrated that there have been improvements in staff training and it is apparent that there is a training programme in place. The manager reported that many staff have now attended training in dementia care and challenging behaviours. She reported that she is also completing an NVQ course as an NVQ assessor in dementia care and can then ensure that this knowledge is passed on to the care staff. A staff member spoken to reported that they have attended the dementia training course and another staff member said that they have been enrolled on the course. Evidence of training in this area was seen in one of the staff files looked at during the inspection. Staff spoken to were positive about working at the home. One said that they ‘enjoyed’ their work and felt it was a ‘nice supportive team.’ A staff member wrote that the home was ‘very peaceful and holy, which makes the environment happy and cheerful.’ Duchesne House DS0000010188.V329954.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 good. This judgement has been made using available evidence including a visit to this service. The manager is experienced, conscientious and caring. She keeps up-to-date with current developments in care. This home continues to be run well and resident’s needs are met. This home is run in the best interests of the residents. EVIDENCE: The manager is experienced and has worked at the home for many years. She has a NVQ 4 management qualification in care. She also continues to keep herself up-to-date by reading on a wide range of care and social issues and attending relevant courses. Staff and residents spoke highly of her. One Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 20 residents said that she ‘is wonderful.’ Another said that the manager ‘is out of this world.’ And that she ‘takes such care.’ A temporary deputy manager has been appointed to cover the duties of the deputy manager who is on leave at present. The manager reported that they are performing a very good job. One of the residents is also the bursar for the home, a post she has held for a long time. She is responsible for ensuring the residents have enough money for personal use. The manager reported that all other finances are looked after by the organisation. From the evidence in the staff files there was not enough evidence to demonstrate that all staff are receiving one-to-one supervision at least six times a year. This was discussed with the manager at the time of inspection. All care staff must receive supervision to ensure that they are receiving the support and direction they need for their roles. Up-to-date certificates were available for gas safety, legionella testing, portable appliance testing and the five-yearly electrical installations. This helps to ensure the safety of the home for the residents and staff. As stated in the previous inspection report the home needs to ensure that all incidents requiring notification under the Care Homes Regulations 2001 are reported to the CSCI. One resident commented ‘I like living here – on the whole it is beautiful.’ Another said ‘we are extremely lucky to have such a beautiful home where we are so well looked after.’ Duchesne House DS0000010188.V329954.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 N/A 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 2 X 2 Duchesne House DS0000010188.V329954.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 12 (2) 15 (1) (2) Requirement The registered person must ensure that: 1. The information in the care plans is updated monthly. 2. There is evidence of involvement and agreement from the service users. The registered person must ensure that there are signed agreements in place to indicate a resident’s agreement to bedrails or wheelchair use. This may be signed by the relative and/or their relatives. Information must also be in place to demonstrate that the appropriate health and social care professionals have been consulted and agree. The registered provider must ensure that all staff are up-todate with training in abuse awareness and the protection of vulnerable adults (POVA) training The registered person must ensure that all care staff receive a minimum of six supervision sessions per year. This must be DS0000010188.V329954.R01.S.doc Timescale for action 01/05/07 2 OP7 12 (1) (2) 13 (4) 01/05/07 3 OP18 12 (1) 13 (6) 01/05/07 4 OP36 18 (2) 01/05/07 Duchesne House Version 5.2 Page 23 5 OP38 37 fully documented. The registered person must ensure that they give notice without delay of any event in the care home which adversely affects the well-being or safety of any service user. Previous timescale of 01/02/06 not met. 01/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Duchesne House DS0000010188.V329954.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Duchesne House DS0000010188.V329954.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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