Inspection on 05/09/07 for Rushall Care Centre

This inspection was carried out on 5th September 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rushall Care Centre 19/08/09

Rushall Care Centre 04/11/08

Rushall Care Centre 05/07/06

Rushall Care Centre 18/11/05

Rushall Care Centre 23/08/05

Rushall Care Centre 11/10/04

Rushall Care Centre 27/08/04

Rushall Care Centre 17/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Rushall Care Centre 204 Lichfield Road Rushall Walsall West Midlands WS4 1SA Lead Inspector Mrs Joanna Wooller DRAFT: Key Unannounced Inspection 5th September 2007 09:15 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 Rushall Care Centre DS0000020795.V344252.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. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rushall Care Centre Address 204 Lichfield Road Rushall Walsall West Midlands WS4 1SA 01922 635328 01922 642393 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) the.willows@ashbourne.co.uk Exceler Healthcare Services Limited Ashbourne Homes Limited Maxine Ann Murphy Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 39 Frail elderly over the age of 60 Date of last inspection Brief Description of the Service: Rushall Care Centre is a care home providing nursing and personal care for up to thirty-nine older people. The home was opened in 1990 and is a purpose built, three storey building. The home offers mainly single accommodation and has two communal lounges and a dining room. There is a passenger lift giving access to all three floors. Laundry and catering services are provided within the home. There is a small secure garden at the rear of the home. Southern Cross Healthcare owns the home. The home is located in Rushall, close to all local amenities. There is a main bus route to Walsall town centre; limited car parking is available at the home. Fees £ 465.45 to £620 Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 5th September by the lead inspector. The Manager was at a care conference at the start of the visit and the deputy manager and administrator assisted the inspector. The Deputy manager was in charge supported by one trained nurse and six carers. The inspection included the following elements; A tour of the building, Observation and inspection of records relating to provision of care, Discussions with several service users, Discussions with several of the staff members on duty, Observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, training, recruitment and health & safety. The Inspector was made very welcome in the home and all assistance was given to gain the evidence required for the report. No complaints had been dealt with by Commission for Social Care Inspection since the last inspection. Service Users spoken to at the visit were complimentary about the home. One gentleman spoken to at length said, “The home had made an amazing turn around, and it was excellent now. Maxine the manager listens to what we have to say and gives us choices. The last inspector would not recognise the home now, its been really smartened up, the staff are lovely and friendly and the nurse in charge comes to see you every day to make sure you are alright.” What the service does well: The home management and staff offer good quality nursing and personal care in clean and tidy premises. The home has been redecorated to a good standard. The staff appeared with professional, well trained and fully competent. The Manager accepts only the highest standards of care, attention and professionalism from all her staff in all departments. The care staff were Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 6 evidenced to support the Service Users in a compassionate way promoting their independence as far as possible and protecting their privacy and dignity. The care records were individual and personalised, well written and updated as required. What has improved since the last inspection? What they could do better: The one outstanding requirement remains from previous visits and this relates to a malodour. The main communal toilets are in the reception area of the entrance to the home and this is not ideal, however the inspector noted that the extractor fans in both toilets were not working and this is in the process of being rectified. The manager was also asked to investigate purchasing odour eating products for this area. Individual life stories/ history are to be introduced for each Service Users to understand their past and their experiences for use with the carers and activity staff. The management of the home must remain focused on the refurbishment of the home. The encouragements of relatives and visitors to attend meetings has been noted and through surveys, encourage them to assess the performance of the home. Rushall Care Centre DS0000020795.V344252.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. Rushall Care Centre DS0000020795.V344252.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 Rushall Care Centre DS0000020795.V344252.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): Standards 1, 2, 3, 4 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective Service Users do have the information they need to make an informed choice about the home. All individual needs are assessed prior to admission. EVIDENCE: The Statement of Purpose and Service User Guide were all updated as necessary and available for all prospective and current Service Users. The home manager or senior nurse completes pre-admission assessments for all potential Service Users. A medical history is obtained to ensure that the home appropriately registered and the home has sufficient resources in terms of skills, staff and equipment. The dependency of the individual is also considered so their needs do not affect other Service Users already being cared for in the home. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 10 All pre-admission forms were evidenced as being completed in current case notes; the assessor completes a detailed draft care plan, which is then used to formulate the initial care plan. This is then presented to the Service User or a representative for discussion and is audited by the home manager on completion then bi-monthly after that. The named nurse carries out full reviews of the care provided after 1 month, 3 months, then at 6 months after admission. No intermediate care is provided at the home. Rushall Care Centre DS0000020795.V344252.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): Standards 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. Individual Service Users health, personal and social care needs were documented in detailed format, evidencing that their needs were being met by monthly review. Medication procedures were in order and well audited. Respect and dignity were afforded to the Service Users at all times. EVIDENCE: Good relationships with the GPs and other professionals serving the home have enabled strong links for effective health care for all Service Users. There is evidence that all service users are assessed in a timely manner to assure them of the best treatment and care available. The homes auditing procedures ensure that medications and care plans are at a satisfactory standard. Boots Chemist audits the medication administration, records, storage, stocks and disposal. This audit form is available in the home. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 12 Referrals to specialist nurses are documented within the individuals care records. The clinical room has been relocated to a more suitable room, which allows suitable storage and efficient working. Chiropody services are available however most Service Users have private chiropody as required. Access to NHS services is available at all times and staff escort those Service Users when relatives are unable to go with them. All the trained nurses in the home have undergone update training in safe handling of medication and care planning. All the staff spoken to were committed to ensure that they promote and respect the privacy of all Service Users and their need to maintain their dignity as individuals in the home. The hairdresser attends the home twice a week and she ensures Service Users have their hair styled to their liking. All staff had received a company update in ‘customer care’ during the previous months. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 to 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users enjoy a range of activities whilst their individual choices are also considered. Contact with relatives and friends is encouraged and Service Users receive a balanced and appetising diet. EVIDENCE: There was evidence that the home provides a range of activities that Service Users can choose to participate in based on personal preferences. Likes, dislikes and hobbies are documented on admission and the home strives to accommodate them as far as possible. There was evidence of good relationships with families and visitors and they are encouraged to be as involved as much as they like in the homes life, there is a League of Friends who raise monies to buy items for the Service Users or extra entertainment for the pleasure of the Service Users. Friends, relatives and visitors are invited to seasonal events to spend time with their loved ones. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 14 There was evidence that all Service Users are treated as individuals and their personal wishes are respected. One gentleman told the inspector that the home manager listens to the Service Users and changes things accordingly to suit the individual requests. He also told the inspector that he feels respected by the carers and all staff. He attends the monthly meetings held by the manager to discuss events in the home. This meeting is held without other staff being involved to encourage honest discussion of any problems they have, in confidence. It is clearly evident that the manager has an ‘open door’ policy and her relocated ground floor office has assisted her to demonstrate this. Menus are based on nutritionally balanced guidelines with Service Users preferences being included. Service Users have a choice of meals with alternatives to the main menu. The chef is involved with monitoring the nutritional status of Service Users and implements suggestions by the dietician or nurse. New tables and chairs have been purchased for the dining room, the floor has been replaced and the room decorated, all this has allowed the dining room to be a much more pleasant place to dine. The tray service, which has always been offered, has now improved also. Social assessments were evident in Service Users files which is completed with the involvement of the Service User themselves or relatives if necessary. Likes and dislikes regarding food and activities are updated as required. This year a ‘Gentleman’s Group’ has been established to allow the men time to play cards and talk. The local vicar now visits the home twice a week as requested by the Service Users. The ‘Rushall News’ is printed and distributed monthly to all Service Users and visiting relatives – it tells everyone what is going on and who is celebrating birthdays etc also forthcoming events. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 17 and 18 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 visible to all Service Users on admission, on notice boards and the Service User Guide. Service Users legal rights are protected and staff are confident that they protect the Service Users from abuse. EVIDENCE: All complaints are logged, investigated and responded to by the home manager within 48hrs of the complaint being raised. There are no outstanding complaints on file at the home. The complaints procedure is on display and had been updated with the new Commission For Social Care Inspection local office address. Ten complaints had been received in the last 12 months. Five had been upheld and appropriate action taken. One complaint had been referred to safeguarding adults’ team. All staff had undergone abuse awareness training annually and have access to the POVA procedures and contacts at all times. There is a copy of the “No Secrets” document in the home for the staff to refer to along with a comprehensive company policy on abuse. All staff working at Rushall has issued a clear POVA first record, a clear Criminal Record Check and satisfactory references. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 16 The staff have an increased awareness of vulnerable adults policy etc, which gives them the confidence to report any concerns or issues. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 17 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): Standards 19 to 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users now live in a well-maintained safe environment with access to pleasant communal facilities. There are sufficient bathroom facilities and specialist equipment. Service Users bedrooms are personalised, comfortable and suited their needs. The home was clean and hygienic. One issue relating to Standard 26 was noted to have not been addressed (see evidence) EVIDENCE: The home has now got an established schedule for maintenance of the building which includes health and safety checks, decorating, general maintenance, repairs and gardening tasks. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 18 The homes house keeping team now also have an effective cleaning schedule in place that maintains the homes cleanliness and complies with infection control regulations. Maintenance and cleaning schedules are recorded, signed and monitored as part of the homes audit process. The home manager continually monitors the standard of cleanliness on a daily walk-around. The bedrooms were found to be clean and tidy and some were very personalised. Some refurbishment points were highlighted but the home is now on a rolling programme to be upgraded. The communal areas had all been decorated during the last 12 months, which included the Service Users choosing the wallpaper and flooring. Old furniture had been removed and replaced with new. The garage had been converted into a store area for pads and also for wheelchairs when not in use. Toilets and bathrooms were in good order and clean and hygienic. • One issue relating to malodours in the main entrance is due to the communal toilets being sited there. The extractor fans are awaiting replacement and must be installed as soon as possible. Also further investigation into ‘odour eating’ sources are to be followed up. This problem has been addressed with much improvement but further actions are to be taken. Over the next few months the emphasis of the homes budget will be towards further refurbishment of individuals rooms. New flooring, furniture and textiles are to be purchased to improve their comfort and overall presentation of the home. Rushall Care Centre DS0000020795.V344252.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): Standards 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staffing levels reflected the current dependencies of the Service Users in the home. Service Users felt like they were in safe hands and staff were competent to look after them. The company’s recruitment policy and procedures protected the Service Users. EVIDENCE: The home has a comprehensive recruitment policy and procedure to ensure that employees are competent and able to do the tasks that the post entails. All staff is inducted on commencement of employment at the home and personal competencies are checked to assess for further training needs. Trained nurse PIN numbers are verified with the Nursing and Midwifery Council along with all employees’ qualifications. 71 of care staff holds either Level 1 or 2 NVQ, and the remaining 5 carers will be commencing training in November. The manager has completed her Registered Manager Award and also gained an intermediate certificate in supervisory health and safety. The manager and her activity co-ordinator have completed the ‘Yesterday, Today and Tomorrow’ training. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 20 There was evidence of an established home training plan and the home has two home trainers. The manager has introduced a training board which focuses on a particular topic, the current topics is Safety in the Sun, which is based on the Department of Health guidelines. The training statistics demonstrate that 85 of statutory training is completed at present. A forthcoming First aid course should result in 100 of the staff being trained. Training packs are now evidence based and refer to legal changes and updates. The manager feels that the staff are trained to a standard which the Service Users expect and deserve. Rushall Care Centre DS0000020795.V344252.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): Standards 31 to 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users told the inspector that they live in a well managed home. There was evidence that the ethos of the home ensures that it is run in the best interests of the Service Users. Robust policies and procedures safeguard the Service Users in all aspects of care whilst at the home. EVIDENCE: The manager clearly demonstrates she is fully aware of her responsibilities as the manager and she ensures at all times that the home is run in the best interests of the Service Users. There is s strong ethos in the home that ensures the Service Users have choices and make their own decisions. Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 22 Service Users told the inspector that they enjoy making decisions in the home and had recently chosen wallpaper and carpets. They also get involved with deciding menus and activities. The manager has over the last few months established a robust monitoring system to ensure that documentation and performance of each department is to a satisfactory standard. The manager expressed that the health and safety of each Service User is of prime importance and also the staff. There was evidence that these systems are in place and effective to monitor this in the home. Health and safety documentation was evidenced at the visit, which the maintenance man showed the inspector in detail. Safety checks are all recorded as necessary and records were in good order. Training relating to manual handling, fire safety, first aid, and food hygiene and infection control were all addressed and up to date. New fire legislation has enforced the home to ensure they are fully trained on evacuation of all Service Users. The new training has been carried out over the last few weeks and staff have become accustomed to the new procedures. Service Users name badges have been fixed to the relevant bedroom doorframes to be used in case of emergency evacuation. The badges have the Service Users name on, GP, date of birth, any allergies and next of kin. The doorplates also have a coloured dot in place to show staff at a quick glance how the individual is to be manually handled safely out of the home. There was evidence of good communication within the home, with relatives and staff ensuring everyone is updated appropriately. There was evidence that the manager has established an auditing system in the home to assess the quality of care and practices in the home and the views of all the residents is taken into account before any home alterations are made. The manager holds surgeries each month that are advertised to ensure Service Users or relatives are able to meet her in private. Relative meetings are held 3 monthly and Service Users meetings are held monthly. Southern Cross financial system is used to safeguard the Service Users from financial abuse. The account balances are updated regularly and documentation is kept in the home. Rushall Care Centre DS0000020795.V344252.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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 24 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 OP26 Regulation 16(2)(k) Requirement The registered person shall ensure that the home must be kept free of any mal odour. The unpleasant odour remains apparent outside the lounge, which should be addressed by repair or replacement of the extractor fans in the communal toilets and further investigation into odour eating products. Timescale for action 05/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rushall Care Centre DS0000020795.V344252.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-46 Stephenson Street BIRMINGHAM B2 4UZ 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 Rushall Care Centre DS0000020795.V344252.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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