Inspection on 16/07/07 for Old Oak Road, 20

This inspection was carried out on 16th July 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Oak Road, 20 09/07/09

Old Oak Road, 20 20/08/08

Old Oak Road, 20 31/01/08

Old Oak Road, 20 04/05/06

Old Oak Road, 20 28/09/05

Old Oak Road, 20 06/01/05

Old Oak Road, 20 11/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Old Oak Road, 20 Old Oak Road 20 Old Oak Road Acton London W3 7HL Lead Inspector Jacqueline Derbyshire Unannounced Inspection 16th July 2007 09:30 Old Oak Road, 20 DS0000019140.V337281.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 Old Oak Road, 20 DS0000019140.V337281.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. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Oak Road, 20 Address Old Oak Road 20 Old Oak Road Acton London W3 7HL 020 8740 1296 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) info@yarrowhousing.org.uk Yarrow Housing Ms Martyne Rosaria O Reilly Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons for whom residential accommodation with both board and care is provided at any one time shall not exceed 6 people with learning The number of persons for whom residential accommodation with both board and care is provided at any one time shall not exceed 6 people with learning difficulties two of whom may have a physical disability 4th May 2006 Date of last inspection Brief Description of the Service: 20 Old Oak Road is a registered care home providing accommodation and personal care for six men and women with a learning disability. At the time of this inspection, one male and five women were living in the home. The home is located in a residential area of Acton and there are good transport links with the community facilities in Hammersmith and Shepherds Bush. Shepherd’s Bush Housing Association owns the property and the care is provided by Yarrow Housing Limited, a voluntary organisation. The home provides a good standard of accommodation. It was fully accessible to people with a physical disability and people with limited mobility, including those who use a wheelchair with lift access to the top floor. The weekly fee for Old Oak Road is £1042.37. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 16th July 2007; the inspector spent 5.00 hours visiting the home. The Inspector spoke with two of the people living at the home, the Manager, the Deputy manager and staff. The Inspector checked the care records of two residents; two of the residents finance records and all of the resident’s medication records. Four of the residents bedrooms were looked at and all communal parts of the home. The home provides an adequate standard of accommodation that was seen to be clean and tidy on the day of this inspection. 6 questionnaires from resident’s families were returned to the CSCI, information from the questionnaires will be included in this report. 4 of the 6 requirements that were set May 2006 have been met; 6 new requirements have been set from this visit. There are issues that initiated 3 immediate requirements that will be written in this report; also staffing levels at the weekend need to be looked at to make sure all residents have access to activities. All staff needs to complete mandatory training. What the service does well: The Person Centred Planning (PCP) has improved immensely and all residents are now fully involved in the process. All Person Centred Planning (PCP) review meetings were up to date with relevant records in place to show the service users aims and aspirations. Passport books on individual service users are excellent with information telling their story of who they are what are their likes and dislikes. These books have photographs and picture details also. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Old Oak Road, 20 DS0000019140.V337281.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 Old Oak Road, 20 DS0000019140.V337281.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): Standard 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective individuals are given the opportunity to spend time in the home. EVIDENCE: The Inspector looked at two residents files and records were in place that showed how the home would be suitable for each person. All prospective residents have their needs assessed with their aims and aspirations looked at to make sure the home is suitable and that staff are adequately trained to be able to meet them. The Inspector met with two residents who stated they were happy living at Old Oak Road. The two residents files that the Inspector checked had been living at the home for a long time and in discussion with the Manager the records that had the introductory visits in had been archived as required on a previous inspection. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 10 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): Standards 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service recognises the right of individuals to take control of their lives and to make their own choices. EVIDENCE: The Inspector looked at two residents files that were very comprehensive and had a lot of information that show how the home is going to meet the individual’s needs. Review records were all up to date with records showing how aims will be met. In discussion with one of the residents they were happy to talk about their (PCP) and how they had done a presentation showing pictures and drawings of their likes and dislikes and what their future aspirations are. The Inspector looked at the (PCP’s) and discussed the progression with them in the home and how residents were now totally involved in the process. The Manager told the Inspector that they are liaising with the Local Authorities designated (PCP) Coordinator to make sure that they are going in the right direction for all residents. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 11 Passport books on individual service users are excellent with information telling their story of who they are what are their likes and dislikes. These books have photographs and picture details also. Questionnaires from family members to the Commission stated that they felt that residents are looked after very well in Old Oak Road. None of the residents look after their own finances all of the residents requires different levels of assistance. The Inspector checked the financial transactions and monies kept for two residents and all was seen to be recorded correctly with the relevant balance in place. The Inspector saw risk assessments in the two files that were comprehensive and up to date that had been reviewed in March 2007. There are residents in Old Oak Road that require a lot of assistance in all areas of their daily lives and in discussion with the Manager the Inspector was told that there are risk assessments completed when there is an identified risk. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 12 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): Standards 12,13,15,16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and attempts to provide a service that is as individual as possible using its staff and resources effectively. EVIDENCE: All of the residents have an activity plan that was written in their files and also on the notice board in the office. The residents are all escorted to attend different venue’s in the local community where they participate in activities. One of the residents told the Inspector that they do lots of activities in the week at different venues and that they go to stay with either parent at the weekend. The resident also told the Inspector they were going to Edinburgh for a holiday in September with a friend. In discussion with the Manager the Inspector was told that all of the residents do have family and friends visiting Old Oak Road, two of the residents also go to see their friends on a regular basis. Some activities are provided in the house such as massages where a professional masseur visits. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 13 The Manager must look at the staffing levels at the weekend to make sure that there is sufficient staff on duty to ensure all residents have the opportunity to participate in activities. There is a TV, video and music centre in the lounge. The Inspector looked at the weekly menu that includes the likes of all residents, the menus include different dishes from the different cultural backgrounds of some residents. In discussion with two of the residents they told the Inspector they were happy with the meals. The inspector checked the storage of food and it was seen to be adequate with safe temperatures in the fridge and freezer. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 14 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): Standards 18,19 and 20.Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the services have access to health care services both within the home and in the local community. EVIDENCE: All of the six residents are assisted with personal care; this is done either in the resident’s bedroom or in one of the bathrooms. Full care plans are in place showing the assistance that each resident needs. There is an issue regarding the inappropriate care and loss of dignity leading to safeguarding action of one of the residents. In discussion with the Manager the resident’s hair gets very thick and difficult to manage, there had been no communication at the time for a member of staff to use the hair clippers and remove all of the resident’s hair. The Inspector discussed the resident having an advocate involved to look at all of their needs. The Inspector looked at two residents files and each contained healthcare records. All of the individual’s regular health care checks had taken place, optical, dental and GP. The Inspector also saw records of appointments with psychiatrists, speech therapists and other professionals. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 15 The Inspector checked the medication administration records for all of the people living in the home. Overall the Inspector felt that the standard of medication recording was good with all staff following the medication procedure. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 16 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): Standards 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. All staff must be up to date in the Safeguarding of Vulnerable Adults procedures, to make sure all residents are safe in the home. EVIDENCE: There have been two complaints at the home in the last 12 months that are being looked at by the organisation in regard to staffing levels at the weekend. There is a complaints procedure available for all residents that is available in different formats. Questionnaires returned to the Commission shows that resident’s families are aware of the complaints procedure. As written in this report the staff must not provide personal care tasks for residents that are not written in their care plan. There is an issue regarding the inappropriate care and loss of dignity leading to safeguarding action of one of the residents. The Manager must notify the Local Authority social services to initiate a safeguarding strategy meeting. The Manager must make sure that all staff are fully aware and trained in the Safeguarding of Vulnerable Adults procedures and that staff will not in the future deviate from residents care plans in relation to personal assistance without first liaising with Management. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 17 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): Standards 24,25,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The programme for repairs and decoration in the home is reactive; there are issues to the structure of the house that need immediate attention. EVIDENCE: A full tour of the home was given and four of the service users bedrooms were seen, they were all different with the service users individual tastes taken into account. One service user was happy to show the inspector his bedroom and stated he was very happy with the furniture and the décor, his bedroom had a TV and video/DVD player as the service user liked to watch films in his room. There is a lift for access on to the top floor that is maintained annually. There is an ongoing issue with remedial works not being completed. In discussion with the Manager the Inspector was told that in April 2007 a survey took place and the findings were that the house has subsidence due to water retention at a lower level. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 18 This must be looked at straight away and ascertain if there are any risks to the people living at the home. The house has still got cracks showing in all areas and new ones appearing frequently, the landlords are repairing some of the cracks however the house is looking in a bad state of repair. The Inspector set an Immediate Requirement that was immediately actioned by the Manager. Two representatives from Shepherds Bush Housing (the landlords) visited the house 17/07/07 and have completed a report stating that works will be undertaken by them to show the level of subsidence and what works will need to be carried out to repair the structure of the home. All areas of the home were seen to be very clean, tidy and bright. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 19 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): Standards 32,33,34 and 35.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing rotas need to take into account the needs and routines of the people using the service. EVIDENCE: The Inspector looked at the staff rota; there are adequate staff on duty on all weekdays, there are issues regarding the staffing levels at the weekend. As written throughout this report the Manager must look at the weekend staffing levels to ensure all of the residents needs would be met. The Inspector checked the training and development records and also had discussions with staff. Training is not up to date for all staff and in discussion with the Manager arrangements have been made to make sure all staff attend the training as soon as possible. The Managers and staff should monitor training on a regular basis so that mandatory training is up to date for all. The ratio of staff having completed NVQ’s is below the 50 . In discussion with the Manager the Inspector was told that all staff are now registered to complete an NVQ with all hoping to achieve in the next 12 months. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 20 The Human Resources team based at Yarrow head office carries out all recruitment. CRB records were checked and all staff has up to date checks completed. The Manager confirmed that there are currently two vacancies for Residential Support Workers. The Inspector checked supervision records of two staff that were seen to be up to date; both had also had an annual appraisal. In discussion with the Manager and looking at records the staff at Old Oak Road are receiving regular supervision sessions. The Manager must make sure at supervision sessions that the mandatory training of staff is up to date and if not put forward for the next training. In discussion with the Manager and staff the Inspector was told that there are difficulties in staff attending training, as the courses are fully booked. The organisation must make sure that sufficient training sessions are available to all staff. The Manager told the Inspector that she would provide a training session imminently for all staff in moving and handling, as she is one of the organisations training Coordinators. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 21 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): Standards 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager is qualified and has the necessary experience to run the home. EVIDENCE: In discussion with the Manger the Inspector was told that she has started Registered Managers Award training (RMA). The Manager has worked in social care for many years and has lots of experience; the Manager is also a qualified Nurse. The Manager is also a training Coordinator for Yarrow. The Inspector looked at two residents files and each had quality assurance questionnaires in place. The residents had both been assisted by a member of their family to complete the questionnaires. The residents had no issues and stated they were happy living at Old Oak Road. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 22 Yarrow collates all of their quality assurance information and produces a document annually to show outcomes of their audits. The Inspector had discussions with two of the residents living at Old Oak Road who were able to express their feelings about the staff and the home, and they stated they were happy. The home to have regular PIC visits by the organisation, as this is not happening. The Inspector looked at the training records of staff and in discussion with the Manager is was apparent that the Manager must make sure that there is at all times member of staff with first aid training on duty, and that all staff are up to date with moving and handling and food hygiene. As written throughout this report the organisation must make sure that the landlords complete all works necessary and have a structural survey completed on the foundations of the house. Remedial works and redecoration of these areas needs to be completed throughout the house. The Water temperatures records show that they are to low, all thermostats to be checked and set at the correct temperature. Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 x 28 x 29 2 30 3 STAFFING Standard No Score 31 x 32 2 33 2 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 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 3 x 3 x 2 x x 1 x Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 24 Yes 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 2 Standard YA14 YA23 Regulation 16 13 Requirement The Manager must make sure that activities are provided to all residents at the weekend. The manager to notify the Local Authority social services to initiate a safeguarding strategy meeting concerning a female resident whose hair was shaven off. This is an immediate Requirement. The Manager must make sure that there is adequate staffing numbers on duty at the weekend to provide the relevant care to all residents. The home to have regular PIC visits by the organisation, as this is not happening. The Manager to make sure all staff are up to date with moving and handling and all other mandatory training. The Manager to make sure that there is at all times member of staff with first aid training on duty. DS0000019140.V337281.R01.S.doc Timescale for action 16/08/07 18/07/07 3 YA33 18 16/08/07 4 5 YA39 YA42 26 13 16/08/07 16/08/07 6 YA42 13 16/12/07 Old Oak Road, 20 Version 5.2 Page 25 7 YA42 23 The Manager to liaise with the landlords and have a survey completed on the structural foundations of the house. Remedial works to be completed on cracks throughout the house. This is an immediate Requirement. Water temperatures are to low, all thermostats to be checked and set at the correct temperature. This is a repeat requirement from 04/05/06. 18/07/07 8 YA42 23 16/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Old Oak Road, 20 DS0000019140.V337281.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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