Inspection on 01/08/07 for Swan Lodge

This inspection was carried out on 1st August 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

Swan Lodge 10/08/06

Swan Lodge 13/12/05

Swan Lodge 05/05/05

Swan Lodge 11/10/04

Swan Lodge 29/04/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Swan Lodge Kent Avenue Wallsend Tyne & Wear NE28 0JE Lead Inspector Suzanne McKean Key Unannounced Inspection 09:30 1 & 23rd August 2007 st 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 Swan Lodge DS0000028821.V343952.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. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swan Lodge Address Kent Avenue Wallsend Tyne & Wear NE28 0JE 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) 0191 263 9434 0191 2621413 swan.lodge@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Vacant Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 46 The maximum number of service users who can be accommodated is: 46 10th August 2006 2. Date of last inspection Brief Description of the Service: Swan Lodge is a purpose built care home situated on the same site as another care home owned by the same company. The home provides nursing and social care for up to 46 older persons. There is also a contract with the NHS to provide 6 beds for the local GPs. The home has lounges, dining rooms and separate smoking rooms on each floor. All of the bedrooms are single and have en-suite facilities. There are a range of specialist bathrooms, showers and toilet facilities throughout the home. The first floor is accessible by stairs and a passenger lift and the grounds are readily accessible. There is ample car parking to the front of the home. The home shares the kitchen and laundry services with the adjacent home. Swan Lodge is well positioned for local transport and all local amenities. The fees charged by the home range between £361 and £420 depending upon the resident’s needs and service they receive. Additional fees are paid to the home via the nursing care element (free nursing care payment). There is information about the service through the service user guide containing the statement of purpose. A copy of the last inspection report from Commission for Social Care Inspection is available in the entrance to the home. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 26th January 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 1st August and a further visit was made on 23rd August 2007. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable, We told the manager what we found. What the service does well: The home is purpose built and all residents have single accommodation rooms with en suite bathrooms containing a toilet and sink. These were personalised according to the needs and choices of the resident occupying them. The home is well decorated and continuing to improve. The residents are positive about the way they are treated by the staff in the home. An example of this being “the staff are nice” and “nothing is a bother”. Relatives were happy with the care given and said that the home “keeps me informed of any changes to my fathers condition” and felt that the staff were good saying “the carers are brilliant but often due to their other work commitments (the residents) have to wait for assistance”. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 6 No resident enters the home without having a detailed assessment undertaken to ensure that the home can meet his or her needs before care is offered. 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. Swan Lodge DS0000028821.V343952.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 Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good pre-admission assessments are carried out and this is shown in the care plan, this means that the residents can be confident that they can have their needs met. EVIDENCE: The care plans showed that there are comprehensive assessments carried out before any resident is admitted to the home. The care manager’s preadmission assessment was in the care plans. Residents who need nursing care are assessed by the NHS nurse assessor, these written assessments were also in the plan. These records form the basis of the care planning process for the resident and these are added to during the placement. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents have their needs met and individual care planning is up to date and detailed. The residents are treated with respect and their privacy is being maintained. The residents receive their prescribed medication in line with safe working practices. The medicines in the home are well managed and safely disposed of as necessary. EVIDENCE: Individual care plans are in place for all residents, these identify their care needs and how they are to be met. These are based on an admission assessment, which is then added to during the placement. The care plans contained enough information regarding the needs of the resident to allow staff to give the necessary care. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 10 There are risk assessments available for nutrition, wound care, moving and assisting, and continence promotion. The plans are regularly reviewed and updated to make sure that they contain up to date and accurate information. The care plans show that the residents have access to all NHS services and facilities. There was a good range of pressure relieving mattresses in use for the prevention of pressure sores. Only two residents currently have wounds. The records showed how the wounds were being cared for which was appropriate. External advice was being sought from NHS advisors for specific care needs for one resident. The systems for managing medicines in the home are appropriate. The staff record the medicines being ordered. The prescriptions are then checked on receipt from the General Practitioners and are then sent to the Chemist for dispensing. The medicines are checked again when received into the home so that any errors can be picked up. The home has a contract with a Pharmacist, which included giving advice as necessary. No residents are currently managing their own medication. There is a contract in place for the disposal of those medicines no longer needed by residents. The contract is part of the pharmacy agreement. The home has recently provided additional training in medicine administration for the nurses all of whom must reach a standard set. The deputy manager has recently completed the training. The Manager, nursing and care staff, and support staff provided information to show that they aware of the needs of the residents. The Commission for Social Care Inspection questionnaires returned from both residents and relatives were complementary about the way the care is being delivered. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with the flexibility of their daily routines, which take into account their cultural, and religious needs. There are now enough opportunities for residents to be involved in varied and individualised social activities. The food offers a nutritious and balanced diet and gives choice and variety. Catering staff accommodate residents individual needs within the restrictions of multi-occupancy living. Arrangements for residents to maintain contact with family, friends and local community are good and suited to individual’s needs and vary accordingly. EVIDENCE: There are social care assessments in the care plans. The activities coordinator works twenty hours a week. She is involved in organising in house activities carpet bowls, scrabble, and videos. There has been a recent trip out Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 12 for some residents and a summer fair on the weekend between the two visits to the home. Unfortunately this was not well attended as the weather was poor but those residents who were involved said they enjoyed it. Due to the dependency level of some of the residents a number of the activities offered are less active and provided on a more one to one basis. This is now sufficiently developed to offer individualised activities for the residents in line with their social assessment. The records of the activities provided are more detailed and shows on an individual basis what activities the people living in the home are enjoying. There are relatives and residents meetings organised regularly and the records of these are available. These made available to the relatives and relatives who were unable to attend. The residents described the ways they are encouraged to take control of their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. Staff confirmed that they assist residents to make choices about how they spend their day. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives are given information within the residents’ guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. The food served on the day that these standards were being looked was sausage and hash browns or soup and sandwiches then fruit scones or ice cream. All residents seemed to enjoy the food served. The scones were tasted and found to be tasty and were nutritious. The mealtime was well organised and the food being served was well received by the residents. An example of this was one who said, “this is nice” and “ the food is lovely”. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good complaints policy in place that is known to residents, relatives and staff. This describes the system for managing and dealing with complaints, which is being followed. The residents are protected from abuse by staff training, recruitment and selection and effective documentation. EVIDENCE: The complaints procedure is available in the service users guide and a copy is displayed in the home. The record of complaints made and investigated was looked at. There have been no complaints recorded in the last twelve months, although there is a system for recording them as part of the company policies and procedures. The Manager does not record all expressions of concern so only the more formal expression of complaint. This means she cannot use the information as part of the quality assurance system. There is also a mechanism for analysing the complaints and a monthly report is sent to headquarters to that the company can monitor it centrally. There has been one protection of vulnerable adult investigations in the last twelve months this was raised by the home. It was agreed that the home would carry out the investigation and take the necessary action or make the Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 14 improvements. This has now been resolved and the manager has taken action to make sure that they have learned lessons from the issue both in improving the documentation and changing practice as necessary. Two of the residents who were interviewed during the visit understood how to make a complaint, and could identify the way this would be dealt with. The returned questionnaires confirmed that both relatives and residents are informed about the complaints procedure and all but one had not needed to use it. All staff working in the home are given protection of vulnerable adults training both as part of the in-house training package and from external trainers as available. Swan Lodge DS0000028821.V343952.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, 21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and safe, it is organised and well decorated, and there is an ongoing programme to make sure that all of the areas are maintained to a good standard. Good records are kept of the health and safety practices and maintenance of the building and facilities. The home has suitable bathing facilities in sufficient numbers to meet the needs of the people living in the home. The staff are knowledgeable regarding the ways to prevent the risk of cross infection in the home. EVIDENCE: Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 16 The communal rooms including the lounges and dining areas are clean and well decorated. There is a good selection of lounge chairs and a number of the residents were sitting comfortably watching television. The dining areas have been improved recently and are well decorated and set out to with condiments and a centrepiece. Menus were displayed on the tables. The corridors have been recently redecorated and are light and pleasant. Bedrooms are personalised and are organised in line with the wishes and choices of the resident. There are a still a few bedrooms which require replacement of the carpet, although all of the carpets on the first floor that needed have been replaced. The manager has a list of these with priority given to those in greatest need. The Manager has plans to further improve the environment generally as part of the redecoration programme. The home was clean and odour free on both of the visits. There is liquid soap and disposable paper in the en-suites and appropriate waste bins are available so staff can dispose of the paper without leaving the room. The kitchen was clean and well organised, however the walls are ceramic tiled and although they have been cleaned they re Appropriately coloured aprons are available to allow staff to follow control of infection policies, and staff were seen to be using them correctly. Red dissolvable laundry bags are available and staff were therefore not handling soiled linen prior to it being washed. The following bathing facilities are available in the home:Ground floor – First floor High/Low assisted bath (this is a new facility) Non assisted bath – can be used with a free standing hoist Arjo assisted bath (Jacuzzi facility) Non assisted bath – can be used with a free standing hoist Shower Arjo assisted bath Swan Lodge DS0000028821.V343952.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed for the number of residents in the home. There are sufficient numbers of ancillary staff and these can make sure that the home is cleaned effectively. The home has an effective recruitment and selection system, which ensures that residents are cared for by competent staff and are in safe hands. The training programme is up to date for all staff and a significant amount of training is being given to the staff in health and safety, statutory and clinical areas of practice. EVIDENCE: The staffing levels and skill mix is being maintained at levels agreed under the Registered Homes Act. This is on a sliding scale according to the number of residents accommodated and their dependency. On the first visit the staffing was as follows: Manager 2 nurses 4 carers Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 18 2 domestics Cook – (the kitchen covers Swan Lodge and the attached home) 3 kitchen assistants (the kitchen serves Swan Lodge and the attached home) Activities co-ordinator Administrator Staff records were complete including application forms, two references and a completed interview form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. Where necessary a work permit was in place. Health certificates/information were on in file and proof of qualifications where necessary. Induction information is included in the records and quality assessments had been documented. The manager makes sure that the staff are up to date with moving and handling, first aid, and food handling and hygiene training. However the records for fire training suggest that some staff are not up to date with their fire training updates. The staff are offered a number of other training opportunities including pressure area care and continence training. The care staff are encouraged to undertake National Vocational Qualifications (NVQ 2). The NVQ training is commenced once staff have completed their induction training. Swan Lodge DS0000028821.V343952.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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is registered with the Commission for Social Care Inspection. The company has policies and procedures in place to ensure that the home is managed effectively. Resident’s personal allowances are managed effectively. The residents are protected through good health and safety practices and staff training. Only the fire risk assessment is not up to date. EVIDENCE: The manager in the home is now registered with Commission for Social Care Inspection. The records of the arrangements to ensure that persons working at Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 20 the care home receive suitable training in fire prevention, and by means of fire drills and training in the procedures to be followed in the case of fire were examined and were adequate. The updates for all staff are up to date. There is a fire risk assessment in place however this has not up to date as a previous manager completed it on 16 December 2005. It may not therefore reflect any changed that have been made since its completion increasing the risk to the resident and staff. There is a system in place to review health and safety in the home involving the staff, for which records are available. There were no obvious risks evident in the home, and the Manager confirmed that she undertakes daily tours herself to ensure that it remains so. There have been some problems in the past with maintenance in the home. A relative commented, “Repairs seem to take a long time - e.g. shower out of service over a year - now repaired. Now front door entry system/doorbell out of order” however this situation has now been improved and things are being done quicker. Records were examined of the staff meetings, and the contents of these suggest that there is a broad spectrum of relevant issues discussed. These are posted in the staff room for those staff who were unable to attend. The Manager has also had one to one meetings with the relatives and residents as appropriate. There has been a resident/relative questionnaires and this is being analysed so that it can contribute to the homes quality assurance process. The personal records kept in the home for residents who are receiving assistance to manage their finances were examined and are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. Supervision has been given to the staff in line with the national minimum standard. They are on schedule to provide supervision six times per year. Swan Lodge DS0000028821.V343952.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 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 16 (2) Requirement The floor and the walls in the kitchen must be deep cleaned or treated to ensure that their cleanliness can be ensured. The home must have an up to date Fire risk assessment. Timescale for action 01/11/07 2. OP38 23 (4) 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 1. Refer to Standard OP16 OP35 Good Practice Recommendations The home should record all expressions of concern so that the action taken can be recorded and they can be used as part of the quality assurance process. The home should assist the residents to manage their personal finances in their best interest to ensue that they have the opportunity to get interest. Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swan Lodge DS0000028821.V343952.R01.S.doc Version 5.2 Page 24 - 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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