Inspection on 10/11/05 for Tropicana

This inspection was carried out on 10th November 2005.

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

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

Other inspections for this house

Tropicana 11/09/07

Tropicana 15/05/06

Tropicana 14/06/05

Tropicana 10/02/05

Tropicana 05/08/04

Tropicana 22/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Tropicana Newquay Road St Columb Major Cornwall TR9 6SD Lead Inspector Kerensa Livingstone Unannounced Inspection 10th November 2005 09:30 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 Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tropicana Address Newquay Road St Columb Major Cornwall TR9 6SD 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) 01637 880779 01637 880779 Mrs Marina Westbrook Mr Ernest Westbrook Care Home 10 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (10) Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2005 Brief Description of the Service: Tropicana is a large Victorian house with well-kept secluded gardens to the rear of the home and a small car park to the front of the home. It is situated within a short distance of St. Columb Major town centre. The house has been extended to provide a small quiet home for up to ten Service Users who require personal care and are over the age of sixty-five. This is a family run home, the Registered Providers, with their daughter manage the day to day running of the home and live on site. Seven service users are currently in residence. Accommodation is on two floors. There is no lift or stair lift to the first floor. There is large lounge and a comfortable dining room on the ground floor. Wheelchair access is available to the side of the property. Regular contact with friends and family is encouraged, visitors are welcomed. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection which took place over one day, the Inspector met, spoke with all the Service Users staff, Providers and their daughter. The documentation, Policies and Procedures and the environment were inspected. Tropicana is a ‘family-run’ home, which provides a comfortable and appropriate home for up to 10 service users. On the day of the inspection there were six permanent Service Users and one respite Service User. The relaxed family atmosphere, and the evident contentment of the service users impressed the Inspector. The Registered Providers must give priority to the requirements and recommendations identified in this report, which are of a managerial nature. Additional time has been allowed to give the Providers time to meet the outstanding requirements, however there are still unresolved requirements that require immediate action. The Commission for Social Care Inspection is considering what action should be taken. This should not detract from how highly the Service Users speak about their home, the staff and the care that they receive. What the service does well: What has improved since the last inspection? What they could do better: The Registered Providers must take note of the requirements and recommendations identified in this report to better demonstrate the work they put in, and the care needs and capabilities of the service users. The Registered Providers must prioritise the management aspects of the home, such as Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 6 developing and implementing policies and procedures (e.g. employment), environmental risk assessments and ensuring appropriate training is provided for staff. Time must be allowed for administrative tasks to enable effective management. No one within the home is undertaking the Registered Managers Award. Training and supervision must be prioritised for the staff and Providers. 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. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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 Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Service users are well informed and clearly enjoy a relaxed relationship with the Registered Provider and their daughter. EVIDENCE: The Registered Providers have produced a Statement of Purpose, which includes the information required. The Service Users Guide requires a couple of further minor adjustments, but it meets the requirements and is provided to prospective Service Users. Two contracts including terms and conditions have been compiled, there have been plans at previous inspections for these to be combined, this should be done and include a clear breakdown of fees. All Service Users agree a contract with the Providers. The last service user to be admitted stayed for two weeks prior to deciding to stay permanently. The Registered Provider stated that prospective service users are welcome to visit prior to making a decision. Intermediate care is not offered at Tropicana. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 9 Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10 Service users confirmed that they receive a good standard of care and felt well looked after by staff. EVIDENCE: Service users health, spiritual, social and personal care needs are set out in an individual Plan of Care and these are being reviewed at least monthly. There was evidence that the plan of care is being devised and reviewed with service user and/or representative involvement. Daily entries in the care documentation show the involvement of other healthcare agencies as appropriate to the needs of the service user. There is an improvement in the storage of medicines, with the provision of a medicines cupboard and fridge, in addition to a cupboard for the storage of controlled drugs. A Controlled Drugs register is to be purchased, this had been ordered at the time of the last inspection. The Registered Providers are recommended to record medicines such as Temazepam in this register and as a minimum obtain two signatures and a record of the number of tablets stored. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 11 The Registered Providers ensure all staff receive safe handling of medicines training. Service users and their representatives or relatives are treated with respect and their right to privacy is upheld. Staff were observed to treat service users with respect and dignity at all times throughout the day of the inspection. The Service Users preferred name is documented. Service Users and relatives confirmed that they are treated respectfully; their privacy and rights to make decisions are supported. Service Users spoke very highly of the staff and the autonomy that they are afforded. Service users are able to meet relatives and friends within the communal areas, in the garden or in their own rooms. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 Service users said that the staff could not do enough for them, and that they were free to see visitors as they wished. Service Users stated that they enjoyed the food that was provided. EVIDENCE: The Service Users informed the Inspector that they were able to make choices about how to spend their time, they felt that their recreational interests were being met on an individual basis. Individual interests are recorded at initial assessment and this information is built upon with the service user. Service Users were observed to be able to choose where to eat e.g. dining room, lounge or in their room. Spiritual and social needs are included in the Service Users plan. There is a broad range of reading matter and a large selection of videos available within the home. Service Users have a daily paper delivered if desired. Preferred meal, waking up and getting up times are clearly documented and respected. The Service Users were happy with the flexibility within the home and felt that it met their needs and wishes. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 13 Service users are able to meet relatives and friends within the communal areas, in the garden or in their own rooms. Visitors are welcomed to the home, depending on the Service Users wishes which are respected at all times. Visitors were observed to be welcomed on the day of the inspection. No volunteers work within the home. During the year there are regular visitors from the local community. Service Users are offered a set menu at lunchtime, Service Users were not aware of what was on offer on the day of the inspection. The likes and dislikes of each Service User are noted and an alternative provided if the Service User is known not to like something. The importance of a choice being made available to the Service User was discussed. This is provided at teatime, Service Users commented that they could anything at all that they fancied. Food records are kept and special diets are catered for, as required. Fresh fruit and vegetables are readily available. Baking takes place on a regular basis. Service Users reported liking the food. The dining room provides an attractive, comfortable setting this is laid up for Service Users who choose to eat there. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. The Registered Provider and staff were seen to interact well with service users, who confirmed that they would feel able to raise any concerns. EVIDENCE: There is a complaints procedure is in use this includes the contact details for the Commission for Social Care Inspection and timescales, this needs to be reviewed to ensure that it is clear that it is the Complaints Procedure, rather than part of the qualitative review within the home e.g. Comments, Suggestions. This must be provided to Service Users. There is a Protection of Vulnerable Adults policy and a whistle blowing policy. The Registered Provider stated that staff had watched video training and completed questionnaires regarding No Secrets guidance. The protection of vulnerable adults and related policies should be reviewed to ensure that staff know how and to whom concerns may be brought, along with the relevant contact details. The Inspector and Providers discussed the centrally provided training from Cornwall Social Services as no one within the home has attended this. This was discussed in February this year. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 22, 23, 24 & 26 Service users said that they were comfortable and very happy with their accommodation. Service user rooms were personalised and comfortably furnished. There is no lift or other aid to assist access between floors. The environment is clean, homely and hygienic. EVIDENCE: The grounds are accessible and attractive. There is a small extension of five rooms to the rear of the property, all having easy access to the gardens through individual French doors. Four rooms are situated on the second floor. There is no lift. The home meets the needs of the current service users. The home is decorated with paintings, pictures and fresh flowers. Service Users informed the Inspector, without exception that they found their accommodation very homely, comfortable and it met their needs. The home is non-smoking. Service users have access to safe and comfortable indoor and outdoor communal facilities. There is a designated dining room and Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 16 a large lounge. There is an attractive, private garden to the rear of the home and seating to encourage people to go outside and enjoy the grounds. Service Users have sufficient and suitable lavatories and washing facilities. There is a walk-in shower on the ground floor and assisted bathroom upstairs. There are two toilets downstairs which are accessible to the lounge area. There are handrails and equipment to aid independence. Specialist equipment (e.g. hoists and mattresses) is sought on an individual basis, following discussion with the Community Nursing Service. All Service Users are provided with a key to their door (all are fitted with locks) if they wish and a lockable space within their room. Several Service Users have been provided with these facilities. Adjustable beds are provided for the Service Users who require them. Hot water within the home must be risk assessed as required from the previous inspections, evidence of regulated water supplies is required at inspection. The home is clean, pleasant and free from any odours. Gloves and aprons are available within the home. Hand towels and a soap dispenser are available. Laundry facilities are suitable for the size of this home. The Registered Provider feels that the machine within the home meets their needs at this time, however consideration must be given to one with a sluice facility. Care staff undertakes all laundering within the home. There is an up to date Infection Control Policy. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28 The current induction and training records do not demonstrate that staff are provided with the skills and knowledge to perform their roles. The gaps in the recruitment must be explored to ensure that Service Users are safeguarded. Service Users without exception spoke very highly of the staff and the care that they receive. EVIDENCE: Only one staff member has achieved the NVQ Level 2 qualification, another is due to complete their course. The inspector was advised one other is currently booked on a course. One staff member has the Intermediate Food Hygiene Certificate. Individual staff training records have been commenced however dates were missing. Moving and Handling training had not been arranged prior to the inspection. The Registered Provider must keep staff records that show training undertaken and compliance with regulation 18. The personnel file of the most recently employed staff member was inspected. The application form was incomplete, any gaps in employment must be explored. All staff have an enhanced Criminal Records Bureau check completed. The Registered Provider must operate a thorough and robust employment procedure to ensure the protection of service users. The Registered Provider should keep a record of interview. The need for designated managerial/administrative was discussed. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 18 Service Users stated that nothing was too much trouble and they had no complaints, only praise for the Providers, daughter and staff. The induction records were observed to be incomplete. The Registered Provider must ensure that induction training for new staff complies with the National Training Organisation units and is completed within the first six weeks of employment. There are no waking night staff in the home, with two sleeping in staff. On the day of the inspection there were three carers on duty and a housekeeping member of staff. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 & 37 The Inspector could observe that the Registered Providers has the service users best interests at heart. There must be adequate administration and management time to ensure this is reflected in the homes policies and procedures, staff training and staff supervision records. EVIDENCE: The Registered Providers have been working within the care profession for over thirty years; running this home since 1984. Their daughter is the Senior Carer within the home and is due start studying for National Vocational Qualification Level 3. There are clear lines of accountability within the home. The Registered Providers are aware of the need to have a National Vocational qualification at level 4 in management and care. Service users informed the Inspector that they felt able to raise any issues within the home with the Registered Providers. Staff share break times Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 20 together and are able to discuss any issues with the Registered Providers as they arise. Feedback is gathered informally from the four care staff that are not members of the family. There should be evidence of clear management planning and practice that encourages innovation, creativity and development. Evidence must be available at inspection that demonstrates staff, Service Users and other stakeholders affect the way the service is delivered. Feedback has been gathered from respite admissions, this must be extended to include the Service Users and other stakeholders, as part of the annual development plan. Results of service users surveys must be published and made available to current and prospective Service Users, their representatives and other interested parties including the Commission for Social Care Inspection. Service Users who spoke to the Inspector were extremely positive about the home, their care and the Providers and staff, feeling able to make any suggestions. There is a Visitors Book, which is accessible. Generally the home has an unwritten policy of not handling Service Users monies. The Registered Provider must ensure there is a policy and procedure in operation for the handling of service user monies/valuables. The Registered Provider should supplement the existing financial record with a duplicate book for all transactions. There are no supervision records. The Registered Provider must arrange for the regular and recorded supervision of staff to occur at least six times a year. Several staff have attended First Aid training as recommended at the last inspection. Evidence of this must be demonstrated within the training records. The Registered Provider must arrange for moving and handling training for all staff. The Registered Provider must implement risk-assessments in relation to the risk of scalding from hot water outlets, whilst ensuring the fitment of hot water thermostatic valves on all total immersion areas (e.g. baths). Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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 2 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X 3 3 3 3 x 2 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X X X 3 X Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP25 Regulation 13 Requirement The Registered Provider must implement risk-assessments in relation to the risk of scalding from hot water outlets, whilst ensuring the fitment of hot water thermostatic valves on all total immersion areas (e.g. baths). Previous timescales not met 1/5/04 Timescale for action 15/12/05 2. 3. OP38 OP28 13 17, 18 As above The Registered Provider must keep staff records that show training undertaken and compliance with regulation 18 e.g. Moving and Handling Previous timescales not met 01/01/05 15/12/05 01/01/06 4. OP30 18, 19 The Registered Provider must ensure that induction training for new staff complies with the National Training Organisation units and is completed within the first six weeks of employment. Previous timescales not met 14/06/05 01/01/06 5. OP32 10(1) The Registered Provider shall having regard for the size of the care home, the Statement of Purpose and the number and the needs carry on or manage the DS0000009243.V254532.R01.S.doc 01/01/06 Tropicana Version 5.0 Page 23 6. OP33 24 7. OP35 17 care home with sufficient care, competence and skill. The Registered Person shall establish and maintain a system for reviewing and improving the quality of care. The report must be provided to all Service Users, their representatives and the Commission for Social Care Inspection. The Registered Provider must ensure there is a policy in operation for the handling of service user monies/valuables. Previous timescales not met 01/08/05 01/01/06 01/01/06 8. OP36 18 The Registered Provider must arrange for the regular and recorded supervision of staff to occur at least six times a year. Previous timescales not met 01/09/04 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP9 OP9 OP15 OP16 OP18 Good Practice Recommendations The Registered Provider should purchase a Controlled Drugs Book. The Registered Providers should ensure that two staff sign for the administration of Temazepam and a record kept of the number of tablets left. For Service Users to be offered a choice at lunchtime, rather than just an alternative if they do not like what is provided. The registered provider should review the complaints policy. The protection of vulnerable adults and related policies should be reviewed to ensure that staff know how and to whom concerns may be brought, along with the relevant contact details. DS0000009243.V254532.R01.S.doc Version 5.0 Page 24 Tropicana 6. 7. OP18 OP26 8. 9. OP29 OP35 For the Providers and staff to access the Adult Protection training that is being offered by Social Services. The Registered Provider should consider the replacement of the existing washing machine with an industrial-type machine with a sluice facility to be better able to cope with soiled linen and enhance infection control within the home. At this time the Registered Provider should then introduce the use of dissolving sacks for the handling of soiled linen. The Registered Provider should keep a record of interview. The Registered Provider should supplement the existing financial record with a duplicate book for all transactions. Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Tropicana DS0000009243.V254532.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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