Inspection on 03/12/07 for The Cherries

This inspection was carried out on 3rd December 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cherries 27/03/07

The Cherries 17/07/06

The Cherries 21/11/05

The Cherries 12/04/05

The Cherries 10/08/04

The Cherries 26/04/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Cherries Heath End Road Flackwell Heath High Wycombe Bucks HP10 9DY Lead Inspector Kate Harrison Key Unannounced Inspection 3rd December 2007 10:30 The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cherries Address Heath End Road Flackwell Heath High Wycombe Bucks HP10 9DY 01628 530657 01628 850474 zuvani_claire@msn.com www.macintyrecharity.org MacIntyre Care 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) Miss Claire Samuels Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th March 2007 Brief Description of the Service: The Cherries is registered to provide accommodation for up to seven adults with learning disabilities. The provider, MacIntyre Care Services, has kept occupancy levels at six since a service user moved out a few years ago. The service user group is a stable one and individuals have a range of personal care needs. The home is close to the centre of Flackwell Heath where there are shops, pubs, banks, a library and community centre and transport links to nearby towns such as High Wycombe. The Cherries is built into the side of a hill, which has resulted in a split-level style of accommodation. Bedrooms, bathrooms and the laundry are on a lower ground level with the lounge, kitchen and dining room on an upper ground level. The office and a training/resource room are in a separate building, linked to service users accommodation by a patio walkway. There are front, side and rear gardens with a parking area at the front of the building. The current annual charges are £43,904.78 per person as part of a block contract. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’, and was the second inspection visit this year. We arrived at the service at 10.30 hours and spent 5 hours in the home. We were accompanied by an ‘Expert by Experience’, a person who has received a similar service, and who is trained to help us carry out our inspections. This inspection was a thorough look at how well the service is doing. We took into account detailed information provided by the service’s manager through the Annual Quality Assurance Assessment, and any information that we had received about the home since the last inspection. We saw most areas of the home, including individual’s rooms, and looked at records and documents relating to the care of the residents. There were six people living at the home at the time of the visit. We asked the views of the people who live in the home about the quality of the service they receive during our visit, and we spoke to the manager and carers at the home. We looked at how well the home was meeting the standards set by the government and have in this report made judgements about the standard of the service. From the evidence seen and from comments received we consider that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Because the bedrooms and bathrooms are all on the lower ground level, and there is no lift, this home would not be able to provide a service to people who have difficulty getting up and down stairs. What the service does well: What has improved since the last inspection? New paperwork has been developed for each person living at the home, and each individual has contributed, so that the documents show how each person wants to be supported. Communications boards have been provided for each person living at the home, so that it is easier to communicate with staff and visitors. A ‘suggestions’ box is available in the hall, so that any ideas about improving the service can be made easily, and there is a ‘guide to The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 6 compliments’, so that good work can be recognised. The work to update and refurbish the bathrooms was taking place at the time of our inspection visit. Refurbishment of communal areas has taken place and improvements have been made to the outside areas. 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. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. Good arrangements are in place to make sure that the home can assess and test out needs before admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s brochure, the service user guide, has recently been updated, and is presented in an easy read format with pictures and photographs, so that people living in the home know what to expect. The people living in the home moved in together in 1989, and no new person has been admitted to this home since then. The manager explained that admissions would not made to the home until a full needs assessment has been undertaken, and a gradual introduction to the staff and people living there already would be planned. The home would then be able to confirm that they can meet the needs of the individual through the service they deliver. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. People living at the home are supported to live their lives as they want to, to make decisions, take reasonable risks and have personal plans showing staff how to support them reach their goals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the people in the home have individual care plans, and these are presented in two files. One file is mainly for the use of the individual where the individual describes his or her needs, fears, hopes and dreams, and the choices and support he/she wants and needs. We saw two care plans, and both were reviewed recently. What progress the individual had made was documented, and also what was needed to continue the progression. We saw that what had been identified at review had subsequently been supplied, and the individual showed us that he/she was very happy with the progress made. Each individual has a personal key worker, and this member of staff is responsible for developing a relationship of trust, so that the key worker can work to the best interests of the individual. Individuals are supported to make choices about how they live their daily lives, through the use of different communication methods. One individual ticked The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 10 the ‘always’ box in our survey asking if he/she could make decisions about what to do every day. Staff members have had training about how the new Mental Capacity Act affects their work in the home, and are aware that they need to take all reasonable steps to help individuals make decisions. The home uses a video and listening monitor at night to ensure the health and safety of one individual, and the reasons why these are needed have been documented. All appropriate parties concerned with the individual have been consulted, and reviews of the continued use of the monitors are conducted. Risk assessments are carried out for areas of individuals’ lifestyle, such as smoking, though these documents are held in a separate file. It is recommended that the risk assessment documentation be held on the individual’s file, and if this is not possible, there should be a reference in the individual’s plan to the risk assessment held separately. This will make it easier to understand the rationale behind decision- making. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. People living at the home can use community facilities as they wish, are supported to take responsibility and keep contact with friends and family as they wish. Mealtimes are a regular communal activity and individuals have some say about the weekly menu. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home take part in activities they choose outside the home. The care plans we saw showed what activities people choose to do, and what support is available to help individuals take part in activities. Our expert by experience talked to one individual who said that she/he goes out to the pub, goes to the community centre and also goes to the day centre. Another individual is able to go to the shop alone, likes going to the cinema and having a pub lunch. Individuals have opportunities to become members of local churches if they want to, and one individual regularly attends church functions. Staff members support people at the home to have an annual holiday. All these community activities provide opportunities for making new friends. All the people living at the home are encouraged to take responsibility for their lives as much as possible, and participate in the weekly planning of the menus, The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 12 and take part in the house chores such as shopping, setting the table and cleaning up after meals. One individual said in response to our survey ‘I like the food here’. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. The personal, physical and emotional needs of people living in the home are recognised and met, with support from caring staff members and through the home’s procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans show how people at the home want to be supported, in all the activities they cannot manage alone. One individual said in response to our survey that staff ‘always’ treated him/her well, and that staff ‘always’ listen and act on what he/she said. The key worker role allows protected time for individuals to be with a trusted member of staff, and this helps give a sense of being valued. All the individuals are registered with a general practitioner (GP) and we saw records of visits to the GP as necessary. Each person has a Personal and Health Profile, detailing what the GP has said about health issues, and giving details of medication. We saw detailed care plans to support health needs, such as accessing the chiropodist and help with continence issues. The local chemist supplies medication from the GP’s prescriptions and delivers monthly. The medication is kept securely, and there are available guidelines for individual medicines. Nobody at the home is able to manage his/her own medication, and only staff members who have been trained in managing The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 14 medication can administer medication in the home. We saw the records for some individuals, and all were complete and accurate. The healthcare professionals who prescribe medications for each individual recently reviewed the medication in the home, and there has been a recent audit by the supplying pharmacy with no issues arising. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. People living at the home can make complaints easily if they need to, and they are protected for harm through the home’s procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is easy for people living at the home to understand, and that meets regulations. Our expert said after spending time with the individuals that they knew how to make a complaint, and the procedure is easily available for them. People can made suggestions, anonymously if they prefer, through the recently available Suggestions Box to improve the service. One individual in response to our survey said that he/she knew how to make a complaint. There have been no complaints made to the home since our last inspection visit, and we have not received information about any complaints about the home. All the staff members have had training about how to protect the people at the home from harm. The local safeguarding interagency procedures are readily available, and staff members knew whom to contact if necessary. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. The home is comfortable and clean, work to improve the home is being carried out, but more needs to be done to improve the safety of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some of the people living in the home invited us to see their bedrooms, and showed that they were happy with their furniture and furnishings. The downstairs bathrooms were being refurbished at the time of the inspection visit, and when completed will include a walk-in wash area for individuals who find it difficult to use a bath. The cause of the leak discussed in last year’s report has been discovered, and the surrounding area has been made good. Our expert saw the outside patio area, which is also used as a fire assembly point, and described it as very slippery when it rains. It is recommended that a risk assessment be carried out to see how best to manage this problem, so that no injury is caused to people living at the home, or to staff, in the event of using the patio during a fire. The steps leading downstairs should be marked with yellow proximity strips, to help people to go safely downstairs. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 17 We understood that people passing the home through the path to the side of the house sometimes throw stones, and this recently resulted in a broken window in the dining room. The window was repaired. A risk assessment should be carried out to see how risks to people in the dining room could be minimised, in the event of more stones being thrown from the pathway. At last year’s inspection visit, it was pointed out that the home did not provide a suitable environment for one individual. Arrangements are now in hand for the individual to move into another home, with a more suitable environment. Staff members manage the home’s laundry, and are aware of infection control policies and procedures. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. The people living at the home know and trust the staff members, and staff are recruited and trained to meet the needs of the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the 12 staff members at the home 1 has a National Vocational Qualification (NVQ) in Care, though two are doing the course and two more are awaiting funding. More staff members need to gain the NVQ in Care to meet the national minimum standard of 50 trained staff. Three staff members have certificates showing they are skilled in caring for people with learning difficulties. Staff training is organised and all the staff members have individual training portfolios. All the staff members have had recent training in safeguarding vulnerable people. Several carers at the home are long-term members of the staff team, know how to care for all the people there and this brings a feeling of security and safety to the people living at the home. The home’s induction training is to the appropriate standard, and is job specific. The staff team is well organised, with the key worker system, and a senior carer is in charge when the manager is not available. Team meetings are held, and used to disseminate important information and learning points, such as the implications of the Mental Capacity Act on carers’ work. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 19 To check the home’s recruitment procedures we saw the recruitment files for some of the carers. Not all the recruitment information is kept at the home, so it took some time to clarify some necessary details about the recruitment procedure. A ‘Staff Recruitment Summary’ is kept at the home, and it should include the date of any POVA First disclosure, so that it is clear that nobody starts work at the home unless evidence is available that they are safe to do so. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. The manager has good systems in place to make sure that the rights and best interests of the people living in the home are protected, but she has yet to gain her management qualifications. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has experience and skills to run the home and is developing a strong staff team. She has, with the senior carer, created good systems and supporting material to further the improvement of the home, so that the people living there are at the heart of service. MacIntyre Care recently supplied a computer, and this will make it easier for the manager to run the service. The manager has not yet started the Registered Manager’s Award (RMA), as she needs to complete her National Vocational Qualification (NVQ) Level 3 in Care before she can start. She is currently waiting for funding to start her NVQ Level 3 training. As no progress has been made about the manager’s The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 21 training since the last inspection visit MacIntyre Care should consider how they could best support the manager to gain her RMA as quickly as possible. MacIntyre Care conducts a regular quality audit ‘Big Respect’ about the quality of the service through the views of the people living at the organisations’ homes. The last one was in November 2006, and we were told that another is due soon. The organisation has also developed a new post of Family Liaison Officer, so that families have a point of contact if they need information and support. Annual reviews are held about the care of the individuals living at the home, and family members and professionals involved with their care are invited to take part. There is a Suggestions Box near the entrance for people to give their views, and the manager makes herself available to meet with family and others when necessary. We saw recent reports of the unannounced monthly quality visits made by a senior manager to the home. The organisation has a health and safety policy statement and provides training to staff about health and safety matters. The manager is the named person responsible for heath and safety at the home, and has access to the maintenance department to address maintenance issues. The home has a fire risk assessment in place and our requirement about conducting a risk assessment regarding the patio area needs to be considered when updating the fire risk assessment. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 23 NO 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 2 Standard YA24 YA24 Regulation 23(2)(b) 23(2)(o) Requirement The broken window in the dining room must be repaired. A risk assessment must be carried out regarding the unsafe patio area, so that no injury is caused to people living at the home, or to staff, in the event of a fire. A risk assessment must be carried out to minimise risks to people in the dining room, in the event of more stones being thrown from the pathway. Timescale for action 07/12/07 31/12/07 3 YA24 13(4)(a) 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA24 YA35 Good Practice Recommendations The steps leading downstairs should be marked with yellow proximity strips, to help people to go safely downstairs. More staff should be supported to undertake NVQ qualifications. This recommendation remains from the inspection report of 27th March 2007. DS0000023062.V353862.R01.S.doc Version 5.2 Page 24 The Cherries 3 YA9 4 YA34 5 YA37 The risk assessment documentation should be held on the individual’s file, and if this is not possible, there should be a reference in the individual’s plan to the risk assessment held separately. All the necessary evidence about people working at the home should be available on the ‘Staff Recruitment Summary’, including the date of the PoVA First disclosure, so that it is clear that nobody starts work at the home unless evidence is available that they are safe to do so. MacIntyre Care should consider how they could best support the manager to gain her RMA as quickly as possible. The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 25 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 The Cherries DS0000023062.V353862.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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