Care Home: Alderney Street, 117

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What the care home does well This is an improving service that care practices showed puts the rights, needs and wishes of each individual person who uses the service first, enabling them to choose and pursue a lifestyle within a safe, risk assessed environment. The staff observed were professional and caring throughout the inspection. They were also well qualified. People that use the service participated in their care plan development. These were person centred, choice enabling and under-pinned by regularly reviewed risk assessments. The home provides a clean, safe and homely environment for people to live in and enjoy.There is a thorough quality assurance process that contains performance indicators and the facility for people who use the service and their friends to participate in. Health and safety checks are carried out and recorded as required. The home recognises the importance of recognizing equality and diversity as reflected in its philosophy, policies, procedures and care practices. What has improved since the last inspection? The requirements and good practice recommendations made at the previous key inspection were all met at this one. The previous inspection was in January 2008 and this demonstrates how hard the staff team and Care Manager have strived to meet the requirements made in a short period of time and how well the service has developed. The inspection found that the care plans are working documents that inform daily activities, detailing and keeping receipts of all financial transactions made by residents individually or jointly, regular reviews of care plans and risk assessments, providing appropriate activities when day services are not available and making sure health action plans and records are up to date and signed. In addition the home were not to display a person who uses the service`s personal care support needs on their bedroom wall, plan their shift to meet goals and needs and the Care Manager to register with the CSCI and forward monthly monitoring visit reports. CARE HOME ADULTS 18-65 Alderney Street, 117 117 Alderney Street London SW1V 4HE Lead Inspector Wynne Price-Rees Key Unannounced Inspection 2nd April 2008 10:30 Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alderney Street, 117 Address 117 Alderney Street London SW1V 4HE 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) 020 7834 1161 020 7834 1161 info@outlookcare.org.uk Outlook Care Mr Leslie McLeary Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 08/01/2008 Date of last inspection Brief Description of the Service: 117 Alderney Street is a residential care home for 4 people with a learning disability and/or challenging behaviours. At the time of this inspection there were two women and two men living in the home. Alderney Street is owned by Westminster Council who lease the property to New Era Housing Group. Outlook Care provides care and staffing. The home is located between Pimlico and Victoria. There are local shops and other services close by. Transport links are very good with easy access to both tube and buses. The accommodation is in a large terraced house in Victoria, with wheel chair access and a lift serving all floors. Each resident their own room with communal areas. There is a small paved garden leading from the dining room. Details of fees charged can be obtained from the New Era Housing Group. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and took place over six hours on the 2nd April 2008. All four residents’ files were case tracked, records and procedures checked, care practices observed and a premises tour carried out. The information was then triangulated with that recorded since the previous key inspection to determine the home’s new quality rating. There were three residents present during the inspection. Due to differing levels of communication skills the Inspector focused on care practice observation rather than gaining direct views to determine if residents’ wishes and needs were met. Part of a staff meeting was also attended during which the staff team gave their views regarding the care provided, way the home ran and support and training provided by the organisation. There were three questionnaires on file that had been filled in jointly by residents’ and relatives that indicated they were happy with the service received and manner in which care was delivered. The home’s AQAA was being completed on the day of the inspection and the information contained was incorporated within the inspection process. An AQAA is an annual quality assurance assessment carried out by the home. The AQAA information provided reflected the triangulated evidence found. Information from regulation 26 provider visits and Regulation 37 notifications forwarded was also used to triangulate evidence found on the inspection day. What the service does well: This is an improving service that care practices showed puts the rights, needs and wishes of each individual person who uses the service first, enabling them to choose and pursue a lifestyle within a safe, risk assessed environment. The staff observed were professional and caring throughout the inspection. They were also well qualified. People that use the service participated in their care plan development. These were person centred, choice enabling and under-pinned by regularly reviewed risk assessments. The home provides a clean, safe and homely environment for people to live in and enjoy. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 6 There is a thorough quality assurance process that contains performance indicators and the facility for people who use the service and their friends to participate in. Health and safety checks are carried out and recorded as required. The home recognises the importance of recognizing equality and diversity as reflected in its philosophy, policies, procedures and care practices. What has improved since the last inspection? What they could do better: The home must continue to develop the systems and care practices that have met the minimum standards and provides good quality outcomes for people who use the service. Please contact the provider for advice of actions taken in response to this Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 7 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. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use this service experience good quality outcomes in this area. People who may wish to use the service are fully assessed prior to admission to ensure their needs can be met. They are given the opportunity to visit the home to decide if they wish to live there enabling them to use. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All four residents’ have lived at the home for a long period of time with the last one moving in over two years ago, before the current Care Manager was in post. The Care Manager verbally described the assessment procedure steps that would be followed prior to a new resident moving in, without need to refer to the written procedure and this matched the steps the procedure described. The procedure meets the requirements of the standard with a balance between the home being able to identify if a prospective resident’s needs and wishes can be met and giving the resident an opportunity to decide if this is the place for them. This is achieved by receiving an initial referral from the placing authority that is generally Westminster City Council, visiting the resident at their current address and inviting them to visit the home at different times during the day, culminating in an overnight stay prior to a mutual decision being made. The visits can take place over six weeks and a placement review is conducted after six months. The home does not provide emergency placements. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 10 Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9. People who use this service experience good quality outcomes in this area. All people who use the service have enabling care plans, underpinned by risk assessments increasing their choice options and opportunity to purse the lifestyle of their choice in a safe environment. Any expenditure is correctly recorded meaning their finances are safe guarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ support plans were all case tracked and although the system is being updated, each contained comprehensive, up to date information that was regularly reviewed. The support plans had been compiled by individual residents’ and their identified key-workers. They were in a combination of written and pictorial form to make them easier for the residents’ to contribute to. Goals and wishes were identified with progress towards achieving them recorded in daily recording notes that feed monthly reviews and are signed off by the Care manager or Deputy. The information is also used at six monthly placement reviews. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 12 The goals identified from residents’ needs and wishes are enabled by regularly reviewed risk assessments. There were also general up to date health and safety risk assessments for the home. The risk assessments are incorporated within the support plans and identify areas specific to the individual. One resident demonstrates challenging behaviour under certain circumstances and there was a comprehensive positive behaviour plan that outlined course of action to follow when this occurs. The Inspector was present during one of these moments and observed that staff on duty successfully put the plan into operation, calming the resident and also ensuring the safety of other residents’. There is also a separate key information file for agency workers that enable them to become familiar with residents, their wishes, needs and preferences more quickly. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. People who use this service experience good quality outcomes in this area. People who use the service are enabled to follow their chosen lifestyle, within a supportive and encouraging environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has an individual weekly chosen activities chart that shows a balance between those provided by the day centre and the home. Bi-monthly meetings take place between the home’s Care Manager and the Day centre Manager to check if the activities provided still meet the needs and wishes of each resident and identify any activities that might need to be changed. The home is introducing a system of more personalised activities that get to the root of what an individual really wants. One resident indicated that they wished to watch a football match. Instead of just making football accessible on TV or taking them to a professional match, staff are going to take them to watch a local park match to identify what they really want to see and then if they wish to will take them to a professional game. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 14 Residents pursue a variety of activities that they have chosen including music, art and life-skills development. One person is attending a City Lit music group. They also go swimming, bowling and have visited a number of shopping venues that are varied at intervals. The last trip was to Canada Water. A concert at the Albert Hall was also attended and an Easter party took place at the home with relatives and friends invited. Where possible residents are encouraged to participate in training that takes place at the home that encourages them to feel they are part of the team, with one resident obtaining certificates in fire and diversity awareness training. The activities are mixed between the individual and group depending on level of interest with good use made of local amenities such as parks, local shops, church and pubs. The residents are encouraged and supported to choose a weekly menu each Monday using pictures of meals. These are changed if a resident decides the want something different. The kitchen was well stocked with a variety of food and the fridge and freezer temperatures are checked and recorded twice daily. The staff team has three male and three female members and preference regarding personal care is adhered to by having a person of either gender on duty whenever possible. There are policies and procedures regarding diversity and equality that care practices showed staff understand and follow. This is also reflected in the type of meals provided that are based on the preferences of the individual person using the service that includes any religious or cultural requirements. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People who use this service experience good quality outcomes in this area. Personal and health care are delivered appropriately ensuring that the needs of people who use the service are met and their health maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has a separate health care file that details health history and other relevant information such as the side effects of medication residents have been prescribed. There are regularly reviewed health care action plans. Everyone is registered with a GP and has access to community based health care services. A challenging behaviour nurse visited during the inspection to participate in the team meeting, review documentation for one resident and discuss preventative strategies to minimise challenging behaviour. There is a medication policy and procedure and staff who administer medication have been trained to do so. The medication administration records were checked for each resident and found to be correctly completed. The Care Manager or Deputy checks these weekly. The home adopts a proactive stance regarding health and one resident who has spent most of their time in a wheelchair is being supported and encouraged to walk more with a target set of them walking to Lupus Street. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 16 The home has requested OT assessments to support and enable this goal to be achieved. The home’s policy and philosophy is to provide personal care in an unobtrusive manner that respects the privacy and dignity of residents taking account of gender preference where possible. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People who use this service experience good quality outcomes in this area. They are protected, listened to and complaints investigated with positive outcomes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure available in pictorial format to make it more available to residents. The complaints log indicates that they are aware of how to use the procedure as they have made complaints. They also have access to an advocate who supports them to make complaints as required. The home also investigates and records complaints made from outside the home. A complaint was made by a neighbour on 31/03/08 regarding the fire alarm going off for a long period of time. The complaints made were responded to within twenty-eight days and fully documented with action taken and outcomes. All staff have received adult protection training and are required to undertake annual refresher courses by the organisation. Each resident’s case file contained a procedure with contact numbers in the event of a resident going missing. There are currently no adult protection issues and all staff have been CRB checked prior to commencing employment. Personal monies held on behalf of residents were checked and tallied with the records and receipts kept. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. People who use this service experience good quality outcomes in this area. They live in safe, comfortable and hygienic accommodation of their choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A premises tour showed the home is suitable for its stated purpose, clean, tidy, well decorated and maintained. Residents were comfortable walking around what they regard is their home. The communal areas have recently been redecorated and new carpeting and furniture are included in the budget for the new financial year. There is an organisational Housing Officer and they are responsible for complying with health and safety legislation. An annual health and safety audit is carried out and hot water temperatures are checked and recorded weekly. Fridge and freezer temperatures a checked and recorded twice daily, the fire alarm weekly, monthly fire drills take place and the fire fighting equipment was checked and serviced in February 2008. This takes place annually. The lift is checked six weekly and had an annual service on 19th March 2008. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 19 There is an accident and incident file that is updated as required and checked as part of the unannounced provider’s representative monthly visits. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People who use this service experience good quality outcomes in this area. Efficient, qualified & capable staff are in sufficient numbers to meet the needs of people using the service ensuring that they are well supported and enabled to follow the activities and lifestyle of their choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has competent, professional and qualified staff and the rota showed they are in sufficient numbers to meet residents’ needs at all times. All six staff had all attained NVQ level 3 and surpassed the required 50 of staff with NVQ level 2 qualifications or above. Currently there is one fulltime support worker vacancy that will be advertised shortly and the post is covered internally or by agency. The home seeks assurances from the agency, in writing that any agency staff have been appropriately vetted before they are used. Staff observed were very patient, caring and supportive in their care practice approach. Whilst focused on the needs of the individual they were also aware of those of others. A thorough written recruitment procedure is followed that meets the requirements of the standard and includes CRB and POVA clearance. Staff confirmed they receive thorough core induction training followed by specific service induction and were very happy with the type and quality of Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 21 training that the organisation provide. They said they felt well supported by the home’s management team, organisation in general, able to progress their careers and listened to. There is a rolling training programme and development needs are identified during one to one supervision and annual appraisal. They felt the most affective training received so far was the person centred planning that has enabled them to review, re-focus and improve their approach to how they deliver care. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. People who use this service experience good quality outcomes in this area. The home is well managed in the residents’ best interests enabling them to pursue their lives the way they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care Manager came into post six months ago and is currently undertaking the CSCI registration process. He has attained NVQ level 4 qualifications in management and care. He has been with the Outlook Care organisation for twelve years with five years at management level including overseeing the management of homes’ in crises with the remit to improve them to an acceptable standard. During the inspection, the Inspector found him to be knowledgeable and helpful. His managerial skills were borne out by the efficient keeping of records and professional way staff conducted themselves during the inspection. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 23 The organisation has a thorough quality assurance system that contains measurable performance indicators and trigger levels that are regularly reviewed. Part of the system includes monthly Regulation 26 unannounced visits and self-monitoring through feedback from resident and key-worker one to ones and questionnaires. The home has found residents’ meetings to not be particularly affective due to the differing levels of communication skills of the residents’. The questionnaires seen were filled in jointly by residents and their relatives and indicated they were happy with the service received and way it is delivered. Currently the home is working on the annual building development plan. There is a written policy regarding safe working practices. Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Alderney Street, 117 DS0000065866.V361440.R01.S.doc Version 5.2 Page 27 - 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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