Inspection on 12/01/07 for Winthorpe Hall Care Home

This inspection was carried out on 12th January 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Winthorpe Hall Care Home 27/08/08

Winthorpe Hall Care Home 12/11/07

Winthorpe Hall Care Home 04/04/06

Winthorpe Hall Care Home 19/09/05

Winthorpe Hall Care Home 20/07/05

Winthorpe Hall Care Home 21/03/05

Winthorpe Hall Care Home 27/07/04

Winthorpe Hall Care Home 29/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Winthorpe Hall Care Home Gainsborough Road Winthorpe Newark Nottinghamshire NG24 2NR Lead Inspector Vanessa Gent Key Unannounced Inspection 12th January 2007 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 Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winthorpe Hall Care Home Address Gainsborough Road Winthorpe Newark Nottinghamshire NG24 2NR 01636 701826 01636 701234 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) Mr R C Pountney ** Post Vacant *** Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total number of beds, a maximum of 28 may be used for the category OP 1st June 2006 Date of last inspection Brief Description of the Service: Winthorpe Hall is a privately-owned care home registered to provide accommodation and personal care for up to twenty-eight people over the age of 65 years. It is a spacious, converted manor house, providing accommodation on three floors, with a two-floor extension in keeping with the architecture of the original building. It is situated in the village of Winthorpe, north of the market town of Newark, close to major road networks. A local bus service goes to both Newark and Gainsborough. Amenities available within the village itself include a post office cum general shop, parish church, village hall and public house. The village of Collingham, three miles away, has a larger number of amenities, including shops, a doctor’s surgery, dentist, optician, pharmacy and public library as well as restaurants and pubs. The accommodation contains 26 spacious single bedrooms, 16 of which are ensuite, and one double bedroom. There is a passenger lift to the upper floors. The main lounge areas and dining room are on the middle floor with further sitting areas on the ground floor. The property is surrounded by extensive, well-kept gardens which provide residents with a tranquil, safe area to walk and sit in. There is a large car parking area for staff and visitors. The fees are from £336 to £400 per week. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit was made to the home as part of a key inspection. It started at 14.00 and lasted 5½ hours. Information already held on file was used to plan the visit and contributed to making judgements. The main method of inspection used is called ‘case-tracking’, which involves selecting a proportion of residents, and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices. The owner of the home provided a pre-inspection questionnaire saying what the current facilities of the home are. No survey forms giving the opinions of staff, residents or visitors were received before the inspection. The visit to the home focused on whether key standards and requirements from previous inspections had been met and how the residents and staff feel about the service provided. Three residents’ assessments and care plans were examined to ensure the health, safety and welfare of the residents is checked and that residents are given respect and allowed dignity, autonomy and choice. A partial tour of the home was made and a sample of other records examined. Five staff, a visitor, a healthcare professional and four of the twenty-two residents, including those being case-tracked, spoke with the inspector. The manager and provider were present throughout most of the inspection visit to the home. What the service does well: The care plans are kept on computer, which ensures that they are reviewed every month. Staff say that the acting manager and provider support them in their caring roles as well as with training and in supervisions. Staff say they work together as a good team. There is a fairly comprehensive training programme in place but there is need to focus on one or two areas to make sure that all staff are trained appropriately to care for the residents adequately. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users guide need to be modified to comply with the regulations and ensure that prospective residents know what to expect from the home before they make their choice. The acting manager shows, in the assessments done before admission, that they can meet the needs of the residents. EVIDENCE: The statement of purpose appears to be a one page document within the service users guide and does not contain all the information required by the Care Homes Regulations, Care Standards Act 2000. The service users guide is a large, comprehensive document that contains the information that should be Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 9 in the statement of purpose. The statement of purpose and service users guide must be documents fit for their purpose. The acting manager says that a copy is available for prospective residents to see what the home has to offer before making a decision to live at the home. One resident said, “we looked at the home and liked the look of it but we weren’t given any written information about the home before I moved in”. Other residents said that the decision of which home to go in to was made for them. Pre-admission assessments are done for all people who want to live at the home, to ensure the home can meet their needs once they have moved in. The acting manager also uses the assessments that Social Services do for the residents. One resident said they were fully involved in the production of their care plans. Their care plans backed up what they said by having a signature of agreement in them. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for safely and their needs are met by clear care planning and reviews, good liaison with other professionals and safe medication practices. Residents’ privacy and dignity are respected by most but not all staff at all times. EVIDENCE: The care plans are kept as electronic records but staff say they are also printed for residents and their representatives to be involved in whenever they wish. One of the care plans examined contained no printed copy of the care plans. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 11 One resident said they were involved in the original creation of their care plans but have not been invited to be involved since. They are reviewed monthly. Several healthcare professionals spoke with the inspector. They spoke of cooperation and good liaison between the manager and staff of the home and the district nurses, GPs and other professionals to maintain the health and welfare of the residents. They said the care staff are mostly very caring and pleasant although one or two can be impatient with the residents. One frequent visitor commented on the excellent service and care provided by the provider and staff. However, others have noticed that occasionally there is a lack of privacy and dignity, with “one or two” staff “talking down” to the residents and not empathising with them. Staff reported that when residents present challenging behaviour, not all staff know how to handle the resident to retain their respect and dignity. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Daily activities are not well enough recorded to show that residents are kept occupied and their wishes catered for. Limited choice in daily activities, routines and meals might prevent residents from achieving their full wishes and potential in their lives at the home or receiving a balanced, nutrition and varied diet. EVIDENCE: The manager and staff say activities are provided every day. No activities took place during the inspection visit. Residents say, “There’s not a lot of things going on most of the time although the entertainments are interesting”. “We just sit and watch people go by and watch the television.” Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 13 Staff say they do hand massage, reminiscence and chat with the residents often. Nothing is documented of what activities are provided or undertaken by staff to confirm this. A visitor said they are very welcome to visit at any time. They said that during the Christmas season, visitors were invited to join in with the festive activities and meals, which were enjoyable. Although the previous inspection report states that “residents confirmed that they are able to get up and retire when they wish”, there is insufficient evidence to show that some residents are able to choose where to spend their waking days in the home. Some residents stay in their rooms but others have a different perception of this. They say that staff insist that they sit in the communal lounge. The acting manager said that there is always a full choice of menu. The records kept in the kitchen of what residents eat each day show that the choice is limited at lunchtimes to one main meal choice or a jacket potato with cheese. All the vegetables, except onions, are frozen or tinned, of which there is an ample supply. Residents and staff confirmed that they do not often get fresh fruit. Residents say that for their evening meal they have only sandwiches, with a limited variety of fillings, and those are not very well filled. The uneaten sandwiches seen had very little filling. They also have some cake. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives know what to do if they have concerns or complaints and most feel they will be listened to and taken notice of. Most staff are caring and affectionate to the residents. The lack of adequate awareness training for safeguarding vulnerable adults in the home puts residents at risk of harm or abuse. EVIDENCE: No complaints have been received by the provider or manager. A concern about the lack of adequate heating and some staff not being respectful to residents was received by the commission. The complainant said they were happy to take the matter to the provider to deal with, feeling that they will be listened to and the issue resolved. No documentation was seen to show evidence that adult protection training has been specifically undertaken by all the staff, although some staff have taken or are in the process of taking National Vocational Qualifications (NVQs) in which they say they learn about safeguarding vulnerable adults. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 15 Staff said they know how to keep residents safe from harm. However, staff say they have not received specific training in how to manage incidents of challenging behaviour from residents, which may put the residents and staff at risk of harm. One visitor said that the staff are very caring and show affection to the residents. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well-decorated and maintained in a clean, tidy and hygienic state according to the wishes and needs of the residents. The heating is not always adequate to keep all residents as warm and comfortable as they need or want. EVIDENCE: The home has an ongoing programme of re-decoration and renovation to make it a comfortable, homely and pleasant place for the residents in which to live. During the visit to the home, everywhere looked clean and tidy and residents confirm this is always so. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 17 Residents say that their rooms are spacious, pleasantly decorated and have lovely outlooks. All the rooms in the extension are double-glazed, warm, light and airy. This was confirmed on the tour of parts of the building. All entrances to the home are accessible to wheelchair users. Equipment for specialist use has been provided where necessary for people with physical disabilities. The original part of the building is Grade One listed in which alterations are not permissible to the ‘fabric’ or ‘design’ of the building. The manager says that the high ceilings and single frame, original windows in this area of the home can cause draughts and cold areas. Some rooms are shut off when not in use to keep the rest of the building warm. The acting manager says that a new boiler is to be installed in February 2007 as the old boiler was working on reduced capacity before Christmas last year. A relative has concerns that the residents are often not warm enough. Several residents confirmed this although others said they are warm most of the time. The inspector also found the home to be rather chilly during the visit to the home. One resident said, “the water in my room is always nice and hot. I really like my room.” Other residents said, “I am satisfied with my room”. The maintenance programme ensures that the home is kept in good condition and safe for residents and staff. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by an adequate numbers of staff on duty at any time. Staff are recruited appropriately to protect residents from risk of harm or abuse. Staff are supported by the management. EVIDENCE: The number of staff on duty at any time meets the needs of the residents. Residents say they do not have to wait long for staff to attend to them. One resident said that the staff are very kind and considerate, smile at them and chat to them. Another resident said, “The treatment of residents is warm, affectionate. It is absolutely marvellous here.” One visitor said that one or two staff are a bit rough sometimes with the residents. Recruitment procedures are now in order, with two references, a police and a protection of vulnerable adults check being obtained as required, prior to employing new staff. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 19 Staff say their induction period lasts “as long as it takes” for them to feel confident to assist residents on their own. They complete induction booklets and sign when they feel competent. Staff say that the provider and manager are enthusiastic about them doing plenty of training. The provider and manager say that most areas of basic, mandatory training have been done by all staff. Staff say that NVQ courses (National Vocational Qualification) are encouraged, with four currently doing Level 2 and two doing Level 3. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by an acting manager who is well thought of and who ensures that residents’ finances and health and safety are safe-guarded but who has not registered as required by law, which means that residents may be put at risk of harm or neglect. EVIDENCE: The acting manager is seen as supportive and encouraging. However, at the previous two inspections, it has been a requirement for the acting manager to register to run the home within the law. As yet, this has not been achieved. A Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 21 requirement has been set for this to be accomplished within a short time frame to safeguard the residents from possible harm. The acting manager is currently undertaking the Registered Manager’s Award. As the provider attends the home regularly each week, he does not complete monthly audit reports on the home but says he monitors the service himself. He says that staff know that they can come to him or the manager with any concerns or problems. Staff say that the provider and manager are supportive and considerate. They say they have formal supervisions with the manager and that they sign to say they agree with them. The acting manager stated that regular residents’ forums take place every six weeks or so. The inspector did not see evidence of how the provider and acting manager gain the views, opinions and wishes of residents, relatives or staff to operate in accordance with the residents’ needs and wishes. The previous inspector found that residents are protected from financial abuse and their financial interests are safeguarded. The pre-inspection questionnaire completed by the provider states that only one resident’s personal allowance is looked after by the staff. All other residents either control their finances themselves or their families do it for them. Maintenance records are all in order and confirm the provider’s statement in the pre-inspection questionnaire that all servicing and repairs in the home are up-to-date. Winthorpe Hall Care Home DS0000024670.V325352.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 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 X 3 Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation 4(2); 5(2) Requirement The registered person must ensure that the statement of purpose and the service users guide comply with the Care Homes Regulations, Care Standards Act 2000 and that a copy of each is supplied to the commission. The registered person must ensure that residents are treated with respect and dignity, and given privacy at all times. The registered person provide evidence of social activities in sufficient quantity and variety to meet the needs, capacity and preferences of the residents. The registered person must ensure that a varied and balanced diet is provided that meets with the residents’ wishes and dietary needs at all times. The registered person must ensure that all staff are adequately trained to keep the residents safe from risk of harm or abuse at all times. The registered person must ensure that both private and DS0000024670.V325352.R01.S.doc Timescale for action 14/02/07 2. OP10 12(4)(a) 28/02/07 3. OP12 16(2)(n) 30/04/07 5. OP15 16(2)(i) 28/02/07 6. OP18 13(6) 30/04/07 7. OP25 23(2)(p) 28/02/07 Winthorpe Hall Care Home Version 5.2 Page 24 8. OP30 18(1)(c) 9. OP31 9(1) 10. OP33 24(1) communal areas of the home are kept warm enough to meet the residents’ needs at all times. The registered person must 28/02/07 ensure that staff are sufficiently trained to meet all the needs of the residents living in the home. (Outstanding from previous inspections.) The manager must be registered 28/02/07 by the commission as required by Care Homes Regulations, Care Standards Act 2000, to demonstrate fitness to practice and to safeguard the residents at all times. (Outstanding from previous inspections.) The registered person must 30/04/07 ensure that the opinions, wishes and preferences of the residents is known and given priority to within the home at all times. 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 OP15 Good Practice Recommendations The responsible person should seek the advice of a qualified nutritionalist/dietician to ensure that a nutritious and balanced diet is provided at all times. Winthorpe Hall Care Home DS0000024670.V325352.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Winthorpe Hall Care Home DS0000024670.V325352.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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