Inspection on 18/04/07 for Links Lodge

This inspection was carried out on 18th April 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 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

Links Lodge 19/11/08

Links Lodge 16/01/06

Links Lodge 11/10/04

Links Lodge 05/04/04

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

CARE HOME ADULTS 18-65 Links Lodge 16 Links Road Blackpool Lancashire FY1 2RU Lead Inspector Mr Kevan Royston Unannounced Inspection 18th April 2007 09:00 Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 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 Links Lodge DS0000009854.V333158.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 Adults 18-65. 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. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Links Lodge Address 16 Links Road Blackpool Lancashire FY1 2RU 01253 354744 01253 590198 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 Karen Bradley vacant post Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Links Lodge is a care home for up to eight adults with learning disabilities. The home is a large detached house situated in the North Shore area of Blackpool, close to the sea front and local amenities. There are six single bedrooms and one double bedroom. One is en-suite. There is a large lounge area that leads to a sunroom and a kitchen/diner. There are spacious gardens at the front side and rear of the home. There is a statement of Purpose/Service user Guide, which is given to all prospective residents/relatives. This written information explains the care service treatment programme that is offered, who the owners and staff are and what the resident can expect if he or she decides to live at the home. The fees at the home range from £320.00 to £580 .00 per week. There are no additional costs. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit which included a site visit undertaken over a period of two days commencing on the afternoon of 17/04/07 and concluding on the morning of18/04/07. The Inspector spoke to the home owner; five care staff, and five residents. As part of the inspection process the inspector used case tracking as a means of assessing some of the National Minimum Standards. The process allows the inspector to focus on a small number of people living at the home. All records relating to these persons are examined and the rooms they occupy are looked at. Communication with the residents varies, due to individual difficulties experienced, however evidence was gained through observations made of the positive interaction between staff and residents with different methods of communication used. Prior to the visit the homeowner completed a survey form, which provided information about how the home is run. Residents and staff views were sought which assisted in assessing how the home operated and was meeting National Minimum Standards. Comment cards had been sent out prior to the visit to relatives and in total five were returned plus one from a social work professional expressing their thoughts and views of how the home is run. Records of three members of staff were also examined. A tour of the premises was undertaken. Examination of the homes documentation, policies and procedures formed the basis of the inspection process. What the service does well: Training opportunities for staff are excellent, with specialised training provided to improve communication techniques to enable development of relationships between staff and residents. One member of staff spoken to said, “Different types of communication training is really helpful such as Makaton”. Another member of staff commented. “There is always one course or another to go on to help improve my skills”. All staff have received a three-day medication training course to ensure properly trained staff administer medication. A member of the management team said. “There is always a first aid trained person on duty at all times”. Observation of staff during the visit clearly evidenced residents and staff interaction was excellent and confirmed that they know what the individual needs of the residents are. Staff communicate well with each other and records Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 6 examined confirmed there is clear information of each individuals health and welfare needs being monitored with links to other professionals to ensure the support and care for residents are being identified and met. Staff spoken to said, “We have a small team and know each resident well therefore can offer the care and support needed”. Another said, “We all work well and support each other”. One resident spoken to said, “They are lovely”. The staff have developed “picture communication” techniques, which is a form of understanding the residents wishes and needs. Each resident has their daily plan and general items drawn out in picture form, which enables staff to work with residents with communication difficulties and have a greater understanding of the care and support required for each person. Observation of staff interacting with residents using this method confirmed it is a very useful method of communicating. Staff spoken to said, “We have put a lot of work into this and find it very rewarding”. One resident said, “I like looking at pictures”. The manager and staff carries out very clear and precise assessments of need in the different areas of care they provide service in with detailed care plans developed which take into account the residents and relatives wishes and needs. The homeowner and staff team are all qualified and experienced people, and show a commitment to, and a pride in, their work, taking into account the diverse needs of their residents. One staff member spoken to said “It’s a joy to work with the residents its like a big family”. The home has achieved the “Investors in People Award”, which is a recognised quality mark received for providing a good service and demonstrates the owners commitment to staff training. A member of staff said, “We are proud of having achieved this award”. What has improved since the last inspection? The manager is always improving forms and systems to make them more detailed or easier to follow, ensuring the care is consistent and continues to improve the home for the residents. Since the last inspection there has been some redecoration and continuous updating of the property with new stair rails fitted to support residents and provide a safer environment. Examination of training records confirm that nearly all the staff have completed a recognised qualification in care ensuring staff have the confidence and ability to provide the care and support for the residents. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 7 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. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The admission and assessment process is clear and precise to make sure the care needs of the residents are met. EVIDENCE: The records of two residents were examined and had comprehensive assessment information recorded in detail to ensure a thorough care plan could be developed. The written assessments seen confirmed there is involvement of the resident, other professionals and where possible relatives so that everybody who needs to be is involved in the best interest of the resident. Discussion with staff, the homeowner and examination of documentation confirm residents are admitted to the home when a comprehensive assessment has been carried out by qualified staff. This is so that the home knows that they will be able to meet individual needs and ensure they will be well cared for and able to reach there individual potential. One staff member spoken to said, “Introductory visits, discussion with relatives and consultation with other professionals helps us to do a thorough assessment”. Staff spoken to had a clear understanding of how the assessment procedures work and are part of the process so that they know how to meet the individual needs of the residents being admitted. One staff member said, “Its important Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 10 all staff get to know potential residents during the early admission process as some of the needs of residents are complex ”. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are helped to make decisions, which supports them in their day-today lives, whilst taking risks into account. EVIDENCE: Two resident’s records were examined and included detailed information about their personal, social, emotional, welfare and healthcare needs to ensure staff know exactly what is needed to provide and promote good quality care to the individual. Staff members spoken to said, “It is important to develop a thorough care plan”. Each resident has a daily programme of education, social, or day centre activity chosen by them with staff and family support detailed in picture form to ensure the individual is able to communicate with staff. One resident spoken to said, “I like going out each day”. The homeowner said “We encourage as Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 12 much as possible with support to make decisions and choices in their lives and provide as much information and help as needed”. Records examined confirmed risk assessments are completed, regularly reviewed and updated to ensure residents independence and living skills are developed in line with their care plans. A relative commented, “The home has improved her quality of life and social skills”. Observation and discussion with staff and residents found some residents have difficulty with verbal communication. The staff at the home have to be commended for learning and developing specialist communication techniques to ensure residents as much as possible are understood. There were clear examples of where specialist communication systems are in use. In particular the use of pictures to improve the quality of life of some residents resulting in increased confidence and helping to participate in more social events. Staff spoken to stated they have received training in areas of specialist communication and this has helped when providing care for residents with difficulty understanding conversation. One staff member spoken to said. “The picture communication method definitely helps”. One relative survey said, “The home has improved her ability to communicate”. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for development and community participation are addressed in the care plans, to ensure residents have opportunities for personal development. EVIDENCE: As the home is relatively small, the homeowner is aware of making sure individual lifestyles are reflective of their needs. This is achieved through recognising individual need, and ensuring support to achieve recognised goals that have been identified on care plans. Residents have a range of activities available to them, which included television, music, videos and board games. Observation at the time of the visit witnessed a member of staff helping do a jigsaw with a resident who when spoken to commented, “I like them”. Activities are arranged to meet individual wishes and abilities, so that everybody is included. “One relative survey Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 14 returned said, “Her social life has improved and she has meals out and goes shopping which she likes”. Lunchtime meals were seen being prepared, and were wholesome, home baked with evidence of fresh produce providing a nutritious meal. Menus examined are balanced and interesting. Meal times are set although flexible enough to accommodate preferences. Details of individual preferences and dietary needs were recorded on the resident’s care plan. The homeowner said, “All staff have received food hygiene training”. This was confirmed through examination of staff training documentation. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health care is taken seriously and needs are closely monitored ensuring health issues are met. EVIDENCE: There is evidence the home has good access to specialist healthcare services in individual records examined, for the benefit of residents using the service, so that their healthcare needs are met. One care professional survey returned commented, “I recently visited the home and found staff made particular effort to support individuals to attend GP and dentists”. The records are well maintained and provide evidence the home works closely with the resident, their family and other professionals so that the staff know all about the specific needs of the individual. Staff spoken to had a good knowledge of the individual needs of residents, including their individual preferences, their specific medical needs and their personal choices and preferences. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 16 Medication practices were safe and good records had been kept ensuring residents health is maintained. The homeowner said, “ All staff have received medication training”. There has been staff training in areas of equality and diversity so that staff understand the need to make sure no individual is disadvantaged due to any cultural difference. Staff spoken to said. “ Special diets could be catered for”. And, “religious beliefs are respected”. Staff spoken to had a clear understanding of the areas of equality and diversity and how it impacts on the lives of the residents. One survey returned from a social worker said, “Discussions with staff and management suggest they know the importance of maintaining equality and dignity”. From the documentation seen, discussions with staff, comments received from relatives and observations made during the visit, evidence was gained that the residents are receiving the personal support they needed sensitively. The management team and staff makes sure personal support is sensitive but positive so that all issues regarding personal care is delivered for the benefit of the residents. Staff spoken to said, “If support is needed we give it”. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for recording and reporting of complaints are good ensuring people feel listened to. The management team and staff have good knowledge and understanding of adult safeguarding issues, which protect residents from abuse. EVIDENCE: Links Lodge has a detailed complaints procedure, which is made available to all residents and relatives on admission and displayed in the Statement of Purpose and Service User Guide. There have been no complaints since the last inspection. The procedure has been revised to provide an easier format for residents and relatives. This was evidenced from surveys returned from relatives in whom all said they knew the policy and who to speak to if wishing to make a complaint. A member of staff spoken to said, “We now have pictures to explain complaints”. Staff have attended training in safeguarding adults. They are also attending training with the Learning Disabilities Award Framework (LDAF), and this has been completed for all staff to ensure they have a knowledge of abuse issues. One member of staff said, “Its covered in National vocational Training (NVQ)”. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and clean maintained to a good standard providing comfortable surroundings for the residents. EVIDENCE: A tour of the building found the home to be clean and tidy. The decoration and furnishings are maintained to a high standard ensuring the residents live in pleasant and safe surroundings. New handrails had been fitted to support residents who have difficulties with stairs. Surveys returned from relatives commented on the cleanliness of the home. And included, “ Very clean”. Bedrooms are individually decorated and furnished well . All rooms had good lighting and personalised by the families and residents to make it feel homely. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 19 The home has a laundry facility with policies and procedures in place to control the risk of infection. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are robust to make sure residents are safe and protected. Training for staff is excellent ensuring they have the skills and competences to carry out their roles. EVIDENCE: Training for staff is excellent records shows the target of 50 of care staff to complete National Vocational Qualification (NVQ) level 2 in care has been achieved and close to 100 with some staff trained to level 3. One member of staff said, “ Definitely benefited from the training”. Each member of staff have their own individual record of training. All staff have received medication training and the Learning Disability Award Framework (LDAF) training. The member of staff who manages the administration of the home has a Higher National Diploma (HND) in Business studies. Another member of staff is completing the Registered Managers Award (RMA). Staff spoken to confirmed the excellent training opportunities available with comments like, “Any training linked to work is accessible”. And “I have now completed my level 3 NVQ which I was able to do”. One survey returned for a social worker said. “It has been Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 21 clear that regular training is seen as important as the manager has contacted The Learning Disability Partnership Board for suitable training for staff”. Comments received through relative surveys about the staff included. “”There is a caring atmosphere”. And “The staff are patient and understanding”. Examination of two staff files confirmed the recording procedures of the home are good. Staff records include, application forms, individual photographs, Criminal records Bureau (CRB), Protection of Vulnerable Adults (POVA) disclosures and references were in place to ensure the residents are protected. All checks had been completed prior to commencement of employment. A suggestion to improve the recruitment procedure would be to date references received which would evidence commencement of employment after they had been checked. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well and systems, policies and procedures are in place for the protection of staff and residents. EVIDENCE: The homeowner has the necessary skills and qualifications required to support the staff and residents and enable the home to meet its stated purpose and objectives. One member of staff spoken to said. “They are always willing to listen and help if needed”. The management team approach is relaxed so that there is no formality in the day-to-day management of the home. Residents are encouraged to follow their individual routines supported by staff, which was observed and examined Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 23 throughout the inspection and was seen to meet the individual needs of the residents. There was evidence of clear leadership, and staff confirmed that they felt supported one said, “You can always talk if you have a problem”. Comments received from relatives confirmed that they were satisfied with how the home was managed and run ensuring residents receive the best care possible. The homeowner has developed good systems to gather staff, residents and relative’s views as part of his monitoring of quality to ensure the home is run smoothly and effectively. One relative survey returned commented, “The home is well run”. The home has an annual development plan in place in order to continue to develop the home to ensure the safety and comfort of the residents. Regular staff and resident meetings are held and recorded and suggestions are carried out if agreed by both parties. Examination of records for residents confirmed they are comprehensive, well written and up to date. Records of money being handled by the manager for residents were up to date, explaining the reason for any expenditure and the balance of the money that was being retained. Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X X X X X 3 Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Links Lodge DS0000009854.V333158.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Links Lodge DS0000009854.V333158.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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