Care Home: The Ellenborough Nursing and Residential Home

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What the care home does well What has improved since the last inspection? A number of requirements were made at the last inspection. They related to care plans, supervision of staff and the homes practice around risk assessments and health and safety issues. This inspection looked at whether these requirements had been addressed and found that practice had improved in all of these areas leading to some improvements particularly in relation to care plans. What the care home could do better: This inspection identified the need to improve training for staff specifically in the area of Safeguarding and making sure all staff undertake the "mandatory" training i.e. moving and handling. Care plans need to be more person centred reflecting the individual needs rather then purely being care tasks. There lacked information about social circumstances, daily routine, likes and dislikes. In addition whilst there is good practice in identifying risks such as that of individuals developing pressure sores the home must make sure that actions are taken as a consequence of identified high risk. CARE HOMES FOR OLDER PEOPLE The Ellenborough Nursing and Residential Home 9-11 Neva Road Weston Super Mare North Somerset BS23 1YD Lead Inspector Jon Clarke Key Unannounced Inspection 7th August 2008 10:00 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 The Ellenborough Nursing and Residential Home DS0000062713.V368657.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. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ellenborough Nursing and Residential Home Address 9-11 Neva Road Weston Super Mare North Somerset BS23 1YD 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) 01934 621006 01934 418569 ellenborough@cedarscaregroup.co.uk Ellenborough Care Limited Mrs Sophie Chandy (application pending) Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 31 8th August 2007 Date of last inspection Brief Description of the Service: The Ellenborough Nursing and Residential Care home is owned by Mr and Mrs Yilmaz (Cedars Care Group) since November 2004, operating under the name of Ellenborough Care Limited. The home accommodates residents of 65 years or older who require nursing or personal care. The home is an attractive Victorian building conversion of two detached properties. The accommodation is arranged over two floors with a passenger lift or chair lift for access. The majority of the rooms offer en-suite facilities with 15 en-suite single rooms and 5 en-suite doubles. There are two separate lounge areas and two separate dining areas. The home accommodates residents who smoke with a designated smoking area overlooking the rear garden. It is close to local amenities and public transport, bus and rail are within easy reach. Fees £545.00 inclusive of all care. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of an inspection. A number of documents were looked at during this visit including care plans, staff records (recruitment and training), medication and those relating to health and safety practice in the home. There was also an opportunity to discuss with individuals who live in the home and staff their experience of living and working in the home. A number of Have Your Say questionnaire were sent to the home before this inspection responses were received from 9 residents and 13 members of staff. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: The home provides a well-maintained and homely environment and a number of individuals we spoke with commented on the improved décor over the years. One individual said “its such a lovely place to live always so clean and tidy”. There is good practice around care planning with clear details about the care needs of individuals who live in the home. Individuals we spoke with were all very positive about staffing in the home “they are all so helpful and always there if we need them” and “you can’t fault the staff here”. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Ellenborough Nursing and Residential Home DS0000062713.V368657.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 The Ellenborough Nursing and Residential Home DS0000062713.V368657.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs of the individual. EVIDENCE: A number of pre-admission assessments were looked at and they provided information about the physical health and care needs including Activities of Daily Living of the individual. The home undertakes an initial nursing assessment. Where individuals are supported by the local authority a copy of the health and social care assessment is obtained and in addition where there are mental health needs a mental health assessment forms part of the admission assessment. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and care tasks are clearly identified. However there needs to be improved practice in making sure care plans include information about the social needs of individuals and care plans are more person centred so that care being provided is centred on the individual. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of a care plans were looked at and showed that the required assessments had been completed including Moving and Handling, Nutritional, Pressure Sore (Waterlow). For those individuals at high risk of pressure sores The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 10 turn charts are completed. In one instance where individual had pressure sore a map had been completed and Pressure Sore care Plan giving specific tasks needed. Currently there are no individuals who have pressure sores. In one instance where preventative measures had been completed in identified high risk of pressure sores the individual had not been identified as needing turning as an outcome of identified high risk. It was observed during this visit that this individual was not being turned and indeed had developed a “sore”. This was discussed with the acting manager at the time of this visit and the inspector has sought further advise about this approach. Care plans had been reviewed on a monthly basis. Weight and blood pressures are taken monthly. A number of individuals had bed rails and consent had been obtained for their use from the individual or their representative. However there was no written evidence as reason for their use in the form of a risk assessment. Life and Social History are part of the individuals care plans though these had not always been completed and there was limited personal information about the individual such as likes and dislikes, social interests. Records seen evidenced the providing of community health services such as chiropody (every 6 weeks), dental and optician. Continence assessments are completed and forwarded to the Continence Service for advice and support where there are care needs around maintaining continence for an individual. Referrals to the community physiotherapy service are undertaken where individuals may benefit from this service. One individual we spoke with said “they are very quick to call the doctor if we need them”. All of the respondents (individuals who live in the home) to the Have Your Say questionnaire said that they “Always” Receive the medical support they need. We spoke to a health professional visiting the home and they said that they found staff “very approachable” “welcoming” “never seen anything of concern”. Importantly they said how the home always “follows up on advice” and felt the care provided was “excellent”. Medication administering records were looked at and had been completed as required. Controlled drug record was seen and medication in storage for three individuals was checked and found to be correct. Storage is satisfactory including that stored in fridge with daily temperatures recorded. Where individuals self-administering medication risk assessments had been completed (this was subject of requirement at the last inspection). In talking with individuals who live in the home they all spoke of staff treating them “as I would want” “always respectful”. Staff were observed assisting individuals in a sensitive and supportive way. Individuals said they felt their privacy was respected and said how staff always knock on their door and wait before entering and this was also observed during our visit. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 11 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. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: Individuals we spoke with said they found there was “enough to do” and said that there were activities available if “I wanted to”. One said how they enjoyed the painting and bingo. On the day of this visit a number of individuals were doing crafts and had also made gift cards. Respondents (individuals who live in the home) to the Have Your Say questionnaire said there was “always” (8) “usually” (1) activities arranged they could take part in. A local church provides regular services in the home. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 12 In talking with individuals they said how their visitors were always made to feel welcome. A relative we spoke with on the day of the visit said they found “staff very friendly” and how they always “let me know how my relative is”. Importantly they said how they felt able to approach staff if they had any worries or concerns. In relation to daily routine individuals we spoke to said that they felt “able to do as I wish” and another said “its up to me what I do”. When asked about specific routines such as getting up and going to bed again individuals said it was their choice one said how they felt it was all “easy going” “no restrictions whatsoever”. The main meal on the day of our visit was well presented and individuals said how they had enjoyed the meal and thought the food provided was “always very good” “I enjoy my meals here”. The menu offered a wide variety of meals and suitable arrangements are made for those with specific dietary needs. A choice of meals is made available and individuals confirmed that they were offered an alternative if there was something on the menu they didn’t like. “If the meal is not what I enjoy there is always an alternative offered” another “there’s always a choice on the menu and I like the food” (from questionnaire) All respondents said they “always” liked the meals provided at the home. Staff were available during the meal to offer assistance if this was necessary. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 13 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. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: The complaints log was examined there had been one complaint made since the last inspection. This related to a member of staff behaviour towards an individual living in the home. A meeting had been held to discuss the complaint and letter sent to the complainant within the home’s complaint’s procedure timescales and appropriate actions taken regarding the member of staff. We spoke to a number of individuals about what they would do if they were unhappy or had a complaint. All said they would “go to a member of staff” “speak to the matron”. Importantly they were confident that their concern or worry would be listened to and “something done about it”. One individual commented on questionnaire response “the staff are good and helpful I feel like I can talk to any member of staff if I need to and they listen well”. All respondent to the questionnaire said they were aware of the home’s The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 14 complaints procedure and this was confirmed when we spoke to individuals in the home. The home has a Safeguarding Adults policy and in the past the home has acted professionally when dealing with any issues around Safeguarding Adults. Training is provided to staff however training records looked at for four members of staff showed that 3 had not completed this training. On the day of this visit we spoke to 4 members of staff all had completed Safeguarding training. We also spoke to a senior member of staff about their knowledge of Adult abuse and what actions they would take if they had any concerns in this area. They illustrated a good understanding of Safeguarding issues and were able to provide good examples of where abuse may happen in a care home and their response to any concerns they had or allegations made to them directly. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 15 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 home provides a safe and hygienic environment for the residents and staff. EVIDENCE: On the day of this visit the home was found to be clean and well decorated and all areas of the home in good order. A number of individuals who live and work in the home commented on the real improvements that have been made in the environment and decoration of the home over the past few years. One individual who has lived in the home a number of years said that the environment was “better then it was” and also how “it is always clean and tidy”. The home has the necessary procedures in place regarding infection control and staff undertake training in this area confirmed by records examined. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 16 The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. However training needs to be improved to make sure all staff undertake the “mandatory” areas of training. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of residents is protected. EVIDENCE: Staffing arrangements at the home are satisfactory and rotas looked at confirmed there are adequate numbers of staff on duty (5 am, 4 pm) with waking night staff. On the day of this visit there were 4 care staff on duty am plus registered nurse and 3 pm plus registered nurse. In response to the Have Your Say questionnaire individuals who live in the home said that there is “Always” (8) “usually” (1) staff available when you need them. Comments received about availability of staff included; “the staff are available all the time whenever I need them” and “there’s always someone around if I needed them”. One individual we spoke with on the day of this visit said: “you only have to use the call bell and staff are there for you”. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 18 Training records were looked at for 4 members of staff we also asked staff on the day what training they had undertaken. From the records there was no evidence that 3 had undertaken moving and handling training (this included a bank nurse) or Safeguarding training. The staff spoken with had all undertaken the required “mandatory” areas of training: moving and handling, fire safety, infection control. The acting manager advised in their AQAA that 70 of staff have completed NVQ professional training with other staff currently undertaking this training. One member of staff commented, “my work has been very supportive with my NVQ training. They have helped me a lot with training sessions and are always there if I need help.” Recruitment records were looked at and all had Criminal Record Bureau checks completed before employment, two references obtained and full details of employment history. Registered nurses working in the home had their own Personal Identification Numbers verified by the Nursing and Midwifery Council (NMC). One individual employed by the home was in this country on a work permit and a copy was on their personnel file. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 19 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): 31,33,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: Staff were very positive about the management of the home and how “approachable” they were. One commented “we can approach our manager at any time. They are always there to listen and are extremely helpful if we have any problems”. The current manager has yet to be registered with the CSCI and the inspector was advised that her application to be registered had been The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 20 made. Staff felt that they “worked as a team”. Individuals who live in the home said they could “always go and see the manager” “the matron is always around if we want to see her”. Individuals who live in the home have opportunity through resident’s meetings and questionnaires to discuss and register their views about the service they receive. This aspect of the home policy was not looked at in any detail on this visit but will be addressed at the next inspection. Supervision records were looked at for five members of staff. They showed that they had received regular supervision and frequency (normally every 2 months) had improved since the last inspection. One staff member commented “my manager meets with me to give me support and supervision every two months”. Health & Safety records relating to equipment in the home were looked at and showed that regular servicing takes place. Work is being undertaken to improve electrical systems in the home following an inspection in April 08. There are the required risk assessments in place relating to the environment. The Fire system is regularly serviced the last being 10/07/08, fire drills held monthly and weekly tests of equipment take place. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 3 The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 22 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 OP36 Regulation 13 (6) Requirement Timescale for action 01/10/08 2 OP36 18 (1) (a) (c) 3 OP7 12 (1) The manager (designate) to ensure by training staff, the prevention of service users being harmed or suffering abuse or being placed at risk of harm or abuse. The manager (designate) to 01/10/08 make sure that at all times suitably qualified, competent and experienced persons are working at the care home and make sure that persons employed receive training appropriate to the work they are to perform. (This refers to mandatory training particularly moving and handling) 08/08/08 The manager (designate) to make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (This refers to following up identified high risk assessments with actions to make sure that risks are alleviated as far as possible) The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 23 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 Care Plans to provide information which is person centred and care focused on the individual. The Ellenborough Nursing and Residential Home DS0000062713.V368657.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Ellenborough Nursing and Residential Home DS0000062713.V368657.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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