Inspection on 24/10/08 for Knoll House

This inspection was carried out on 24th October 2008.

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

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

Other inspections for this house

Knoll House 26/10/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Knoll House Somerset Court Harp Road Brent Knoll Highbridge Somerset TA9 4HQ     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: Jane Poole     Date: 2 4 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 28 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 Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Knoll House Harp Road Somerset Court Brent Knoll Highbridge Somerset TA9 4HQ 01278761907 01278760747 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Linda Cording Type of registration: Number of places registered: National Autistic Society care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Knoll House is registered to provide care for up to 7 people. It is owned by the National Autistic Society and the registered manager is Ms Lyn Cording. All accomodation is on the ground floor and all bedrooms are for single occupancy. The home is set in its own garden but is within the extensive grounds of Somerset Court. The home is not on a public transport route but transport is provided to ensure that people living at the home are able to access the local community. Day services are provided on site. 7 7 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. This inspection was carried out by one inspector over a 6 hour period. During this time people living and working at the home were spoken with, care practices were observed and records were examined. Care Homes for Adults (18-65 years) Page 5 of 28 The inspector was given unrestricted access to the building and all records requested were made available. The manager was available throughout the inspection. Prior to the inspection the manager completed an Annual Quality Assurance Assessment setting out the home achievements in the past 12 months and their plans for the future. 5 people living at the home and 7 members of staff completed questionnaires prior to the inspection. Some of their comments have been incorporated into this report. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report. 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 Care Homes for Adults (18-65 years) Page 7 of 28 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 Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Anyone wishing to move into Knoll House has their needs assessed and is able to spend time getting to know the home and the people who live there. Evidence: Since the last inspection the statement of purpose and service user guide has been updated to ensure that it continues to reflect the services, staff and facilities. Everyone who completed a questionnaire said that they received adequate information about the home before they moved in. Anyone who wishes to move to the home has their needs assessed to ensure that Knoll House is the right place for them. There is evidence that the manager considers the people already living at the home to ensure anyone moving in is compatible with the people currently live at the home. People wishing to move in are able to visit and spend time in the home before they Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: decide to move in. Details of visits by new people are recorded and these records were viewed. In one instance an independent advocate was involved to assist the person to make their decision about moving in. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff use various forms of communication to assist people to make choices about their lives. Risk assessments are carried out to ensure that people are able to safely take part in activities of their choosing. Evidence: Everyone living at the home has a care plan which sets out their needs, likes, dislikes and personal goals for the future. The home is currently changing to a more person centred care planning system that will give people more involvement in their care plan. Care plans are reviewed on a six monthly basis involving the person and appropriate representatives. 2 care plans were viewed in detail, both were comprehensive and gave good information about the individual. It was noted that although care plans are thoroughly reviewed on a six monthly basis they are not always updated when needs Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: or situations change at other times. Staff write daily reports on each person and at the end of each month a summary is written which records any significant changes but these are not always transferred to the care plan document. Risk assessments are completed to ensure that risks are minimised but people are not prevented from undertaking activities of their choosing. Since the last inspection all staff have worked hard to ensure that people living in the home are involved in its day to day running and are enabled to make choices about their lives. Some people living at the home have limited verbal communication and staff use various forms of communication to ensure that people are able to make decisions about their day-to-day lives. Pictures are used to assist people to make choices about activities and food. Minutes of meetings show how colour charts and brochures have been used to assist people to make decisions about decoration and furnishings. Everyone who completed a questionnaire answered YES to the question Can you do what you want during the evening and weekend? During the inspection it was noted that people were able to choose how they spent their time. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Routines in the home are flexible to accommodate peoples choices and organised activities. People living at the home are fully involved in menu planning and choosing meals. Evidence: During the week there are some routines to ensure that people get up in time to attend day activities but these are more relaxed at weekends when people can choose what time they get up. One person spoken with said that they can do what they like in the evenings and at weekends. People said that they could go to bed at whatever time they wished. Everyone living at Knoll House has access to a full range of day activities including Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: communication skills, woodwork, gardening, art and craft. People also have an in house day where they are supported by staff to undertake activities of their choosing. People are encouraged to learn and develop independent living skills by taking part in household chores and personal tasks such as personal laundry and shopping. During the inspection it was observed that people contributed to the household running in line with their abilities and interests. Some people were seen assisting in the kitchen and another person was clearing tables after dinner. People have access to a wide range of leisure activities at the home and in the community. Records seen showed that people go out shopping, to the pub, bowling and to the cinema. One person goes out to church with family and others are assisted by staff to attend church locally. There are photos in the home showing activities that people have taken part in. One person said that they enjoyed going swimming and another person showed pictures of a holiday they had been on. On the day of the inspection some people living at the home had taken part in a sports activity organised by Somerset Court. People have keys to their individual rooms and the front door of the house. Currently no one living at the home attends college or undertakes voluntary or paid employment. The main meal of the day is in the evening when everyone is at home. At lunch time people have a lighter meal at day services. Each day one person chooses the main meal for the day, everyone living at the home has an opportunity to choose each week. The home has a huge range of pictures to assist people to communicate their choices. The picture of the days choice is put on the menu board outside the kitchen to ensure that everyone knows what the days meal is. The home has a pleasant dining room with ample space for people living and working at the home to eat together. The main meal of the day was observed, the meal was well presented and portions were ample. The meal was relaxed and people were able to eat at their own speed. It was noted that people were able to have hot and cold drinks at any time. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People are able to access healthcare professionals according to their individual needs. Medication policies and procedures promote safe practice in this area. Evidence: Care plans give details of the level of support that people require with personal care. All rooms have wash hand-basins and there are two bathrooms and a level access shower room for communal use. The home employs both male and female carers to enable people to make a choice about the gender of the person who assists them with intimate personal care. People are able to choose their own clothing and hairstyles and staff assist people to shop for new clothes and personal items. People have access to healthcare professionals outside the home according to their individual needs. All appointments with healthcare professionals are recorded and records show that people have regular access to GPs, dentists, chiropodists and Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: opticians as well as professionals specific to their needs. Everyone has an annual health check. One person spoken with said that staff assisted them to attend appointments outside the home. Nobody living at the home administers or controls their medication. There is a policy in respect of all medication that gives guidelines for the safe storage, recording and administration by staff. Medication is given out by two staff, one person administers and the other witnesses. There are also two sets of Medication Administration Records (MARS.) Medication Administration Records were viewed and found to be correctly signed when received into the home and when administered or refused. This gives a clear audit trail. One person had a written prescription for a medication to be given PRN (as required) There were no guidelines available to direct staff as to when this medication should be administered. Since the last inspection staff have undertaken training in the safe administration of medication. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The home has taken reasonable steps to minimise the risk of abuse to the people who live there. The complaints procedure has been made available to everyone in an appropriate format. Evidence: The home has policies and procedures in respect of making a complaint, safeguarding adults and the prevention of abuse and whistle blowing. Everyone living at the home who completed a questionnaire said that they knew how to make a complaint. People said that the complaint form was in picture format in their room; another said that they had picture cards to tell staff if they were unhappy. All staff answered YES to the question Do you know what to do if a service user or advocate has concerns about the home? No complaints have been made in the last 12 months. All staff receive training in the protection of vulnerable adults as part of the homes induction training programme. Staff spoken with demonstrated a clear understanding of procedures to be followed in the event of an allegation being made. All staff were Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: aware of the whistle blowing procedure and the ability to take serious concerns outside the home. The home assists people to manage day-to-day personal finance. There are secure storage facilities and a robust recording system in place. Records checked correlated with monies held. All new staff are checked against the Protection Of Vulnerable Adults register and undergo an Enhanced Criminal Records Bureau check before they begin work. Care Homes for Adults (18-65 years) Page 19 of 28 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Knoll House provides a clean homely environment for the people who live there. Evidence: Knoll House is a single storey building set in its own garden within the extensive grounds of Somerset Court. There are no shops or amenities within walking distance and the home is not on a public transport route. All areas are fitted with a fire detection and emergency lighting system, which is tested regularly. Communal areas consist of a large lounge and a dining room. Both have recently been redecorated in line with choices made by people who live at the home. All bedrooms are for single occupancy and all have been personalised to reflect the needs and personalities of their occupants. One person said that they had chosen the colour and furniture for their bedroom. No bedrooms have en-suite facilities but there are two communal bathrooms and a level access shower available for all to use. There are ample toilets in the home. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Bathrooms have been redecorated and made more homely since the last inspection. To promote good infection control practices bathrooms have been fitted with electric hand driers. There is a large industrial style laundry within the grounds of Somerset Court where the bulk of household laundry is washed. The manager stated that this is being changed so that people living in the homes that make up Somerset Court can use the laundry in a launderette style way. Knoll House has a washing machine and drier in the kitchen were people are able to do personal laundry when the kitchen is not being used for food preparation. The home should consider the provision of a utility room to enable people to care for their personal laundry in a domestic setting at anytime. All areas of the home seen during the inspection were clean and fresh. Some people living at the home said that they were encouraged to help with household chores to maintain a pleasant environment. Everyone who completed a questionnaire answered ALWAYS to the question Is the home clean and fresh? Care Homes for Adults (18-65 years) Page 21 of 28 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported by a well trained and highly motivated staff team. Recruitment practices minimise the risks of abuse to people living at the home. Evidence: All staff have clearly defined job descriptions and there are clear lines of accountability. The home employs 13 care staff, 9 (69 ) have a National Vocational Qualification (NVQ) in care at level 2 or above. All staff who completed questionnaires said that they were happy with the induction programme and ongoing training provided by the National Autistic Society. 2 members of staffed said training is excellent. Staff spoken with during the inspection said that they received regular supervision and were able to attend training courses that were appropriate to their role. Everyone said that they felt well supported by the management team. Records of supervisions Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: showed that a wide variety of issues, including training needs, are discussed at these sessions. Staff who completed questionnaires, and those spoken with during the inspection, felt that there was excellent communication and that all staff worked as a team. It was said that people were always flexible ensuring that the home was always adequately staffed. There are regular staff meetings and staff said that they were able to express their views and opinions during meetings. There are also handover meetings at each shift to promote good communication and ensure that all staff have up to date information about the people who live at the home. The home employs both male and female staff of varying ages, which is reflective of the people who live at Knoll House. One person wrote on their questionnaire that the felt that the variety of staff meant that staff were able to relate to all individuals living at the home. Staff spoken with were very enthusiastic about their jobs and demonstrated a commitment to providing a high quality service. During the inspection there was constant interaction between staff and the people living at the home. Interactions were warm and friendly and everyone appeared very relaxed and comfortable with all staff on duty. The recruitment files of the two most recently employed members of staff were viewed. These gave evidence of a robust and thorough recruitment procedure which minimises the risk of abuse to people who live at the home. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 is effectively managed taking into account the views of the people who live and work there. There are measures in place to ensure the health and safety of people at the home. Evidence: The registered manager of the home is Lyn Cording, she holds the Registered Managers Award (NVQ level 4) and has also completed a middle managers course. The manager demonstrated that she keeps her knowledge up to date. She showed a good understanding of the needs and personalities of individual service users and of the abilities of staff. There is also a senior practitioner who deputises in the absence of the manager. Prior to this inspection the manager completed an Annual Quality Assurance Assessment (AQAA) which clearly sets out the homes achievements in the last 12 Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: months and their plans for the future. It demonstrated a commitment to ongoing improvement. Staff who completed questionnaires were happy with the support that they received from the manager. One person wrote The house manager is always available, approachable and supportive. Another said The manager has an open door policy and works alongside other staff. Staff spoken with during the inspection said that there were clear lines of accountability and that they felt very well supported by the management team. The home holds regular meetings for the people who live at the home and also one to one meetings between people living at the home and their keyworkers. This is an opportunity for staff to gauge peoples level of satisfaction with the service provided. Prior to the inspection staff assisted people living at the home to complete satisfaction questionnaires. All records viewed by the inspector were up to date and well maintained. All confidential material was securely stored. Appropriate steps have been taken to maintain health and safety in the building. There are regular in house checks of fire safety equipment and the fire detection system is regularly serviced. Communal hot water temperatures are thermostatically controlled and water is regularly tested and temperatures recorded. Staff have received training in health and safety issues such as food hygiene, fire safety, first aid and manual handling. A gas safety certificate was issued on the 4/08/08. Portable Electrical appliances were last tested in February 2008. The certificate of registration is displayed in the office. Care Homes for Adults (18-65 years) Page 25 of 28 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 Adults (18-65 years) Page 26 of 28 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 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 1 2 3 6 20 30 The manager should ensure that all care plans are updated when needs, wishes and goals change The manager should ensure that there are individual protocols in place for the use of as required medication. The home should consider providing a utility room to enable people to undertake their personal laundry at anytime. Care Homes for Adults (18-65 years) Page 27 of 28 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 Adults (18-65 years) Page 28 of 28 - 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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