Care Home: Kilsby House Residential Home

What the care home does well What has improved since the last inspection? The home had met all of the requirements from the last inspection What the care home could do better: The home has worked very hard to meet the needs of the people. No requirements were made at this inspection. CARE HOMES FOR OLDER PEOPLE Kilsby House Residential Home Rugby Road Kilsby Rugby Warks CV23 8XX Lead Inspector Ansuya Chudasama Unannounced Inspection 18th February 2009 09:00 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 Kilsby House Residential Home DS0000012830.V374306.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. Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kilsby House Residential Home Address Rugby Road Kilsby Rugby Warks CV23 8XX 01788 822276 01788 824713 kilsbyhouse@aol.com 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) Advent Estates Limited Vacant Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home limits its services to the following service user categories. No person falling within the category DE (E) can be admitted where there are 39 persons of category DE (E) already in the home. As part of the total number the home may accommodate a maximum of two people in the category of OP who have a relationship with a service user in the category DE (E). Total number of service users in the home must not exceed 39. Date of last inspection 21st October 2008 Brief Description of the Service: Kilsby House is an extended period property, situated in the village of Kilsby, which is on the border between Warwickshire and Northamptonshire The home offers care for up to 39 older people who suffer from dementia related conditions and promotes a person-centred approach to dementia care. The house is organised into two units with one unit having its own lounge and a dining room with kitchenette facilities. There are single and shared rooms, the majority of which (85 ) have en-suite facilities to include a toilet and sink. There are two passenger lifts, one in the original house and one in the new extension. The home has a two raised (decking) patio areas, accessible to the people. Kilsby is a small village with limited public transport to local towns. Visitors to the home will therefore, require transport arrangements. The range of fees is £348.55 to £480 per week. This information was confirmed as current on 04/07/07. Further information about the home in the form of the Statement of Purpose, Service Users Guide or most recent inspection report can be obtained from the Manager or Registered Owner at the home. Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home has two star rating and this means that the people using the service receive a good service. This unannounced inspection was carried out on the 18th of February 09. Vanessa Nuttall the acting manager of the home was not working on the day of the inspection, as it was her day off. Mrs Chew the Director of the home was on duty and assisted throughout the inspection, along with other staff. We spoke to the staff and some of the people living in the home. Information about policies and procedures was looked at, which tells the staff how to do things in the home. We looked at the training staff do to look after the people. We looked at information about some of the people to find out how their needs are being met by the home. This is called case tracking. We watched how the people and staff in the home got along together. A Random inspection took place on the 21st of October 08 to find out if the requirements made at the last inspection were met by the home. This was a very positive inspection and some of the information has been used in this report. We found the home has been very cooperative with CSCI and has worked very hard to meet all the requirements made at the last inspection. What the service does well: The people living in the home says: • • • • • • • ‘The staff are lovely’ and ‘very good’. ‘The food is very nice ’ ‘Food very good and the service’. ‘Different people do come and do activities’. ‘It’s a nice place and I like it here’. ‘When you live on your own, its better to live in a place like this’. ‘Cant complain, they keep the place nice and clean’. The visitors say: • • • The ‘home is decorated nicely’ and ‘have a lovely atmosphere’. Staff were ‘brilliant’ and they ‘could not have had better care’ when caring for their family member. The acting manager was said to be ‘brilliant’ and ‘approachable and caring with families’. DS0000012830.V374306.R01.S.doc Version 5.2 Page 6 Kilsby House Residential Home • • • • • The ‘changes are brilliant’ and ‘lots of activities’ for the people. ‘The people are doing well’. ‘We could not fault this place’. The ‘staff are very caring with the residents’. The care ‘was very good when mum was ill’. The staff say: • They ‘like working at the home’. • They are a ‘Lovely team’. • They ‘get supervision and its good’. • They ‘get lots of training’. • The ‘manager is very supportive’. • ‘Staff are very good to the residents’. • ‘Every day is different and no day is the same’. • The staff were observed always talking to the people and explaining to them with what ever was happening in a positive manner. The staff were also very kind to the people. 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. Kilsby House Residential Home DS0000012830.V374306.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 Kilsby House Residential Home DS0000012830.V374306.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): 1,2,3,4,5, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All new people admitted to the home receive a full needs assessment before admission to ensure that their needs will be met by the home. EVIDENCE: A copy of the Service user Guide, which was in picture format, is given to new people interested in coming to the home. The assessment of a new person was inspected in detail. Evidence showed that the acting manager had visited the person in hospital and had completed the needs assessment with them. The assessment was very detailed and had Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 9 information about the person’s wishes. There was information on personal care and medical details, and information from family and other people. The wishes of the person were taken into account. For example the person liked staff to bring the person a glass of beer in the evenings when they are relaxing. There was information on mobility, continence care, food and drink, mental health needs, emotional well being, life history, social interest, hobbies, skin care, communication, and foot and hair care. There was information on funeral arrangements and the capacity to consent form was completed. All the people living at the home have a ‘contract of residency’ so that they understand their rights and responsibilities. The contract seen was signed by the person living in the home and their families were involved with this too. The home does not provide intermediate care Kilsby House Residential Home DS0000012830.V374306.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): 7,8,9,10,11 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home’s care planning system provides staff with the information they need to meet the people’s needs. EVIDENCE: A new person’ file was looked at in detail. Evidence showed that the person was involved in their care planning and they had signed the plan. This was also confirmed by talking to the person. The care plan had information about how the persons care needs, daily routines, eating, drinking, activities, medical condition, medication, and continence care needs were being met by the home. There were assessments seen on nutrition, waterlow scale, moving and handling and falls. A record was kept of people’s weight. The daily notes read said that the person went to bed and got up when they wanted to do this. The medical records in the medical file showed that the district nurse and the GP had been involved in the care of the person. Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 11 Staff told us that they were all involved in reviewing care plans for the people. This was done by writing any changes in the care plan and the manager later typed this up. Other care plans seen showed that these were also being reviewed on a monthly basis. A family spoken to stated that their family member died in December 08. They said that the staff were ‘brilliant’ and they ‘could not have had better care’ especially in the last 4 weeks when their family member was ill. The staff also kept them informed of when the GP visited and any thing that was happening with the person. The family also said that the staff made time to talk to them. We were told that the time their family member had been at the home, they only made one complaint and it did not involve the home but the Director of the helped sort it out. Evidence seen in the assessment of a new person showed that there was information on burial arrangements. One file looked at showed that there was information from a family asking the home not to resuscitate their family member. This was discussed with the Director of the home and we were told that they would be having a discussion with the family. The Director was due to attend a training session on deprivation of liberty safeguards on the 5th of March 09. The manager has started training staff using the information produced by the Department of Health. The home was also going to complete the capacity to consent form. The medication records looked at showed that only staff who had received this training gave out medication. The records looked at were satisfactory and evidence showed that management was monitoring this. To stop the staff from getting disturbed when giving out medication, they wear a red apron. Kilsby House Residential Home DS0000012830.V374306.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 good. This judgement has been made using available evidence including a visit to this service. Meal times are relaxed, staff are patient and helpful, and allow the people the time they need to finish their meal comfortably. EVIDENCE: We spoke to families and other visitors at the inspection. One family told us that their relative had passed away but they still visited the home. They told us the ‘changes are brilliant’ because before the home did not have many activities but now there were lots of activities. We were told that it was like seeing people living in the home ‘as different people’. The acting manager was said to be ‘brilliant’ and ‘approachable and caring with families’. People who visited the home said that the food served always looked and smelled nice. One family said that the staff gave their family member a pureed dinner and a small normal dinner. This was to make sure that the person had Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 13 the choice to eat the meal that they preferred, and this depended on their mood. The staff were observed feeding people sitting down and in a relaxed manner. They were observed telling the people what they were eating and a choice of drinks was offered. The people were observed being given lots of time to eat their dinner and staff helped out when needed. The menus were done in picture format and the staff used different vibrant table covers for different meal times. This was to help the people to associate the colours with the different meal times. This was very good in helping the people to understand the different times in the day. One of people spoken to said that ‘it’s a nice place’. All the other people told us that they like living at the home. Another person told us ‘when you live on your own its better to live in a place like this’. We were told that ‘the staff are very good’ and ‘you can’t complain because they keep the place nice and clean’. The food was said to be very good. The people spoken to told us that different people came and did different activities. This was observed on the day of the inspection. In the smaller quiet room one person was observed singing old songs and some of the people were observed either singing or listening to the person. The people were observed walking up and down the corridors and doing what they wanted to do. They were also observed getting on well with each other and staff. It was good to see staff using the names of the people when talking to them. The home has an activities organiser and comes to the home six days a week. The activities are listed in one of the unit. A volunteer comes to the home every Wednesdays and carries out singing sessions with the people. We observed people enjoying this session in the afternoon. The home also has out side people who come and do physical motivation with the people every Mondays. They also have ‘wild bill’ come to the home to do line dancing with the people every 3 to 4 weeks and we were told that people also do this sitting in their chairs. The home recently had a valentine’s party and the photos from this event were displayed on the walls in different units. The primrose unit was turned into a dinning room and this was spacious and pleasantly decorated. The toilet in this room was also refurbished and made bigger to meet the people’s needs. The home also had a ‘Scooby’ day once a week and this was when the people in the home have the opportunity to pat a dog. We were told that the people enjoyed this. Kilsby House Residential Home DS0000012830.V374306.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 good This judgement has been made using available evidence including a visit to this service. All staff have received training in the area of protection to ensure that they have good understanding in making sure that the people are kept safe. EVIDENCE: The people and families spoken to said that they knew how to complain and it was said that they would tell the manager or staff. Information on how to make a complaint was recorded in the service user guide. The home had received one complaint but this was nothing to do with the home. The home had not made any safe guarding referrals or received any since the last visit. All the staff had received training on safeguarding of vulnerable people and had good understanding of this. They also had good understanding of the needs of the people and know when they are not happy. One family spoken to stated that their family member had been at the home for two and a half years and they had only made one complaint. We were told that the complaint was nothing to do with the home but the Director helped them resolve this with the funding authority. Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 15 Kilsby House Residential Home DS0000012830.V374306.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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people live in a homely environment, which is clean and pleasantly decorated to meet the people’s needs. EVIDENCE: The front of the entrance was very pleasant and had artificial flower pots laid out. The entrance to the home was welcoming and warm. The reception area was really bright, airy, and it had a homely feel to it. There were plants, lots of pictures and various textured decorations. There was a bus stop and a bench in the reception so the people could accept visitors leaving more easily. This was observed as the people waved good bye to their families and they were observed smiling and waving. Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 17 The people were observed walking up and down from the lounges to the dining area. They appeared to be very relaxed and talking to who ever walked past them. The staff were observed talking to the people all the time and helping out as and when required. The main lounge downstairs had a very homely feel to it. The room had nice ornaments, pictures, and paintings and new curtains. The bedrooms seen were individually decorated to personal tastes with personal photographs and ornaments. One bedroom was decorated in rich gold with large old paintings on the wall and it was very homely and a comfortable room. This was very in fitting with the generation of the people living at the home. Some bedrooms had been rearranged so that the people could get full benefit from watching the television. All the bedrooms had names of the people and had a picture of any thing that the person could identify with. Two people who were bed bound were sharing a room and both looked comfortable and had a screen between the beds. The room was also individualised to each person on the side the person was sleeping. Prior to the move of the two people sharing and moving to a different unit, the home had consulted their families and had discussed the reasons for the move. Some old memorabilia around the home for example an old singer sewing machine was seen. The Bathrooms were clean and refurbishment in some areas of the home was ongoing internally, and we were informed that the home has plans to ensure that the decking leading to the exterior back garden is treated with anti-slip as soon as possible and for a ramp to be built leading down to the grounds. This will allow the people to access the grounds out side in a safe way. This work is to happen when the weather gets better. The home has a redecoration programme, and evidence showed that this was on going and lots of the places had been decorated. The people, staff and visitors told us that the ‘home is decorated nicely’ Kilsby House Residential Home DS0000012830.V374306.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 good This judgement has been made using available evidence including a visit to this service. The staff enjoy working at the home and receive good training to meet the needs of the people living in the home. EVIDENCE: The staff told us that the team is nice and they have lots of training. The evidence showed that more than 50 of the staff had NVQ level 2 or 3 in care and the rest of the care staff were doing this training. We were told that the changes that have taken place are better for the people. All the staff told us that they enjoyed working at the home. One staff said that ‘every day is different and no day is the same’ and they enjoy this. We were told that they had been involved in reviewing the care plans for all the people and they wrote in their daily notes. The staff spoken to and observation showed that there was adequate number of staff on duty to meet the needs of the people. We spoke to an NVQ assessor and we were told that the staff were pleasant and the acting manager was said to be very supportive to her staff. The staff Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 19 were also said to treat the people as individuals and they followed the care plans. The home was said to ‘have a lovely atmosphere’ and the acting manager was excellent. The staff have meetings and it was said that these were good and they were encouraged to put ideas forward. The staff recruitment files seen showed that the information required to safe guard the people was being obtained and staff received good induction. Kilsby House Residential Home DS0000012830.V374306.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is run in the best interest of the people living in the home to ensure their needs are met EVIDENCE: The home has worked very hard to meet all the requirements from the last inspection. Visitors, staff and the people say the home has a homely atmosphere. The acting manager was said to be excellent and supportive to families, staff and the people. The staff said that management is very supportive and they are listening to them. We were told that the home is going to put forward the application form for the acting manager to become the registered manager of the home. Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 21 The office for staff and management is now situated in the main house and this room is in the middle of the home. The office was large and the information was very well laid out so staff could find the information easily. The office had a big window facing the main lounge area. The acting manager is able to monitor what is happening in the main lounge. The people were also able to see the manager and staff working in the office. It was good to see the people coming to the office as and when they wanted to see who ever was in the office. The registered person was carrying out regulation 26 visits. Information read showed that the home had received compliments from professionals and families regarding care provided by the home. Management audited people’s bedrooms, weight charts, medication, accident and incident records, care plans, and health and safety records. The home had conducted a survey and the information read in the ‘survey summary for winter 2008 was very positive. A ‘residents satisfaction survey was nearly completed and we were told that the analysis will be completed in March 09. The home is sending CSCI regulation 37 notifications and we were told that all staff had received training on how to report incidents to the appropriate agencies. The people’s money checked was correct. The water temperatures checked in some resident’s rooms was fine and window restrictors were placed on all windows. All the people sleep on beds and no person sleeps on a mattress on the floor. All fire records were kept up to date. The fire procedures were being carried out regularly and staff were receiving fire drill practices. Risk assessment for the environment and fire risk assessment for the home was done. The Environment Health Officer visited on the 7th of November 08 and awarded 4 stars to the home Staff confirmed that they receive supervision every 4 to 6 weeks. Kilsby House Residential Home DS0000012830.V374306.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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 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 3 3 X 3 3 3 3 Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 23 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. 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 Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Kilsby House Residential Home DS0000012830.V374306.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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