Inspection on 05/07/06 for Heathcote

This inspection was carried out on 5th July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heathcote 09/07/07

Heathcote 08/11/05

Heathcote 17/06/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Heathcote 6 Cecil Road Swanage Dorset BH19 1JJ Lead Inspector Gloria Ashwell Key Unannounced Inspection 13:20 5th July 2006 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 DS0000062289.V301097.R02.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. DS0000062289.V301097.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathcote Address 6 Cecil Road Swanage Dorset BH19 1JJ 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) 01929 423778 01929 475869 Mr Mark Charig Mrs Lisa Heather Charig Mr Mark Charig Care Home 10 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10) DS0000062289.V301097.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 4 persons (within the total of 10) under the age of 65 in the category of MD may be accommodated. 8th November 2005 Date of last inspection Brief Description of the Service: Heathcote is registered to provide personal care for up to 10 people over the age of 65 years, and has been granted a variation to this condition to enable up to 4 persons (within the total number of 10) below the age of 65 to be accommodated and cared for. The home is registered to Mr and Mrs Charig who live on the top floor of the premises with their family; Mr Charig is the registered manager and Mrs Charig also works within the home. Heathcote is an older style property, situated in a quiet residential road close to Swanage town centre where there are a number of shops, restaurants and other facilities including public transport buses. The home has a large garden to the rear and smaller garden with off road parking at the front of the home; additional unrestricted parking is available on the road. Resident’s accommodation is on the ground and first floors; the owners private accommodation is on the second floor. Access between the first and second floor is by a central stairway and passenger lift from the ground floor. Communal areas include a lounge and an adjoining dining room with patio doors providing access to the rear garden. The home has a laundry equipped with a washing machine and tumble drier. Arrangements can be made for a hairdresser, chiropodists, opticians and other health and social care professionals to visit individual residents. Fees are charged weekly and at present range between £366 and £550 per person. DS0000062289.V301097.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a statutory inspection required in accordance with the Care Standards Act 2000. The inspection was unannounced; the inspector arrived at 13.30 toured the premises and spoke to residents and staff and with registered manager Mr Charig discussed and examined documentation. At present 8 permanent residents are accommodated at Heathcote; two are each occupying rooms registered for two persons, so although the home is registered to accommodate up to ten residents there are no vacancies. The home is registered to accommodate up to 4 persons below 65 years of age; at present 2 residents below 65 years are accommodated. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same resident were examined, and the resident spoken with. Additional information used to inform the inspection process included the monthly reports regularly sent to the Commission by the provider and the Preinspection Questionnaire completed in advance of the inspection by Mr Charig. Since the previous inspection five completed Comment Cards were sent to the Commission by the relatives of residents, and one from a health and social care professionals. All comments indicated satisfaction with the home; one observed “Heathcote stop at nothing to ensure their residents are constantly cared for around the clock. The whole idea of a family run business works extremely well as this ensures the residents feel welcome, entertained, loved…”. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the service does well: Heathcote is a small family run home where residents experience few staff changes and live in a cosily domestic environment. Relatives of residents hold the home in high regard. Comments received by the Commission in advance of this inspection included “I feel this home has so much to offer. It really is like being within a family”. DS0000062289.V301097.R02.S.doc Version 5.2 Page 6 The home provides good care to residents who are mainly of low and medium levels of dependency, and frequently experience mild degrees of dementia. Meals are appetising and of good quantity and quality. Staff are kind and helpful to residents. Residents are treated with respect and their privacy is protected. Residents feel safe and well cared for and the home provides a range of social and recreational activities. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000062289.V301097.R02.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 DS0000062289.V301097.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so Standard 6 does not apply) Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Prospective residents (or their representatives) are provided with information about Heathcote and are encouraged to visit in advance of admission to establish their impressions of life at the home and the standard of available accommodation. Prior to admission, the needs of each proposed resident are assessed and the home then writes to prospective residents confirming the ability to properly care for them. EVIDENCE: The records of a recently admitted resident included details of pre-admission assessment which had been carried out by Mrs Charig when she visited the prospective resident at her previous address. DS0000062289.V301097.R02.S.doc Version 5.2 Page 9 In advance of making the decision to enter the home the closest relatives of the prospective resident visited Heathcote to view the premises on her behalf because she was too frail to do this herself. The inspector spoke to the resident who confirmed satisfaction with the home and said “I like it here”. Comments received by the Commission in advance of the inspection included “X was very poorly before arrival at Heathcote but was quickly made to feel at home and has settled really well. Nothing is ever too much trouble for the staff and we love the family environment…. we have made an excellent choice in this care home and praise the staff in all they do”. DS0000062289.V301097.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is variable; feedback from the relatives of residents provides evidence of good care provision but documentation does not always support this and must be improved. This judgment has been made using available evidence including a visit to the service. For each resident there is a written plan of care but these are not all comprehensive and thereby fail to ensure that staff have sufficient information upon which to base their care practice. Residents’ health needs are fully met and periodic audit of accidents is recorded to minimise risks of recurrence. Medicines prescribed by doctors are administered to residents by staff trained in this work, thereby protecting residents from medicine errors. Improvements must be made to the recording systems for Controlled Drugs to ensure that these medicines are accurately administered and properly accounted for. Residents are treated with respect and their privacy and dignity is protected at all times. DS0000062289.V301097.R02.S.doc Version 5.2 Page 11 EVIDENCE: Relatives of residents believe they are properly cared for; comments received by the Commission in advance of the inspection included “X is treated by all members of staff with care, kindness and dignity….is always clean, comfortable and appropriately dressed…”. Care records of 3 residents were examined; each contained risk assessments forming the basis for care plans and daily records describing the care of each resident. To ensure correct identification, records contain a recent photograph of each resident. However, for one resident it was noted that the daily records failed to properly describe the behaviour of the resident, and in the care plan there was no description of a wound stated to be present, of the treatment of the wound and of other skin care provided at the direction of a visiting nurse. To monitor the care of a resident at night an electrically operated ‘pressure mat’ is placed on the floor next to the bed; the use of this device has not been subject to a consent or risk assessment process and is not referred to in the care plan. This report contains associated requirements for the improvement of care plans and associated records and processes, to ensure the provision of sufficient information to staff, enabling them to provide the correct care to each resident. All accidents are recorded and the home periodically audits accidents to identify any trends or patterns and subsequently to introduce measures to reduce the risks. Residents wishing to do so can manage their own medicines in accord with a risk assessment process; at present none of the currently accommodated residents manage their own medicines. Records indicated that in general, medicines had been accurately administered and residents said that they receive the correct medicines at correct times. However, records of Controlled Drugs did not provide a reliable audit trail for the safe keeping and correct use of these medicines; it is required that accurate records be kept of the receipt, use and disposal of Controlled Drugs. Additionally it is recommended that the index of pages used in the Controlled Drug register include the name of the resident, (i.e. not only the drug), to ensure accuracy of the audit trail, accountability for all Controlled Drugs and the consequent provision of prescribed health care to residents. DS0000062289.V301097.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The quality of daily life in the home is good with residents assisted to maintain as much independence as possible. Social and leisure activities are suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. On the ground floor there is a well-appointed dining room; residents may also take meals in their bedrooms. EVIDENCE: Residents are very satisfied with all aspects of the home, including the range of activities, meal provision, staff and premises. Mr Charig and care staff arrange local excursions, one-to-one and small group social and recreational activities. Residents enjoy the activities and consider them appropriate and of good variety; in advance of the inspection a residents’ DS0000062289.V301097.R02.S.doc Version 5.2 Page 13 relative commented to the Commission ”It really is like being within a family. It is a delight to have children and a friendly dog in the home and this appears to give all the residents lots of enjoyment and interest on a day to day basis”. Visitors are welcome at any time and the one present during the inspection said he is always made to feel welcome and placed at ease by the staff. Residents said they were satisfied with the quality, choice and quantity of food provided; one resident said ”It always suits me”. DS0000062289.V301097.R02.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The complaints procedure provides information on the procedure to follow to persons wishing to make complaint; all complaints are recorded and properly investigated. The home protects residents from harm and abuse. EVIDENCE: To ensure residents and their representatives have access to the complaints procedure it is included in the service user guide to the home and a copy is provided to each residents’ relative/representative. Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. Comments received by the Commission in advance of the inspection included “Never had to complain”. The home keeps records of all complaints received and investigated. Since the last inspection no complaints against the home have been received or investigated. The home adheres to a policy/procedure for the prevention of abuse and all staff have received training in this subject to ensure that they remain vigilant to protect vulnerable residents from risks of abuse and know how to properly manage any allegation or suspicion of abuse. DS0000062289.V301097.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The premises are comfortable and clean. EVIDENCE: Residents’ bedrooms are on the ground and first floors of the home. A passenger lift provides smooth access to all parts of the registered premises. It is recommended that the suitability of the premises be formally assessed by an occupational therapist to provide reliable evidence that it properly meets the needs of the currently accommodated residents. Rooms are attractively decorated and appropriately furnished and the home has a cosy and relaxed atmosphere. The home is clean, well ordered and properly maintained. DS0000062289.V301097.R02.S.doc Version 5.2 Page 16 There is an ongoing programme of improvements; since the last inspection these have included relocation of the office to a small building in the grounds, close to the main house. A comment card completed by a residents relative and provided to the Commission in advance of the inspection stated that Heathcote is “spotlessly clean…light, warm and homely”. DS0000062289.V301097.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good with regard to the number of staff and their competency but improvements must be made to employment processes to ensure the protection of residents against the employment of unsuitable staff who may place them at risk of harm. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. Employment records of two recently employed staff were examined; for each person in advance of employment the home had obtained evidence of identity and CRB disclosure but for one of the staff there was no evidence of any reference having been obtained, and the history of employment recorded by the other staff member was inaccurate and this aspect had not been considered during the employment process. For all new staff, in advance of employment, the home must obtain at least two written references and an accurate history of past employment to ensure residents are not placed at risk by the employment of potentially unsuitable staff. An Immediate Requirement in this regard was issued during the inspection. DS0000062289.V301097.R02.S.doc Version 5.2 Page 18 Mr Charig is a trained nurse experienced in the care of people with mental health needs, although he does not work in this capacity in Heathcote because the home is not registered to provide nursing care. At present 3 of the 8 care staff currently employed by the home are training for a National Vocational Qualification in care; when these qualifications are obtained the home will be close to meeting the standard for at least 50 of the care staff to hold an NVQ in care. The home uses an external training provider and Mr Charig is a ‘basic life support’ trainer. Staff receive training in appropriate subjects including moving and handling, infection control, understanding dementia, food hygiene and health and safety promotion. To assist the training of care staff there is available a range of opportunities including www.picbdp.co.uk (the Partners in Care web site), www.skillsforcare.org.uk (the Skills for Care web site), www.traintogain.gov.uk (a programme and funding stream supported by the Learning and Skills Council and Business Link) and www.lsc.gov.uk/bdp/employer/eggt_intro.htm (the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility). DS0000062289.V301097.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is generally good; the home is well managed and suitably staffed, much liked by residents and their representatives and well maintained although staff training in fire safety must be improved to ensure the continued safety of all persons in the home. This judgment has been made using available evidence including a visit to the service. The home does not manage the finances of residents. The premises and equipment are properly maintained in good condition. DS0000062289.V301097.R02.S.doc Version 5.2 Page 20 EVIDENCE: Mr Charig is the registered manager of the home; he has extensive experience in the care of older persons and the care of people with mental health needs. The home has ongoing systems for quality assurance; satisfaction surveys are periodically issued and the results audited by an external consultancy employed by the home. To ensure continuity of approach the home operates in accord with a selection of policy and procedure documents; it is recommended that at the earliest opportunity these are extended to include all those referred to by the Commission in the pre-inspection questionnaire, including the subjects of clinical procedures and volunteers. With the exception of safe keeping some amounts of cash (for which all transactions are confirmed by receipt), the home does not manage the finances of residents. Staff trained in First Aid are on duty in the home at all times. All staff are supervised and each has a personal profile containing records of appraisal. The premises are well maintained and there are regular checks/tests of all equipment. Details of equipment servicing and maintenance were provided to the Commission in advance of this inspection. The inspector examined some records to verify this information including the following: - passenger lift: routine service 2 June 2006 - report of water testing for risks contamination on 31.5.06, confirming that “no species of Legionella bacteria were isolated from the samples(s) analysed” - records of regular checks/tests of fire safety equipment. As the result of the misunderstanding of requirements by Mr Charig staff have been receiving fire safety training annually, not twice each year as required by Dorset Fire & Rescue Service. A requirement was issued during the inspection to effect that by 5 August 2006 all staff who have not received fire safety training during the previous 8 months must receive this training and records must be kept to provide evidence. For excursions the home has a ‘people carrier’ driven by Mr or Mrs Charig. It is recommended that to ensure the safety of passengers the designated drivers of the minibus receive associated training and work in association with a specific policy/procedure giving guidance on accompanying residents on excursions. DS0000062289.V301097.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 DS0000062289.V301097.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP7 Regulation 15 17 & Sch 3 (3k) Requirement A comprehensive care plan must be drawn up for each resident. For each service user the home must keep clear and comprehensive records of the persons’ condition(s) and all interventions. The use of the electrically operated ‘pressure mat’ must be in accordance with a consent, risk assessment and care planning process. Clear and accurate records must be kept of the receipt, use and disposal of Controlled Drugs. There must be evidence that the home operates a robust recruitment system; new staff must not commence work in the home without evidence of written references and accurate employment history. Previous timescale of 8/11/05 not met. All staff who have not received fire safety training during the previous 8 months must receive this training and records must be kept to provide evidence. DS0000062289.V301097.R02.S.doc Timescale for action 05/08/06 05/08/06 3. OP8 13 05/08/06 4. 5. OP9 OP29 13 19 & Sch 2 05/08/06 05/07/06 6. OP38 13 05/08/06 Version 5.2 Page 23 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. 3. Refer to Standard OP9 OP22 OP38 Good Practice Recommendations It is recommended that the index of pages used in the Controlled Drug register include the name of the resident. The suitability of the premises should be formally assessed by an Occupational Therapist. To ensure the safety of passengers the designated drivers of the minibus should receive associated training and work in association with a specific policy/procedure giving guidance on accompanying residents on excursions. At the earliest opportunity written policies and procedures should be developed and implemented for all subjects referred to by the Commission in the pre-inspection questionnaire. 4. OP38 DS0000062289.V301097.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000062289.V301097.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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