Inspection on 08/08/05 for Gibraltar Crescent (36a)

This inspection was carried out on 8th August 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gibraltar Crescent (36a) 20/02/07

Gibraltar Crescent (36a) 26/01/06

Gibraltar Crescent (36a) 17/11/04

Gibraltar Crescent (36a) 10/06/04

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

CARE HOME ADULTS 18-65 Gibraltar Crescent (36a) 36a Gibraltar Crescent Epsom Surrey KT19 9BT Lead Inspector Sandra Holland Announced 08 August 2005 10:30 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 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 Stationary 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. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gibraltar Crescent (36a) Address 36a Gibraltar Crescent, Epsom, Surrey, KT19 9BT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 393 0865 0208 393 8649 RNID Care Services South West and Wales, Berkeley House, The Square, Lower Bristol Road, Bath, BA2 3BH Mrs Anne Edwards Care Home (CRH) 6 Category(ies) of Learning disability (LD), 6 registration, with number Sensory impairment (SI), 6 of places Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The age/age range of the persons to be accommodated will be: 18-65 YEARS 2 The gender of those accommodated will be MALE and FEMALE Date of last inspection 17 November 2004 Brief Description of the Service: Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the first to be carried out in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. The inspection took place over six hours and was carried out by Mrs. Sandra Holland, Lead Inspector for the service. Mrs. Christine Downing, manager was present representing the service. A number of records and documents were examined, including individual plans, staff files, medication administration records (MAR) and a number of health and safety records. All six residents were greeted by the inspector on their return from their day’s activities and three members of staff were spoken with. As the inspector does not share the communication methods of the residents, the information for this report was obtained from speaking to staff, from records and documents and from the inspector’s observations of residents and staff. The inspector was able to interact with residents in a limited way, but was able to assess their body language and facial expressions. Members of staff explained about the inspection and the inspector’s role to residents. The people living at 36a Gibraltar Crescent prefer to be known as residents and that is the term that will be used throughout this report. What the service does well: What has improved since the last inspection? The manager is undertaking the process to be registered with CSCI. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 6 Window restrictors have been fitted to all windows on the upper floor. 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. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 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 standard(s) 2, 3, 4 and 5 Service users are fully assessed prior to admission to the service and are offered the opportunity of trial visits. EVIDENCE: A comprehensive preadmission assessment is carried out by the home, the manager stated. This covers all aspects of support the prospective resident would need and other relevant information, including behaviours, likes and dislikes, any areas of risk to the individual, and mobility and communication needs. The preadmission assessment of the most recently arrived resident was seen. The manager advised that the home gathers information required to ensure the home can meet the needs of the prospective resident. This is obtained from the resident and their representative, from their own preadmission assessment, from any care management assessment and from any other relevant specialists. It was clear that trial visits to the home are offered to prospective residents. This provides the prospective resident with the opportunity to meet other residents and staff, for the staff to assess the needs of the prospective resident and to ensure that the prospective resident is compatible with the existing resident group. A record of the trial visits of the most recently arrived resident was seen. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 9 The manager advised that residents are provided with a tenancy agreement (contract) with the Royal National Institute for the Deaf (RNID) who manage the home and with the Chichester Diocese Housing Association (CDHA) who own and maintain the premises. These were seen and did not contain all the required information. This was a requirement from the last inspection and the manager advised that she and other home managers have asked the RNID to urgently arrange for these to be reviewed. A requirement has been made. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 6, 7, 8 and 9. An individual plan is drawn up for each resident. Residents are supported to be as independent as possible. EVIDENCE: Detailed and comprehensive individual plans of each resident’s support needs are drawn up when the resident moves into the home, the manager stated. These were seen to be jointly available in written and makaton symbol format and had been signed by the resident to show their involvement. All the resident’s specific needs were included, along with the extent to which a resident would be expected to assist with household tasks. It was pleasing to see individual goals included, along with an action plan as to how these goals would be achieved. Staff advised that residents are supported to maintain and develop their independence and are actively encouraged to make personal choices. Residents are supported to choose their own activities, food, holidays, to manage their own finances and to vote. Photographs were seen of residents attending the local polling station. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 11 The manager advised that residents are also supported by a representative of the Royal Association for the Deaf (RAD) to ensure that they have access to an independent person. The representative attends support group meetings with residents and minutes of these, in both written and makaton forms were seen to be available to residents. The manager advised that the RAD representative had supported residents to complete pre-inspection comment cards, which provide feedback to CSCI on the residents’ views of the home. Any areas of risk to the health and welfare of the residents, such as the risks involved in cooking, bathing or fire safety are identified, assessed and recorded. These records are explained to residents in an appropriate form, including makaton. Residents are supported to be independent with reference to the level of risk identified. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 11,12, 13, 14, 15 and 16. Residents are supported by staff to develop their skills and to lead active and fulfilled lives. EVIDENCE: Residents are supported to take part in a wide range of activities, both educational and leisure. Staff advised that some residents attend adult education classes and some attend a day centre. Individual programmes of activities at the day centre are developed and presented as a diary sheet in makaton for residents. Activities were seen to include music and dance, crafts, office work and health and beauty. The manager spoke of the leisure and community activities enjoyed by residents, which include outings to pubs, theatres, bowling, and personal shopping trips to the local town centre. Some residents also attend a local church and others a group of scouts. Staff advised that residents enjoy their holidays away from the home and residents had recently returned from a holiday in the New Forest, staying in log Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 13 cabins, with members of staff. Photographs that were seen showed residents enjoying themselves there and on a day’s outing to Swanage. Most residents have family involvement and two residents are able go for short stays with their families. Pre-inspection comment cards were supplied to the resident’s representatives and those returned, made positive comments about the support their relatives receive. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 14 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 standard(s) 18, 19 and 20. Residents receive appropriate personal support. Their healthcare needs are well met. EVIDENCE: It was clear from observing residents and staff together, that personal support is provided according to the needs of the individual and in the way that the residents prefer. Personal support was given sensitively and discreetly and residents were spoken to in a respectful manner, using their preferred name. From the individual plans and speaking to staff, it was evident that a number of healthcare professionals are involved in the support of the residents. These include general practitioners (G.P.’s), community nurse, chiropodist, dentist and audiologist. Other specialists are accessed via a G.P. referral as required, the manager confirmed on the pre-inspection questionnaire. Medication administration is effectively carried out, using a medication dosage system, in which medication is provided individually in “blister” packs. Records seen were accurately maintained and the amount of medication held in the home matched the records held. The home’s procedures for administering medication are monitored by a pharmacist. On the last visit the pharmacist made very complimentary comments about the home’s administration of medication on the record sheet that he left. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 15 Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 22 and 23. A complaints procedure is widely available in a format suited to the needs of the residents. Staff are aware of their responsibilities in the protection of residents. EVIDENCE: A complaints procedure is in place and is available to residents in their “Resident User Guides” in their bedrooms and in their individual plans. A complaints record book is maintained, was seen and did not contain any entries. The complaints record book is currently stored in the upstairs office and is not freely accessible to anyone wishing to use it. Although no complaints had been recorded, it is required that the complaints procedure and record book are made available in a communal area, for anyone to use. From speaking to staff and the records seen, it was clear that staff are aware of their responsibilities in the protection of residents. The home holds a copy of the Surrey Multi Agency Procedure for the Protection Of Vulnerable Adults (POVA). Staff have undertaken POVA training and those spoken to stated that they felt able and were willing, to notify any concerns they had. A recommendation has been made. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 17 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 standard(s) 24, 27, 29 and 30. The décor of the home provides a comfortable and homely environment for those living there. EVIDENCE: The home is situated in a residential area of Epsom, with easy access to local shops, pubs, public transport and other facilities. It is cheerfully decorated and is well maintained and furnished. An attractive garden is available at the back of the house and has a number of chairs and tables. All residents have single bedrooms and most hold the key to their bedroom door. Resident’s individual plans record those residents who do not wish to hold a key to their room or who are unable to do so. Two residents were happy to show their bedrooms and these have been personalised with their own belongings, including televisions, music facilities, pictures and ornaments. Staff advised that residents are supported to take responsibility for keeping their own bedrooms clean and tidy, usually on an allocated “home day”. The manager stated that all residents are fully mobile, but specialist equipment or adaptations are provided as necessary, following appropriate assessment. A Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 18 bath was in the process of being changed on the day of inspection, to meet the needs of a resident who found the original bath too high to safely access. It was pleasing to hear that the manager had commissioned a private, occupational therapist assessment of the resident’s needs in relation to the bathroom. This was because there was too long a delay in waiting for an assessment via the health service. Appropriate adaptations have been made to the home to meet the sensory impairment needs of the residents. A flashing light is fitted in each resident’s bedroom to indicate when the fire alarm is activated. Some residents (and the staff sleepover room) also have a “Shakeawake” mat fitted to their beds, which vibrate to indicate when the fire alarm is activated. All areas of the home were seen to be clean, hygienic and freshly aired. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36. Residents are supported by a committed and enthusiastic team of staff. EVIDENCE: The residents are supported by a small team of support staff under the leadership of the manager and her deputy. Staff advised that they all share the support tasks within the home, including shopping, cooking, laundry and assisting with personal care. Training for members of staff in the home, is well organised and includes mandatory and other training courses, to the benefit of the residents. The staff training record was seen and from this it was clear that staff undertake regular and appropriate training, including fire awareness, manual handling, food hygiene, medication administration and POVA. Training specific to the needs of residents is also undertaken, including British Sign Language (BSL). A number of staff have taken, or are undertaking National Vocational Qualification (NVQ) training courses and the home is on target to meet the required ratio of 50 of trained care staff. The manager stated that formal supervision meetings are held with members of staff on a regular basis and to the required frequency. A record of the Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 20 planned meetings is openly accessible and was seen, but the confidential supervision notes are kept in a locked provision. Recruitment records were seen and a small number of shortfalls were noted: • A contract of employment was not available for one member of staff • Medical questionnaires are not held in recruitment files • In the event that a conviction or caution is shown on a CRB disclosure, a risk assessment must be carried out in respect of that person. A record should also be retained to show how the decision to employ any such person, was made. A requirement has been made. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39 and 42. Residents of the home benefit from an open and inclusive ethos and effective management of the home. EVIDENCE: It was evident from the standard of record keeping, the high standard of the home’s premises and the approach of staff, that the home is effectively managed. The manager advised that her application to be registered with CSCI is in progress. The manager was seen to interact in an informal but professional manner with residents and staff. The manager advised that annual quality questionnaires are circulated to families and representatives of residents and to stakeholders in the community, such as G.P.’s and chiropodists. The summary of the last survey was seen and contained positive responses. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 22 Visits to the home under the requirements of Regulation 26 take place and a record is retained. It was noted that these visits are not always unannounced as required. A number of records in relation to health and safety (but not all) were seen and these were found to be satisfactory. The records relating to fire safety were seen and found to be up to date, with appropriate equipment in place for residents with sensory impairments, which is regularly serviced. The records of hot water temperatures were also seen and recorded that the hot water supply was within a safe range. It was very positive to see that regular safety checks carried out in the home have been formulated in makaton symbols, in order that interested residents can be involved. A record was seen that confirmed that water samples had been sent for testing for Legionella bacteria. The report of the outcome of the test was not available and it is recommended that this be obtained. A requirement and a recommendation have been made. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 x 4 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gibraltar Crescent (36a) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x 2 x H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 24 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 YA5 Regulation 5(1) (b)& 17(2) Schedule 4 (8) Requirement The registered person must produce a statement of the terms and conditions in respect of accommodation to be provided for residents, including as to the amount and method of payment of fees; and a standard form of contract for the provision of services and facilities by the registered provider to residents; this statement/contract to be specific to each individual resident. REQUIREMENT CARRIED FORWARD FROM 10/11/04 The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home and the information and documents specified in in Schedule 2 have been obtained in respect of that person. The registered person must maintain a record of all persons employed at the care home, including in respect of each person so employed, records in relation to his employment. Specifically, all persons employed must be supplied with Timescale for action 11th November 2005 2. YA34 19(1)(a) (b) Schedule 2 & 17 (2) Schedule 4 9th september 2005 Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 25 3. YA39 26 (3) a statement of the terms and conditions of their employment. Where the registered provider is an individual, but not in day to day charge of the care home, he shall visit the care home in accordance with this regulation. Visits must take place at least once a month and must be unannounced 9th september 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 22 42 Good Practice Recommendations It is recommended that the complaints record book is retained in a communal area in order that it is available to all who may wish to use it. It is recommended that the report of the water testing for Legionella bacteria, be obtained. Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Gibraltar Crescent (36a) H09 H58 S13491 Gibraltar Crescent V231902 080805 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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