Inspection on 27/02/07 for Parkview

This inspection was carried out on 27th February 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Parkview 26/06/07

Parkview 31/10/05

Parkview 28/06/05

Parkview 30/11/04

Parkview 03/08/04

Parkview 11/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Parkview 113 Sussex Road Watford Hertfordshire WD24 5HR Lead Inspector Sheila Knopp Unannounced Inspection 27 February & 7 & 13 March 2007 11:10 th th th Parkview DS0000019491.V329785.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 Parkview DS0000019491.V329785.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. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkview Address 113 Sussex Road Watford Hertfordshire WD24 5HR 01923 230586 01923 230586 FP viv.fenmore@turning-point.co.uk www.turning-point.co.uk Turning Point Southern Area Office 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) Vivienne Inara Fenemore Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6), Mental disorder, excluding of places learning disability or dementia (6) Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: Parkview is a single storey, purpose built home, providing care for six service users who may have a learning disability or mental disorder. The home is also registered to provide services to individuals in these categories who are over sixty-five years of age. The home is situated in a residential area of Watford, at the end of a cul-de-sac and directly opposite a large park. The home has its own vehicle to transport service users. The main town of Watford is a short drive away, and provides extensive shopping and transport facilities, as well as a wide range of social opportunities. Parkview is a Turning Point home. Information about the service and the inspection reports can be obtained from the manager. The fees are funded by a Hertfordshire County Council block contract of £1450 per week for each person (correct on 7/3/07). Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information in this inspection report is based on three unannounced visits to the home and information received by the Commission between inspections. The inspector spent time with individuals living at Parkview and the staff supporting them. The Commission sent survey forms to four health care professionals who have contact with the residents at Park View so they could give their views. One response has been received. Two relatives were also contacted by telephone. What the service does well: What has improved since the last inspection? The last two inspections have required Turning Point to make sure a more person centred approach is used in planning the support and care of individuals. This process is now underway but progress has been slow due to staff changes. Further requirements have not been made as the Commission can see the company are monitoring this, through their quality assurance processes. Staff have started looking at ways of involving individuals in the running of their home through resident meetings but acknowledge this needs more Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 6 thought in terms of how those with varying communication skills can be included. Individuals are being encouraged to make food choices by having pictures available for them to consider. 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. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 7 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 Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 8 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 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an assessment process in place that enables individuals to spend time at Parkview before making a final decision to make it their home. Staff ensure they have the required information to assess whether they can meet that person’s individual needs. EVIDENCE: The records and interviews with staff and a relative confirmed that individuals looking to live at Parkview are offered the opportunity to visit over a period of time and meet residents. Information is gathered from relatives and health & social care professionals. This information is used to assess whether the service is suitable for their needs. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 9 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 & 9 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person has a plan of their individual care and assessment of identified risks. These records are gradually being updated to reflect a more person centred approach to describing the personal goals of each individual and how they can be achieved. They are not yet in place for everyone and there was an inconsistent approach to updating and reviewing individual guidelines. Further work, described in other areas of this report, is required to ensure that staff use the risk assessments to demonstrate the rights and safety of individuals is supported at all times. EVIDENCE: Annual Whole Life reviews had been carried out with key people in the individual’s life. A social care professional who completed a survey for the Commission said ‘When discussed at a Whole Life review meeting tenants apparent wishes were considered and at the forefront of discussion’. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 10 A key worker showed the inspector the work being carried out to introduce a new approach to care planning, which should reflect the individual goals and aspiration for each person in a much clearer way. The timetable for implementation of this work has slipped due to changes in key staff. This is being monitored by Turning Point. Further training for staff has been arranged. Not all risk assessments had been reviewed within the timescales set or in response to changes that had occurred. For example the walking guidelines for an individual had not been reviewed following two falls. Further information under standards 20 and 42 refer to work required on risk assessments to ensure that the rights and safety of service users are supported at all times. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 11 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 & 17 - Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The move to a more person centred approach will encourage further opportunities for personal development within the home and wider community and make it clearer how these are being met. The current records of opportunities for personal development and leisure activities are inconsistent. Restrictions are placed on individual residents using the front door and this is not recorded as part of their care plan. EVIDENCE: Service users attend a variety of different day centres and colleges accessing courses suitable to their individual needs and aspirations. Information regarding individual trips and events arranged to meet the personal preference for individuals was available. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 12 Staff were involved with individual residents when the inspector visited the home providing quiet activities such as massage, listening to music and nail manicures on an individual basis. The garden provides occupation for some residents in the summer who grow vegetables and plants. On one of the days three individuals had gone to Southend for the day with staff. There is a system for recording the activities residents are involved with each day but these were inconsistent and did not always describe the response of the individual in terms of their enjoyment or well-being. The home has access to a mini bus and allocated drivers, which enables a degree of independence and spontaneity when planning things to do. However the bus was out of action at the time of the inspection and a social care professional who completed a survey for the Commission commented that recent problems with transport has meant an individual has not been able to attend their day centre for a couple of weeks. The home is centrally located, and is within a short distance from shops and the local community amenities. There is evidence from the care records of varying degrees of involvement of family members and advocates. The care plan review taking place will enable staff to reflect on who the key people are in each individual’s life and whether fresh approaches need to be made to people who have not had recent contact. One person the inspector spoke with said the home had not been in touch for some while and if invited they would go to a review. A resident who had been bereaved several years previously did not appear to have an independent advocate available to them. The front door has a high handle, which stops residents from using it. This restriction does not appear to have been considered as part of each residents individual care plan. The reasons and limitations for the use of a listening device in a resident’s room should also be recorded so it is used appropriately and the individual is able to maintain their privacy when it is not required to be on. Meal choices are provided within the home and staff are developing service user involvement with choices and meal planning. Menus were available and the home has a four-week rolling seasonal menu, which appeared well balanced. The nutritional needs of each individual are regularly reviewed. It was reported that the management team also check that the planned menu is being followed by staff. During the first visit it was identified that residents were eating their meals from chipped mismatched crockery. This is not dignified and could also spread infection. New crockery had been provided by the time of the second visit. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the individual support they need to maintain their personal care, in a manner that reflects their choice and preferences. Residents have good access to medical and community health services to maintain their health. Overall there are suitable systems in place for the management of medication but these need to be followed by staff to ensure any gaps in recording or discrepancies are investigated as soon as they are identified. The risk assessment recording medicines that are given to identified residents with food (such as jam) should be reviewed, as this has not been carried out for some time. Thus ensuring they remain appropriate and protect the rights of each person. EVIDENCE: Individuals were observed to be well dressed in clothing that matched their age, physical requirements and reflected their individuality. The care records Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 14 described the individual routines required to support their personal hygiene and dental care. Staff were able to describe how they knew if individuals were distressed or feeling unwell. The care records provided good evidence of the support provided by local doctors and community staff who have known the residents and the service provided at Parkview for a long time. This included a sensitive and reassuring approach to a resident who needed to have a blood sample taken. Requirements from the last inspection in relation to locking the medication refrigerator and securing a storage cabinet have been met. The first visit of this series identified gaps in the recording of medication that had not been investigated and the quantities of some medication could not been reconciled against the records. By the time of the second visit the manager had introduced a chart to audit the medication on a daily basis to pick up any issues. This process would also be helped if staff consistently added the dates of opening on bottles and packets as required following the last inspection. There is a covert medication procedure in place for some residents who have their tablets placed on jam before giving it to them. These records signed by the individual’s GP had not been reviewed since 2003. To protect the rights of individuals these should be reviewed as part of the regular reviews process but also in respect of the obligations placed on staff by the Mental Capacity Act. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is sufficient and adequate for the service users to feel that their individual views are listened to. Policies, procedures and training are in place to ensure individuals are protected and safe. EVIDENCE: No concerns or complaints have been raised with the Commission between inspections. The home has a comprehensive complaints procedure in place, which states that all complaints are responded to within 28 days. A record is maintained within the home of complaints made detailing actions and outcomes as necessary. Individuals are informed and reminded about the complaints procedure, which is in a pictorial form. This is also on display within the home. Procedures are in place to ensure that individuals are protected from abuse and harm. Staff receive Safe Guarding Adult training, and a copy of local guidance is available. The Commission is not aware of any referrals to social services under this procedure. Checks are made on staff to ensure their suitability to work with vulnerable people is explored and the required checks on their integrity are in place. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 16 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 & 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Parkview provides individuals with modern ground floor accommodation in a residential area. There appears to be a lack of urgency in dealing with environmental matters, which could affect the safety of service users. A more consistent approach to reducing the risk of infection by providing staff with suitable equipment to wash and dry their hands needs to be taken. EVIDENCE: The home is light, airy and well decorated. The spacious lounge and wide corridors compliment the space available in each person’s room. Individual rooms reflected personal interest, styles and preferences. Some individuals have specialist equipment, the use of which is detailed in their care records. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 17 During a tour of the premises it was identified on the first day of this inspection that hot water was being delivered to a bath (52.9oC) above health & safety temperature limits (43oC) to prevent accidental scalding and there was no system in place to manage the risk. This is reviewed further under section 42 of this report. A broken ceramic cistern lid in one of the toilets needs to be replaced. The mattress of one individual was showing signs of wear and the sheet was laid directly on to the plastic mattress cover. During the follow up visit it was reported a mattress overlay cover had been purchased and there were plans to buy a new bed. To improve hygiene and the look of the kitchen a new work surface has been fitted which meets a requirement from the last inspection. The first of the visits to this service identified an inconsistent approach to reducing the spread of infection as not all areas where personal care is carried out had paper towels and liquid soap available for hand hygiene. This had been rectified at the time of the second visit but needs to be kept under review. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 18 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, 34 & 35 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is in the process of developing a permanent staff team following recent changes due to retirement and long-term sick leave. This will enable consistent staff to develop their roles with the individuals who live at Park View. Turning Point has training in place to support the development of staff from their induction through to NVQ training. The recruitment process ensures the required checks are carried out on staff before they have contact with vulnerable people. EVIDENCE: Three staff are provided during the day to support individuals at home and there is one person at night with another worker doing a sleep in duty to provide support if required. Turning Point bank staff are currently covering four full time vacancies and it is hoped some of these staff will take up permanent positions. The manager is supernumerary to the staff on duty. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 19 Staff spoke to the inspector about their training and training records were available. The records of three newly recruited staff were examined. This demonstrated that the required checks are being carried out on staff before they are employed to work work with vulnerable people. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 20 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 & 42 - Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. It is acknowledged by Turning Point that this service has gone through a difficult period due to a vacancy in the senior team and staff changes. A senior project worker has now been recruited to support the manager and staff recruitment is taking place, which should enable the service to move forward in the best interest of the service users. Turning Point has various quality assurance systems in place to monitor the effectiveness of the service provided. Greater urgency needs to be given to addressing health & safety issues and putting interim measures in place to protect individuals from harm. EVIDENCE: Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 21 The Registered Manager has the required qualifications and experience to carry out their role. The reports of visits by representatives of the organisation demonstrated that Turning Point monitor the experience of residents and have been looking at improving the quality of care planning. Turning Point also has a system of peer review where a manager from another service carries out an inspection. Action plans with timescales are then produced for the manager and monitored. A requirement from the last inspection was to start meetings with the individuals living at Parkview to ensure they were consulted and participated in the running of the home. These have started but the Manager acknowledged they needed further direction to engage individuals with limited communication. The last inspection required the Manager to ensure hot water temperature did not exceed 43oC. There were records of regular testing of the bath water but when the mixer valve failed a safe system was not put in place while it was rectified. Staff on duty were unaware of the raised temperatures. It was also concerning that advice from the inspector to notify the company area office were not taken forward and there was a delay in the work being completed. The third visit carried out confirmed that water to the bath was being delivered at a safe temperature. Turning Point need to risk assess the supplies to sinks in individual rooms as these were also above safe limits. Parkview DS0000019491.V329785.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 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 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 1 x Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 YA16 Regulation 13(8) Requirement Review the restrictive arrangements of having a high handle on the front door. Record any limitations placed on each individual and how this decision has been reached on their care plan. Review and update the ‘covert’ medication procedures in place for identified service users. Ensure the procedures are complaint with the Mental Capacity Act when fully implemented. Ensure all gaps in the recording of medication are investigated. Ensure systems are in place to enable the amount of medication held in stock to be reconciled against the administration records. The previous inspection required the dates of opening to be included on bottles and packets. Ensure staff follow the principles of good infection control practice. DS0000019491.V329785.R01.S.doc Timescale for action 30/06/07 2 YA20 13(2) 30/06/07 3 YA20 13(2) 30/06/07 4 YA30 13(3) 30/06/07 Parkview Version 5.2 Page 24 5 YA42 13(4) (a)(b)(c) Provide liquid soap and disposable hand towels in all areas where personal care is carried out. To protect residents safety monitoring procedures must be followed and repairs carried out in a timely manner according to company policy. Hot water temperatures must be maintained at 43 degrees centigrade supported by suitable risk assessments. Previous requirement made 13/10/05. The broken WC cistern needs to be replaced. 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA15 Good Practice Recommendations Review and update contact arrangements with family representatives and advocacy services to ensure each resident has access to people who will maintain an interest in them. Parkview DS0000019491.V329785.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Parkview DS0000019491.V329785.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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