Inspection on 19/11/07 for Nightingale Nursing Home

This inspection was carried out on 19th November 2007.

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

Nightingale Nursing Home 10/01/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Nightingale Nursing Home 2 Roslin Road Talbot Woods Bournemouth Dorset BH3 7JA Lead Inspector Jo Palmer Key Unannounced Inspection 19th November 2007 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nightingale Nursing Home Address 2 Roslin Road Talbot Woods Bournemouth Dorset BH3 7JA 01202 520120 01202 520120 nightingale@mitchellworld.plus.com 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) Nightingale (Bournemouth) Ltd Mrs Rita Philomena Mitchell Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10th January 2007 Brief Description of the Service: Nightingale Nursing Home is a care home registered with the Commission for Social Care Inspection to provide nursing and personal care for up to twentyeight older people. The home is situated in a tree lined residential area five minutes drive from Bournemouth town centre. There is a mature well-maintained garden that is accessible to service users and visitors. Car parking is available in the grounds of the home or in the surrounding roads. Accommodation is situated on two floors with eight bedrooms on the ground floor and thirteen on the first floor. A passenger lift provides access to the first floor for service users and visitors with mobility problems. The Registered Providers are Nightingale (Bournemouth) Ltd. Mrs Mitchell, a director of the company, is the Registered Manager. At the time of the inspection the weekly fees are £680 for a single room and £595 for a shared room. Additional charges are made for hairdressing and chiropody. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx Nightingale Nursing Home DS0000068085.V353222.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 19th November 2007 between 10.45 and 14.50. Ms Rita Mitchell, owner of Nightingale (Bournemouth) Ltd and registered manager for Nightingale Nursing Home was present and assisted with the inspection process. The main purpose of this key inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting the requirement and recommendations made at the previous inspection. The inspector spoke with five residents, one staff member, took a tour of the premises and examined relevant records. The Commission for Social Care Inspection sends questionnaires to service users, their relatives, staff and visiting professionals in order to obtain feedback about the services provided, an Annual Quality Assurance Assessment (AQAA) is also sent for completion by the manager/responsible person, the completed AQAA was used to inform parts of this inspection. Surveys from three staff had been returned and three relatives had been returned; comments included: (from staff) ‘What the service does well’ • Communicative and homely care • Provides person oriented level of care, flexible to the needs of the resident ‘What could the service do better’ • Weekend cleaner • Laundry staff should not work as care assistant • Care assistant should not do kitchen duty • We have no complaints • The staff make an effort with the residents although (name) thinks they are short staffed. • More entertainment for residents • Have laundry and kitchen assistants so the staff do not have to do these jobs, valuable time could be spent with residents. (from relatives) • The staff do their best to provide the attention and friendly approach that makes for a good atmosphere. • It always is fresh – no smells • Very polite, welcoming and friendly Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 6 • • I feel I can ask questions and get a sensible answer The only thing lacking in Nightingale is a form of entertainment. What the service does well: What has improved since the last inspection? A requirement of the last inspection has been addressed ensuring that hot water temperatures are controlled to prevent accidental scalding. Waste bins in the sluice areas of the home have been mended or replaced ensuring that they are now covered. Testing of portable electrical appliances has been undertaken, this is now to be done annually. A passenger lift has been installed since the last inspection, a condition regarding the accommodation of residents above ground floor level can now be removed from the home’s registration certificate. Nightingale Nursing Home DS0000068085.V353222.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. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough pre admission procedure is in place and assessments are routinely undertaken to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: Four resident’s care files were reviewed and each contained pre admission assessment information. The needs of the resident are assessed prior to them agreeing to move into the home using set formats that has been developed to take into consideration their health and welfare needs. The records indicated that the needs and circumstances of the people had been properly taken into account. The assessment indicated that other relevant people had been consulted with regard to this persons care needs and a local authority single assessment care plan for the placement at was available for staff reference for one resident. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 10 Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents although some areas of assessment and care planning require attention to ensure they provide accurate detail. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care plans for four residents were reviewed. Generally these are well maintained and detailed and provide staff with sufficient information in order that residents needs can be met as assessed. Care plans are developed from on-going, reviewed assessments of areas of health and well being related to mobility, skin care, continence and nutrition and safe working practices. One file seen however identified through assessment, that the resident’s catheter had been removed (in July 2007), there was no associated plan of care for this persons needs to be met in relation to elimination; it was evident from a further review of daily records that the person was incontinent of both urine Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 12 and faeces although there was no instruction for staff as to how this was to be managed. All care files held assessments for the use of bed rails, one such assessment identified that the person needed to get out of bed during the night. The assessment format stated that if this was the case, bed rails were not to be used and yet this person had bed rails in situ and the daily report highlighted one instance where the resident had climbed out of the bottom of the bed ion order to use the commode. (See also standard 38 re Health and safety) Care files were well organised, easy to read and accessible to staff to provide information about the needs of the resident and how the home was to meet these needs. It was clear that reviews were being undertaken and plans updated with changes (with the exception of those areas identified above). Staff complete daily records which support and evidence the delivery of care to residents and feed into the regular reviews of care plans. Evidence was available on file and through discussion with management that GPs, opticians and chiropodists are available to residents. Medication records are well kept and evidenced that residents are in receipt of any medication as prescribed by their GP, storage of medicines in the home was safe and in order. Medication administration records were seen to be in order, well kept and with clear instruction. A record is kept of the safe return to the pharmacy of any medication that is no longer required. Medicines are issued in their original containers, the containers are dated when opened to ensure an accurate audit trail can be maintained. Residents spoken with said that they were treated well and that staff were kind and friendly. Staff were seen to treat residents with courtesy, patience, kindness and respect. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social care is limited to the extent of resident’s abilities to participate, people are generally encouraged to make choices about their life style and to maintain contact with their family and friends. The meals in this home are wholesome and varied and are served in a pleasant environment. EVIDENCE: Care files examined evidenced that resident’s social care and leisure needs are taken into consideration at the assessment stage. Of five residents spoken with during this inspection, three were unable to comment and two confirmed that their social needs and expectations were met. On comment cards returned, one staff member and one relative commented that more entertainment could be provided by the home. An activity file is held detailing all social events in the home, this was seen to include fortnightly musical performances by a visiting entertainers, a tea party in the summer, transport booked to see the Christmas lights in Bournemouth, carol singing and in-house activities such as Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 14 hand massage, flexicise, and a visiting puppy that some residents enjoy petting. Residents confirmed that they are able to maintain contact with their friends and family and visitors are welcomed to the home. Four of the five residents spoken with confirmed that meals are well prepared, appetising and plentiful, one resident was less complimentary although had no complaints. One comment received on a returned comment care was that ‘Nightingale is fortunate to have an expert chef who will always provide little delicacies for those who are gravely ill’. The chef was spoken with briefly who was evidently committed to providing a varied diet of fresh meals for residents, a set menu is available and although there is no choice for residents, chef knows individual likes and dislikes and will offer an alternative to those residents who do not like the dish of the day. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies, procedures and staff training programmes are in place to protect the residents living at the home; residents can be reassured that they can express any concerns they may have and that any incidents will be managed appropriately although some amendments are required to ensure the procedures are robust. EVIDENCE: No complaints or incidents have been reported. A complaints procedure is available to residents to inform of the process of making a complaint although there is no procedure available to staff detailing how they should manage a complaint should they receive one. Residents spoken with and returned surveys indicated a level of satisfaction with the service provided. An adult protection procedure is in place which refers staff to the local authority guidelines on managing any incidents that may be witnessed or reported. However, the procedure, written by Nightingale (Bournemouth) Ltd’s consultant company states that if any such incident is witnessed, the witness should consider ‘challenging the abuser’, this is in contradiction of the local authority guidelines. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Nightingale Nursing Home provides residents with a comfortable environment in which to live where they are safe, warm and have suitable facilities to meet their needs. EVIDENCE: Since the last inspection, a passenger lift has been installed to replace the stair lift and ease access between floors. Residents spoken with confirmed that they are comfortable in their rooms and are able to bring personal effects to make their space more homely. Bathrooms, showers and toilets are sited around the home, these provide suitable facilities, are clean and mobility equipment is installed and serviced as necessary. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 17 Radiators and hot surfaces have been guarded to reduce risks of accidental scalding and a requirement of the last inspection has been addressed with regard to hot water temperatures. Valves have been fitted to hot water outlets to ensure water is not excessively hot; temperatures measured during this inspection confirmed them to be around 43 degrees centigrade. Communal areas of the home are pleasantly furnished and decorated and some residents were seen to be making good use of these areas. The home was clean and well maintained at the time of inspection with no unpleasant odours; infection control procedures are in place. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff are on duty to meet resident’s needs. Training is provided to staff in order that they have the skills and are competent to do their jobs. Safe staff recruitment practice is used. EVIDENCE: Staff rotas seen demonstrate that there are sufficient numbers of staff on duty to meet residents needs; residents confirmed that staff are available when they need them. There are two first level registered nurses and four care staff on duty for each day shift and one first level registered nurse with two care staff each night. Additionally, there is a housekeeper on duty each weekday morning, and a chef and kitchen assistant throughout the day over seven days. A criticism from staff and relatives in returned surveys was that care staff are taken away from care duties at various times to carry out some domestic, laundry and catering tasks. Three care staff employed are currently undertaking the NVQ level 2 award and more are booked to start this training in January 2008; two care staff have already attained the award. One member of care staff has attained level 3 NVQ. Fifteen care staff are employed, a recommendation of the previous Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 19 inspection is repeated with regard to 50 of the care staff being trained to NVQ level 2. Staff files seen demonstrated the extent of training courses attended by staff. Those seen included certificates in the following: • Adult protection • Moving and Handling • Infection control • Food Hygiene • First Aid • Diabetes • Catheter care • Mental Health Mrs Mitchell confirmed that some staff are booked for updates of these courses. Staff files seen demonstrated appropriate recruitment. Application forms are used to recruit into vacant posts, applicants provide personal details as required in Schedule 4 (Care Homes Regulations) including work history and qualification, provide names of referees and sign a Rehabilitation of Offenders statement. References, POVA (Adult Protection) and Criminal Records checks are made before an applicant is successful and starts employment at the home and for trained nurses, their pin number (registration) is verified with the Nursing and Midwifery Council. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are can be confident that the home is well managed and that systems are in place that centre around their care needs. Management practices and records kept, confirm the health and safety of people in the home. EVIDENCE: Mrs Mitchell, registered manager and joint owner of Nightingale Nursing Home is currently undertaking the NVQ level 4 award. Mrs Mitchell is a first level registered nurse and is competent manager who is able to efficiently run the home with the support of a cohesive staff team. Residents spoken with confirmed they were happy with the management arrangements stating that Mrs Mitchell and the staff were available when needed. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 21 The Commission for Social Care Inspection send all care homes an AQAA (Annual Quality Assurance Assessment) to complete prior to inspection. A completed AQAA which provided detail of the home’s intention to continue to monitor and evaluate quality of service provided was submitted which identifies what the home feels they do well and sets out their plans for improvement over the next twelve months. An internal quality assurance report is not available to residents although Mrs Mitchell confirmed that the process of monitoring quality of service provision has started as questionnaires have been sent to residents, relatives, GPs and other relevant parties; it is advised that the significant points of the AQAA are used to formulate part of the homes Quality Assurance report that is available for residents. In order to protect residents, it is the policy of the home not to have any involvement in their personal finances. Therefore, any resident unable or not wishing to handle their own affairs has a relative or other representative to deal with their finances etc. The home has a fire risk assessment that was reviewed in August 2007, Dorset Fire and Rescue Service last visited the home in July 2007, records examined demonstrated that the fire warning systems, equipment and emergency lighting are checked and serviced at the recommended intervals and staff receive regular fire training updates. A recommendation of the last inspection report has been addressed, the homes portable electrical appliances have been tested, this is an annual requirement. Assessments are made regarding the health and safety of residents in relation to the use of bed rails, one such assessment identified reasons why bed rails should not be used although bed rails were in situ compromising this residents safety. (See also standard 7 re Care Planning) Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 1 Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 14 Requirement Identified needs in relation to continence care and elimination must be supported by a plan of care providing staff with clear instruction on how these needs art to be met. Bed rails must be removed where risks to the resident’s safety have been identified. A procedure must be in place detailing the action staff need to follow on receipt of a complaint. The home’s adult protection policy must be reviewed to ensure it is held in accordance with local authority guidelines. Timescale for action 31/01/08 2 3 4 OP38 OP16 OP18 13 22 13 31/01/08 31/01/08 31/01/08 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 OP27 Good Practice Recommendations Nightingale (Bournemouth) Ltd should consider employing designated staff to carry out the domestic, laundry and DS0000068085.V353222.R01.S.doc Version 5.2 Page 24 Nightingale Nursing Home 2. OP28 catering duties needed by the home in order that care staff are not removed from resident care services. A minimum ratio of 50 of care staff should be trained to the NVQ level 2 or equivalent. Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Nightingale Nursing Home DS0000068085.V353222.R01.S.doc Version 5.2 Page 26 - 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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