Inspection on 16/11/06 for Richmond House - North Yorkshire County Council

This inspection was carried out on 16th November 2006.

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

Richmond House - North Yorkshire... 02/03/06

Richmond House - North Yorkshire... 15/02/05

Richmond House - North Yorkshire... 26/08/04

Richmond House - North Yorkshire... 04/02/04

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Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Richmond House - North Yorkshire County Council Richmond House Reeth Road Richmond North Yorkshire DL10 4EF Lead Inspector Kate Shackleton Key Unannounced Inspection 16th November 2006 09:30 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 Richmond House - North Yorkshire County Council DS0000034414.V320725.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. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Richmond House - North Yorkshire County Council Richmond House Reeth Road Richmond North Yorkshire DL10 4EF 01748 823135 01748 821465 richmond.house@northyorks.gov.uk Address 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) North Yorkshire County Council Mrs Judith Ann Benson Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 Brief Description of the Service: Richmond House is a care home owned and operated by North Yorkshire County Council and registered to provide a service for 31 older people of either gender aged over 65 years who do not have any specialist requirements. The home was purpose built approximately 45 years ago. Service users’ bedrooms are on the ground and first floors. All bedrooms are intended for single occupancy. There is direct access from the home to extensive grounds and gardens to the rear of the home. A day centre providing up to 20 places per weekday is situated in a separate area of the ground floor. The home is located within a short walk of Richmond town centre. At the time of this visit the weekly fee is £368-90. There are no additional charges made by the home. The Commission for Social Care Inspection report is displayed in the home for anyone to read. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the homes file since its last inspection. •An unannounced visit to the home lasting eight hours. The majority of the time was spent in the care home. The visit included a tour of the premises; talking to service users, care staff, visitors and management. Examining some records and observing staff working with service users What the service does well: The home is clean and comfortable. Staff are kind and helpful. Emphasis is placed on maintaining independence and enabling people who use the service the opportunity to exercise choice in key areas of their lives. This ensures that service users maintain some control. Comments like “The staff are excellent, they are very concerned and help all they can” and “The girls are great” were heard. People who use the service have access to the primary health care team and other health professionals. A good choice of food and drinks are available. This means that service users receive a varied and nutritious diet. One service user spoken to said, “The food is very good” Visitors are encouraged and made welcome. This helps service users maintain contact with family and friends. There is a varied programme of activities that interest service users. There is a clear and user-friendly complaints procedure and complaints are taken seriously. Arrangements are in place to measure the quality of the service delivered which includes feedback from service users. This ensures that the staff continue to deliver care in the best interests of people who live in the home. The staff are provided with comprehensive training to improve their knowledge and skills. This makes sure that service users receive care from a wellinformed staff team whose practice is up to date. The safety of service users is an important aspect of the service delivered. It is demonstrated through good recruitment practices, staff training and the servicing of equipment and maintenance of the premises. Richmond House - North Yorkshire County Council DS0000034414.V320725.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 be made available in other formats on request. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 7 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 Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have the opportunity to discuss all of their needs before they move into the home so as to be confident that the service can meet their specific needs. EVIDENCE: A number of people admitted to the home for permanent care have previously attended the homes day centre and or had short stays/respite care. In these cases staff already know a lot about the persons needs. Anyone contemplating admission is offered the opportunity to visit and have a look around before an admission date is arranged. Files examined showed that prior to admission a local authority care manager and a manager from Richmond house complete a needs assessment. Service users are admitted on a six-week trial basis before a final decision is made. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 9 During this site visit the manager visited a prospective service user to carry out an assessment. Also someone who had been assessed yesterday was admitted to the home during this visit. Relatives were in the home to support the service user to settle in. Service users spoken to said that they and their families were involved with the decisions made about their admission to the home. Relatives spoken to confirmed this to be the case. Staff spoken to said that they are given enough information about the needs of new admissions and are able to read the care managers care plan. During these discussions issues were raised about the high dependency needs of people being admitted without additional staffing hours being provided. A key worker scheme operates in the home, but a key worker is not allocated to each service user on admission. This happens sometime later. Best practice dictates that the key worker should be available on admission to ease the transition into a care home and be on hand to help the new person settle in. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are met. EVIDENCE: Two of the three people case tracked had a care plan. The service user without a care plan had had previous stays in the home and staff were aware of the persons needs. The staff hadn’t had time to develop a new plan. It was stated that care plans are written up in staff’s own time because this task cannot be fitted in during their shift. Care plans contain all of the information needed to deliver a service in line with service users needs. The promotion of independence is a key aspect of the service delivered. Plans are reviewed regularly and there are daily handovers of information to keep staff up to date. Some files did not have a complete set of risk assessments. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 11 Service users are registered with a General Practitioner and are able to access other health care professionals as and when needed. As part of the initial assessment it is discussed who is to be responsible for the administration of medication. Service users can if they want and subject to a risk assessment self medicate. Medicines are administered and stored in a safe manner. Discussions held with service users and visitors confirmed that they were very satisfied with the care service that they receive and highly commended the staff team. Comments like “The staff are excellent, they are very concerned and help all they can” and “The girls are great” were heard. Service users looked clean and well cared for. Staff were observed providing a service in a kind and helpful manner. Relationships between service users and staff were positive and friendly with good-natured banter being exchanged. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive a service that they are content with. EVIDENCE: There is evidence that some of the routines are in place primarily to fit with staff shift patterns. This has the potential to restrict choice if not managed properly. There is a rota for baths which states the people who have to be bathed in the morning and evening and who has bed baths. It was difficult to assess just how much choice service users have in these arrangements and discussions with staff seemed to suggest that this was the only way to make sure everyone got a bath. Again some of the arrangements regarding bed baths seemed to be that the bathing facilities in the home didn’t suit some service users. It seemed unlikely that in the event of a number of service users asking to be bathed more often that this could be accommodated. Lunch is served at 1pm followed by tea at 4:15pm Tea is served this early because the afternoon staff finish at 5pm and only two staff come on at 5pm. The two evening staff would not be able to deal with the demands of serving tea and supporting service users who need help with feeding in two dining Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 13 rooms or service users bedrooms. It is more usual to find a four-hour break between meals. Service users spoken to were satisfied with the meals provided and had no objections to the timings of meals. There is a choice of food at all mealtimes and special diets are catered for. Catering staff know service users likes and dislikes regarding food. Lunch was taken with service users. The dining room tables were attractively set with tablecloths, cutlery and condiments. Meals are plated and served by staff. The mealtime was relaxed and unhurried. People were given enough time to eat their food and discreet support was offered where needed. Staff checked that everyone had had enough to eat. Service users mostly eat in the dining room but can have their meal elsewhere in the house. In order to further promote independence consideration should be given to enabling service users who can to serve themselves from tureens. This would require careful supervision to make sure everyone got enough to eat. There are a number of small service user kitchen areas around the home which service users and visitors are welcome to use. There is a range of activities every weekday, which service users enjoy. A designated member of staff organises activities. Views are sought through individual discussions and a monthly newsletter. A day centre for people living in the local community operates within the home, which service users can join in with. Throughout the day, service users were occupying themselves watching TV, conversing with each other and staff, engaged in a craft activity and moving freely around the house. Visitors are encouraged and made welcome. Religious services are held in the home and arrangements can be made for people to attend church. In discussions with staff they were able to give numerous examples of how they support service users to exercise choice and maintain some control of their lives. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users feel able to air their concerns without any fear of repercussions. EVIDENCE: The complaints procedure is given to everyone as part of the information pack provided when people come to live at the home. It is clearly written and easy to understand. Service users spoken to say they would complain if there were a need to, saying that they would talk to the manager or a member of staff. Visitors confirmed that staff are easy to talk to and make every effort to sort out any concerns. Records examined showed that any concerns raised were acted on and an early resolution sought. At a staff meeting held at the time of this visit, complaints and how to record the information was discussed. Staff take complaints seriously and act on them without delay. There is a vulnerable adults procedure and staff receive training in this aspect of their work including whistle blowing. Staff spoken to were very clear about reporting any suspicion or allegation of abuse. Staff receive training in this aspect of their work. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe comfortable home EVIDENCE: The home is clean and smelt fresh. It is well decorated and comfortably furnished. Service users are encouraged to personalise their bedrooms to encourage feelings of ownership. A carpet in one bedroom needed replacing it was badly stained. The accommodation is arranged over two floors and all of the bedrooms are single. None of them have en suite facilities but commodes are provided. Service users felt that the cleanliness of the home is good. The home employs domestic staff to do the cleaning. There are notices pinned up around the home instructing staff about their duties. This institutional practice is a poor management strategy for the proper support and guidance of staff. It is also not conducive with promoting a relaxed comfortable environment for service users. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 16 Aids and adaptations are provided. There are assisted bathing facilities and a number of toilets strategically placed around the home. Call bells are sited in a way that service users can easily summon help if needed. The home employs a handyman who is responsible for routine maintenance and the monitoring of some health and safety aspects of the premises. There is an attractive garden with a summerhouse. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well trained and competent but it is questionable whether or not there are sufficient care staff to provide the range of support that service users need. EVIDENCE: Discussions heard in the staff meeting and in separate discussions with staff raised issues about the home being short staff. It is the staff’s view that because of the high dependency needs of service users being admitted to the home they are unable to give the time and attention to service users that they need. They were able to give many examples where they had to cope with competing demands from service users on their own. There seems to be times of peak activity when they say they need more help. The manager is of the view that because the home doesn’t achieve a certain score relating to the dependency needs of service users it therefore cannot attract more staff hours. There is always a manager in the office that can be called on for assistance. Discussions with some service users and visitors suggest that staff are very busy and that they don’t have time to sit and chat. For some service users who spend most of their time in their rooms having staff to chat with is an important aspect of service delivery. Other service users spoken to say that staff are always available to provide appropriate support and that they felt safe living in the home. There is evidence earlier in this report re daily routines and Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 18 incomplete care plans that suggests that either additional staffing is needed or that the existing staff team is deployed differently. The rota examined on the day of this visit showed five staff on in the afternoon up to 5pm and then two staff coming on at 5pm until night staff arrive at 10pm. Staff seemed to suggest that the majority of service users want to retire before night staff come on duty making it difficult for two staff to meet service users needs in a relaxed manner with time to make sure that everyone has had proper support. Previous inspections of this home have raised issues of staff being over stretched. There is a robust selection and recruitment process to ensure that only suitable people are employed. Interviews were being held at the time of this visit. Staff files showed that references are taken up before any one is offered employment and everyone is employed subject to a probationary period. In one staff file examined one referee was a family member. This is contrary to the Local Authorities policy and is poor practice. There is a comprehensive training programme and staff are encouraged to undertake National Vocational Qualification level 2. Staff complete thorough induction training and on going training needs are identified. Statutory health and safety training is provided alongside other specialist training. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to be actively involved in the running of the home. EVIDENCE: The registered manager is qualified and experienced in managing a care home. Observations made throughout this visit failed to see pro-active involvement of the team managers in directing the care staff about what had to be achieved throughout the shift. Care staff are left to their own devices. The team managers seemed to be office based dealing with administrative tasks. Given the level of staff disquiet about having too much to do and not enough time to do it properly, management need to make some decisions as to how they can support and deploy staff more efficiently throughout the day as well as developing an understanding about the amount of work that has to be done in order to deliver a quality service. Staff felt that management don’t have a true Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 20 picture of the high dependency needs of some of the people living in the home. Service users are encouraged to attend service users meetings where they can contribute to how the home is run. There is a quality assurance scheme that seeks the views of service users and their relatives through surveys. Quality audits are completed and senior managers visit the service monthly and talk to service users. The information gathered informs a service development plan for the following year, which is reviewed six monthly to make sure the service is meeting the targets set. People who use the service say that they receive a reliable service from staff who are courteous, respectful, communicate well and deliver services in a responsible and professional manner. They also say that the management team are approachable and easy to talk to. Regular service user meetings, staff meetings and staff supervision promotes an open and transparent management style that is focussed on providing a service that meets the needs of service users. The home has sound policies and procedures in line with current thinking and practice. Efficient systems are in place to monitor staff adherence to policies and procedures in their practice. Service users are encouraged to manage their own financial affairs and spend their money as they wish. Staff provide support for service users who require help in managing their finances and there is a robust procedure in place to direct staff in their practice and protect service users from financial abuse The home works to a clear health and safety policy and regular safety checks are carried out. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 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 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP26 OP27 Regulation 23(2)(d) 18 Requirement Floor coverings must be kept clean. A proper review of the staffing levels and the deployment of staff must take place in order to establish if the staffing levels match the dependency needs of the service users. Timescale for action 31/12/06 31/12/06 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 Refer to Standard OP3 OP7 Good Practice Recommendations A key worker should be allocated to service users on admission to the home to help with the settling in period. As part of the promotion of independence aspect of the care plan, a full set of risk assessments should be completed to ensure the safety of service users and staff. The manager needs to closely examine some of the homes routines in order to make sure that they are in place for the benefit of the service users and not to fit with staff DS0000034414.V320725.R01.S.doc Version 5.2 Page 23 3 OP14 Richmond House - North Yorkshire County Council shift patterns. 4 5 OP15 OP19 To maximise service users independence consideration should be given to the use of tureens at mealtimes. Staff notices should not be displayed in service users communal areas. Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Richmond House - North Yorkshire County Council DS0000034414.V320725.R01.S.doc Version 5.2 Page 25 - 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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