Inspection on 05/02/08 for Mansion House

This inspection was carried out on 5th February 2008.

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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mansion House 11/07/06

Mansion House 04/10/05

Mansion House 28/04/05

Mansion House 15/11/04

Mansion House 10/05/04

Similar services:

Dovedale Court

Lyncol House

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

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

CARE HOME ADULTS 18-65 Mansion House 15 Mansion Row Brompton Gillingham Kent ME7 5SE Lead Inspector Eamonn Kelly Unannounced Inspection 5th February 2008 11:30 Mansion House DS0000028936.V352618.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 Mansion House DS0000028936.V352618.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. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mansion House Address 15 Mansion Row Brompton Gillingham Kent ME7 5SE 01634 841280 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of manager Type of registration No. of places registered (if applicable) www.ilg.co.uk ILG Ltd Mrs Sally Fulbrook Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2006 Brief Description of the Service: Mansion House provides care and support for up to 10 residents. Bedroom accommodation (single rooms, five of which have en-suite facilities) is on the ground, first and second floors. Residents and staff have the use of a garden and there is parking at the front. Independent Living Group Ltd owns the business together with some 33 others in Hampshire, Sussex and Kent. There is a separate smaller premise in the grounds that is undergoing refurbishment to accommodate a further 2 or 3 residents. The web-site www.ilg.co.uk provides information about the company’s objectives and makes available on download a copy of its “Guide to Residential Care” with advice to parents and others on managing a successful transition. Weekly fees are £1080 to £2500. Additional charges are made for hairdressing, chiropody, toiletries and personal spending. ILG Ltd contributes about £250 towards an annual holiday for residents and the company meets the costs of accompanying staff on outings and planned holidays. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 5th February 2008. It consisted of meeting with the manager (Mrs Sally Fulbrook), support workers on duty and residents. Care practices were observed and discussed. A variety of records was seen during the visit principally those addressing the personal and healthcare support of residents. We received an annual quality assurance assessment (AQAA) from the manager of the service. We also received ten quality assurance questionnaires from residents who were helped by staff to complete them. The previous report included a request for risk assessments to be improved. These are now in place and they contain relevant information to enable staff to support residents effectively. This report requests that staff training in dealing with incidents of challenging behaviour (SCIP) is accelerated for the benefit of residents and staff. It also advises the manager to ensure that there is a personal contract in place for each resident. What the service does well: What has improved since the last inspection? There has been a major refurbishment of most parts of the premises. The laundry service has been improved. Kitchen cupboards have been fitted with a device for enabling some restriction of access but without recourse to keys and Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 6 locks. Many bedrooms have an en-suite facility but the refurbishment of a bathroom is imminent. The staff development programme and outcomes of formal supervision is proving useful in enabling staff to work effectively with residents with very high support needs. The newly developed risk assessment procedure is valued as an effective working tool by staff. The Coach House, currently vacant, will soon be redecorated and re-equipped. 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 Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Mansion House DS0000028936.V352618.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 Mansion House DS0000028936.V352618.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): 1, 2, 3, 4, 5. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents do have their individual aspirations and needs assessed before they enter residential care. They do not have the added advantage of an individual personal contract based on their specific situation and support needs. EVIDENCE: Prospective residents and their advocates receive information about the home’s services and facilities. This is through information from the manager and members of staff, through the written guide, and via the information for parents and others on the company’s website. This includes recommendations to help manage a successful transition. Detailed assessments are made of each prospective resident. There are some concerns that the levels of support necessary may be too high for staff but the home has a successful record over the past 2 years in working effectively with clients. Information gathered at this early stage forms part of care plan records and a risk assessment is constructed by the manager and deputy managers as a working tool for support workers. Depending on the support needs of residents, different methods of assessment and initial introduction to the premises are practiced. Prospective residents Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 10 generally visit for shorter periods and may have an overnight stay. During the initial settling-in period, the assessment process continues and mostly the outcome is positive for both parties. The company has a business contract for each resident with the sponsoring organisation. There is not an individual contract available for each resident (although it is understood the company may have these at its Camberley office). Such contracts need to contain information on the rights and responsibilities of both parties. It would, for example, contain information on specific needs such as use of resident’s private monies and whether an appointee approves this use. Mansion House DS0000028936.V352618.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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are helped to make decisions and to express themselves as part of developing their confidence and quality of life. EVIDENCE: The manager has introduced detailed risk assessments for each resident. These contain concise blocks of information relating to the resident’s developmental needs and how these can be addressed for his/her benefit and continuing comfort/safety of other residents and staff. Support workers also have recourse to information maintained in essential life plans (ELP’s). Deputy managers are involved in updating risk assessments and allocating risk scores in each area measured. These are part of the overall care plan process which includes records of identified support needs, how these are being met and reviews of resident’s progress. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 12 Each resident has notes kept on their pattern of activity, their preferred options and how they are progressing. Communication profiles are being introduced as many residents have communication difficulties. A support worker is undertaking training in a communication method. Residents are very active within and outside the premises. They are encouraged to have independent lifestyles and care plan/ELP procedures are used as working tools to meet this objective. Mansion House DS0000028936.V352618.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): 11-17. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Routines and activities developed with each resident give them opportunities to exercise preferences on a day-to-day basis. They are helped to take part in activities they enjoy and to be a part of community life. EVIDENCE: Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 14 Residents are encouraged to take part in activities in which they have an interest and aptitude. A 7-seater vehicle is available for the purpose of independent travel to a variety of locations and another such vehicle will soon become available. Residents have access to educational opportunities, leisure pursuits and customised activities. Care plan folders contain information of the types of activities they enjoy and derive benefit from. They are encouraged to maintain contact with relatives and friends where they wish to and can do so. They are helped to maintain private relationships and their continuing safety is monitored. Information on improvement or deterioration is maintained in essential life plan (ELP) records. Residents can use the kitchen under supervision. Where some residents must be prevented from unsupervised access to cupboards in the kitchen, a locking system that does not involve overt locking devices is in use. Meal times are flexible to suit the service users’ activities and schedules. Mrs Fulbrook showed how resident’s dietary needs are monitored. They are able to choose where to eat and some can make drinks, meals and snacks for themselves and others with staff support should they wish. Some are centrally involved in planning and choosing menus. Their weights are recorded at an external location when thought necessary for the purpose of monitoring health. Mansion House DS0000028936.V352618.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, 20. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents receive good physical, emotional and personal support. They are protected by procedures for administering medication. EVIDENCE: Times of getting up and going to bed, having baths, eating meals and other activities are flexible to allow for resident’s respective daily routines. They are able to make their own choice where possible about what they wish to wear and general hairstyles. There is a high and discreet staff input into the support they need and receive. Each resident’s care plan record documents personal, physical and emotional healthcare needs. Records of health care provided by G.P, chiropodist, dentist, and opticians are part of each folder. The intention is that procedures are in place to enable them to receive the personal and healthcare support needed and that potential complications and problems are recognised and dealt with at an early stage. Regular appointments are seen as important and there are systems in place to make sure residents are reminded and appointments are not missed. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 16 Residents who could keep their own medicines could do so subject to recorded risk assessment and regular review. No residents currently maintain their own medicines. There are examples where residents have improved greatly since admission when their medicines were reviewed and reduced. The AQAA (annual quality assurance assessment) refers in detail to how healthcare support is considered a priority, for example, residents have access to the local psychiatry team, they can avail of well man/woman clinics, medication audits have increased and resident involvement is increasing. Mansion House DS0000028936.V352618.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, 23. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are protected from abuse and are able (directly or via staff skills in anticipating their actions/concerns) to make their views known to members of staff and others. The level of support provided in terms of numbers of staff and their training is being improved for the safety and protection of staff and residents. EVIDENCE: Essential life plans are used to identify patterns for development of resident’s lifestyles and health. The identified and recorded information contributes to the way staff use their SCIP skills to defuse threatening situations and address such situations. Staffing levels, with the presence of male and female staff, is also a positive factor in maintaining good relationships within reason. There are examples where the key-worker system is of great benefit to some residents. These support workers achieve deeper insights into resident’s conditions and are able to identify patterns of anxiety and where challenging actions are likely. A recruitment process that includes CRB and POVA checks is in place. Members of staff receive information in Safeguarding Adults procedures operated by local authorities. The AQAA (annual quality assurance assessment) identifies factors regarded as important for protecting residents, for example, accurate incident records are maintained and entered into the computer data base to monitor trends and assess responses, records are maintained of all financial Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 18 transactions affecting clients, the needs of vulnerable people are kept under constant review. Please refer to the later section in this report on staffing and staff development which outlines concerns about the current shortfalls in staff support that may be placing residents and members of staff at risk. The owners of the business have been advised by the local authority to improve the level of training given to staff to help them in working with people with frequent and occasional behavioural challenges. These concerns form part of a Safeguarding Adults adult protection alert. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 19 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, 30. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. The premises are suitable for the support of residents. EVIDENCE: Over the last 18 months, there has been major re-decoration, a new laundry has been installed and the kitchen was replaced. About half of the bedrooms have an en-suite facility. A communal bathroom needs some re-decoration. Electric hand driers may be introduced. The garden is suitable for use by residents. The smaller premises on the site, the Coach House, will soon be redecorated and re-equipped (before new residents are admitted). Bedrooms (all single) are suitable for the accommodation and care of residents as are the extensive communal areas on the ground and first floors. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 20 The maximum number of residents has, in late 2007, been reduced to 10 to enable residents to have single bedrooms, to make optimum use of communal areas and to enable residents with high support and surveillance requirements receive the support they need. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 21 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, 35. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are in the care of members of staff that are generally well supported by the company. This support would be enhanced if they received access to the training they need in working effectively with residents with more challenging behaviours. EVIDENCE: According to staff files available and information contained in the company’s HR/management database, all required recruitment checks are carried out before a new member of staff is employed. Over the past 18 months, the training received by staff has improved in essential areas of procedures and knowledge. The personal development needs of staff are formally discussed and recorded and agreed actions are implemented. An area of concern is that members of staff are experiencing difficulties in achieving NVQ Level 3 in Care because ILG Ltd does not receive enough free training/training grants. In an environment where sponsors are willing to pay significantly higher levels of weekly fees for specialist support of their clients, members of staff need to be able to progress without hindrance to Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 22 the next level of basic training. The evidence is that the company is failing to expedite this required progression. Another important area that needs attention relates to continuation of SCIP training. Detailed incident reports are submitted to the company’s area manager and the information is entered in the computer network database. The evidence is that there are a high number of incidents suggesting dangers to staff. Members of staff are not receiving “control and restraint” training and they are not currently participating in the remainder of the SCIP programme (levels 6-12). Members of staff are known to feel vulnerable by support shortfall and, during this inspection, there was evidence that skilled staff leave because of their security and personal safety concerns. The support needs of clients are reflected in the weekly fees sponsoring Local Authorities are prepared to pay (£1100 to £2500). Additionally, the profiles of some residents suggest that staffing ratios may not be fully adequate even though four currently have 1:1 staffing ratios. The need for full staff training is therefore paramount. The above fears were confirmed in March 2008 when we became aware that the local authority are concerned about staffing arrangements and the levels of training available to staff. We understand that the manager is restarting a programme called Promoting Safer Therapeutic Services that may address some of the concerns brought to the attention of the owners. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 23 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, 42. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents live in an environment that is well managed. Residents and members of staff are benefiting from improvements in the way the business is conducted. EVIDENCE: Mrs Sally Fulbrook is nurse-qualified (RGN) and has wide experience in residential care management. She also manages the separately registered premises (Coach House) in the grounds of Mansion House. This report refers to the changes that have taken place in 2007. These include premises refurbishment, improvements in bedroom and communal areas, more realistic staffing levels, introduction of better risk assessments, improved staff Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 24 support, better information system and better knowledge of how to work with highly dependent residents. We were provided with relevant information in the AQAA (annual quality assurance assessment) including a declaration that all necessary safety checks on premises and equipment is carried out. The recent fire safety officer visit led to a number of statutory requirements and the manager has addressed these. We also received completed questionnaires from all residents most of whom needed significant staff assistance in making this communication. Close attention is given to recording incidents and their outcomes. The purpose is to monitor how they are dealt with and to improve procedures. As part of this process and in response to fears by staff as to their vulnerability, the company should accelerate staff training. The manager should also take steps to have a personal contract in place for each resident. Where the support of a resident may involve additional aspects (eg. guardianship or appointees and outcomes from these arrangements) the personal contract should contain information on how these arrangements take place. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 4 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 3 3 3 3 2 3 Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 YA35YA35 Regulation Requirement Timescale for action 01/12/08 2 YA23YA23 YA42YA42 YA35YA35 18(1)(c)(1) All members of staff must receive training in the remainder of the SCIP programme (levels 6-12) or in a suitable alternative programme. This is for their personal development and safety and for the need for residents to be under the supervision of suitably trained staff. The timescale date shown is for implementation of the full programme for all staff. We understand that the manager is restarting a programme called Promoting Safer Therapeutic Services that may address some of the concerns brought to the attention of the owners. 18 (1) (a) There should be sufficient numbers of staff on duty at all times including those periods when residents need additional or temporary emergency supervision. 01/04/08 Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 27 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 YA5YA5 Good Practice Recommendations Each resident should have a personal contract that outlines the rights and responsibilities of both parties. This is in addition to the business contract affecting residents between sponsoring organisations and ILG Ltd. Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Mansion House DS0000028936.V352618.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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