Inspection on 26/10/08 for Green Hill

This inspection was carried out on 26th October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Green Hill 12/07/09

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Green Hill Station Road Crowhurst Nr Battle East Sussex TN33 9DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 2 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Green Hill Station Road Crowhurst Nr Battle East Sussex TN33 9DB 01424830295 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rooks (Care Homes) Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 30. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Green Hill is registered to provide care for up to 30 older people with a dementia type illness. The home is a large detached property situated in a semi-rural area close to the local railway station in the village of Crowhurst, near Battle in East Sussex. Due to the rural location access to community facilities are limited. Accommodation is on two floors and comprises twenty single and five double rooms, all of which have a wash hand basin. The home has four bathrooms and aids and adaptations have been installed throughout the home to suit the needs of service users. These include assisted baths toilet riser seats and grab rails. Communal areas comprise a dining room and a large lounge separated into one large area and two smaller ones giving service users the opportunity to sit quietly, a further lounge is situated off the dining room. There is a large amount of refurbishing that is being undertaken by the new Care Homes for Older People Page 4 of 27 30 Over 65 0 Brief description of the care home provider and there may be changes to the communal bathrooms and double rooms. There are attractive well maintained gardens to the front and rear of the property which are accessible via ramps. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Green Hill Care Home will be referred to as residents. This was the homes first key inspection that included an unannounced visit to the home on the 26 October 2008 and follow up contact with two health social care professionals who have had some recent involvement with the home. The allocated inspector spent approximately five hours in the home and was able to discuss the inspection process with the deputy manager, who also received the Care Homes for Older People Page 6 of 27 inspection feedback at the conclusion of the visit. During the assessment visits the inspector spent time meeting with residents staff and observing practice in the home. A tour of the premises was undertaken and a range of documentation was reviewed including the homes Statement of Purpose, pre-admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, quality assurance systems and health and safety records. The care documentation pertaining to four residents were reviewed in depth and the inspector was invited to the midday meal. This inspection has been completed with a proportionate approach and it must be bourne in mind that this is a new service that is operating at approximately a third of its full occupancy The home has therefore been judged on its current provision service and management arrangements Fees currently range from 375.00 pounds to 575.00 pounds per week. Additional charges are made for individual newspapers, chiropody, hairdressing and physiotherapy. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services, and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. Evidence: The homes Statement of Purpose and Service Users Guide was available on request. In addition the home has an on going brochure on display in the entrance of the home that includes photographs of the improvements to the home as they are completed. These documents were informative and contained information about the home and the services it provides, along with the qualifications of the staff, fees and additional costs. The Service Users Guide was written before the ownership was finalised and therefore areas of the document are in need of updating and the manager structure of the home Care Homes for Older People Page 10 of 27 Evidence: needs ammending. An assessment of the admission process followed included the review of the documentation relating to the last two admissions to the home. This confirmed that all prospective residents are assessed by the registered or the deputy manager. The assessments viewed were completed in full and informative and took into account the individual needs and what the home could offer the prospective resident. The deputy manager demonstrated a clear understanding of the homes admission criteria and is therefore aware that any changing needs are subject to constant reassessment that may lead to relocation to another more suitable care home. It was confirmed that the home confirm in writing that they can meet the assessed needs of the prospective resident. The home does offer short respite care and one resident that came to the home for respite has now moved in permanently. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. From reviewing the care documentation and from direct observation, the health and personal care needs of residents are met with evidence of specialist advice sought when necessary. The care plans were informative and person centred with evidence of regular review. On the whole the homes practice ensure residents medicines are administered safely. Evidence: The care documentation pertaining to five residents were reviewed in depth as part of the inspection process. The care plans clearly identify the residents individual needs with a plan of action for staff to follow and an associated risk assessment in place to guide staff and ensure the residents safety. There was evidence of regular review and family involvement where possible. As previously identified the risk assessments are included in the care planning format used by the home, and were found to be person centred and related to the identified care need. There was evidence of weights being recorded and followed through with a plan of action where necessary. Residents mental health needs and behavioural traits are clearly documented with a plan of Care Homes for Older People Page 12 of 27 Evidence: action in place for staff to manage in a consistent way. Doctors input in to the residents care is recorded and evidenced that the staff are proactive when identifying a health need and in contacting the relevant health professional. Observation of practices in the home confirmed that staff were meeting residents needs in a flexible way allowing residents to direct the care and support that they need. Feedback from a health professional was positive regarding the home and confirmed that advice was sought as and when required. The clinical room is of an adequate size and there are suitable storage facilities for medication stocks and dressings a medicine trolley is stored securely and appropriately when not in use. An appropriate controlled medication cabinet is in place. From direct observation the midday medications were administered safely and were in line with the homes policies and procedures. There are policies and procedures in place for staff to refer to regarding the safe administration storage disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. The Medication Administration Charts (MAR) were viewed and were accurately completed. The comparison signatures of staff able to administer medication were available and current. Staff were seen to be respectful and considerate to all residents, whilst attending to their needs. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Care is delivered in such a way that promotes and protects the residents privacy, dignity and individuality. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to live their life in accordance within their own expectations and preferences maintaining links with family and friends. Residents preferences are well respected and the food provided is both appetising and wholesome. Evidence: The home have individually assessed the residents capabilities and have with the help of families and friends built up a life history of the residents living in the home. The residents all have a life box that contains pictures, objects, information of the family members, particular interests and past hobbies of the residents. Throughout the day staff were seen inviting residents to the area designated for activities and interacting with residents on a one to one basis. Photographs displayed on the wall evidenced residents participating in various activities either as group for cooking or with staff on a one to one activity. There is no activity programme as the ten residents have varying capabilities but this will change as more residents come to live in the home. The deputy manager shared her plans for the activities, which include a nature trail in the coppice beside the home which is being cleared for this purpose, visits from Care Homes for Older People Page 14 of 27 Evidence: entertainers are being explored and making use of the patio which is secure planting flowers. The staff keep a diary of the residents participation and daily activites. The minister visits the home regularly and it was confirmed that the residents wishes regarding their religous needs are taken into consideration and faciliated upon admission where possible. There are no set routines in the home and this allows the care and services to be flexible. Green Hill has an open visiting policy and all visitors are warmly welcomed. There was one visitor during the afternoon of the inspection who was seen to have a good rapport with the staff and was complimentary regarding the home, no complaints, very nice staff, kind and suppotive. Residents rooms are seen as their own private accommodation and staff always knock on doors and wait for a reply before entering. The deputy manager works well with residents and staff to ensure that this freedom and protection of individuals rights is maintained. The kitchen is clean and well organised, the deputy manager is aware that the kitchen has some improvements needed and this will be undertaken when some of the refurbishment is completed in respect of electrical and plumbing work. The meal eaten in the home was found to be of a good standard and included beef pie, roast potatoes and vegetables, followed by rice pudding. It was enjoyed by the residents and residents were offered support in a discreet and helpful manner. One resident who was not eating was given an alternative. The kitchen is well managed and the menus are based on residents choices preferences and needs. The cook completes the safer cooking better business book as supplied by the Environmental Health Organisation. Residents appetites are recorded and fortified food or an alternative is offered for those who have not eaten or are losing weight. The dining area is attractive, well ventilated with natural light. The furniture is matched to the needs of the residents. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a formal complaints system with evidence that families feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. Evidence: A complaints procedure is available in the home. A review of this documentation identified that it was clear and detailed response times. Everyone spoken to as part of the inspection process confirmed that they would feel comfortable in raising any concern with the deputy manager and were sure that she would deal with any matter in an effective way. There have been no complaints received since the home opened in June this year There is a Safeguarding Vulnerable Adults procedure in place, which clearly identifies the importance of reporting any allegation or suspicion of abuse to Social Services who are the lead authority. It was noted that the home did not have the most recent local policies and procedures on Safeguarding Vulnerable Adults and they need to ensure a copy is available in the home. The deputy manager confirmed that she had completed train the trainer training on Safeguarding Vulnerable Adults and was able to demonstrate a good understanding of the issues. All staff have received formal training on Safeguarding Vulnerable Adults. Care Homes for Older People Page 16 of 27 Evidence: Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable clean and safe environment for those living in the home and visiting. Residents rooms are homely and comfortable and reflect the residents personalities and interests. Evidence: The tour of the home evidenced that the planned refurbishment of the home is well underway. The first floor has been totally refurbished and redecorated and is ready for use. The ground floor bedrooms that are in use were clean and attractively furnished. It was confirmed that routine maintenance issues are attended to alongside the refurbishment programme. The communal areas are decorated in calm, neutral colours and provide attractive and comfortable areas for the residents. The appointed manager has brightened the home with pictures and ornaments and one of the recently arrived residents has brought in her piano. The second smaller lounge is still decorated in an older style, but old style pictures and books have made this in to a comfortable remembrance room, the deputy manager has further plans for this area. The gardens and patio areas are well looked after and attractive and the patio is enclosed for the residents safety. The garden and coppice areas are being cleared and will in the future provide country walks. Care Homes for Older People Page 18 of 27 Evidence: The resident bedrooms in use at this time are all on the ground floor, one double room is being used as a single room and the other double room has an appropriate portable screen to ensure privacy. The newer wing has seven single bedrooms which are all attractively decorated with good quality furniture, the rooms are personalised and comfortable. There are adequate communal bathrooms in the home, one has a specialist chair to ensure all residents can have a bath. One bathroom on the ground floor is being converted in to a hairdressing salon and beauty therapy room. There is written evidence that staff test temperatures of baths before bathing a resident. It was confirmed that hot water temperatures are checked and recorded regularly by the maintenance person. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. It was verbally confirmed that these are up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open during the inspection. Call bells are provided in all bedrooms and communal areas and risk assessments are in place for the residents that do not have the capacity to use a call bell. The use of bedrails is assessed clearly and reflected in the individual care plans. The laundry room was found clean and tidy and the residents clothes are well looked after. The cleanliness in the home was found to be of a good standard. The cleaning is undertaken by the care team at this time, but this will be reviewed when the number of residents increase. All Staff attend training in infection control. There are areas of the home that have not yet been refurbished or redecorated, but these areas are not accessible to residents or visitors. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are in place to protect residents and staff training ensures they are aware of their roles and are able to provide the support and care that the residents need. Evidence: The residency levels at the home currently run at 10 and the staffing levels are at present sufficient to meet the residents needs. Three carers are on duty for the day shift and two carers on at night. The deputy manager lives in the home and provides on call cover. In addition to the care staff there is a full time cook in post, a registered manager and deputy manager and a maintenance person. The carers currently cover the cleaning and the laundry, this will be reviewed once the residency ratio increases. The induction programme has been introduced for all new staff, two members of staff have recently commenced work and are working alongside a senior carer on the Skills for Care induction programme. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been introduced to protect residents and contained all the relevant information required. There was evidence of application forms, health questionnaires, Criminal Record Bureau checks, two references, a resume of previous Care Homes for Older People Page 20 of 27 Evidence: employment and work permits where necessary. All the paperwork is kept within a locked room Discussion took place regarding the training in place for the staff. The deputy manager provided a training spreadsheet which clearly identified that the training records for staff were up to date and evidenced an on going training programme. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the deputy manager. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from a managerial structure that provides leadership and support to the staff and promotes the health and safety of the residents. Evidence: The registered manager has been in post since February 2008 and became the registered provider and manager of Green Hill in June 2008. She has experience in managing and owning a care home for older people in Kent. The deputy manager completes the management structure and is the person who takes the responsibility for the day to day running of the home and as she lives on the premises is on call for any emergency, evenings, nights and weekends. Discussion with the registered provider following the site visit took place regarding the current management structure of the home and the deputy manager is now the appointed manager. This needs to be clearly reflected in the Statement of Purpose and Service Users Guide. Quality assurance systems have recently been introduced and audited and it is Care Homes for Older People Page 22 of 27 Evidence: recommended that these are displayed to the families and visitors to the home. Regulation 26 visits have not been carried out by the registered provider and thus the provider is not monitoring the performance of the home as part of the quality assurance systems. This was fully discussed and needs to be commenced. The home does not handle any of the residents monies and any extra charges such as chiropody are invoiced to the residents family or representative. There is now evidence of staff supervision having been being commenced for all the staff employed in the home. However the deputy manager is not having formal supervision sessions and this needs to be introduced to monitor her progress and give her the support required in the absence of the registered manager. There are policies and procedures in place that have been developed since the new provider took over the home. Two policies were reviewed and were found to be service specific and relevant to the homes category. The staff employed in the home have received training in Food Hygiene, Safeguarding Vulnerable Adults, Health and Safety, Fire Safety and First Aid in order to promote good practice and ensure the health safety and well being of the residents living in Green Hill. Green Hill looked well maintained and systems are in place to report any problems to the maintenance team that need attention. The staff were observed working safely in the home in all aspects of care. The deputy manager confirmed that specialist advice had been sought regarding wheel chairs and they were awaiting delivery. The furniture was seen to be suitable for the residents living in the home at this time it was confirmed that new furniture will be introduced gradually as new residents arrive. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 That the registered person ensures that the Statement of Purpose and Service Users Guide is up to date and reflects the new ownership of the home. To provide the correct information. 14/01/2009 2 33 26 That the registered person who is not in day to day charge of the home will visit the home once a month and be unannounced. To ensure the home is managed appropriately and in the best intrest of the residents. 14/01/2009 3 36 18 That the registered person ensures that all staff receive formal supervision. This pertains to the deputy manager. That staff are appropriately supervised. 14/01/2009 Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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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