Inspection on 15/02/07 for Primecare Nursing Home

This inspection was carried out on 15th 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 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

Primecare Nursing Home 16/02/10

Primecare Nursing Home 23/01/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Primecare Nursing Home 62 Downs Grove Vange Basildon Essex SS16 4QL Lead Inspector Sarah Buckle Unannounced Inspection 15th February 2007 09:00 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 Primecare Nursing Home DS0000068042.V336323.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. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Primecare Nursing Home Address 62 Downs Grove Vange Basildon Essex SS16 4QL 01384 70275 01384 79658 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) Choicecare 2000 Limited Vacant Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Primecare is a purpose built care home situated in a residential area of Vange, Basildon. The home provided accommodation and nursing care for up to a maximum of forty- two people who are over the age of sixty-five years of age. Accommodation is provided over two floors, the first floor accessible via a shaft lift. The accommodation is comprised of thirty-four single and five shared bedrooms. There are two large communal lounge areas, one on each floor. The dining room is situated on the ground floor. People living at the home have access to a patio and garden which is accessible to people who use wheelchairs. The fees for placement range from £426.00 for residential care to £510.45 for nursing care. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced Key Inspection carried on 8th February 2007. Records including assessments, care plans, daily care notes and risk assessment documents in respect of three people living at the home were examined. The relatives of twenty-three residents at the home were contacted by post so as to offer them the opportunity to make comments about the services provided by the home. Nine responded. A number of residents and relatives were spoken with. Four members of staff including the homes manager were spoken with and a number of records including duty rota’s and staff recruitment files were examined. A tour of the premises was carried out and the serving of breakfast, lunch and the evening meal was observed. Each of the Key Standards as identified in the intended outcomes sections of this report have been inspected during this Key Inspection. Other standards, which have not been assessed at this time, may be assessed at the next inspection visit. Where other standards have not been inspected on this occasion they will have been inspected at the previous inspections. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk Below is a brief overview of the findings of the inspection, which are covered more fully throughout the main body of the report. What the service does well: Most of the people who spoke with the inspector or who completed surveys said that they were very satisfied with the care provided by the home. A number of people commented about how kind, caring and friendly staff working at the home are, and how they make a difference to the lives of the people who live there. There is a good range of activities offered including regular trips outside of the home for residents who are more able. There is a good choice of meals and residents said that they enjoyed the food provided by the home. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 6 Staff are trained and supervised so that they can provide a good standard of care to residents. The home is well managed and there are regular checks carried out including auditing of the service so as to maintain and improve standards. The homes environment is homely and comfortable, clean and well maintained. What has improved since the last inspection? What they could do better: People must have their needs assessed before they are offered a place at the home. Care plans need to clearly detail the needs of the person and how staff are to support residents to meet these needs and where there are risks to a persons health and safety these should be clearly identified and there should be evidence as to how these risks are to be minimised. Some relatives said that more could be done to ensure that all residents receive basic care such as assistance to clean teeth etc. Some people feel that more activities and stimulation could be provided for the less able people living at the home. The numbers of staff working at the home had been reduced at the time of the inspection. Residents and relatives commented that there are not always enough staff on duty and that sometimes residents have to wait for unacceptable lengths of time for support to use the toilet etc. Staff are not always recruited to work at the home in a consistent and robust way with all of the checks as required by regulation undertaken before the person starts work at the home. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 7 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. Primecare Nursing Home DS0000068042.V336323.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 Primecare Nursing Home DS0000068042.V336323.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): 1,3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Detailed information is available about the home and the services and facilities provided. The process for assessing people’s needs before offering them a place at the home is not carried out in a consistent manner. EVIDENCE: The home has a detailed statement of purpose, which clearly sets out the facilities and services provided by the home and the ethos behind the provision of care. The acting manager was advised that this should include a detailed breakdown of the fees charged for a place at the home. There is a detailed guide for residents living at the home. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 10 The pre-admission assessments for five people who had recently been admitted to the home were assessed. It was noted that no assessment had been completed for one person and that there was very little information recorded for another person so as to determine that taking into account the needs of the people already living at the home and the resources available that the home will be able to meet the needs of the individual to be admitted to the home. The assessments for the remaining three people were detailed in respect of the persons nursing and care needs. Primecare does not provide intermediate or rehabilitative care Primecare Nursing Home DS0000068042.V336323.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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home receive the nursing and medical treatment they need however more could be done so as to ensure that risks to resident’s safety are managed and resident’s basic hygiene needs are met. EVIDENCE: Of the nine residents relatives who completed ‘Have Your Say About..’ surveys four said that they always get enough information about the care home to help them make decisions. Of the remaining five two said that they usually did and three said that the sometimes did. One of the latter three said that relatives ‘have to questions to gain information, as this is not always volunteered. Six of the nine residents relatives who completed surveys said that they feel that the home always meets the needs of residents. One person commented that their relative living at the home is ‘kept clean, fed a balanced diet and spoken to in a kind manner..’ Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 12 Of the remaining three two said that the home usually meets the resident’s needs and one said that the home sometimes does. Two of these three people commented about the care received by their relatives. One said that their relative was not as well cared for as they were when they lived at home. Another relative said that their relative’s teeth are cleaned or looked after as much as required as the resident was unable to carry out any of their own personal hygiene. The care plans for three people living at the home were assessed. The home uses pre- printed care plans and the information contained within them was not specific to the needs of the residents. There was a care plan in place for one person to deal with constipation. However this had not been identified as a need for the person and staff confirmed that the person had no problems with elimination. One person had been admitted to the home from hospital with pressure sores. There was no plan of care in place in respect of how these were to be treated The care plan for one other person who had been at risk of falls and had required the support of staff and use of a lifting hoist when admitted to the home had not been revised in light of the changes to the persons condition which meant that the person no longer required the use of a hoist and could mobilise short distances. The acting manager said that there is a new care plan template being introduced within the next few days. The assessments carried out in respect of risks to residents associated with the use of bedrails were not clear in respect of the risks or what action staff should take so as to minimise risks. Six of the nine residents relatives said that they were always kept up to date with important issues affecting residents. One person commented that staff always informed them when the G.P. has visited, any changes in medication and changes to the residents general health. The remaining three said that they were usually kept up to date. One person said that they would like to be informed when the G.P. is due to visit the home so as they could be present. Six relatives said that the home gives the support or care to residents as expected or as agreed. One of the six said that ‘staff are very kind and considerate..’ another person said that their relative was admitted to the home ‘looking very unkempt..’ and due to the care and good diet that ‘she now looks a different woman..’ One person said that the home usually gives the support as expected and two said that the home sometimes does. During the day of the inspection nursing staff were observed to administer medication to residents at the appropriate time and in accordance with the Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 13 homes policies and procedures. Medicines are stored appropriately. The records in respect of medicines were not assessed during this inspection. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The majority of people living at the home are provided with opportunities for socialising, occupation and recreation and are supported in living their lives so far as possible according to their wishes. EVIDENCE: Five of the nine residents who completed surveys commented about the activities provided by the home. Two of the five made positive comments. One relative said that are activities available and that entertainers visit the home on a frequent basis and that residents who are capable are offered the opportunity to visit outside clubs. Of the remaining three people who answered this question they generally felt that there was not always enough stimulation available for residents, particularly if they were confined to bed due to their condition. The home employs a dedicated activities coordinator between the hours of 10am and 4pm each Monday, Wednesday and Friday. The acting manager said Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 15 that on Mondays and Tuesdays care staff provide activities cover and since this inspection visit the homes acting manager has recruited an extra activities coordinator for these days and to cover for annual leave and absence due to sickness. There are no activities planned for weekends. There was evidence that activities are planned but that the plan is flexible to take into account the wishes of the people living at the home. A number of the more able residents are supported in accessing activities outside of the home. On the day of the inspection an entertainer was booked and visited the home in the afternoon and provided 1940’s music and song which residents and their relatives were seen to enjoy. Four of the nine relatives residents who completed surveys said that the home helps residents keep in touch with relatives. One said that the home usually did. This person commented that ‘residents never seem to telephone their relative even though there is the facility..’ The remaining four people did not answer this question. During the day of the inspection staff were observed to interact and engage with residents in a positive and sensitive manner. Residents who were spoken with said that the food was very good. The homes menu was provided and there was evidence of a varied and balanced diet. The staff record what food residents eat after each meal and any comments made about the food. This information is used so as to improve where necessary the provision of food. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are usually dealt with in an appropriate and people feel confident that their concerns will be taken seriously. People living in the home are protected from abuse, harm and neglect. EVIDENCE: Prime care has a detailed policy and procedure for receiving and dealing with complaints. There have been no complaints made to the Commission in respect of the home and the acting manager advised that no complaints had been made since the last inspection. Each of the nine residents relatives who completed surveys said that they knew how to make a complaint. Seven said that the care home always responds appropriate if concerns are raised about care of residents. Of the remaining two, one said that the home usually does but commented that they wondered if issues were followed up. The other person said that the home never responds appropriately and that a number of concerns have not been dealt with. Ten of the thirty-eight people working at the home had received training in respect of protecting people who may be vulnerable from abuse, harm or Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 17 neglect. Only one member of staff had under this training within the previous twelve months. The acting manager said that care staff who had completed and those who were undertaking their National Vocational Qualification (NVQ) in care received PoVA training. The home has a Whistle blowing policy and the acting manager said that she intends to provide video based training for all staff using the local social services video training package. There have been no allegations of abuse or inappropriate staff behaviour and residents looked well cared for. Staff were observed to treat residents in a kind and sensitive manner when carrying out care and offering support. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Primecare provides clean, comfortable and well-maintained accommodation for the people who live there. EVIDENCE: One of the nine people who completed surveys said that the resident’s bedrooms were sometimes ‘very dusty..’ Others commented on the cleanliness and comfortable homely feel of the home. Housekeeping and domestic staff are employed each day at the home. During the day of the inspection the home was noted to be homely, clean and free from unpleasant odours. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four of the nine residents relatives who completed surveys said that the care staff have the right skills and experience to look after people properly. One person said ‘staff are very caring, kind and supportive..’ Four people said that staff usually have the right skills and experience and one said that they sometimes did. Six of the nine relatives commented that there are not always enough staff on duty. Some relatives commented that on occasions residents have to wait a long time to be assisted to the toilet, put back to bed or to be made comfortable. A number of relatives commented that staff are not always available to speak with them about residents needs. The minimum agreed staffing levels for the home are 2 qualified nurses and seven care staff in the morning, one qualified nurse and six carers in the afternoon and one qualified and four carers at night. The acting manager said that the numbers of staff had been reduced as the home was not fully occupied. The actual staffing numbers are one qualified nurse and five care staff for day duty, one qualified nurse and three carers at night. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 20 There was no evidence that this decision had been made taking into consideration the needs and dependencies of the residents living at the home. Staff do not work excessive hours without off duty days. Five of the twenty-four care staff (21 ) have undertaken National Vocational Qualification (NVQ) training and other staff have commenced this training. One relative said that there is always new members of staff, another commented that there are often ‘young, new staff working with more experienced staff ..’ which is ‘no good when two experienced carers are needed at the same time..’ The staff files for five people who had recently been recruited to work at the home were assessed. References had not been obtained from one persons previously employer and where there were inconsistencies in the information provided this was not explored.. There was evidence that staff complete a period of induction when they commence employment at the home. From the staff training matrix there was evidence that there is an ongoing programme of training so as to ensure staff working at the home receive moving & handling, fire safety, health & safety and food safety training. There is also a programme for providing training in first aid, infection control and care of people who have dementia. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 21 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, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Primecare is well managed and run in the interests of the people who live there. EVIDENCE: The homes acting manager is a registered nurse with over twenty-five years experience and has been in post since 2004 and is undertaking the Registered Managers Award (RMA). There was evidence that the quality of care is audited on a regular basis so as to make maintain standards and make improvements where shortfalls are Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 22 identified. The registered provider ensures that visits are made to the home in accordance with Regulation 26 of the Care Homes Regulations 2001. The records in respect of monies held on behalf of residents are well maintained and checked regularly so as to minimise the risk of mishandling or errors. Staff working at the home are supported and supervised. Records in the home are kept in good order and there was evidence that the electric, gas, fire safety and other mechanical systems and equipment in the home is well maintained and that checks are carried out on a regular basis. Primecare Nursing Home DS0000068042.V336323.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 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement People must only be offered a place at the home after suitably qualified staff has undertaken a detailed assessment of their nursing and care needs. Resident’s needs must be recorded in a plan of care which is revised at any time that there is a change in these needs. Risks to residents health, safety and health must be identified and managed. Staffing levels must be reviewed so that staff are employed in sufficient numbers for the needs of the people living at the home. Staff must only be employed to work at the home after all of the checks as required by regulation have been carried out and are satisfactory. Timescale for action 30/06/07 2. OP7 15(1) (2) 30/06/07 3. 4. OP8 OP27 13(4) (c) 18 30/06/07 30/06/07 5. OP29 19 30/06/07 Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 25 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. 2. 3. 4. Refer to Standard OP10 OP11 OP12 OP18 Good Practice Recommendations More could be done so as to ensure that residents basic and hygiene needs are met. People’s wishes for how and where they would like to be cared for if their condition deteriorates or as they reach the end of life should be recorded. More could be done so as to provide stimulation for people who are confined to bed etc. All staff working at the home should receive training in respect of protecting people who may be vulnerable from abuse, harm and neglect. Primecare Nursing Home DS0000068042.V336323.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Primecare Nursing Home DS0000068042.V336323.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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