Inspection on 19/04/07 for Foxton Grange

This inspection was carried out on 19th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Foxton Grange 08/04/08

Foxton Grange 28/04/06

Foxton Grange 17/11/05

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

CARE HOMES FOR OLDER PEOPLE Foxton Grange 571 Gipsy Lane Leicester Leicestershire LE5 0TA Lead Inspector Lesley Allison-White Key Unannounced Inspection 19th April 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 Foxton Grange DS0000063830.V336764.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. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foxton Grange Address 571 Gipsy Lane Leicester Leicestershire LE5 0TA 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) 0116 2460616 0116 2766593 home.fxg@mha.org.uk Methodist Homes for the Aged Linda Gazzard Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36) Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V25523. By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V32612. By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V38468. No person to be admitted into Foxton Grange in categories DE, DE(E) or MD(E) when 36 persons in total of these categories/combined categories are already accommodated in Foxton Grange Nursing and Residential Care Home. The maximum number of persons to be accommodated within Foxton Grange Nursing and Residential Care Home is 36. 20th September 2006 5. Date of last inspection Brief Description of the Service: Foxton Grange Nursing and Residential Home is a care home offering accommodation for up to thirty-six older people. The home is registered to accommodate older people with dementia and/or mental disorder. The home is divided into four separate units individually named. Two of the units are now dining areas. The home is located approximately fifteen minutes away from the centre of Leicester if travelling by car. Bus services are available near to the home. The home can be easily found just off the outer ring road. The building itself is purpose built and situated in a quiet area. There is parking available at the front of the building. All accommodation is provided on the ground floor level. All areas of the home is accessible to people who use wheelchairs. The home has a secure garden area for service users to walk. The home’s fees range from £567.00 to £660.00 per week. The Employers Liability Certificate of insurance is clearly displayed in the entrance hallway. Also seen was Registration Certificate from the Commission of Social Care Inspection (CSCI) and the last inspection report was displayed in the attractive hallway. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for residents and their views of the service provided. An unannounced inspection was undertaken. The inspection took place on a Thursday. It took seven hours to complete. Preparation for the inspection included review of the previous inspection report, service history, questionnaires returned by relatives. The primary method of inspection used was “case tracking”. This involved making observations of the residents who use the service provided, looking at two residents care plans, talking with two residents and observing care practices. Many of the residents were unable to convey their wishes. Three relatives spoke with the inspector. Two members of staff were interviewed. The following areas were covered during the inspection: case tracking, medication, sample of policy review, staff rota, quality assurance, accident records, fire records, observing communal areas of the home. All the required key standards were inspected during this visit. Requirements from the previous inspection have been met and during this inspection a requirement has been made. The Registered Person facilitated the inspection. What the service does well: Comments from relatives included ‘I think care here is brilliant, I visit regularly during the week and the staff are very good’ ‘When my relative is awkward they leave them alone and return to them later which is a very good idea they will not force them to do anything’. ‘I have found that my relative has improved my relative is able to find their way to the toilets on their own’. ‘Female care staff use to be a problem to my relative however it is very nice to see that the male staff will always try to attend to my relative knowing how important it is to him’. ‘My relative had a problem but once it was spotted it was treated. The staff called the specialist to see them.’ Residents were observed walking freely and unrestricted within the home. This is a good thing for residents. Foxton Grange DS0000063830.V336764.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. Foxton Grange DS0000063830.V336764.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 Foxton Grange DS0000063830.V336764.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given information about the home in order to make an informed decision about whether the service is right for them. EVIDENCE: Risk assessments are carried out before a resident is accepted to the home. They look at both physical health and mental health needs. The paper work relating to the risk assessments and care plans are being reviewed by the organisation and should lead to continued improvements in the assessments performed by the Registered Manager. A copy of the Service User Guide is available for prospective residents and also a copy of the Statement of Purpose. A copy of the Commission of Social Care inspection report is displayed in the foyer at the entrance to Foxton Grange. Intermediate care is not carried out by this home. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 9 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information relating to residents who fall should be recorded in their daily records in this way the continuity of care can be maintained. EVIDENCE: Two residents were case tracked. Assessments for the planned care needs were documented in both cases. The planned care needs were clearly written. Risk assessments for the prevention of falls were in place as were assessments of residents’ personal needs. Social care needs were not well documented a new activities coordinator has now been appointed and is making progress in this area. There was evidence that the home reviews the care plans and that the staff update them. The paper work for all the care plans the inspector was told is being updated. One of the care plans had the new paper work in it. It was well written with a good level of awareness of the resident’s needs which included Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 10 records of the daily health needs, changes and monitoring. The other resident’s care plan was in the process of being updated. Families are invited to attend reviews on residents care whenever possible. All residents have access to a General Practitioner (GP) and all have access to the opticians and other community services. Comments from relatives included ‘I think care here is brilliant, I visit regularly during the week and the staff are very good’ ‘When my relative is awkward they leave them alone and return to them later which is a very good idea they will not force them to do anything’. ‘I have found that my relative has improved my relative is able to find their way to the toilets on their own’. ‘Female care staff use to be a problem to my relative however it is very nice to see that the male staff will always try to attend to my relative knowing how important it is to him’. ‘My relative had a problem but once it was spotted it was treated. The staff called the specialist to see them.’ ‘My relative was fine but I do have a concern now that they are less able.’ The medications of the two residents case tracked were checked and found to be satisfactory. A different residents controlled drugs was checked and found to be satisfactory. On the day of inspection staff were observed using a standing aid to assist residents to stand before they were transferred to the wheelchairs. Staff remembered to ensure that residents’ clothes were correctly pulled down once transferred in this way the staff demonstrated the need to ensure that residents’ privacy and dignity is maintained. Staff did not always put the brakes on when carrying out this movement, which could lead to accidents. Wheelchairs with footplates on them were seen being used. A tall resident was seen being transported in a wheelchair, the footplates were not lowered to make it more comfortable for the resident whilst being transported neither did the staff find a more appropriate wheelchair. During the inspection a resident fell in the hallway there were no apparent witnesses. (The CSCI inspector found the resident). The care staff attended the resident and a Nurse went to the resident. A visual check was given of the resident and the resident was assisted back on to her feet by the staff. There did not appear to be any follow-up of this by the nurse in terms of Blood Pressure (BP), Temperature, Pulse and Respirations (TPR), and head injury checks. The Registered Manager was contacted about the incident later and she explained that an accident form had been completed by the Nurse however the Nurse did not follow company procedure as there was nothing entered in the daily records about the fall. This does not provide sufficient protection to the residents’ health and wellbeing, also if this is not recorded in the residents records this could be a Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 11 cause for concern later in the day or night. There will have been no history of a fall recorded in the resident’s records, which could be the cause of any symptoms presenting at a later moment in time. A requirement will be issued for this. Follow up on the supervision of care given by the Nurse, was not apparent, the care staff were not instructed either to follow-up on care or observations. This resident did not have her slippers on at the time of the fall. She had socks on her feet, this was left uncorrected. Residents were observed walking freely and unrestricted within the home. This is a good thing for residents however staff may also need to check on residents whereabouts at frequent intervals to ensure that all the residents are safe and accounted for. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements are being made so that activities within the home will succeed in meeting the identified daily and social needs of residents. The outcome is good for all the residents. EVIDENCE: In the hallway of Foxton Grange there is a display board of photographs with activities that have taken place, however to make it more memorable for people with memory problems they would find it more useful if the events were printed in large letters and dated. Family and friends were seen on the day of inspection and many of them felt welcome at the home. One of the relatives who spoke to the inspector felt that they could visit at any time to see their relative. A member of staff who spoke with the inspector told that the inspector that they use visiting times as a way of meeting with relatives and are able to ask relatives to buy small items such as toiletries when required for the resident who they are key worker to. The key worker system offers the staff member an opportunity to get to know the resident better as an individual. A new activities coordinator has been appointed who was previously a member of the care staff at Foxton Grange. Information about the residents’ likes, Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 13 dislikes and hobbies is in progress. The picture board in the hallway has pictures of her attending the wedding of a granddaughter the Grandmother from Foxton Grange. Photographs showed the resident to be well dressed for the occasion escorted by two staff members on the day. Other activities included residents going out as a small group. The activities coordinator explained that she provides the opportunity of one to one activities with residents including taking a resident home to see her family member who finds travelling to the home difficult to do, playing cards with individuals who normally do not choose or cannot join in group activities due to their limited concentration time. She will help to set residents hair or massage their hands and do foot spas. The activities coordinator does baking as a group activity. She explained that the residents really enjoy this as they enjoy the sensory smell of the baking and can hardly wait to eat the food once baked. She receives help to do this planned activity from the care staff. The social activity plans are being updated in each residents records when this is done it will give further evidence of being able to provide person centred activities which other staff can follow when she is not on duty. The activities coordinator also assisted residents with their meals at lunchtime she was also noticed to encourage conversations between residents at the dining table. A choice of two menus is offered to all residents. Specialised diets in the form of softened meals were also offered to residents who needed this, other specialised diets included diets for diabetic residents. On the day of inspection two kithen staff were seen serving the meals. Meals are now served from the kitchenette areas of each of the two dining areas at Foxton Grange this seems to be working well as the scent of the food will act as a reminder for many residents that it is a meal time and will prompt them to remember the type of meal being served to them. Staff were seen seated assisting residents (1 care staff to 3 or 4 residents) at the tables to have their meals although, if the meal was delayed in any way some of the walking residents would get up and wonder away from the table and staff were seen having to patiently return them to their meal. On the last Thursday of the month a religious service is provided for residents who wish to take part the minister brings a small choir with them and will spend time talking with residents and relatives afterwards. A priest will visit every two weeks to offer communion to residents of the Catholic faith. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff feel able to deal with most care situations. There are policies and procedures for dealing with complaints and protection. This protects residents. EVIDENCE: The Commission of Social Care Inspection has received complaints about Foxton Grange since the last inspection. Relatives felt that they could go to the Registered Manager if they had a concern or a complaint. However one set of relatives did not feel that concerns were acted on appropriately at all times and there was a need for better monitoring of residents by staff working at the home. However, on speaking to all parties it was decided that the family and the staff needed to work together so that a relationship of trust in the family and trust based on staff judgements would be developed. The Registered Manager was able to show the inspector the staff training records. On the issue of the Protection of Vulnerable Adults (POVA) over half of the staff had received training on this. Staff felt able to deal with most care situations. There are policies and procedures for dealing with complaints and protection. This protects residents. Foxton Grange DS0000063830.V336764.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, hygienic and comfortable environment. EVIDENCE: The inspector saw three bedrooms they were clean, uncluttered and tidy. Two of the bedrooms had specialised mattresses in them and or bed rails if assessed to be the most appropriate way of protecting the resident from fall injuries when in bed. The bedrooms had a walk in shower, toilet and face basin facilities in them. The corridors were well-lit, clean uncluttered areas. Bathroom and toilet doors were brightly painted in a bright orange. This would provide consistency for residents who are confused as they would be prompted to remember where these convenience rooms are situated in and around the home through the use of bright colours as visual aids. Bedroom doors were also in bright colours. One relative who spoke to the inspector said that his relative who is confused has learnt to find his way to the toilet areas in the home and will use them. Large sized street names of local areas are placed on Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 16 a section of the home’s walls. This is experimental by Foxton Grange to see if it helps residents to find their way back to their bedrooms. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained and supported. Staff receives regular supervision in this way residents are protected and not put at risk. EVIDENCE: Staff records contained evidence of relevant training. This included Moving and Handling, National Vocational Qualification (NVQ) level 2 in care, First Aid, Fire and the Protection of Vulnerable Adults training. The Registered Manager explained that the numbers and skill mix of staff were sufficient to meet the needs of the residents. Other training included risk assessment training and medication training for specific staff members. Specialist training such as challenging behaviour is to take place this month. There was evidence of good recruitment practices. Staff records inspected were satisfactory and had relevant information in them. However, the inspector was unable to see evidence of the Criminal Record Bureau Checks (CRB’s) on two of the three staff members records checked however this information was sent through as promised. By following satisfactory recruitment practices the residents are supported and protected by staff competent to do their jobs. The Registered Manager does formal supervision of staff at regular intervals. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 18 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are trained and supported. Staff receives regular supervision in this way residents are protected. EVIDENCE: The Registered Manager is a Registered Nurse who is experienced to run the home. She ensures that it meets its stated purpose, aims and objectives. The Registered Manager at Foxton Grange undertook a quality review with residents and relatives in December 2006 it was specific to the changes in the use of two of the lounge areas to become dining rooms. The results indicated that the majority of relatives did not mind the changes. Comments included: Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 19 ‘Good idea’ ‘Residents may see it as going out for dinner or lunch’ ‘I do not have any strong views but I feel that it loses its homely atmosphere’. ‘I’m not keen on the idea.’ ‘I feel that the kitchen area in the units is too small to serve food from.’ ‘I think the kitchen area in the units would be better if relatives could use it.’ ‘We have found that the new system works well.’ Staff responses to the changes were favourable as they thought that it was good for residents have a change of environment during the day. The Registered Manager has agreed to continue to monitor residents’ reactions and relatives feelings towards the changes surrounding dining arrangements. Money held on behalf of residents is kept safely. The money of two residents case tracked were checked and correct. Methodist homes also does regular quarterly checks on residents’ balances kept at their establishments. The Registered Manager explained that the fire records were up to date. This ensures the safety of residents living at the home. Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 17 X 18 3 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 3 X 3 X 3 X X 3 Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 21 None 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 OP37 Regulation 13 (4) (c) Timescale for action Entries relating to the health and 19/06/07 safety of any resident must be recorded in the individuals care plan so that changes in a resident’s condition can be traced and treated appropriately. Requirement 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 Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Foxton Grange DS0000063830.V336764.R01.S.doc Version 5.2 Page 23 - 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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