Inspection on 23/02/06 for St Johns Nursing Home

This inspection was carried out on 23rd February 2006.

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

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

Other inspections for this house

St Johns Nursing Home 08/01/10

St Johns Nursing Home 27/02/07

St Johns Nursing Home 15/07/05

St Johns Nursing Home 01/02/05

St Johns Nursing Home 27/06/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE St Johns Nursing Home St Peters Walk Droitwich Worcestershire WR9 8EU Lead Inspector Andrew Spearing-Brown Unannounced Inspection 23rd February 2006 08:15 X10029.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 St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 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 and 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. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Johns Nursing Home Address St Peters Walk Droitwich Worcestershire WR9 8EU 01905 794506 01905 794792 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) Shaw healthcare Limited Ms Julia Patricia Roberts Care Home 40 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number disorder, excluding learning disability or of places dementia (14), Mental Disorder, excluding learning disability or dementia - over 65 years of age (14) St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may also accommodate people with dementia illness between the ages of 55 - 64 years. 15th July 2005 Date of last inspection Brief Description of the Service: St John’s nursing home is currently registered for 40 residents. The home specialises in providing 24 hour nursing care for residents with a degree of mental illness and a dementia type illness. The home is registered to care for residents from the age of 55 years onwards. St John’s is part of the Shaw healthcare (Homes) Limited. The responsible individual is Mr P J Nixey. The registered manager is Julia Roberts. St John’s moved into the home during October 2002. The home was then further extended in May 2003 to provide accommodation for an additional 17 residents. The home is situated in Droitwich close to the town centre and public transport. Car parking spaces are available at both the side and rear of the home for staff and visitors. The home is spacious. All bedrooms are single occupancy with en-suite facilities of a toilet and shower. Communal areas include lounges, dining areas and specialist bathrooms. The kitchen room contains kitchenette facilities for visitors; this room is to become an activities room in the near future. The home has enclosed gardens. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken by a regulation inspector from the Worcester office of the Commission for Social Care Inspection (CSCI). The inspection took place over a period lasting a total of 3 ½ hours commencing at 08.15. The last inspection at St Johns took place during July 2005 making this inspection the second statutory visit during the 2005 – 2006 inspection year. The home had no vacancies on the day of this inspection. Part of this inspection was to assess the progress made in relation to the small number of requirements from the previous inspection as well as assess some other key standards. Throughout the inspection the registered manager was on duty. During this inspection a number of documents were viewed and a number of different persons consulted. What the service does well: What has improved since the last inspection? What they could do better: The management and recording of medication needs to be further improved. Records to ensure that a full audit of residents money saved within the home can be undertaken need to be improved. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 6 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. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section were assessed in any great detail as part of this inspection. As a result these standards will be assessed as part of a forthcoming inspection at St Johns. EVIDENCE: As previously noted a range of information about the home and services offered were on display in the reception lobby for prospective residents and or their relatives. None of this information was read during this inspection. Residents and or their representatives are able to visit the home prior to admission. A trail period takes place before residents become long term. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8 and 9 Further progress has been made with regard to improving care plans to ensure that residents care needs are met. Care plans are clear and effective. Improvement in medication management is required to fully safeguard residents. EVIDENCE: Care plans were assessed as part of the previous inspection when it was found that progress had been made to ensure that all aspects of health, personal and social care were identified. One care plan viewed in detail showed that this progress had continued. The file seen contained detailed care plans, monthly St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 10 reviews and risk assessments as well as other documents relevant to the individual. The standard of recording was good in that each area of identified need was up to date and was able to be cross-referenced with other documentation. The records would be able to guide staff in order that consistence in care and meeting individual needs can be achieved. As part of the inspection the management, administration and recording of medication was assessed. Since the previous inspection the organisation has contracted to use a major high street chemist to provide all medication, this has resulted in a change in supplier at St. Johns. The current months Medication Administration Record (MAR) sheets were viewed. A small number of gaps were in evidence on the MAR sheets whereby no signature or code was entered. These gaps were despite a system in place for checking the MAR sheets at the conclusion of each shift. The use of coding on the MAR sheets was drawn to the attention of the manager and team manager as some persons only use one initial as a means of signing for medication given. This single letter can be the same as the codes used to indicate a reason for none administration of medication and therefore lead to confusion. As previously identified handwritten amendments to MAR sheets did not always have two signatures as required. Furthermore when medication was prescribed on a variable dose it was not always evident what dosage was administered. No protocols are in place upon individual care plans regarding when medication prescribed on a ‘as and when’ or ‘when required’ basis would be administered. It was noted that the date of opening is not recorded on boxed medication; this assists in carrying out a full audit of medication. A record of items to be destroyed was available and appeared to be in order although no audit was carried out against these records. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 and 13 Activities are provided which stimulate residents living in the home. EVIDENCE: St Johns employees a full time activities coordinator who spends time with residents both downstairs in the older peoples unit and upstairs in the mental health unit. A room currently used for training purposes is going to become an activities room in the near future. During this inspection a member of staff was playing an electric organ in the downstairs lounge to the amusement of residents and staff. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 12 The previous inspection report highlighted upon the favourable comments made by residents in relation to the food on offer. Menus at that time were found to be balanced and interesting. One resident consulted during this inspection stated that the food is good. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Any complaints are listened to and taken seriously. EVIDENCE: The registered manager stated that St Johns has not received any complaints since the last inspection. The CSCI have not received any complaints. The complaints procedure was not viewed on this occasion. Staff have received training in relation to the recognition of abuse in vulnerable people. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 and 26 The appearance of the home and the grounds continues to create a comfortable and homely environment for residents EVIDENCE: All bedrooms at the home are single and have en-suite facilities. Communal bathrooms are toilets are available throughout the home and are of a suitable size. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 15 Communal areas are located on each floor and are suitable for purpose. The home has good systems for the management of infection control including hand gel by the main door and a notice requesting that person clean their hands on arriving and departing. A similar hand gel dispenser is situated near to the kitchen. On the day of this inspection the home was clean, tidy and free from odour. The registered manager is aware that odours can occasionally be in place and makes a determined effort to manage this. Residents bedrooms are well furnished, residents are able to bring in their own personal possessions therefore generating ownership. One bedroom seen has wooden flooring as opposed to carpeting. The carpet near the offices, main lounge and dining area is stained in places, this carpet is due to be replaced and was in the process of been measured during this visit. Cigarette burns and stains from spilt drinks have damaged the floor-covering coming down the stairs from ‘The Limes’ and the corridor leading to the smoking room. The floor covering in the smoking room is now tiled and therefore not susceptible to cigarette burns. It was reported that a officer from the local Environmental Health Department recently visited and that suitable action has taken place to meet their recommendations. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 29 and 30 A sufficient number of staff were on duty. A commitment to staff training was demonstrated which assists to safeguard residents. EVIDENCE: Sufficient nursing, care and ancillary staff are on duty to provide care and support to residents within the home. Each morning at least 8 carers and 2 trained members of staff are on duty; in the afternoon the staffing ratio is 7 carers and 2 trained members of staff. Throughout the night the home has 4 carers and 2 trained persons on wakeful duty. Morale was described as better than in the past. Sickness levels were described as low. Currently 12 members of staff hold an NVQ (National Vocational Qualification) level II. Additional staff are presently undertaking this training which will equip the home to achieve the 50 level of staff holding this qualification. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 34, 35, 36, 37 and 38 There is clear leadership, guidance and direction to staff, which ensures that residents receive consistency in care delivery. Improvement is necessary in the documentation of resident money and fire safety checks to protect residents welfare and safety. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 18 EVIDENCE: The registered manager is suitably competent and has experience in managing care services. A recent external quality audit demonstrated that the home was meeting the majority of the National Minimum Standards. Residents representatives were recently surveyed for comments regarding aspects of the care home by means of a questionnaire. The home has facilities for the safekeeping of small amounts of money on behalf of residents in order to fund matters such as hairdressing or personal purchases. The balance of one residents money was checked and found to balance with records held, monthly auditing takes place. The home does however need to improve the documentation held in that it was not possible to cross reference money deducted against signed invoices/ receipts for items such as private chiropody or hairdressing. Care plans were held in a secure place. Only a small number of health and safety documents were viewed on this occasion. A monthly audit of accidents takes place, which is good practice to establish any pattern in incidents. It was evident that hoisting equipment is serviced every six months as required under the Lifting Operations and Lifting Equipment Regulations 1998. The fire records showed that the fire alarm is tested on a weekly basis, however this is not in sequential order and as a result one break glass point has not been tested as part of this process since January 2005. No records existed regarding a visual check of fire extinguishers. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 19 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 X 2 X 3 X 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 3 21 3 22 3 23 3 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 3 35 2 36 3 37 2 38 2 St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 20 Yes 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 OP9 Regulation 13 (2) Requirement All medication administered to residents must be accurately recorded onto medication administration record charts. (Previous timescale of immediate and on going on 15th July 2005 not met. This requirement must be met immediately) 2. OP9 13 (2) The date of opening must be recorded on all medication not included within the monitored dosage system. Review the current practice of signing MAR sheets to ensure that all staff sign by means of two initials. 23/02/06 Timescale for action 23/02/06 3. OP9 13 (2) 23/02/06 4. OP9 13 (2) Protocols must be recorded 23/02/06 as part of the care planning process for medication prescribed on a ‘as and when / when DS0000004138.V284707.R01.S.doc Version 5.1 Page 21 St Johns Nursing Home required’ basis. 5. OP35 17(2)schedule4(9) Appropriate receipts must be held for the purpose of auditing regarding all items of expenditure made on behalf of residents. 23 (4) The fire alarm must be tested in sequential order to ensure each break glass point is tested. 23 (4) Records regarding visual checking of fire extinguishers must be maintained. 23/02/06 6. OP38 23/02/06 7. OP38 23/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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. St Johns Nursing Home DS0000004138.V284707.R01.S.doc Version 5.1 Page 23 - 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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