Inspection on 23/04/07 for Southwell Road East

This inspection was carried out on 23rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southwell Road East 10/06/08

Similar services:

Hillside

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

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

CARE HOME ADULTS 18-65 Southwell Road East 304 - 306 Southwell Road East Rainworth Mansfield Nottinghamshire NG21 0EB Lead Inspector Judith Avill Unannounced Inspection 23rd April 2007 10.00 Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southwell Road East Address 304 - 306 Southwell Road East Rainworth Mansfield Nottinghamshire NG21 0EB 01623 482703 01623 482704 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) Nottinghamshire County Council Mrs Sarah Janine Bradley-Middleton Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nottinghamshire County Council is registered to provide accommodation and personal care to people at 304 - 306 Southwell Road East, Rainworth, Mansfield, Nottinghamshire, NG21 0EB whose primary care needs fall within the following numbers and category: Learning Disability (LD) - 12. N/A Date of last inspection Brief Description of the Service: Southwell Rd east is a home providing care and support for up to twelve adults with learning disability. Some of the residents also have a physical disability. The home is managed by the Nottinghamshire County Council (NCC) Local Authority and the buildings are managed by the NCHA. The home is comprised of two separate bungalows, which have six bedrooms each. Each bungalow has its own communal lounge, dining room kitchen, laundry and toilet/bathroom facilities. There is an attractive and wellmaintained garden to the front and rears of each bungalow which residents have access to. The home has equipment and adaptations to support people with physical disabilities. The fees are £370.00 per week. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 6 hours on 23rd April 2007. This is the homes first key inspection since the transfer of the home from the Health trust to the Nottinghamshire County Council. Judgements made in this report are based on the pre inspection questionnaire completed by the registered manager Sarah Bradley Middleton and information and evidence gathered from the day of transfer of the home to the new provider. The main method of inspection was, case tracking three residents, which meant checking their records, discussion with staff and observation of care practices. Staff were also observed communicating and interacting with residents. What the service does well: From the three residents files viewed prospective service users are thoroughly assessed before making the decision to come and live at the home. The placing authorities are involved in reviewing the needs of the residents to make sure the home remains suitable and is meeting the resident’s needs. All residents have support plans that cover all areas of personal care health and social care needs. From observations of staff and residents the residents are able to make choices in their daily lives. Staff spoken with were well aware of individual residents preferences and are committed to residents being able to access activities and a good quality of life. In order to meet their health and personal care needs residents have links with specialist healthcare professionals such as psychologists and health professionals. Staff confirmed that they are involved in the personal care, cleaning of the home and preparation of food for residents living at the home. All areas of the home viewed on the day of inspection were clean and well organised. To ensure residents independence is maintained as far as possible equipment for transferring residents and to support individual’s independence is provided. Since the home has been taken over by the local authority all staff have completed a training profile and work is ongoing to ensure all staff are trained to fulfil their roles at the home. Regular testing of equipment, gas, electrical and fire systems are completed to protect the health and safety of residents. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To ensure consistent care and support is given details of individual’s requirements during the day and night need to be more detailed. The new support plans need to be developed for all of the residents living at the home. Risk assessments to ensure residents safety must be carried out and details of action to be taken by staff needs to be recorded. The daily record document for recording changes in the resident’s condition; care and support given were not accurately maintained. It is recommended that the daily records are checked and signed by senior staff to ensure that the written information on the level of support for individual residents is monitored. The manager and staff have worked hard to develop a medication policy and procedure for the home. The procedure needs to include safekeeping of the keys, and all systems of practice used at the home for the receipt, storage, administration and disposal of medication. To ensure the needs of all of the residents are met at all times the staffing levels need to be reviewed, an assessment of residents needs over the twenty four hour period should be completed to identify staffing levels required in each of the bungalows. At the time of inspection the home has not obtained all the Nottinghamshire County Council policies and procedures. These need to be in place and staff made aware of any changes in ways of working. The Information Technology (IT) systems need to be further developed to ensure staff can use all systems. Improve information on staff files to indicate if a Criminal Record Bureau check two references have been obtained for all members of staff. To ensure the kitchen is maintained in a safe and hygienic state the repairs must be completed or an early date arranged for the refurbishment. Southwell Road East DS0000068836.V334343.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. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 &2 People who use this service experience a good service. This judgement has been made using available evidence including a visit to this service. The home has a good system for giving prospective residents information about the home and assessing individual needs. EVIDENCE: The staff at the home have developed the Statement of Purpose and service user guide seen on the day of inspection. All residents have a copy of the service user guide. Some of the details of the service user guide are in picture format. For all three of the resident’s case tracked the placing authorities community care assessment was seen and records of reassessment were seen on two files. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7&9 People who use this service experience an adequate service. This judgement has been made using available evidence including a visit to this service. Resident’s individual needs and choices are met. The recording system for personal health care and social needs would benefit from being simplified. EVIDENCE: Three support plans were viewed. Two of the support plans were in the format used by the previous provider. The support plans seen covered all aspects of health, personal and social care. One support plan seen stated that a resident requires support whist bathing. Records seen contained no information for staff to follow such as a description of the level of support needed or comments that staff make to support and prompt the resident. Another support plan seen for moving and handling had no record of ‘ how’ staff assist the resident. Staff spoken with were well aware of resident individuals preferences and needs. However from the three records case tracked the verbal information that staff gave about individual residents and support plan records evidenced that the written information does not describe the detail of support required for individual residents. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 11 Information provided and staff spoken with confirmed that residents have access to advocates as required. Records seen evidenced that residents are supported in management of their personal finances. One of the financial records checked were not accurate. Risk assessments on moving and handling personal safety and moving outside the home were seen. Staff spoken with were well aware of the support needed for individual residents however documentation did not reflect action to be taken by staff. Since the transfer to The Nottinghamshire County Council (NCC) the format of support plans has been changed. The new format is comprehensive and has a system for staff to follow. From checking information the specific details of ‘how’ staff support individual residents to meet their needs still needs to be recorded. The daily record sheet for individual residents has also been changed to the NCC documentation. One record seen reported a change in a resident’s condition but no follow up of the care provided was seen. The daily record has an area for the team leader/senior staff to sign was not completed. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17 People who use this service experience a good service. This judgement has been made using available evidence including a visit to this service. Residents rights are promoted and staff are committed to enabling individuals to experience a fulfilling quality lifestyle. EVIDENCE: Staff spoken with said how they work with individual residents on activities and enabling them to take part in the local community and amenities. At the time of inspection residents were attending day centre and four residents were on a visit to the zoo. Three residents spoken with said how they enjoyed the outings. Details of attendance at day services are recorded in support plans. Staff said that relative’s resident’s friends and family are welcome to visit at any time. Staff were observed during the inspection respecting privacy and promoting individuals right to choice. Records of communication with individual residents were recorded in support plans. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 13 The menus seen confirmed that the menu is planned on a four weekly basis and records seen show that meals are nutritious. Staff said there was some flexibility in the menu to meet resident’s choices. Risk assessments for choking were seen. The manager reported and staff confirmed that one of the kitchens in the bungalows was to be refurbished. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 People who use this service experience an adequate service. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are met, management could be improved. EVIDENCE: The support plans seen do not contain comprehensive information about ‘how’ resident’s personal care and health needs are to be met. Daily records seen in one support plan evidenced no follow up by staff of treatment and support for skin care. Records of individual residents weight were not consistent but the manager reported this has now improved since the purchase of a new weighing scale. During the inspection the inspector observed medication keys not securely stored. The staff on duty took immediate action following this observation. Resident’s medication was case tracked and appeared to be in order. The manager has developed a new policy and procedure for medication that has to be passed by the Nottinghamshire County Council. No record of the content of the training programme that staff have to attend and satisfactorily complete or details of administration is included in the procedure Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 15 medicine Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use this service experience a good service. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have information about what to do if they feel they have not been listened to. Residents are protected from abuse. EVIDENCE: The Complaints procedure is displayed in the entrance to both bungalows, each service user has information in their personal service user guide. One complaint has been made since the transfer of the home this is still being investigated. The home has complied with legislation for the notification to the Commission for Social Care Inspection in accordance with Regulation 37 on action taken in relation to a complaint made. Staff spoken with demonstrated they are confident in their responsibilities in reporting suspicion or evidence of abuse or neglect of residents to ensure the safety and well being of residents. Gaps in training are being identified in the training needs analysis commenced by the Nottinghamshire County Council. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 &30 People who use this service experience an adequate service. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, clean and homely environment. EVIDENCE: On the day of inspection the bungalows were clean, homely and comfortable. On a partial tour of both of the bungalows all areas were clean and hygienic. Staff reported that Nottinghamshire County Council have said that they are to refurbish the kitchen in one of the bungalows. However the planned date has passed and no new date has been confirmed. On the day of inspection one kitchen drawer front was not in place. Staff reported that the council have said no repair will be completed due to the planned refurbishment. The home has sufficient laundry facilities for the needs of the residents at the time of inspection. Seven of the residents bedrooms seen were well personalised with chosen items and individual decor. The manager said that there are plans to refurbish Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 17 two of the bedrooms to meet the residents’ individual needs. assessments on the environment are in place. Risk Staff spoken with commented on the lack of space for storage due to more specialist equipment required for individual residents. All areas of the home are on a level access. During the tour of the building the inspector observed doors from the lounge to dining room leading to the kitchen wedged open staff said that this is to ensure residents in wheelchairs can access the dining room. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34&35 People who use this service experience an adequate service. This judgement has been made using available evidence including a visit to this service. Qualified and competent staff team support residents. Staffing levels need reviewing to ensure that they are appropriate to meet the needs of the residents. EVIDENCE: Staff spoken with were clear on their roles and responsibilities at the home. From information provided from the pre questionnaire and from staff spoken with during the inspection training is provided on a regular basis. Since the transfer of service all staff have been asked to complete a questionnaire of training previously attended and training requirements. Evidence of mandatory training on Food hygiene, moving and handling and first aid were seen on staff records. Information provided from the pre questionnaire states that five staff are currently attending National Vocational Level 2 training and 50 of staff have attained the certificates. At the time of inspection the registered manager is undertaking her Registered Managers Award Level 4 National Vocational Qualification. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 19 Staff said that they have completed application forms and the home obtains two references and satisfactory Criminal Record Bureau checks before staff commence work at the home. Some of the staff have worked at the home for a number of years. Documentation such as details of references or information about Criminal Record Bureau check was not seen on two of the files checked. Staff spoken with confirmed that these had been obtained prior to them commencing work at the home. The manager needs to obtain confirmation of these documents for the staff files held at the home. From the staff rota provided the rota states that two members of staff work in each of the bungalows for the morning and afternoon shift. Night cover is one member of staff in each bungalow. Staff spoken with raised concerns over the level of support some of the residents with complex needs require. Some of the residents require two members of staff with personal care that leaves the other residents unsupervised. Certain tasks such as assistance with eating may take considerable time which may result in staff have to leave residents unsupervised whilst staff are completing other tasks for example picking other residents up from day service or providing personal support. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 40, 41 &42 People who use this service experience an adequate service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre inspection questionnaire evidence that the necessary servicing of gas electrical services and equipment are carried out. The fire log evidenced that necessary testing and checks are maintained up to date. The manager reported that systems are in place for prevention of Legionella. The registered manager reported that she is currently undertaking the National Vocational Qualification Registered Managers Award. The home has not sought the views of residents or their representatives on the quality of service at the home since the change of provider. At the time of inspection the home has not obtained copies of the Nottinghamshire County Council Policies and procedures for staff to follow. The Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 21 manager said and staff confirm that due to Information Technology (IT) difficulties the system is not linked to Internet and despite having IT equipment staff are unable to access emails and record paperwork at present. The support plans for transferring residents from bed to wheel chair do not detail specific action to be taken by staff. During the inspection it was observed that doors from the dining room to the lounges were wedged open to enable residents in wheelchairs to access the rooms. Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 2 2 2 X Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 23 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Timescale for action Ensure that individual Support 31/08/07 plans provide detailed information for staff to follow when providing support to residents Ensure residents finances are 31/08/07 accurately maintained Ensure that risk assessments include details of action to be taken by staff Ensure that daily records of individual residents include records of follow up treatment/ support Ensure that medication keys are stored securely Ensure that the medication policy and procedure reflects the procedures of the home Consult with the Fire safety officer regarding fire precaution’s for doors from the lounge to dining rooms Ensure resident have access to the dining room /lounge Review staffing levels to ensure that they are appropriate to the needs of the residents Obtain evidence of agreement DS0000068836.V334343.R01.S.doc Requirement 2 3 4 YA7 YA41 YA9 YA41 17 (1) (a) Schedule 49 13 (4) 17(1) Schedule 3 (m) (n) 13 (2) 13 (2) 23(4) (a) 31/08/07 31/08/07 5 6 7 YA20 YA20 YA24 23/04/07 31/08/07 23/04/07 8 9 10 YA24 YA33 23 (2) (n) 18 (1)(a) 19 31/08/07 31/08/07 31/08/07 Page 24 YA34 Southwell Road East Version 5.2 11 YA39 24(1) (2)(3) for staff to commence work from Criminal Record Bureau checks and evidence of two references obtained for staff working at the home Develop a system of obtaining 28/09/07 the views of the residents and their representatives RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA41 Good Practice Recommendations Ensure that senior staff regularly monitor daily records to check records of care and support are accurately recorded Southwell Road East DS0000068836.V334343.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Southwell Road East DS0000068836.V334343.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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