Inspection on 23/05/07 for Hillside Manor

This inspection was carried out on 23rd May 2007.

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

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

Other inspections for this house

Hillside Manor 23/05/06

Hillside Manor 16/02/06

Hillside Manor 21/10/04

Hillside Manor 24/06/04

Hillside Manor 12/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Hillside Manor 133 Barkerend Road Undercliffe Bradford West Yorkshire BD3 9AU Lead Inspector Ashley Fawthrop Key Unannounced Inspection 23rd May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Manor Address 133 Barkerend Road Undercliffe Bradford West Yorkshire BD3 9AU 01274 735116 01274 743353 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) Mrs Marie Davey vacant post Care Home 19 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (15), of places Physical disability over 65 years of age (1) Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2006 Brief Description of the Service: Hillside Manor is a semi detached Victorian building accommodating 19 older people, a number of which have special needs relating to either physical disabilities and/or dementia related illnesses in both single and twin rooms with en suite facilities on two floors. There is one open plan lounge and separate dining room on the ground floor, bathrooms and WCs are situated on each floor. There is a garden and sitting area to the front of the premises and parking to the rear. The home is situated in Barkerend Road several hundred yards from the Cathedral and approximately quarter of a mile from Bradford City centre. There are shops in the locality; the home is situated on a main bus route. The inspection reports are kept in the main office, however, there is a notice on display stating that inspection reports are available to read. The level of fee charged ranges between £335.00 and £450.00, however, the expected rate to be paid at this time is the higher level. Additional charges above the fee are charged for hairdressing, toiletries, papers/magazines and holidays. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and undertaken on the 23rd May 2007 by one inspector. The inspection was undertaken in one day and included reading records, talking to service users and their visitors, the manager and the staff. Also as part of the inspection a number of people were case tracked from admission to the day of the inspection to ensure that their care plan reflected the changes in their health and well being so that their present needs were being addressed. The pre inspection information was completed by the home and returned to the Commission before the date required which shows a willingness to comply with the Standards and Regulations of the Care Standards Act 2000. The pre admission information is up to date and available to service users The care plans reflected the needs documented in the pre admission assessment this made a good foundation for staff to build the care plan and is good practice. The activities are meaningful and reflect the individual needs of the people. The manager and the staff were open in their responses to the inspection and service users said that the staff were very helpful and there was evidence of good relationships between staff and people who live in the home. Staff addressed service users with respect and there was humorous banter between them and staff were not patronising at any time. There are good risk assessments that reflect the abilities of the individual and staff assist to the level required to allow the service user to maintain the maximum of independence. There are a number of issues that need addressing and these are reflected in the body of the report and the requirements that the registered provider must address to meet the standards. What the service does well: The service provides a good level of care on an individual basis on reading the written information it is clear that the individual is central to the care given the social activity is as important as any physical care that may be required. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 6 The staff continues to be consistent with a low turn over and when speaking to individual services users they say they could not get better more helpful carers and there is a balance of ages and experience that works well in the home. Staff training is seen as important and all staff are given the opportunity to develop. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service People who wish to use the service have the information they need before moving into the home to make an informed a judgement as to whether or not the service can meet their needs. Pre admission assessments and staff training do ensure that the home can meet the needs of the individual planned training make sure care is effectively. The home does not provide intermediate care. EVIDENCE: Information is made available to people and their representatives such as social workers and family before making a decision to move into the home. This includes a brochure that acts as a service users guide for the service provided. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 9 The brochure includes a description of the home; it’s philosophy of care including the staff team and the training they have undertaken. A list of facilities, meal times, social events, arrangements for visiting and the procedure for safe recording and handling of service users belongings. There is also a statement of purpose for the home that explains in more depth how the home delivers the service. The document includes the process for care planning, procedures for the continued health and well being of people including medical issues and mental health the quality audit policy, pre admission procedures, complaints, prevention of abuse policy and residents meetings. Four people were case tracked and the two recent admissions had pre admission assessments on file the two that had been in the home some time The information was individual and appropriate to the care provided and was used as the starting point of the care plan. The specialist services offered includes care of service users with Physical Disabilities, Dementia and Mental illness. Since the last inspection the registered person has provided a lot of training for staff. This is good practice as it gives the staff the skills to deliver good care. Hillside Manor DS0000001302.V335905.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service People’s health, personal and social care needs are set out in an individual plan of care. The care plans are well documented and address the assessed needs of the individual. The policies and procedures for ordering and administrating medications was sound, however, the system is made unsafe by staff leaving medication out of the cabinet and unattended. EVIDENCE: Judgements are made by staff on how certain tasks are delivered as well as including others in their decisions this ensures that the care delivered is that expected by the service user. There were many areas of good practice. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 11 The care plans inspected as part of case tracking were consistent in as far as all the tasks of care identified were completed and updated. Information continues to include assessments of daily living that identified where an individual was at risk and a plan was developed to protect them. This is good practice. Where risk from pressures sores are identified the district nurses continues to be involved and assessments of the skin had been undertaken, pressure relieving equipment had been provided on both the bed and the chairs. The level of pressure had been set on mattresses in line with the weight of the individual and in one case where weighing was difficult due to the frailty of the individual weight assessment was made by measuring the body mass to assess the approximate weight. Since the last inspection staff have been trained to do this themselves. This is good practice Continence programmes continue to be individual and in cases where communication is difficult due to dementia the staff record on a trial and error basis in order to try to assess an individual’s personal toilet routine and in one case has had some success. Where people are at risk from falls, assessments have been written and plans of action put in place. Families are informed and agree to the actions being taken by staff. There continues to be evidence that people are involved in the planning of their own care and individuals were aware that information was being written about them. People who use the service and their families are asked to write their own care plan and what they feel their needs are before moving into the home. This is then measured against what the home feels the needs are and a balance is set. There continues to be risk assessments and nutritional assessments in place. Where there is a risk relating to a medication there is evidence that the individual’s doctor had been involved and action plan documented. This is good practice. There was evidence that other professionals are involved in the care including community psychiatric nurses, district nurses, dentists and opticians. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 12 Care plans are updated monthly and there are daily records including a daily report a record of doctor’s visits and a record of bathing. The medication system is a bottle system these are delivered on a monthly basis. The home has a medication policy that is available to staff the records are generally up to date for each resident. Medication administration is undertaken by senior staff and recorded on pre printed administration sheets any medications destroyed or returned to the chemist are recorded and signed for on collection by the chemist. When medication instructions are altered on the administration sheets the senior signs them. Where a doctor does the alteration he signs. This is good practice as a record is available. Arrangements for personal care such as bathing are arranged with the individual and evidence in the record that this varies from weekly to three times a week. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service People living at the home find the lifestyle experienced matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. Social needs are seen as being important as physical needs as they are part of care planning and individual lifestyles are accommodated. The menus are carefully put together and are nutritional with a balance of proteins and fresh fruit and vegetables. EVIDENCE: Care plans include a heading covering social and cultural needs and record each service users preferred activities, hobbies or personal routine including when they like to return to their bedrooms for privacy. There are a number of people that continue to prefer their own privacy at some point in the day. Some return to their rooms after tea and have supper in their rooms. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 14 Routines continue to be flexible to accommodate special events, where people wish to eat in their rooms and spend much of their time there this may relate to sporting events over a number of days. There is evidence that religious needs continue to be seen as important where daily church attendance needed this is accommodated and the homes staff ensure the safe delivery and return from church, pictures of past and present religious leaders have been made available to service users with memory problems so they can see who is the present Pope. People are given the opportunity to be involved in social activities and these were seen as normal activities and not a special event. The dining room is furnished with suitable tables and chairs for the purpose and is set with tablecloths and matching cutlery and crockery. The menu rotate over a three-week period and there is a choice at each sitting. There is a choice of cereals, cooked breakfast and fruit. The lunch has a choice of two hot meals with two portions of vegetables and a choice of one hot and one cold sweet one of which is fruit. The tea is less substantive, however, it is sufficient and again includes a choice including fruit. The menus do provide a balanced diet. The menu is updated seasonally to include seasonal vegetables and fruit. There is no vegetarian choice available and the senior in charged said that this could be accommodated but as yet there had been no requests or indications that this is wanted. There are no diets required for cultural or religious purposes at this time. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The service users are protected by the complaints procedures this was tested last year and was investigated to a satisfactory outcome. People living in the home are protected from abuse. EVIDENCE: There have been no complaints received about the service since the last inspection. There continues to be a copy of the complaints procedure in the statement of purpose that is discussed with service users and their representatives prior to admission. Complaints forms are available to people in the home and their relatives and visitors. People said that they knew who to complain too. Relatives and visitors have access to the person in charge on a daily basis and this ensures that concerns can be acted upon immediately. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 16 All the staff have undertaken training in the protection of vulnerable adults. This is good practice as staff have the skills to identify types of abuse this reduces the risk for people living in the home. There are policies and procedures relating to the prevention of abuse and whistle blowing. These are given to staff on employment and they sign for these after reading there content. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26 People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service People live in a well-maintained and safe environment. The home is well maintained and is appropriate for the needs of the people who live there. People continue to be given the opportunity to personalise their rooms ensuring individuality and ownership. EVIDENCE: The lay out of the home is on three floors with the lounge and dining room being on the ground floor. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 18 There are also a number of bedrooms, WC’s and an assisted bath on this floor. There is level access into the building for wheelchairs and individuals who have difficulty walking. There is a passenger lift to the first and second floors this has been modernised recently to make sure safe access. There are two bathrooms one of which has a lifting aid to help individuals in and out of the bath and WC’s. There is a garden to the front of the home with sitting area. This is well maintained and accessible to people in wheelchairs or who have difficulty walking. The home has a no smoking policy and both staff and people who live there who wish to smoke do so in this area. As part of the case tracking procedure the pressure relieving equipment was checked this was well maintained and at the correct level of pressure for the individual weight. On inspecting people’s rooms it was noted that many were individually decorated and furnished and people are given the opportunity to bring their own personal possessions giving the rooms a feel of individuality and ownership. The home has a pleasant odour and there are staff employed to clean the home. All staff have undertaken training in infection control. This is good practice as it reduces that chances of infection. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service The numbers and skill mix of staff meets people’s needs. The staff are competent to do their jobs and are supervised closely by senior staff. People are protected from potential abuse by the homes recruitment policies and procedures. EVIDENCE: The home has invested significantly into staff training since the last inspection and includes NVQ at levels 2 and 3, First Aid and Infection Control, Moving and Handling, Palliative Care Principle of Care, Administration of Medications, Managing Diabetes and Challenging Behaviour. Since the last inspection a number of senior staff have received training from the District Nurse so they can administer insulin. Since the last inspection the Recruitment and selection procedures have improved. On inspecting staff files it was noted that all the information required to ensure the safety of service users was available including two written references and checks by the Criminal Records Bureau. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 20 All staff undertake a written induction that is signed and dated, I recommend that the manager checks to make sure that the present induction format is in line with the Skills for Care requirements. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to the service Due to the manager not being registered as a fit person there continues to be a question on her fitness to manage the home. However, the people do benefit from the ethos of the home and the management style. The people who live in the home, staff and visitors are protected by the homes health and safety policies. EVIDENCE: Since the last inspection the prospective manager has withdrawn her application to be manager of the home, however, she does plan to resubmit a new form. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 22 Neither has she commenced or completed NVQ training to level in the management of care. I was informed that she is to commence this training with Age Concern in July 2006. However, there is evidence that the home benefits from the ethos of the home and people continue to be involved in the management of the home including people who live there. This is done by having regular meetings these are minuted and available to individuals and their families. There is a quality audit system in place this is includes a questionnaire that is sent to people who live in the home and their representatives. The senior said the issues raised are normally addressed with the individual and there is evidence that in at least one case this has been the case. I recommended that information received from questionnaires be collated and any decisions made relating to the running of the home be made available to the service users or their families in the statement of purpose. The administrator continues to deal with the service users finances. All service users are encouraged to handle their own finances the majority dealt with by a family member and a number are dealt with by the home. The payee is invoiced whether this is the service user or the social services if they are paying the fee. Monies are held separately and stored securely with records held. At the time of the inspection the staff are receiving appraisals at 6 monthly intervals these are documented and asks the employee to rate their performance the manager rates the employees performance separately these are then compared and discussed and level of competency is reached. I informed the senior that another supervision session must to be undertaken in between the appraisal in order to meet the standard. The home does have a management system that is on line and automatically updates policies and procedures as required. The evidence of maintenance of equipment is documented on the maintenance file. Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 23 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 3 X 3 Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 24 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. Standard OP31 Regulation 9 (1) Requirement Timescale for action 30/07/07 2. OP31 9 (1) A person shall not manage the home unless fit to do so. The registered person must ensure that all the relevant information is made available to the Commission so that the fit person process can be completed. (Previous timescale not met 30/07/06) The person managing the home 30/07/07 must be trained to NVQ level 4 in management or the equivalent. The registered person must inform the Commission of the date and course the manager is to attend. (Previous timescale not met. 30/09/07) Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations Information from quality standard audits should be collated and any decisions relating to the running of the home be given to service users and their families and added to the Standard of Purpose. The registered person must make sure that the induction training meets Skills for Care requirements. 2 OP27 Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillside Manor DS0000001302.V335905.R01.S.doc Version 5.2 Page 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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