Inspection on 25/05/05 for The Pines

This inspection was carried out on 25th May 2005.

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

The Pines 10/07/07

The Pines 09/05/06

The Pines 01/11/05

The Pines 15/11/04

The Pines 22/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Pines 39 Portchester Road Charminster Bournemouth Dorset BH8 8JU Lead Inspector Stephanie Omosevwerha Unannounced 25th May 2005 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 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 Stationary 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 Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Pines Address 39 Portchester Road Charminster Bournemouth Dorset BH8 8JU 01202 555048 01202 567682 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sandbourne House Limited Mrs Sarah Alison Dixon CRH PC - Care Home Only 13 Category(ies) of LD Learning disability (13) registration, with number of places LD(E) Learning dis - over 65 (13) PD Physical disability (1) The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. A service may be provided to people in the category of PD in the respite room only. 2. The Manager must complete the Registered Managers Award by 31.12.05. 3. A job description must be in place clarifying the roles and responsibilities of the Manager. Date of last inspection 15 November 2004 Brief Description of the Service: The Pines accommodates 13 adults, with the purpose of providing care and support to residents who have a learning disability. The home was first registered in 1986, and in February 2002 a new provider, Sandbourne House Ltd took over the service.The Pines is a large converted family house. It is a detached property and occupies a corner plot in a residential area of Charminster. Bournemouth town centre, local shops and various community amenities are within easy reach of the home. The home is situated on a bus route.Residents’ accommodation is provided in two double and eight single bedrooms. Communal facilities comprise a separate lounge and dining room on the ground floor and an activities room in the garden, which is accessed via a walkway from the kitchen. Two bathrooms and WCs are located on the first floor, one shower and WC on the ground and a further WC on the top floor. An internal staircase accesses all floors. There is a large office on the ground floor with staff sleeping in facilities. The registered persons have now converted the previous owners accommodation into a respite room with ensuite facilities. This can be separated from the main accommodation by an internal corridor and its own external access if necessary, which is accessible to wheelchair users. Outside there is a large, well-maintained garden with patio area and a further tarmac area providing car parking facilities. The home is staffed 24 hours of the day and is able to provide a comprehensive range of daytime pursuits for those residents not engaged in activities outside the home. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place over 5 hours. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI. During the inspection most communal rooms were seen except for the activities room and a sample of 3 service users bedrooms were viewed. The Pines have recently promoted the assistant manager to manager and she was present throughout the day. The inspector also had the opportunity to speak with 5 residents, 3 members of care staff, the responsible individual and the office administration assistant. A sample of records was checked including care plans, service user files, risk assessments and daily activities sheets. Residents expressed a great deal of satisfaction about their care and spoke positively about the food, their rooms, their choice of activities/leisure pursuits, the staff and their relationships. Members of staff were also enthusiastic about the home, enjoyed their working environment and felt able to make a real contribution to the quality of service. What the service does well: The Pines promotes an open ethos where both service users and staff are encouraged to express their views and contribute to the service. Staff feel valued which promotes high morale resulting in an enthusiastic and motivated staff team. Residents enjoy a great deal of choice and are supported to pursue their own leisure activities and hobbies. Service users have excellent access to the local community and go out on a daily basis. Positive relationships have been formed between service users and staff, which ensures service users support needs and preferences are well known. Residents are treated with respect and there is a real sense of caring, which was clearly demonstrated by the sensitive approach towards a service user whose relative had recently died. The home is responsive towards service users changing needs and is realistic about the care that can be provided, e.g. supporting a resident to move to a more appropriate environment when their care needs changed due to the ageing process. The home’s caring approach is further demonstrated by the contact they maintain with ex-residents supporting those service users in the home who had close relationships to maintain regular contact. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 6 The home works hard to provide a good quality service and is continually looking at ways to improve things for residents e.g. introducing person centred planning and producing documents in accessible formats. 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 Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2. Effective liaison with care managers and excellent opportunities for service users to ‘test drive’ the service ensures that appropriate assessments are in place to ensure that the home will be able to meet the needs and aspirations of prospective service users. EVIDENCE: There had been 2 new admissions to the home since the previous inspection. There was evidence on service users files that a full care management assessment and care plan had been completed prior to admission. The Pines also offers a respite service and service users had been able to utilise this service prior to being admitted to the home. This previous knowledge of the home had ensured they were able to settle in quickly and were confident their needs could be met in the home. The home carries out their own assessments to ensure they are able to meet prospective service user’s needs. For example, they have had to turn down service users for the respite service who proved to have a disruptive influence on the home after a trial visit. All prospective service users are offered an introductory period specific to their individual needs. This could include tea visits, overnight and weekend stays. All new admissions are subject to a trial period and there was evidence that an initial review was held approximately six weeks after the placement began to ensure all parties are happy prior to making the placement permanent. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 9 A service user guide has been produced in an accessible format to give service user further information about the services and facilities available. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9. Service users’ individual plans identify their daily support needs and the home is now developing a person centred approach offering service users opportunities to participate and contribute to more detailed plans setting out a whole range of personal preferences and choices. The home has a clear policy and procedure for the assessment and management of risk ensuring strategies are in place to enable service users to take responsible risks rather than preventing them from doing so. EVIDENCE: During this inspection a care plan was seen for each resident. The home uses a system that sets out care and support needs for each resident on a daily basis e.g. personal care needs, sleeping patterns. They are now working towards person centred planning and service users are taking part in keyworker meetings to set up their own workbooks adapted to a format specific to their needs. There was evidence that care plans were being reviewed at least twice a year. The home has now organised service user files and a sample of 3 residents’ files were observed. These contain all relevant information, e.g. assessments The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 11 from other professionals, financial and medical information. Service users confirmed they were consulted about their care needs and were able to discuss these with their keyworkers. Staff spoken with were clear about their roles as keyworkers and demonstrated a good knowledge of individual service users needs. The home have now set up a risk assessment file and there is a policy on risk assessment and management. A sample of risk assessments were observed for each resident and these included assessments such as management of money, medication, accessing the community and public transport, road safety, and domestic activities. Members of staff confirmed they were able to access this file and were aware of strategies in place to manage areas of risk in the home, e.g. X needs to be supervised in the kitchen area at all times, Y needs to be supported by a member of staff when out in the community. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 16. All service users have an appropriate programme of activities and are encouraged to access the local community on a daily basis. A great emphasis is placed on choice of leisure pursuits and a whole range of trips/outings is provided that can involve individuals, small or large groups according to residents’ interests. The daily routines are flexible promoting independence and freedom of movement. Service users responsibilities for housekeeping tasks in the home are clearly identified and understood by the residents. EVIDENCE: Observation of the service users’ daily activities sheet demonstrated a range of day time activities were being accessed including day centres, college, adult education classes and work experience. Service users confirmed their activities included IT classes, cookery, numeracy, communication skills, music, gardening, recycling. One service said they particularly enjoyed their work, which included helping with maintenance on a children’s play area. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 13 Most service users spent time at the home during the week, which gave them the opportunity to take part in domestic tasks or go out with a member of staff e.g. shopping, walking, visits to cafes, library or having a drive in the car. Service users were also able to access a number of local groups including music, drama and dance and they also attended the local club for service users with disabilities. Service users confirmed their specific interests and hobbies were encouraged and service users could choose from a variety of trips and outings catering for a whole range of tastes, e.g. trips to London, meals out, and one service user had been facilitated to have a driving lesson, which had been a lifelong ambition. There was evidence that the daily routines in the home were flexible and service users were observed to have unrestricted movement around the house, choosing to spend to time in the communal areas or the privacy of their rooms. Service users responsibilities for household tasks were made clear both in the service user guide and in their individual plans e.g. identifying who could make hot drinks or help with activities such as washing up. One service user told the inspector “I help wash up, it’s my turn on Friday” and another resident replied “its alright, I clean it” when asked about their bedroom. The home’s rules on smoking are clear, one resident smokes and there is a designated smoking area in the front porch. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 21. Personal support is offered in a way that promotes and protects service users’ privacy, dignity and independence and takes into account their personal preferences. The healthcare needs of service users are well met with evidence of good multi disciplinary work taking place on a regular basis. Ageing, illness and death are handled with a great deal of sensitivity to ensure the individual is well supported through periods of change/bereavement. EVIDENCE: There was evidence on service users’ care plans that their individual preferences were taken into account e.g. “X likes to dress in a smart, casual way”. The majority of service users living in the home were mainly independent with their personal care with support consisting of monitoring and prompting where necessary. Service users confirmed routines in the home were flexible such as times for getting up/going to bed, meals and other activities. All service users have designated keyworkers and staff spoken with were clear about this role and regular sessions were held with service users to discuss their preferences and facilitate continuity of support. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 15 Observation throughout the day showed that service users were treated with dignity and respect and their personal privacy was promoted. Service users healthcare needs were recorded on their files as well as additional information on relevant conditions e.g. insulin controlled diabetes. Service users allergies were also noted such as plasters and penicillin. Details of all healthcare appointments were kept including G.P., dentists and nurse. There was further evidence of specialist input e.g. psychiatrist and psychologist and any assessments made by professionals were recorded and acted upon, e.g. managing aggressive behaviour. The home has had recent experience of 2 service users moving out because of changing needs due to ageing/illness. The home have remained in contact with these service users and one resident in the home is enabled to visit one of the service users who they had a close relationship with on a regular basis. Another service user told the inspector that a close family relative had recently died. It was clear the service user was being extremely well supported by staff who were sensitive to the residents needs, including supporting the resident to attend the funeral. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. An accessible complaints procedure is in place and service users are encouraged to articulate their views about the home in order that issues raised can be dealt with before they develop into problems and formal complaints. EVIDENCE: A complaints procedure is in place, which has been produced using clip art to convey the information in a way that is clear and easy for service users to follow. Service users confirmed they knew how to make a complaint and who they could talk to e.g. their social worker or the inspector. Some service users were members of a local service user led advocacy group. There is an open door policy in the office and service users are encouraged to raise issues so they can be dealt with before they develop into major problems. No complaints have been made since the previous inspection. Observation and discussion with service users provided further evidence that they felt confident in speaking out. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24. The environment of this home provides service users with a comfortable and homely place to live. There has been some recent investment to improve the communal areas of the home, although a couple of minor repairs were needed in 2 resident’s bedrooms. EVIDENCE: As part of the inspection the inspector viewed all of the communal areas of the home except for the activities room and a sample of 3 resident’s bedrooms. There had been some improvements to the home since the last inspection including new furniture and fireplace in the lounge, new carpets on the hall, stairs and landings, new carpet tiles in the lounge and dining room that had also been repainted, and 4 residents rooms had been redecorated with small modifications being made to enhance their environment such as putting up shelving. A couple of minor repairs were noted during the inspection i.e. one resident’s chest of drawers had a broken bottom drawer and there was a crack in one resident’s window. Residents spoken with liked their rooms and they were described as “nice and cosy” and “alright”. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31. The staff have a very good understanding of service users support needs and this is evident from the positive relationships that have been formed. All staff demonstrate an awareness of their roles and responsibilities and feel able to make a real contribution to the quality of the service. EVIDENCE: Job descriptions were in place that link to the aims and objectives of the home. There was a keyworker system in place with clear guidelines and responsibilities set out. The staff spoken with were clear about their roles and demonstrated a good understanding about service users individual and collective needs. Effective communication tools such as a verbal handover and a handover checklist ensured staff were aware of their responsibilities and duties during their shift. There was further evidence that staff liaised with other professionals recognising when it was appropriate to involve others, e.g. providing strategies to manage potentially aggressive behaviour. Observation during the inspection showed a good rapport between staff and service users and it was clear positive relationships had been formed. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37. The recent changes in the management team have not affected the smooth running of the home. The new manager has been promoted internally and has a sound knowledge of the homes aims and objectives, which are supported throughout the home by all members of staff. EVIDENCE: Sarah Dixon has recently been promoted from Assistant Manager to Manager. She has undergone a successful interview with CSCI is now the registered Manager. An up-dated job description has been forwarded to the commission. Sarah Dixon has over 12 years experience of working in the care industry and has worked for Sandbourne House Ltd, the registered provider, since 1998. In her previous role her duties included supporting the manager in decision making, budgeting and care planning. She was also responsible for staff supervision and training and the day-to-day management of the home. She is currently undertaking her Registered Managers awards and is on target to The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 20 complete this by the end of the year. Helen Somerville remains involved in overseeing the running of the home in her capacity of responsible individual. Staff described the management team as approachable and said they were encouraged to use their own initiative and make a real contribution to the way the service is delivered. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 4 x 3 x Standard No 31 32 33 34 35 36 Score 3 x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Pines Score 3 3 x 4 Standard No 37 38 39 40 41 42 43 Score 3 x x x x x x D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 22 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. Standard 24 Regulation 23 Requirement The registered person must make minor repairs in two residents bedroom, i.e. repair a broken drawer and repair a crack in the window. Timescale for action 31.08.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 5 Good Practice Recommendations It was recommended as a point of best practice that ways of making the format of the service user contract more accessible could be explored, e.g. clip art, tape or video. This recommendation was carried forward from the previous inspection but not assessed on this occasion. It was recommended that it may be useful to hold information regarding what medication is for and any contraindications to ensure staff have a general understanding about each service users specifidc medication. This recommendation was carried forward from the previous inspection but not assessed on this occasion. It was recommended that a system of annual appraisals be set up to review members of staff performance against their job descriptions and agree career development plans. This recommendation was carried forward from the D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 23 2. 20 3. 36 The Pines 4. 39 5. 40 previous inspection but not assessed on this occasion. It was recommended that the information from feedback questionnaires could be collated to form a few action points/targets, which could be monitored to further evidence areas of improvement in the home. This recommendation was carried forward from the previous inspection but not assessed on this occasion. It was recommended that ways to make relevant policies, procedures and codes of practice in more accessible formats for residents are looked at. This recommendation was carried forward from the previous inspection but not assessed on this occasion. The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset BH17 0NF 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 The Pines D55 S3994 The Pines V230104 250505 Stage 4.doc Version 1.30 Page 25 - 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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