Inspection on 18/09/07 for Springfield Manor Nursing Home

This inspection was carried out on 18th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Springfield Manor Nursing Home 24/09/09

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Springfield Manor Nursing Home Hogs Back Puttenham Guildford Surrey GU3 1AQ Lead Inspector Mary Williamson Unannounced Inspection 18th September 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Manor Nursing Home DS0000069504.V350978.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. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Manor Nursing Home Address Hogs Back Puttenham Guildford Surrey GU3 1AQ 01483 810177 01483 810611 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) Springfield Manor UK Limited ****Post Vacant**** Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. 3. Old age, not falling within any other category (OP) The home may provide nursing care to service users in the (OP) category from the age of 60 years The maximum number of service users to be accommodated is 30 Date of last inspection New Service Brief Description of the Service: Springfield Manor Nursing Home is registered to provide nursing care for up to thirty older people. It is located on the Hogs Back in extensive grounds, overlooking the Surrey countryside. The home provides ample communal space, including an attractive conservatory. Resident’s accommodation is provided in single and shared rooms some of which have en-suite facilities. There is a shaft lift to access the first floor and a ramp to access the patio garden at the rear of the home. There is ample parking provided as the home is not accessible by public transport. The fees charged in this home range from £550 to £700 per week. (18/09/2007) Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first visit of a key inspection and was unannounced. Mary Williamson who is a Regulation Inspector undertook the inspection over five hours. The Responsible Individual Mrs. Sonita Nijhawan, and the Home Manager Roz Salmani were present for the duration of the inspection. The home changed ownership and was reregistered in March 2007 under the new providers. A tour of the premises was undertaken and records relating to the care of the residents and the management of the home were examined. It was possible to meet all the residents and gain some feedback on their views about the home. It was also possible to talk with relatives and staff, and listen to their experiences about the home. There has been one complaint since registration, which was managed effectively in line with the homes complaints procedure. Diverse needs of residents are included in individual care plans. The manager completed an AQAA (Annual Quality Assurance Assessment), and a number of comment cards were received from relatives and staff. The Commission for Social Care Inspection would like to thank the residents, relatives, and staff team for their hospitality and help during the inspection. What the service does well: The service provides a good standard of care for the residents living in the home. Needs assessments are in place and the home will only admit residents whose needs can be provided for. Care plans are well written and reflect that residents care needs are being met. Accommodation is provided in single and shared rooms, which have been undergoing refurbishment. There was good interaction between residents and staff. Privacy and dignity are respected. The residents being nursed in bed appeared comfortable, and well cared for. Residents commented that the food was very good, and a relative stated that the food always looked appetising. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Springfield Manor Nursing Home DS0000069504.V350978.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 Springfield Manor Nursing Home DS0000069504.V350978.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): 1, 2, 3, and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents need to be provided with accurate information about the home in order to help them make a choice about living there. Contracts of occupancy need to be updated to reflect the new provider. There are good needs assessments in place. EVIDENCE: The home has a statement of purpose and service user guide in place. This provides prospective residents with some information to help them when choosing the home. However this needs to be updated to include new details of the home, and the management details. The complaints procedure included in the service user guide must be replaced by the new complaints procedure produced by the manager. All prospective residents have a needs assessment undertaken by the manager, which are detailed and informative. The manager has developed a Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 9 new assessment format for the pre admission needs assessments. Four needs assessments were sampled and were well maintained. Contracts of occupancy were examined for four residents. Two set out terms and conditions of occupancy including accommodation offered, care provided, what the fees included, the amount payable and method and frequency of payment. One contract was in the process of being drawn up, as the resident had only been admitted the previous day and the fourth contract was not in place. The provider stated that she would review all the contracts and update these as necessary. Intermediate care is not provided in this home. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans outline the care and support residents required. Appropriate arrangements are in place to meet heath care need, and the medication policy protects the residents in living the home. Residents are treated with dignity and respect. EVIDENCE: Care plans were sampled for four residents. These are written information gathered at the pre admission needs assessment, with input from the resident whenever possible, information obtained from relatives, and any relevant medical reports. The plans outline the care to be provided and by whom. Plans also include risk assessments and have been signed by the resident or a designated representative. Resident’s care plans are kept in their bedrooms and are updated daily by the care staff. Individual files are kept in the office with more detailed information, for example doctor’s letters, social services reviews, and personal details that are also updated and kept secure when not in use. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 11 All the residents are registered with a local GP who visits the home every Friday, or more frequently if required. She was visiting residents during the inspection and stated that she has been visiting the home for fifteen years. Chiropody is arranged every six weeks; the dentist and optician will visit on request. Residents appeared well cared for. Some were sitting in their chairs with knee blankets and all had access to drinks. One resident was observed to have split his coffee as this was placed in an inappropriate position. Some residents were being nursed in bed and appeared comfortable. The beds were specific to their nursing needs and had freshly laundered bed linen. There are currently two residents in the home with pressure sores. Detailed records are in place on the management of these including a body map and Waterlow assessment. The manager stated that the home had access to the tissue viability nurse. The home has pressure-relieving equipment in place and three profile beds were delivered during the inspection. Staff were observed to interact with residents in a professional and respectful manner. Privacy is observed and staff knock on bedroom doors prior to entering. Screens are provided in shared rooms. The home has a medication policy in place. Staff administer medication according to this policy and the Nursing and Midwifery Council (NMC) Code of Professional Conduct. Boots provide the medication to the home mainly in blister pack format. The home has a meeting planned with the chemist on 28/09/07 to discuss and review medication practice. The medication recording charts were seen and are well maintained. The controlled medication is stored correctly and the controlled drug register is well maintained. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of an activities programme does not satisfy the residents social and leisure interests. Family links are maintained. The nutritional needs of the residents are being met, and should be reflected in written menus. EVIDENCE: There is no formal activity programme in place. The manager stated that the home was very much aware of this and was working towards implementing a social and leisure activity programme. She explained that since she was appointed manager in May 2007 she had to make care plans and staff training a priority. Information provided in the AQAA states that an activities coordinator will be recruited. Residents were sitting in the lounge and conservatory talking to each other. Some were reading their daily newspaper, others were watching television, one resident was knitting, some were sleeping, and some residents were sitting in their individual rooms. One resident said, “we have exercise every Wednesday and a quiz”, another resident stated that they have an outside entertainer to play sing along music. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 13 Relatives visiting the home gave positive feedback regarding the care provided and stated that the staff were helpful and kind. One relative said she was always made very welcome in the home. Visitors are encouraged to visit at any reasonable time. Spiritual needs are observed and residents can have visits from their chosen clergy on arrangement. Residents are supported to make choices regarding what time they get up and go to bed, what they wear and where they spend their time. One resident said that the liked to “have a lay in some mornings.” The kitchen was visited and the chef spoken to. Meals are planned by the chef with his knowledge of the dietary requirements of the elderly together with his knowledge of residents’ likes and dislikes. A record is kept in the kitchen of daily meals provided. Both chefs are in the process of planning menus. These will help residents be more involved in daily choice. One resident was asked what was for lunch and she stated, “we don’t know until it is put down in front of us.” Residents agreed that the food served was “very good”. Lunch was observed and consisted of Scrumpy pork, mixed vegetables, green beans and potatoes, followed by bread and butter pudding. Special diets are catered for and cultural needs of residents are met. The kitchen was clean and orderly and all the required documentation relating to food hygiene was in place. The chef has overall control of the catering budget, which must be kept under review in line with the needs of the residents and the number of people living in the home. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure and the abuse awareness procedure in place protect the residents living in the home. EVIDENCE: The home has a complaints procedure in place, which has been updated by the new manager. This is displayed in the main reception area and will be included in the homes new service user guide. Residents and relatives when asked said they had access to this document and knew how to use this. There has been one complaint since registration and this was resolved successfully by the manager in line with procedure and records retained for information. The home has an abuse awareness policy in place and the provider and manager stated that all staff undertake training in this policy during induction training. The home has a copy of Surrey Multi Agency Policies and Procedures on Safeguarding Vulnerable Adults. It was recommended that the manager should access update training in these procedures. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in an environment, which is currently undergoing major refurbishment to improve the standard of accommodation provided for them. The standard of cleanliness is good. EVIDENCE: The home was reregistered in March 2007 and the new provider is currently undertaking a major refurbishment project. The wood panelling in the main hallway and main reception area has been restored to a polished finish. The quiet lounge has been fitted with a new carpet and the dining room has been repainted. The home is comfortable and provides residents with ample communal accommodation, which overlooks spectacular views of the Surrey countryside. There is ramp access to a patio with garden furniture. Residents accommodation is provided in single and shared rooms, some of which have en-suite facilities. The standard of decoration and furniture varies Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 16 according to the refurbishment programme, but the majority of the bedrooms are decorated and furnished to a good standard. Bedrooms have been personalised to reflect individual personalities. The furniture in some bedrooms needs to the replaced as this is either worn or broken. Provision must also be made available for the storage of equipment when not in use, as some of the resident’s rooms were very cluttered with excess commodes, wheelchairs, and sani chairs. There are ample bathrooms and toilets situated throughout the home, which have been adapted to meet the mobility needs of residents. The home is clean and hygienic and the housekeeper stated that she has undertaken NVQ training. The home has an infection control policy in place and arrangements are in place for the collection of clinical waste. The laundry is well equipped and only personal laundry is washed on site. All the main laundry is sent out to contract. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 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. The number and skill mix of staff on duty was sufficient to meet the current resident’s needs. The training and recruitment procedures in place protect the residents living there. EVIDENCE: The staff duty rota was seen and indicated that there were sufficient staff on duty to meet the current residents assessed needs. A discussion was held between the manager, deputy manager and the provider regarding the allocation of more staff to each shift. This was necessary as the home was expecting new residents at the end of the week and the ratio of care staff needed to be increased to meet resident’s needs in accordance with guidance from the Department of Health. The training and development of staff is ongoing. An external training company is engaged to oversee the training in the home. Currently they have provided five care staff in the home who are undertaking NVQ level 4 leading to adaptation training. Some staff have an NVQ level 3. The manager stated that she provided the induction training for all new staff in line with Skill for Care. Mandatory training also takes place and the manager was organising a training plan for the coming year to update this training. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 18 There is a recruitment policy in place. Three staff employment files were seen. These were well maintained and included all the required employment documentation including two written references, an employment history, and a CRB (Criminal Records Bureau) disclosure number. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interest of the residents. The home promotes the health, safety and welfare of the residents living there. EVIDENCE: The home manager has been in post since May 2007 and is in the process of applying to The Commission for Social Care Inspection to become the registered manager. She manages the home well and has several years experience in the provision of care for older people. She is also a qualified nurse and has a registered Managers Award. There is also a deputy manager in post, also a qualified nurse and has the experience and the skills necessary to reflect this post. Between them they have developed a good standard of record keeping relevant to the care of the residents. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 20 There are no formal systems in place to monitor quality assurance. The manager stated that she has compiled a questionnaire for resident, relatives, staff and health care professionals to be used as a survey and feedback acted upon. This is not yet a working tool and a discussion was held with the manager and the provider regarding implementing this. The provider visits the home every week and it was recommended that one of these visits should take the form of a regulation 26 visit in compliance with the Care Homes Regulations and a report kept on file for information. Residents meetings should also be introduced and recorded. The home does not handle personal money for any resident. Relatives or a designated representative handle all financial affairs on behalf of residents. There is no formal staff supervision in place. The manager was aware of this and had it in her action plan, in order of priority. The home has a wide range of health and safety policies and procedures in place and some of these were sampled throughout the day. All staff undertake training in health and safety during their induction training. Risk assessments are in place for all identified risks and safe working practice. Fire safety is observed and there is a contract in place for the maintenance of fire fighting equipment and safe working practice. Accidents and incidents are recorded appropriately. Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 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 2 X 3 2 X 3 Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 4&6 and Schedule 1 Requirement The registered person must ensure that the statement of purpose and service user guide is reviewed and available to all residents and their relatives in order that they have sufficient information available to help them choose the home. The registered person must ensure that all residents have a written contract in place, outlining the accommodation, offered, the care provided, the fees payable, and the method and frequency of payment. The registered person must consult residents about their social interests and provide an activities programme, which is suitable and meaningful to their requirements and needs. The registered person must ensure that quality-monitoring systems are implemented to seek the views of the residents, relatives. The registered person must ensure that the staff in the home are properly supervised and DS0000069504.V350978.R01.S.doc Timescale for action 18/10/07 2 OP2 5(a) 18/10/07 3 OP12 16(2)(n) 18/10/07 4 OP33 24 18/10/07 5 OP36 18(8) 18/10/07 Springfield Manor Nursing Home Version 5.2 Page 23 must introduce formal staff supervision at least six times a year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP15 OP19 Good Practice Recommendations It is recommended that menus are written and available to residents on a daily basis in order to encourage them to be actively involved in choosing their meals. It is recommended that the provider continues with the refurbishment programme, and replaces the old and worn furniture in various bedrooms, and provides appropriate storage space for wheelchairs and wheelchairs. A discussion was held with the provider and the manager regarding the progress of the manager’s application to become registered. It is recommended that the manager submit her application to become the registered manager to the South East Region Registration team as soon as possible. 3 OP31 Springfield Manor Nursing Home DS0000069504.V350978.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Springfield Manor Nursing Home DS0000069504.V350978.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. 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