Inspection on 12/05/05 for Melford Court Nursing Home

This inspection was carried out on 12th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Melford Court Nursing Home 17/07/07

Melford Court Nursing Home 19/07/06

Melford Court Nursing Home 27/10/05

Melford Court Nursing Home 17/01/05

Melford Court Nursing Home 16/06/04

Similar services:

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Melford Court Nursing Home Hall Street Long Melford Sudbury Suffolk, CO10 9JA Lead Inspector Karen Howman Unannounced 12th May 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Melford Court Nursing Home Address Hall Street, Long Melford, Sudbury, Suffolk, CO10 9JA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01787 880545 01787 881845 None BUPA Care Homes Limited Mrs Susan Whitney Care Home with Nursing 52 Category(ies) of Older People - 52, Physical Disabilities - 2, registration, with number Learning Disabilities - 1, Dementia (over the age of places of 65) - 7 Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The Home is registered to provide care for two service users with physical disability (PD) aged from 45-64. The Home may accommodate one named servcie user with learning disabilities (LD). The Home may accommodate seven named service users with dementia (DE E) Date of last inspection 17 January 2005 Brief Description of the Service: Melford Court is situated in the town of Long Melford. The frontage of the Grade II listed building forms part of the main street, enabling service users to have easy access to the local shops, library, church, restaurants and public houses. There is limited parking to both the front and side of the Home. The enclosed courtyard and garden area, runs along the side of the Home. Melford Court was purchased by BUPA from the Community Hospitals Limited in 1997, and has undergone extensive refurbishment. The Home is situated on two floors and consists of 45 en-suite bedrooms, 38 of which are singles and 7 doubles. The Home provides assisted bath and shower facilities, extra communal toilets, a dining room, three lounge/activity rooms and a hairdressing room. Access to the first floor is via stairs or passenger lift. The Home is managed by Mrs Susan Whitney, a Registered Nurse. The Home is registered as a care home with nursing providing care primarily to older people. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken on an unannounced basis, by inspectors Karen Howman and Jane Offord. The inspection started at 8.30am with the Manager arriving shortly afterwards and being available throughout the day. The main focus of the inspection was to look at the morning routines in the Home and to consider how issues such as choice, privacy and dignity were managed. The Inspectors spent some of the day speaking with trained staff and carers as they went about their duties as well as speaking with a small number of service users. The inspectors also viewed a range of supporting documentation including care plans and accident records. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 These standards were not assessed on this occasion. EVIDENCE: Not applicable on this occasion. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9,10. Care plans clearly identify the health, personal and social care needs of service users and evidence that choice and independence are promoted. Medication administration records must be more monitored for missing entries more closely to ensure the protection of service users. Staff understand the values of privacy and dignity and respect these in their work with service users. EVIDENCE: The inspectors viewed the care plans of four service users who were spoken with or met whilst staff were observed providing care during the course of the day. Each plan included a photograph of the service user, important details such as next of kin and GP and identified the key nurse and carer responsible for overseeing their care. Care plans were being reviewed on a monthly basis with the individual’s level of dependency determined at the same time. Moving and handling assessments were current. In one instance the moving and handling assessment did not appear to have been reviewed since January 2005, however the care plan demonstrated that the service user’s current moving and handling needs were recorded and being met. Care plans covered a range of social, personal and health care needs with evidence of pressure care and Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 9 nutritional assessment and monitoring. The moving and handling assessment of one of the service user’s who has a diagnosis of dementia identified that staff needed to assess the service user’s degree of independence on a daily basis reflecting that staff took account of mood and psychological health. One service user spoken with confirmed that the presence of bed rails gave them a sense of safety and security and their care plan included evidence of assessment for their use. Care plans reflected personal choices. For example, one care plan included details of the time the service user preferred to go to bed and the fact that they liked to have two pillows and the time they preferred to get up in the morning. Care plans also identified areas in which service users could be encouraged to retain their independence, for example in only providing assistance with those aspects of personal care that the service user could not do for themselves. One care plan clearly showed that the service user was able to choose their own clothes and should be enabled to do so. Medication was administered by the trained staff on duty. The inspectors briefly spent time with one of the trained nurses at the start of the inspection. Medication was transported in a lockable trolley, which was kept under supervision at all times and locked away in the treatment room once medication had been administered. Each medication administration had a photograph of the service user for identification and medication was administered to each service user requiring it in turn. The MAR (medication administration record) sheets were examined and a small number of missing entries noted on three sheets. The Manager advised that discrepancies or missing entries were usually identified and addressed; she was unable to find a reason on this occasion. Thirty-seven of the forty-five bedrooms at Melford Court are for single occupancy. One service user who did share their room confirmed that they were happy to do so and that staff respected their privacy when providing assistance with personal care, by pulling the privacy curtains around their bed. Staff were observed to knock on doors before entering bedrooms and to close doors respecting the service user’s privacy and dignity when assisting someone with washing and dressing, bathing and toileting. Care staff advised that they were also expected to draw the curtains in a service user’s room whilst providing personal care and this practice was confirmed in discussion with the Manager. A notice had been pinned on the outside of one bedroom door asking that carers provide a particular evening drink at a certain time. The Manager agreed that this information should be more appropriately recorded in the service user plan and the catering staff informed and agreed to find out whether this directive had been made by the service user, relative or staff. Similarly the inspectors noted that a service user was going out to enjoy an outing to a local pub with other service users and staff, in a wheelchair that Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 10 was labelled on the outside and therefore visible, with the service user’s name and instruction to keep the wheelchair in the service user’s bathroom. The Manager agreed to discuss this with the service user with a view to seeing if the wheelchair could be labelled more discreetly to promote the service user’s dignity. It was evident from discussion with two carers that they were aware of the core values of care and both confirmed that they had either finished or were completing their NVQ level 2. They were able to describe what sort of practices ensured that the privacy and dignity of service users was respected. Carers referred to knocking on doors, use of privacy curtains, covering service users with a towel when providing personal care and by wheeling commode chairs into the toilet rather than using the commode in the bedroom wherever possible. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15. Individual routines and preferences are respected with service users able to join in organised activities or to enjoy personal interests as they choose. Service users are offered a varied and appealing diet at a time that suits their needs. EVIDENCE: One service user advised the inspectors that they liked to stay in their room in the morning before joining other service users in the dining room for lunch, whilst another service user expressed a preference to stay in their room as they loved reading and enjoyed the quiet. Service users were observed to have their own routines, choosing to spend time alone or with other service users in one of the lounges. Carers gave priority to providing personal care over bed making in the morning. Whilst this meant that some beds were left until late morning to be made, it did contribute to a relaxed and informal atmosphere within the home. A large number of service users joined in with a regular armchair exercise session, whilst activities staff joined a small group of service users on a visit to a local pub for a drink before lunch. Other service watched television in the ground floor lounge. One service user expressed pleasure in the arrival of warmer weather so that they could sit out in the garden again. The inspection coincided with breakfast time. The kitchen is staffed from 7am – 7pm, so carers are not required to cook but to help serve meals and take them to bedrooms. Preferred meal times were not recorded on care plans Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 12 however staff advised that they were familiar with individual service user’s routines and tried to ensure that those who liked breakfast early were served first, followed by those needing assistance. One service user confirmed that they liked to get up early so was ready for breakfast when it arrived. Service users were able to have an early cup of tea if they wished. Service users are asked to make meal choices two days in advance however the cook and carers spoken with confirmed that they were able to offer an alterative on the day if needed. Service users were offered a good choice for breakfast with juice, cereals, porridge, cooked breakfast, bread or toast. The food looked appetising and a tray individually prepared for each service user when the carers were ready to collect the meal. At the time of this inspection all breakfasts were served to people in their rooms however it would be possible for a service user to eat in the dining room if they wished to. Inspectors observed a carer providing one to one attention to a service user who needed some assistance with eating their breakfast in their room. The environment was not very comfortable with the carer sitting on an unmade bed with sheets furled up and was serving food from a plate on a low wooden chair rather than table. The carer demonstrated patience and did not rush the service user with their breakfast The Inspectors observed the beginning of lunch where service users were assisted to the dining room as needed, offered a choice of meal with special diets catered for and the opportunity to enjoy a drink with their meal. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 These standards were not assessed at this inspection. EVIDENCE: Not applicable on this occasion. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 The Home is generally well maintained however risk assessments were not routinely undertaken with respect to minor maintenance tasks. Staff have access to protective clothing and demonstrated that they were of infection control procedures. EVIDENCE: The Home is located centrally in Long Melford and is easily accessed by service users and visitors. The Home provides comfortable and suitable accommodation and is equipped with a range of aids and adaptations suited to the needs of the service user group including a passenger lift, grab rails, hoists, assisted baths and call bell system. The grounds were well maintained. During the course of the inspection external contractors were on site dealing with some plumbing repairs to a small number of bedrooms and windows were being cleaned. The inspectors noted that in one area where the floor sloped, the grab rail had been removed so that it could be repaired. The home’ s maintenance person Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 15 was on leave so the replacement grab rail was not due to be installed until the following week, however there was no evidence of warning notifications or risk assessment concerning this grab rail. The Home was found to be clean and tidy. The Inspectors spoke with one of the housekeeping staff. It was evident from discussion that they had enjoyed their work and that they understood that they had an important role within the overall provision of care. They stated that they found the Manager supportive and confirmed that they had good access to cleaning materials. They had also been given training in fire safety, care of substances hazardous to health (COSHH) awareness and health and safety. Housekeeping was responsible for restocking supplies of disposable towels and liquid soap. Carers are also provided with protective clothing including disposable aprons and gloves. Infection control procedures were discussed with two carers. Both were able to describe the procedures for managing soiled laundry and for cleaning commodes and were observed to wear protective clothing as they provided personal care. The inaccessibility of the towel dispenser in one bathroom (as described above) led to one carer having to dry their hands with toilet paper. The Inspectors questioned why one carer had not worn protective gloves when taking bedding from one service users room to the sluice room, when this service user had been unwell earlier that morning. The carer advised that the service user was in fact improved and that they had washed their hands after assisting the service user and making their bed. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 There were adequate numbers of staff on duty with an appropriate skill mix. EVIDENCE: At the time of inspection, there were forty-seven service users (including three people on respite care stay) at Melford Court. Staff were observed to be busy throughout the inspection however there was no evidence to suggest that they were rushing service users. Priority was given to ensuring that care needs were met before some of the housekeeping tasks such as bed making. Staff were alerted to call bells through pagers, which were worn as they moved around the home. A carer confirmed that they were responded to in turn and service users did not express any specific concerns about the length of time taken for carers to respond. Inspectors observed that one to one assistance was provided to service users who needed help with eating breakfast, whilst staff worked in pairs to provide appropriate assistance with transfer by hoist or with a service user requiring full support with personal care. Staff spoken with stated that whilst each day varied they felt that staffing levels at that time were satisfactory. Service users spoke positively about staff with one service user stating that they had no need to complain, as the carers were pleasant, courteous and competent. The inspectors noted that in the first floor sluice room, a staff notice had recently been displayed requesting that night staff deal with the morning routine and asking them to wash and dress one or two service users from the Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 17 blue team. This was discussed with the Manager who stated service users would only be assisted to get up by night staff if they wished to do so. On arrival at the Home, inspectors observed that whilst some service users were dressed, a number were still getting up and there was no evidence to suggest that service users were being got up early. There were 3 nurses and 8 carers on duty, supported by administrative, activity, catering, and domestic staff. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38. Records are stored appropriately with care plans accessible to service users, however the Home had not complied with the requirement to have their current Certificate of Registration displayed. Issues of storage were not adequately addressed and some fire fighting equipment was inaccessible. EVIDENCE: Care plans were found to be orderly, well presented and accessible as they are held in the service users bedrooms. All other service user records were found to be stored appropriately. Some missing entries were found in medication administration records. Accident reports were completed satisfactorily. The Home’s complaints log identified that there had been one complaint recorded since the start of the year and there was evidence of complaints monitoring. A new Certificate of Registration had been issued since the last inspection, however the previous certificate was still on display. The Manager advised the Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 19 inspectors of the death of one service user resulting in the need for a further certificate to be issued. The toilet in one bathroom was found to be inaccessible due to the fact that the room was being used as a storage area for hoists and an armchair. Carers were unable to access the towel dispenser after using the washbasin. Two wardrobes were found to be stored in the corridor on the first floor. One wardrobe belonged to a service user occupying an adjoining room whilst the other was unused. The Manager stated that the service user’s relative had requested that the wardrobe be removed when they reorganised the layout of the bedroom, which was shared with another service user. The inspectors expressed concerns that the wardrobes presented a potential hazard. The floor was sloping at this point and one of the wardrobes was secured to the wall by a length of string. A fire extinguisher sited between the two wardrobes was hidden from view. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x 2 2 Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 21 No 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. 1. Standard 9 37 Timescale for action 13(2) Staff must complete and sign the Immediate medication administration records at all times, identifying a reason if medication is not given. Any gaps in records must be routinely investigated. 13(4) Any risks posed following the 20 May removal of a grab rail for repair 2005 must be assessed and appropriate action taken. Section 28 The Home must ensure that the Immediate CSA 2000 current Certificate of Registration is on display. 13(4) Fire extinguishers must be fully Immediate 23(4)(c ) accessible at all times. 23(2)(l) Bathrooms must be cleared of 30 June 13(4) any unnecessary furniture to 2005 ensure that they are fully accessible to staff and service users. 13(4) Wardrobes located on a first Immediate floor corridor must be removed or safely secured to ensure that they do not pose any risk to staff or service users. Regulation Requirement 2. 19 3. 4. 5. 37 38 38 6. 38 Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 22 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 15 Good Practice Recommendations When assisting a service user with meals in their bedrooms, staff should ensure that the room provides a comfortable and pleasing environment in which to eat. Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 5th Floor, St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Melford Court Nursing Home I54 I04 S24445 Melford Court V226607 050512 Stage 4.doc Version 1.30 Page 24 - 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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