Inspection on 14/02/06 for Elm House

This inspection was carried out on 14th February 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elm House 10/07/08

Elm House 25/01/08

Elm House 23/01/07

Elm House 08/06/05

Elm House 20/01/05

Elm House 21/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 192 Wivenhoe Road Alresford Colchester Essex CO7 8AH Lead Inspector Gaynor Elvin Unannounced Inspection 14th February 2006 12:00p 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 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 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 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 Adults 18-65. 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. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 192 Wivenhoe Road Address Alresford Colchester Essex CO7 8AH 01206 824443 01206 824443 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) Partnerships in Care Limited Manager post vacant Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (1) of places 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate 3 persons of either sex who fall within the category of learning disability The home may accommodate one named person, aged 65 years and over, falling within the category of learning disability The total number of service users accommodated in the home must not exceed 3 persons The home may provide assistance to one additional person during the day in order they may use the rehabilitation kitchen. The staff member assisting this person must be additional to staff provided in the home. 20th January 2006 Date of last inspection Brief Description of the Service: 192 Wivenhoe Road is a registered care home providing accommodation for three people under the age of 65 years who have an acquired brain injury. It is one of two homes in the area owned by Partnership in Care which, is now part of the Sinven organisation. A variation to the condition of registration has been given for one named service user who is now over the age of 65 years; the home was still able to meet his assessed needs. The home runs two programmes of care: one for community rehabilitation and the other being long term supported living assistance for service users requiring maintenance of their rehabilitative state, who may also have behavioural problems which, can be managed within the home. 192 Wivenhoe Rd is a detached house situated on the outskirts of the village of Alresford, approximately five miles from the town of Colchester. The home is within walking distance to the village amenities which, include a shop, pub and train station. Single room accommodation is provided, two of which have en suite facilities, one with a bath the other with a shower. The communal bathroom has a shower. The home has a comfortable, safe and fully accessible dining room, lounge and sitting room for shared activities or private use. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on one day in February 2006, over four hours. All of the key standards for young adults and the intended outcomes have been assessed in relation to this service during at least two inspections for the current inspection year (April to March). To view the assessment of standards and outcomes not included within this report, please refer to the previous published report dated 8th June 2005. The service users accommodated at Wivenhoe Rd have sustained an Acquired Brain Injury (ABI) and have varying degrees of permanent cognitive disability following the early stages of recovery. This includes changes in concentration, awareness, perception and insight and in some cases long term and/or shortterm memory loss. Discussion with the service users regarding care delivery was not appropriate. However, during this and previous inspections the service users looked well cared for and from observation of their body language and behaviour it was clear they had a good relationship with the care staff. This inspection focused on the outcomes and National Minimum Standards not assessed in the previous inspection, looking at working practices, supporting documentation and records, as well as progress made in addressing the statutory requirements and good practice recommendations made in the previous inspection report and informal discussion with the Senior care support worker and the Human Resource Manager from Elm Park. The home has been without a manager since the departure of the Registered Manager, Miss N. Rabey, in October 2005 and at the time of inspection there had not been any response to the advertised vacancy. Janet Luck, a Service Manager at Elm Park, an independent hospital also run by Partnerships in Care, the Registered Providers and regulated by the Health Commission is overseeing managerial arrangements two days a week. Whilst these arrangements were agreed by the CSCI on a short-term temporary basis, the Responsible Person must now consider full time managerial arrangements for the home by a Registered Manager, who has knowledge of the National Minimum Standards and Care Homes Regulations, to provide strategic and day-to-day management of the service. What the service does well: The home promotes a safe homely environment, supporting the service users in the readjustment and reconstruction of their lifestyle. Staff have worked as a close team and supported each other during a difficult period of change and have ensured minimal disruption to the lives of the service users. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 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. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1-5 and their intended outcomes were not assessed on this occasion please refer to previous inspection report dated 8th June 2005. EVIDENCE: 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10 Staff respect service users confidences and are fully aware of confidentiality issues. EVIDENCE: The homes confidentiality policy has recently been reviewed and updated. The Senior Carer spoken with was aware of the policy and its contents and had recently completed a piece of work in the home’s Competency Framework on confidentiality. Service users’ individual records were appropriately maintained and stored securely to protect confidentiality. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 17 Opportunities for service users to receive individual support or access the community are limited due to low staffing levels. Staff provided a well balanced diet that met individual needs. EVIDENCE: It was evident from previous inspections and discussion with staff that the home viewed community access and inclusion essential to the rehabilitative process. However, two of the three service users required support on a one to one basis by staff in the Community and this was not always possible due to low staffing levels. The care staff also prepared and cooked the meals for the service users. Staff indicated the Aga is ‘horrendous’ to cook on and is particularly difficult for younger staff with limited cooking abilities. The staff worked closely with the service users producing menus, looking at healthier options and fresh produce, incorporating choice, likes and dislikes. Different approaches to promote choice were discussed with staff such as menu picture books to prompt visual perception. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 11 Mealtimes were seen to be flexible. Staff indicated that the housekeeping budget had limitations with regard to ad-hoc alternatives. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The practice of medication administration was not satisfactory and may potentially cause harm to the service user. EVIDENCE: Service users were unable to retain or self-administer medication. The medication policy reflected all areas of safety. All staff have received accredited training in the safe handling and administration of medication. Care plans reflected individual medication prescribed and included information relating to the side effects and adverse reactions of medicines being taken by the service user, which is good practice. However, medication is dispensed from the GP surgery into Dossett boxes, a system normally used for self- administration. The system provides medicines for seven days. All tablets for a defined administrative time are placed together within the same compartment, making it difficult for the care staff to identify what medication is being administered or even refused. This system deflects from formal reference to appropriate pharmacy computer generated Medication Administration Record (MAR) charts giving correct details of prescription and retrospective signing of the records for safe administration of medication cross referenced with prescription on the MAR chart and tablet container. The cassette was not labelled and did not give details of its contents, dose and frequency. This current practice deflects from the homes policy and procedure 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 13 for the safe administration of medication and is a potential cause of error and harm to the service user. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home had adopted an open approach to complaints. Staff treated service users with dignity and respect, however, a more robust adult protection policy is required to inform staff in the event of any suspicion or allegation of abuse being made. EVIDENCE: The home’s complaints policy and procedure was in place and accessible to the service users’ representatives. Senior staffs spoken with were aware of the procedure to take in the event of a complaint being made. Staff indicated that the current service users were not able to make a written complaint but any verbal concerns or complaints would be listened to, taken seriously and acted upon appropriately. The home had not received any complaints since the last inspection. The home had good policies with regard to preventing abuse through good practice and staff and management support systems and how to recognise abuse. However, there was no guidance for staff on what to do in the event of a suspicion or allegation of abuse incorporating Local policy and Essex Social Services alert forms and contact numbers within the corporate policy and procedure. The staff had received in-house Protection of Vulnerable Adults (POVA) awareness training; the senior was advised to access approved training from Essex Vulnerable Adults Protection Committee (EVAPC). 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The homes premises are suitable for its stated purpose; accessible, safe and well maintained meeting service users’ individual and collective needs in a comfortable and homely way. EVIDENCE: The home presented a clean, comfortable and homely environment, domestic in scale and well maintained. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 & 36 Staffing levels are not always sufficient to adequately meet the needs of the service users. Recruitment practices were thorough and promoted the protection of service users. The quality and frequency with which care workers are formally supported does not meet with good practice. EVIDENCE: It is now more apparent that an authoritative style of management was previously experienced and the previous manager ran a tight ship. Since the lack of full time management the senior staff had to take a more active role in the day to day running of the home with very little experience. Staff demonstrated an awareness of own roles and responsibilities but felt that not everybody takes full responsibility in basic jobs appropriate to the smooth and safe running of the home. Staff previously looked to the manager and did not take responsibility in initiating. The senior staffs were now taking a new approach by prioritising and delegating. Staff at Wivenhoe Rd and from the local sister home Lucerne Rd were deployed in the rotas across both homes. There were currently six staff vacancies between the two homes. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 17 Staff indicated that mostly one and no more than two members of staff, which was not adequate to promote safety, covered shifts at Wivenhoe Rd, particularly as the three service users had high support and behavioural needs. Staff were concerned that current staffing levels and deployment did not ensure a consistent approach in the delivery of support to the individual with an Acquired Brain Injury (ABI), required to develop and/or maintain their rehabilitative state. The current staffing levels at best met the basic needs of the service users but left very little opportunity for quality time, social or community inclusion. The inspection highlighted that care staff also undertake cooking and cleaning duties in addition to providing personal care and support, which further detracts from the adequacy of staff ratio. The home had not recently appointed any new staff. The recruitment files of four members of staff were examined. All the files held evidence of the required checks undertaken including two satisfactory references, evidence of identification and a satisfactory enhanced CRB and POVA first disclosure; with the exception of one file and only one reference had been received. The files also included a completed application form, employment history, a written record of the interview, record of induction and a copy of the Contract of Employment, Statement of Terms and Conditions and a job description. A current annual staff training and development plan was not evident, but from the sample of staff files examined statutory accredited training in health and safety subjects such as Food & Hygiene, Infection Control, First Aid, Managing Challenging Behaviour and Medication Administration required update. This will be reviewed at the next inspection. The newly appointed senior carer confirmed completion of the 1st module of the homes competency framework and said the module reinforced current understanding and skills required for care delivery to people with an ABI, confirmation was obtained by written assessment of current own practice. The homes competency framework is commenced following successful completion of NVQ 2 and is linked to service aims and service users’ needs. Staff confirmed that management support is provided to the home by the Service Providers external management team, based at Elm Park. Ms Luck, the service manager attends the home twice weekly and the Health and Safety Manager attends the home once a week. Opportunities are provided to discuss concerns or care related issues, Service User review and household management at a weekly meeting, held by Ms Luck for all staff. Senior staffs indicated that they have endeavoured to support staff by regular practical supervision through daily contact. However a stronger emphasis on frequent, formal and fully documented supervisions is required to reflect all the elements necessary to support staff in developing and sustaining their working 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 18 practice and identify training and development needs; to be carried out by staff suitably trained in the supervisory process. The responsible person must ensure that more formal arrangements are in place with regard to providing regular supervision for all staff, in addition to providing regular contact on a day-to-day basis, particularly as staff work at times in isolation and the home is currently lacking leadership. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 40, 42 & 43. The home is currently without a manager and the interim managerial arrangements put in place by the Responsible Person are not robust enough for the home to benefit service users and staff in the long term. Health and Safety issues are addressed to promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: While the staff expressed appreciation for the help and support received from the Management at Elm Park, it was evident that a more hands on approach to the essential elements of management within the home was required. Concerns were also expressed that elements of working practice from Elm Park were beginning to overlap into a very different caring environment. Elm Park is regulated differently and works towards different standards and this may be confusing to some staff. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 20 Corporate policies and procedures were in place; they had recently been revised and updated. The staff were currently reviewing and considering their appropriateness to the service. The homes policy and procedure review group, led by the previous manager, had collapsed since her departure. Staff felt this was a shame as the workings of the group brought a clearer understanding of the guidance and relevance to working practice. Records indicated that fire drills had taken place including service users and staff, fire alarms, emergency lighting and fire safety equipment had been serviced within the last year (Sept 2005) and risk assessments and evacuation procedures were in place. The Health and Safety Manager carried out weekly inspections of the home, checks incident reports and ‘near misses’; risk assessments were generated from any reported ‘near misses’. All staff had received Health and Safety awareness training but they felt Fire Marshall training would be of benefit to them also. Records with regard to inspection of electrical installation, testing of personal electrical appliance and cleaning and chlorination of cold-water tanks were current. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 2 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 1 X X 2 X 3 2 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13(2) Requirement The Registered Person must review the current medication system to reduce the potential cause of error and harm to the service user. The Registered Person must ensure robust procedures are in place for responding to suspicion or evidence of abuse, incorporating Local policy and guidelines. The Registered Person must ensure there are sufficient numbers of staff, calculated in accordance with guidance recommended by the DoH, to support service users’ assessed needs. The Registered Person must ensure there is an annual staff training and development programme, informed by individual and team training needs assessment to ensure staff receive appropriate training and update as required to meet the stated purpose of the home. The Registered Person must ensure that staff receive the support and supervision they DS0000017727.V284620.R01.S.doc Timescale for action 01/06/06 2. YA23 13 (6) 01/06/06 3. YA33,YA13 18 01/06/06 4. YA35 18 01/06/06 5. YA36 18 01/06/06 192 Wivenhoe Road Version 5.1 Page 23 need to carry out their jobs. Staff have regular recorded supervisions as required by NMS 36.4. The Registered Person must ensure staff who supervise colleagues are trained and supported/supervised by senior staff. 6. YA37YA43 9 The Registered Person must ensure that service users and staff benefit from appropriate managerial arrangements, leadership and guidance. The Registered Person must ensure effective quality assurance and monitoring systems are in place to review care outcomes and inform future practice. This is a repeat requirement not met within previous timescale of 31st March 2005 and 1st September 2005, not assessed on this occasion and carried over from the last report. 01/05/06 7. YA39 24 01/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA40 Good Practice Recommendations The Registered Person should ensure policies and procedures are appropriate to the service. 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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 192 Wivenhoe Road DS0000017727.V284620.R01.S.doc Version 5.1 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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