Care Home: Primrose Lodge

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What the care home does well We saw excellent care provided for residents in the home and saw evidence that people`s health needs are being met in the way each person prefers. People are provided with choices about how they spend their days and staff take pains to provide a wide range of activities which include the activities residents have shown they are interested in. People are provided with a choice of meals which they said they enjoy and snacks and drinks are available at all times to ensure people are well fed and enjoy good health. Comments in the returned surveys were complementary about the meals and one stated there is "a good variety of meals". Staff are trained to a high standard and provide services in a professional way. Recruitment procedures are also thorough and ensure only appropriate people are employed at the home to protect residents from the risk of abuse. In the returned surveys residents or their relatives commented " the home is five star and cannot be faulted" and the staff "are good friends." Other comments include "staff are very professional" and staff are "friendly and helpful". The home is well managed and there are robust systems in place so that residents and visitors can have their say about the home. The manager has also introduced systems where staff link with individual residents to ensure their needs are all met and have specific safety duties to ensure all staff are involved in safety procedures for the benefit of residents and staff. All the surveys returned to the Commission contained positive comments about the home and its management. What has improved since the last inspection? Care plans are completed in detail and document all appropriate information so that staff can be clear about how to meet individual needs. More activities are being provided for residents and people are taken out by staff. One resident said activities are "great" now. All areas of the home both inside and out have been redecorated and refurbished and the home provides a comfortable and attractive environment for people to enjoy. The kitchen floor has been replaced and a new freezer has been provided. The home has been awarded four out of five stars for hygiene standards by the Environmental Health Department and residents and their relatives can be sure people in the home are proteceted by staff implementing good standards of infection control and hygiene. What the care home could do better: No requirements have been made as a result of this inspection. Key inspection report Care homes for older people Name: Address: Primrose Lodge 29-33 Essex Road Watford Herts WD17 4EL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia House     Date: 1 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Primrose Lodge 29-33 Essex Road Watford Herts WD17 4EL 01923444435 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): albany.home33@yahoo.co.uk Mr Bedanan Guru Seegoolam,Mrs Dhanwantee Seegoolam,Mrs Sangeeta Rukunny,Mr Bolah Rukunny care home 21 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered provider 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: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Primrose Lodge, formerly called The Albany, is a residential home providing care for up to 21 older people. The building is a detached Victorian house, which has been converted to provide care over two floors and has staircases and a passenger lift. There are two lounges, a conservatory and dining room on the ground floor and a large paved garden at the back of the house. There are 7 single bedrooms on the ground floor and 13 bedrooms on the first floor. One bedroom is a double room, which can be Care Homes for Older People Page 4 of 26 Over 65 21 0 2 5 0 9 2 0 0 8 Brief description of the care home shared by two people through mutual consent, but has single occupancy at present. primrose Lodge is situated in a residential area of Watford and has a narrow drive to the side of the building for some parking. There is restricted parking in the roads nearby. There are good road and transport links nearby and the town of Watford is within walking distance and has extensive shopping and leisure facilities. The homes Statement of Purpose and Service Users Guide are displayed in the entrance hall together with a copy of the last CQCinspection report. Fees for the home are currently £437. 18 per week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was completed on 18th June 2008. The information in this report is based on an unannounced inspection of the home, which took place over one day with one regulation inspector carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The registered manager was on duty throughout the day and we spoke with staff, residents and visitors. We visited all parts of the home and checked a variety of records. Before the inspection the manager had completed and returned to the Commission an annual self-assessment quality review, the Annual Quality Assurance Assessment, (the AQAA). This document included statistical information about the home and Care Homes for Older People Page 6 of 26 confirmation of policy reviews and equipment checks. Before the inspection we sent quality surveys to residents and staff. Eight completed surveys have been returned from residents and six from staff at the home. We have used some of the comments from these surveys in this report. We have also reviewed any other information we have received about this service since the last inspection. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 26 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1 and 3. People who use the service are provided with comprehensive information about the home and have their needs fully assessed so that all parties can be sure the home is the right place for them. Evidence: We saw the homes Statement of Purpose and Service Users Guide displayed in the entrance hall and these documents provide comprehensive information for people who use or may want to use the service. As with all service providers the Commissions new address just needs to be updated on all relevant documents. We checked a selection of residents records and saw details of the thorough needs assessment which had been completed before a new resident moved into the home. The manager confirmed that detailed assessments would be completed for any new Care Homes for Older People Page 11 of 26 Evidence: residents and copies of care summaries would be obtained from referring agencies to ensure that all individual needs are identified and it can be assured the home can meet those needs. An initial care plan had been completed for the new resident from the assessment so that all care staff could be clear about the residents needs and how best to meet them. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People who use the service have all their health needs recorded and can be sure that procedures followed in the home will ensure their good health is promoted. The system for administering medication in the home is thorough and also helps to ensure peoples health needs are met. Evidence: We spoke with residents during the inspection both in communal areas and in their bedrooms. We also observed residents and staff interaction through the day. We then tracked a selection of the care plans relating to some of these people. In all cases we saw appropriate details recorded, which reflected the needs and wishes of the people concerned. All plans contained an up to date photograph of the resident for added safety and good management plans for issues such as assisting with transfers and dealing with the risk of falling. Recommendations about diets were recorded with reasons given and we saw documentation confirming how the dietary requirements were followed. Monthly written reviews were recorded and were up to date and where Care Homes for Older People Page 13 of 26 Evidence: pressure relief was required in the plans we saw the appropriate equipment provided in the home. The care plans also detailed the social aspirations and choices of the residents concerned and were signed by the resident or their relative. We saw evidence of appropriate referrals made to and visits from Health professionals and evidence of the treatment and care provided for a resident who had had a pressure sore which was now healed. Currently no one in the home has a pressure sore. Regular visits from chiropodists and dentists are evidenced and the residents have the benefit of a visiting optician. The home has a hoist which can be used when the need arrives and there is a named member of staff whose role includes ensuring the hoist is always electrically charged and ready to be used. We saw one resident walking with a zimmer frame and this person had recently had a hip operation in hospital but had been encouraged and supported by care staff to regain their mobility. Some residents have their own wheel chairs for occasional use. We also met a resident who is 102 years old whom staff support to use all the communal facilities and eat with other residents in the dining room. In general we saw evidence all day of excellent care provided by care staff and the visitors we spoke with confirmed this assessment. During the day we saw great respect shown to the residents by staff and those people we spoke with confirmed that care staff always respected their privacy and promoted their dignity. Residents confirmed they always wear their own clothes, which care staff support them to choose each day. All residents in the home were well dressed and were wearing appropriate clothing and footwear on the day. We checked the system for administering medication in the home. A new medication cabinet has been installed and the small amount of controlled drugs was being appropriately stored and recorded. The home also has a dedicated medication fridge. Only senior staff administer medication and the senior on duty demonstrated a thorough knowledge of legislation and the recommended good practice for dealing with medication. The manager completes regular audits of the medication system and had confirmed that an audit has taken place since the inspection. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. People who use the service are able to enjoy their daily lives in the way they prefer and have their good health promoted by the standard and range of food provided. Evidence: The day of the inspection was quite warm and sunny and the conservatory doors were open and people were sitting in the conservatory and in the garden. A visitor who arrived also sat in the garden with their relative. We saw the weekly activities plan displayed and watched some of the daily events take place. Care staff provide the activities as part of their daily duties and the residents we spoke with confirmed that the advertised events take place. One resident told us that they were really looking forward to the summer fete which was to be held that weekend. This resident said the events at the home were great and they really enjoyed the activities provided. One resident was laying the dining room tables in the morning and a resident who staff said enjoyed cleaning was given a cloth to use around the communal areas. We saw a craft session take place in the afternoon. One resident attends a weekly day centre workshop and a hairdresser visits every two weeks. We saw evidence that care staff take the residents out for walks and for local visits and monthly outside entertainers Care Homes for Older People Page 15 of 26 Evidence: come into the home to provide musical events for the residents. There are weekly exercise classes held for residents to help them maintain their mobility. One resident whom we have seen and spoken with during several past inspections, when the home was under previous management, told us they have now given up smoking and enjoy coming out of their room to take part in the activities. Previously this resident had told us that they stayed in their room as there was little going on and they were often bored. Another resident also said they felt their daily life at the home was now much improved and they now enjoy the use of the garden and conservatory and take part in activities. Two residents told us that if they ring the call alarm in their rooms staff come in seconds. The manager said that residents can use the homes cordless telephone when they wish but that many of the residents now have their own mobile phones. Most of the current residents have lived in the home for some years and the manager is aware that as new people move in the range of activities and outings may need to be increased or adapted according to the wishes of the new people. It may be that in the future the residents may benefit from having a dedicated and trained activity coordinator provide events at the home. We spoke with two family members who visited the home on the day. They confirmed they were welcomed in the home at all times and were invited to the events which take place at the home. One visitor also confirmed that their relative had their wishes respected and could choose how they spend their days. We saw the mid-day meal prepared and served and the food was plentiful and looked nutritious. Staff brought the meals out from the kitchen individually and with covers over the plates so that the food remained hot. Staff waited until all the residents were seated at the tables before serving the food so no one had to wait while someone else was eating. The tables were set attractively and condiments, napkins, drinks and flowers were on the tables. We saw care staff offer the residents tea and coffe after the meal was finished. The food was clearly enjoyed by residents and the whole meal time was a relaxed and meaningful experience. One resident told us that after the evening meal, tea and biscuits were provided at about 8pm but that they could ask for a drink or snack at any time. The kitchen was very clean and the flooring had been replaced and was impermeable to the walls. There was a new freezer in the kitchen and we saw good stocks of food stored. Menus are displayed and there are also picture menus to show any confused residents the food they can choose. We saw records completed of the food eaten by each resident to comply with environmental health requirements. There had been a recent visit from an Environmental Health Officer and the home has been awarded a commendable four out of five stars as a rating. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. Procedures followed by staff at the home ensure that any concerns people might have are listened to and ensure that residents are protected from the risk of abuse. Evidence: The home has written policies on making a complaint, whistle blowing and safeguarding. The staff we spoke with were clear about these policies and aware of their implications. A visitor we spoke with said they were aware of how to make a complaint and there are small cards in the reception area, which visitors can use to write down any concerns they might have and can give these cards to staff for the manager to consider. There is also a compliments book in the entrance hall and there are a large number of positive comments written about the home and these have been signed by the visitors concerned for verification. One long standing member of staff has also written in the book about the new management in one year, all is great, lots of changes, all good. We saw evidence that all staff receive safeguarding training as soon as they start work at the home. The manager also demonstrated a full awareness of the safeguarding procedures used by the joint agencies in Hertfordshire as led by Hertfordshire County Care Homes for Older People Page 17 of 26 Evidence: Council. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. standards 19 and 26. People who use the service benefit from living in a home which is comfortable and well maintained and where procedures followed help to protect them from the risk of harm. Evidence: We visited all parts of the home and garden during the inspection. All areas were clean and were well maintained. Redecoration has taken place in the bathrooms, toilets, hallways and in all bedrooms and the home looked very attractive. The exterior of the building has also been painted and the garden was well planted and very colourful. New furnishings and fittings have been provided in many areas and there is new flooring in a first floor bathroom. All areas of the home were bright and cheerful and provided a pleasant environment for the people living there. We saw liquid soap and paper towels in the communal bathrooms and toilets as required for good infection control. There is a new washing machine in the laundry room which has a sluice programme and a built in disinfectant procedure which operates even on a cool wash to help prevent the spread of infection for the benefit of the residents. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. People who use the service are supported by a competent and professional work force and procedures followed for recruiting staff in the home are thorough and help to protect residents from the risk of abuse. Evidence: There were three care workers on duty when the inspection began as well as the manager and a member of staff in the laundry. The manager confirmed there are normally three care workers on duty in the morning, two in the afternoon and two at night. People we spoke with said there were always enough staff on duty to meet their needs. The manager has recently appointed a new domestic worker for cleaning duties and has introduced a key worker system in the home so that each resident has a named link worker who can ensure their individual needs are met. Staff in the home all have new uniforms and name badges so that all residents can identify who is working with them. The names of staff on duty are also displayed daily on a notice board for the benefit of residents and visitors. The manager said that all five of the senior staff at the home have completed NVQ level 3 training and one senior is currently completing level 4. The manager said all care staff will be encouraged to undertake NVQ training. Care Homes for Older People Page 20 of 26 Evidence: We checked the training records of a selection of the care staff. All the records checked showed that the care staff had either completed or were booked on courses covering all the training seen as basic and essential for care workers. One senior is currently completing a Leadership course and another has completed training in the Mental Capacity Act. Staff said that information from special courses is cascaded to all staff once the course is completed. We saw evidence that all staff receive formal supervision and have personal development plans in place to ensure residents are supported by a competent and professional work force. We checked a selection of staff recruitment records and saw evidence that all the staff concerned had the appropriate recruitment checks in place before they started work at the home. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38. People who use the service live in a home which is well run and where their views are listened to and acted on. Procedures followed by staff ensure residents and staff remain safe in the home. Evidence: During the inspection the visitors who spoke with us, praised the management of the home and commented that their views were always listened to and said they were aware that in the home the care of the residents came before all other considerations and said that anything we mention is done. Care staff also said how supportive both Proprietors were and the residents said the management was really good. The comments in the completed surveys returned to the Commission confirmed this information. The home operates a formal quality assurance system and the manager said that Care Homes for Older People Page 22 of 26 Evidence: surveys will be sent out at regular intervals to interested parties as well as to residents to ensure the services provided are as people prefer. Care staff confirmed they have monthly staff meetings where they are kept up to date with changes and general information. We also saw evidence that regular residents meetings take place and these are minuted. Two residents have their personal allowances held at the home and detailed records and receipts are kept of all transactions. Another resident told us they look after their own money with the help of a friend/advocate. Most residents have relatives who handle their finances. We checked the fire safety and accident recording in the home and all records were well documented. Staff told us that each care worker takes a responsibility for one safety area such as the fire safety tests and so all staff are involved in maintaining safety in the home for the benefit of the residents and staff. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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