Inspection on 19/07/07 for South Bebside Nursing Home

This inspection was carried out on 19th July 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

South Bebside Nursing Home 23/08/06

South Bebside Nursing Home 09/01/06

South Bebside Nursing Home 15/08/05

South Bebside Nursing Home 02/12/04

South Bebside Nursing Home 21/05/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE South Bebside Nursing Home Patterdale Road Blyth Northumberland NE24 4JU Lead Inspector Suzanne McKean Unannounced Inspection 10:00 19 & 24th July 2007 th 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 South Bebside Nursing Home DS0000000503.V343477.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. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service South Bebside Nursing Home Address Patterdale Road Blyth Northumberland NE24 4JU 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) 01670 - 364881 01670 351986 south.bebside@fshc.co.uk www.fshc.co.uk Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mr John Stephen Anderson Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (2) of places South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23rd August 2006 Brief Description of the Service: South Bebside was purpose built in July 1998 to provide care for thirty-eight service users. It is a traditional brick building. The residents have access to the patio area to the front of the building where there is seating. The building has a foyer with seating and the nurses station, and the open area from which the lounge and the bedroom corridors are accessed. The home is situated in an area of predominantly domestic housing although it is close to public services and shopping facilities. The home charges fees of between £332 and £380.42 per week depending upon the needs and requirements of the individual residents. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. The home provides information about the service through the service user guide and a copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Summary: This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 23rd August 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on date 19th July 2007 and a second planned visit was made on the 24th to collect additional information. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: The home provides good healthcare support for the residents and the relationships between the staff and the people living in the home were friendly and respectful. The residents spoken to during the visits were positive about the way they are treated by the nursing and the care staff. An example of this being “every one is really nice and nothing is a bother” and “staff are always around to help”. No resident enters the home without having a detailed assessment undertaken to ensure that the home can meet his or her needs before care is offered. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 6 Care plans are detailed and contain the information required to ensure that the residents can have their needs met. The residents were positive about the food being served to them and all felt that there was choice being offered. The home is purpose built and all residents have single accommodation rooms that are personalised to suite the needs and choices of the residents. 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. South Bebside Nursing Home DS0000000503.V343477.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 South Bebside Nursing Home DS0000000503.V343477.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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive assessments are carried out before and after admission to ensure that people’s needs can be planned and properly met. He makes sure that the equipment is in place and that the staff have the skills they need to care for the people moving into the home. The home does not provide intermediate care. EVIDENCE: The care files contained care manager assessments, which are carried out before admission and given to the home. This helps the manger to decide if the home can provide the right type of service for a specific person. The home also carries out a comprehensive assessment of the prospective service users needs prior to admission for both planned placement and more South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 9 urgent admissions. The admission assessments for the service users whose care plans were examined, were detailed and contained the necessary information on which to base a plan of care. South Bebside Nursing Home DS0000000503.V343477.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, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care planning is good and the care is being delivered in line with these plans. Healthcare needs are well met by using a multi-agency approach. This helps residents to stay healthy. Staff treat the people living in the home with respect. Their privacy is maintained so far as possible when receiving personal care and throughout their daily life. The residents received their prescribed medication in line with safe working practices. The medicines in the home are well managed and safely disposed of as necessary. EVIDENCE: Each resident has an individual plan of care, which is based on the admission assessment and is then added to during the placement. The care plans contain South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 11 an assessment for nutrition, wound care, moving and assisting, and continence promotion as well as a dependency score. These are up to date and detailed. They are regularly reviewed and updated and reviews are regularly held with residents and their representatives. Resident or relatives are consulted when writing the care plans and the people living in the home and the visiting relatives confirmed this. This is formalised by the people living in the home or their representatives signing in the care plan. Residents have access to NHS services and facilities. There is a good range of pressure relieving mattresses for the prevention of pressure sores. Nursing action taken for wound care was well recorded. And the home seeks expert advice from external professionals if necessary. Specialist nursing beds have been purchased to make sure that the people living in the home can be safely given care when they are in bed without the staff being at risk of personal injury. The people living in the home could describe the way that their privacy was maintained and staff were observed to do so when delivering care. The residents were complimentary about the care they received and said that the staff treat them in a “friendly and caring” way. An example of the comments made was that the staff were “all really nice” and “we get really well looked after here”. Staff address the residents by their preferred name and there was a good relationship seen between the residents and the staff. The systems for managing medicines in the home are in line with safe working practice guidelines. The staff record the medicines being ordered, the prescriptions are then checked on receipt from the General Practitioners and are then sent to the Chemist for dispensing. The medicines are then again checked against the records when received into the home so that any errors can be picked up. No residents are currently managing their own medication. South Bebside Nursing Home DS0000000503.V343477.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with the flexibility of their routines and social activities, which meet their cultural, social, religious and recreational interests and needs. There are good arrangements for people living in the home to keep in contact with their family and friends and the local community. These are suited to each individual’s needs and vary accordingly. Residents have a well-balanced nutritious diet, which offers choice and is good quality and well presented. EVIDENCE: People living in the home said that they are encouraged to choose how they live in simple but important ways including the time they get up, what and when they eat. They also said that they make decisions about how they spend their day and said they were satisfied with the activities available. Residents described the recent trips to the local pub and walks out with staff to the local McDonalds. Organised activities are available and staff said that residents are South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 13 able to choose whether or not they are involved. Due to the dependency level of some of the residents a number of the activities offered are less active and provided on a more one to one basis. The home employs an activities coordinator for 21 hours per week. She has organised a weekly programme of activities offering differing opportunities. On the second visit eight of the residents had described their recent trip to the workingmen’s club for the evening. Recent examples of activities included a cowboy karaoke night, a trip to a roman fort and the visit from the “creepy crawley” zoo. The records of the activities provided are now more detailed. The residents’ bedrooms were personalised showing that the people living in the home their individual choices and preferences and three residents asked about their bedrooms said they were happy with the decoration. Residents have visitors at any time and use their own rooms, the small lounges or the larger, busier lounges to see them. Four relatives spoken to on the day confirmed that they are welcomed to the home and one said, “the staff are lovely and make us feel at home”. Relatives are given information within the residents’ guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. South Bebside Nursing Home DS0000000503.V343477.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good complaints policy in place that is known to people living in the home, relatives and staff. This ensures that the complaints can be dealt with effectively. The people living in the home are protected from abuse by staff training, recruitment and selection and good documentation. EVIDENCE: The complaints procedure is available to the people living in the home in the service user guide and a copy is available at the front entrance. The records of the complaints were examined. There has been one complaint recorded since the last inspection. The record of this was detailed and although the investigation was carried out by a manager from another home the manager was given feedback about the outcome so that he could take any action necessary in response. It was noted that not all expressions of minor concern are recorded. However, it would be useful for quality assurance purposes to record them to determine if they can be addressed as part of the general improvement strategy and to prevent minor niggles becoming more serious. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 15 Six of the residents who were interviewed during the visit understood how to make a complaint, and could identify the way this would be dealt with. Four relatives who were visiting the home were aware of the complaints procedure but had not needed to use it and the questionnaire responses supported this. Staff are given protection of vulnerable adults training both as part of the inhouse training package and the Manager has completed the two-day POVA training. The home has written guidance in place regarding the protection of vulnerable adults through detailed policies and procedures. These are included in the induction training and ongoing in-house training. Staff confirmed that they knew about the guidance and could identify the action they would take if they were made aware of or had any concerns regarding this issue. The staff have recently completed an adult protection training workbook, which gives them examples they have to work through, and an assessment to of their understanding. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 16 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, 21, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The communal and corridor areas of the home are generally well decorated, making it a pleasant place for people to live, although some areas are not so well decorated. There are sufficient numbers of bathing facilities in the home but as the upstairs bathroom is out of use it limits choice for the people living in the home. The bedrooms are all single occupancy and are adequately decorated and equipped in a homely and personalised way although some of the furniture and carpets are in poor condition. The infection control measures in the home are good and the home is clean, and pleasant and is odour free. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 17 EVIDENCE: All of the communal areas have recently been redecorated and the plans are in place to complete this including replacement of some of the carpets in the communal areas. Although this has resulted in an improvement in the environment for the people living in the home some of the areas still need to have pictures hung or curtains replaced. The lounge upstairs has had the damaged wall repaired and there are plans to make this area into an room for general activities combined with a computer room. As this room is not currently used by the people living in the home it will offer additional choice. Some of the furniture in the bedrooms is damaged. Some of this has been done but not all that is required. Some bedrooms also need new carpets. There has been an audit carried out to identify the refurbishment priorities and the manager is working through this. The upstairs bathroom is not used and there is only one bathroom on the floor. The lack of a second bathing facility upstairs limits choice so that residents who would like to shower would need to use the one on the ground floor. The shower on the first floor needs redecorating, a resident said that it is “a bit cold and unwelcoming”. Appropriate equipment was available to allow staff to follow control of infection policies, and staff were seen to be using them correctly. Red dissolvable laundry bags are available and staff were therefore not handling soiled linen prior to it being washed. There is now a sluice disinfector on both floors allowing the staff to clean and decontaminate equipment without moving between floors. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 18 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, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective recruitment and selection system, including Criminal Record Bureau checks and use of the Protection of Vulnerable Adults List, which ensures that residents are cared for by competent staff and are in safe hands. The home has sufficient numbers of well-trained qualified nurses and care staff to meet the needs of the residents. However although there is good staffing for the care of the resident there is insufficient domestic staff at times they are required resulting in carers spending time doing domestic care when they should be looking after the residents. There is a good training programme, which is up to date for all staff, which includes health and safety and clinical practice. EVIDENCE: Staff records are completed in line with the company policies and procedures, including two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 19 All staff are receiving supervision at least six times a year and this is well documented. The training records maintained by the Manager to allow him to plan for training were very clearly maintained and offered a good system. The training records showed that the staff are up to date with moving and handling, first aid, and fire training and records for individual staff examined confirmed this. Staff are also offered a number of other training opportunities including pressure area care; continence training and catheter care training. The staff are encouraged to undertake National Vocational Qualifications once they have had their induction training and half of the care staff are trained to NVQ level 2 or above. Staffing on the first day of the visits was: • The manager Mr Anderson • Two qualified nurses • Four carers • Administrator • One domestic • One laundry assistant • The cook • Kitchen assistant • Handyman It was noted that the domestic staff only work from are only employed to work from 07.30 until 14.00. This results in the care staff having to do some domestic tasks after that time. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 20 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager ensures that he has systems in place to make sure that the home is managed effectively taking into account the needs and wishes of the residents. Clear safe working practices are used in the home in line with the company policies and procedures. Formal supervision for the care staff is up to date which ensures that they are working to the expected standard and are supported. Personal allowance management is good and the systems and records are in place to allow audit to be effective. There is still a shared “personal account” for money, which is more than can be held in the home. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mr Anderson is the registered manager of the home. He has completed his Registered Managers Award. He ensures safe working practices in relation to first aid, food hygiene, moving and handling and infection control through staff training, audits and personal observation. The records for this were satisfactory. The staff are aware of the need to maintain a safe environment in the home. This is supported by the policies and procedures examined by discussion with the Manager and by observation of the staff in the home on the visits. The staff have regular meetings and the records of these are in place. Resident/ relative meetings are organised. But they are not well attended. The residents and relatives spoken to on the day felt that they would be able to approach the Manager or senior staff if they had any concerns and were happy with the care being provided. Relative / resident questionnaires have been used to find out the views of the people living in the home and will be used as part of the quality assurance process. Regular audits are being carried out in the kitchen, and for medication and care plans. Accident recording is now in line with best practice as accidents are recorded on documentation, which can be stored as required and no more than one incident/accident is recorded on a page. Personal allowances were examined. Second signatures are being entered for transactions. Some residents had more money than can be kept in the home and this results in it being put into a shared “personal allowance” account. Residents are therefore not able to accrue interest on money they have. The company and The Commission are looking at this issue nationally for Social Care Inspection and a judgement is to be made of the action necessary. South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 8 3 9 3 10 3 11 3 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 2 X X 2 X 3 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 X 3 X 3 X X 3 South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23 (2) Requirement Bathrooms must be in sufficient numbers and made suitable and safe for resident use. Outstanding since 01/11/06 Bedrooms must be redecorated and provided with new furniture and carpeting as necessary. Outstanding since 01/11/06 Domestic staff must be provided at times to ensure that they can carry out the tasks necessary to keep the home clean without encroaching on care staff time. Outstanding since 01/11/06 Timescale for action 01/12/07 2. OP24 23 (2) 01/12/07 3. OP27 18 01/12/07 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 South Bebside Nursing Home DS0000000503.V343477.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 South Bebside Nursing Home DS0000000503.V343477.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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