Care Home: Jubilee Gardens

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What the care home does well People wish to live in the home permanently or for a short period of time a detailed assessment of what their needs was done. To help people make a decision as to whether the home can meet their needs or not the home provides some good information. Relatives and visitors are welcome at most times, some relatives remain keen to help with care, yet this is not expected and people and their relatives are able to have visits in private should they wish.The home is open to people making complaints and manages them well, they have looked into the complaints and have made or started to make improvements where these were needed. There are four units, all are generally well maintained, they are spacious and safe for people to walk about. The staff team are well trained to manage the health and safety needs for people who live in the home and their visitors. What has improved since the last inspection? Improvements have been made as to how care is planned for each person. Staff are given the information they need including the personal choices of each person so that they do what is best for them individually and the staff are given information to help them manage risks. Policy and procedures have improved relating to moving and handling. There were no actions taken by staff that were unsafe. There were good records relating to people`s skin and what staff were doing to prevent pressure sores including referrals to the district nurse and skin viability nurse. The home has improved it`s plan of action to improve the health and safety of people within the home. The home also uses the Social Services multi disciplinary procedures for protecting people The care and service staff have now have regular meetings with a senior manager this makes sure that all staff are supported to do their jobs to the best of their ability. What the care home could do better: Although the care plans have improved considerably and are more person centred. Information to staff needs to be clearer and include what action they should take to reach goals on care plans. Socialisation and activities need to be improved so that people`s social and diverse needs are met. More work needs to be done on life histories and the activity coordinator needs to make a judgement on how best to use her time. CARE HOMES FOR OLDER PEOPLE Jubilee Gardens 26 Wyegate Close Castle Bromwich Birmingham West Midlands B36 0TQ Lead Inspector Ashley Fawthrop Key Unannounced Inspection 19th May 2008 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 Jubilee Gardens DS0000036766.V366646.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. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jubilee Gardens Address 26 Wyegate Close Castle Bromwich Birmingham West Midlands B36 0TQ 0121 730 4560 0121 730 4569 jubilee.gardens@craegmoor.co.uk 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) Parkcare Homes (No2) Ltd Lisa Jane Harvey Care Home 50 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (12) of places Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The number of persons for whom personal care (DE(E)) is provided at any one time shall not exceed 13. The number of persons for whom nursing care (DE(E)) is provided at any one time shall not exceed 25. Where people with personal care needs and people with nursing care needs are cared for together in a single unit, staffing levels for units for people with nursing care will apply. Staffing of the care units and the day centre must be discreet and clearly distinguished from each other. Mechanisms must be in place to support staffing in both areas without detriment to either service. The number of persons for whom transitional care (OP) is provided at any one time shall not exceed 12, of whom three may be under 65 years of age. The Transitional Unit must be staffed separately to the other units in the home. A minimum of 336 care staff hours (excluding qualified staff) must be provided each week. There must be 24 hour RGN cover at all times. Sensitive and regular reviewing mechanisms must be in place to increase staffing levels when the majority of service users have high dependency needs. Service users admitted to the Transitional Unit must be discreet and clearly distinguished from the other units, and must not at any time be cared for in any of the other units in the home. One named service user under the age of 65 years with dementia may reside at the home. 25th April 2007 4. 5. 6. 7. 8. Date of last inspection Brief Description of the Service: Jubilee Gardens is a purpose built home situated in Smiths Woods in Castle Bromwich. It has extensive secure gardens on a level ground making access for residents easy the gardens have matured. The home has facilities for 50 residents in total, 13 requiring personal care, 25 requiring nursing care and 12 transitional care beds, some of the residents occupying permanent accommodation may have dementia. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 5 The home has designated communal and private rooms, all bedrooms have ensuite facilities comprising of a toilet and hand washbasin. The bedrooms are decorated to an acceptable standard, and residents can personalise their own rooms if they wish. Two small lounges have been re-allocated for staff use. The home has adequate parking space and is close to the local shopping area and other local amenities. The level of fee was not determined at this inspection Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star, this means people using the service experience good quality outcomes. The visit was unannounced and was done by one inspector and lasted for one day. before the inspection visit the home had been sent an Annual Quality Assurance Assessment and this was completed before the inspection and the information was used to assess outcomes during the visit. The inspector spent time doing an assessment and spent time talking with people who live at the home and their relatives. A tour of the building was done including people’s rooms and communal and service areas and records about safety of equipment and the building were checked. Records about how staff are recruited, trained and supported were seen to help determine whether the staff have the skills to meet the needs of the people. During the inspection we followed the experiences of living at the home for four people including looking at their care records, talking with them and their visitors as well as looking at the environment they live in. This process is known as case tracking. In the past twelve months the home has received two formal complaints about care in the home, which they have responded to. What the service does well: People wish to live in the home permanently or for a short period of time a detailed assessment of what their needs was done. To help people make a decision as to whether the home can meet their needs or not the home provides some good information. Relatives and visitors are welcome at most times, some relatives remain keen to help with care, yet this is not expected and people and their relatives are able to have visits in private should they wish. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 7 The home is open to people making complaints and manages them well, they have looked into the complaints and have made or started to make improvements where these were needed. There are four units, all are generally well maintained, they are spacious and safe for people to walk about. The staff team are well trained to manage the health and safety needs for people who live in the home and their visitors. 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. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 8 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 Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 9 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 and 6 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are given good information before they move into the home. This allows them to make a decision as to whether the home can meet their needs or not. People’s needs are assessed before moving into the home for both long stay and intermediate care. EVIDENCE: People had been provided with a statement of purpose and a service users guide informing them about the homes services and provisions people visiting the home said they had received copies these. Pre admission assessments are part of the new person centred planning of care. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 10 There were records on people’s files that had been completed about their needs and risks identified before they moved into the home. This gave staff enough information to start the care plan when people move into the home. Assessments were also available for people on the intermediate care unit, there is also an allocated social worker who is involved with the assessment and reviews. This is good as it promotes consistency and the home knows it can meet the needs of the person who is assessed.. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 11 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 and 10 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The homes manager and staff were able to demonstrate that it has the ability to fully meet the health and personal care needs of the people in the home. The medication procedures were safe and people were treat with respect. All health and personal care needs of people were met. EVIDENCE: Four peoples care plans were case tracked all had written care plans The care plans have improved since the last visit, these are more individual and relate to the person it has been written for. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 12 There were some good care plans such as how staff should manage the anxiety of individuals and this included what they should do including spending time with them. All care plans seen had risk assessments. These included assessments of the moving and handling, nutrition, skin condition and whether they were at risk of falling. There were also risk assessments for individual risks such as for use of bed rails and specific health conditions such as diabetes. There was evidence that staff follow the risk assessment management plan as people who needed pressure relieving equipment were provided with these, this makes sure that the risk of pressure sores is reduced. However, more information needs to be available as to what actions staff must take to meet the assessed goal of people. If a goal is to keep a person independent then there should be a record of what action staff must take to achieve this. Records about professional health care support from the community continue to be well maintained for each person, there was good evidence that they see their GP and attend for hospital appointments when needed. There were other records for individuals about meeting with social workers, and appointments with chiropody, dentist and optician. The management of medications was assessed on two of the units. We found records were completed when medicines are received into the home, administered to people and when disposed of. This included the management of some controlled drugs. It was evident that medicines are safely stored, including monitoring the temperatures of the medicines refrigerators. There is a comprehensive medications policy, which does include covert administration of medicines. On observing staff who were assisting people to eat who could not do so themselves, this was done with dignity. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 13 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 and 15 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home did not demonstrate that it has the ability to meet the daily life, and social activity needs of people. EVIDENCE: Staff were observed talking to people and visitors as well as involving people in activities This included games where people were exercising gently and using hand eye coordination like catching a ball. People seemed to enjoy this it stimulated conversation and helped keep people alert and active. There is an activity coordinator who organising and is involved in most of the activities. Entertainment includes entertainers, crafts, exercises and musical instruments. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 14 On speaking with the coordinator she is developing activities on each unit and spending some time on each unit. We suggested that her time might be better used by spending more time each day on one unit, this would give her time to spend with the people on that unit and activities could be more meaningful. Activities do appear to be very general and do not really take individuals own past times into account. We suggested that the personal social care plans be more developed to take into account what people did in the past and how these can be developed in the home. On speaking to people visiting the home we were informed that there were no visiting times and that people were free to come and go as they wished. People living in the home were able to come and go where possible and where people were not safe to be outside on their own risk assessments were in place. Staff were observed to be involved with people throughout the day either seeing to personal needs or assisting with activities. People were taken out to the shops by staff as part of their social past time. Mealtimes were observed on one unit people were being assisted where required the staff did not hover or rush people. People spoken to on the day had no concerns about the food people said it was well cooked and appetising. The dining room was pleasantly furnished, including tables with table cloths, napkins and placemats. There were normal interactions between people and staff. The meal time was relaxed and was used as a chance for people and staff to interact as well as staff to observe food intake where appropriate. Each table was served at the same time, which seemed to be a good service, practical and helped focus people on their own meals. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 15 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): 17 and 18 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. 16 and 18 People and their representatives can be confident that the home manages concerns and complaints well. The service does make sure that people are protected at all times. EVIDENCE: People visiting the home said that they had no complaints about the home and that they knew who to go to if they did. The home does keep a record of complaints made in a complaints folder and since the last inspection there had been two. Both about the quality of food There was evidence that investigations were made into both complaints and the as a result the menus were changed. The complaints procedure is in the service users guide and people had copies of these. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 16 There are comment cards on each unit, this allows people to have their say about the home or voice concerns anonymously, this is evidence that the home has a positive approached to complaints and gives people different avenues to express their concerns or compliments. There is an on going training course relating to the protection of vulnerable adults, this is an external course and records are kept of when people attend. This makes sure that staff have the knowledge to protect people from abuse . The home uses Solihull social services multi agency approach when dealing with suspected abuse. This is good practice as using this approach makes sure that all the people concerned can act quickly to reduce the risk. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 17 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, 21, 22, 23, 24 and 26 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home meets the needs of people who live there. There sufficient numbers of toilets and bathrooms that are equipped to meet people’s needs People have ownership of their rooms and the home is clean. EVIDENCE: The communal areas were furnished with appropriate furniture and decorated with pictures and ornaments giving the environment a homely feel. Since the last inspection visit two dining rooms have had new flooring areas have been redecorated and pictures and ornaments replaced. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 18 On talking to people some said that enjoying the privacy of their rooms people said that they liked their rooms they were allowed to use them as they wished. Most peoples rooms were found to be personalised with photographs, televisions, radios, plants and other items they are fond of such as pictures, soft toys, books and magazines. This gave people’s rooms a feel of ownership and individuality. Each unit has its own communal bathroom and shower facility and also communal toilets. These were seen to be clean. Staff were observed using hoists to assist people, there are also other aids and adaptations such as appropriately sited grab rails in en-suites, communal toilets and washing facilities and people where required were able to use special seats that reclined. There were no unpleasant odours in the home and there was equipment for staff to use to clean the home and help staff with infection control. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 19 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 and 30 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is able to fully demonstrate it has the ability to meet the staffing needs of people living in the home. The recruitment and selection procedures make sure that people are protected from potential abusers. The needs of people are met by people who trained and competent to do so. EVIDENCE: People living in the home said that they have no concerns about the staff and that they are always available. People visiting the home said that the staff work very hard and that they are dedicated to their work and are always friendly. The manager provided an up to date training matrix for all staff employed. It was evident that most staff have completed mandatory training regarding health and safety, POVA and equal opportunities awareness. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 20 Twenty out of forty eight staff had completed or were working towards the National Vocational Qualification at level 2.this is just below 50 and is an improvement since the last visit. The AQAA completed by the manager said that the home does well in the following areas, maintaining adequate staffing levels to ensure quality care, effective employment checks and training and development. Since the last inspection the staff records have improved and show that the care staff have been trained to meet the specific needs of people with dementia related illness. This was confirmed in discussion with staff. The staffing levels on the days of inspection were seen meet the needs of people in the home. There are other dedicated staff employed in service areas such as administration, laundry, catering and cleaning. Staff recruitments records, three were seen and all contained the required information, including completed application forms, evidence of interviews, background checks being Criminal Records Bureau disclosures, POVA first and two written references. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 21 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, 33, 35, 36 and 38 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the skills to run the home to benefit of the people who live in the home. There financial interests are safeguarded, staff are supervised appropriately and people and staff are protected by health and safety policies and procedures. EVIDENCE: The manager has started at the home after the inspection visit of last year and has worked hard with the staff to improve the management in many areas including care planning, the management of complaints and staff training. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 22 This appears to have improved the quality of life for people living in the home and is reflected in what people living there and visitors say about the home both in comment cards and when spoken to. We were informed by the manager that people are encouraged to deal with there own finances. Those that do have monies held by the home have their monies placed in a bank account that calculates the amount of interest made by each persons monies within the account. The only monies held at the home are via petty cash if people need monies on a daily basis it is paid out of this all receipts for purchases are sent to head office for safe keeping however, a record of the transaction is kept in the home and there is evidence that the system is audited regularly. There continues to be evidence of clinical audits such as medication. Within the quality assurance records there was evidence of staff and people’s meetings. In total 26 audits were seen including such areas as kitchen and tissue viability. Each audit included the outcomes and improvements needed yet did not state how the shortfalls would be met and when they would be met. The supervision records for three staff were sampled; it was evident that staff are not having regular meetings with a senior member of staff. For a new member of staff there was no evidence that her probationary period of employment had been reviewed and for a trained nurse there were no records about discussing clinical practices. The manager maintains comprehensive records about health and safety including servicing, tests and maintenance of utilities and equipment. On feeding back information about the visit with the manager there was evidence that much of the work relating to the requirements of last year had been completed. This is good as it shows a commitment to improve the quality of care and outcomes for people living in the home. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 23 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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 12(1)15(2 )(b)(c)(d) Requirement Information recorded in the care plan must detail the action staff must take to reach the identified goals for people. Timescale for action 31/08/08 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 OP7 Good Practice Recommendations Socialisation and activities should be more individual so that the diverse needs of individuals are met. Jubilee Gardens DS0000036766.V366646.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Jubilee Gardens DS0000036766.V366646.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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