Inspection on 29/04/09 for Coton Hill House

This is the latest available inspection report for this service, carried out on 29th April 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Coton Hill House 03/10/05

Coton Hill House 03/06/05

Coton Hill House 23/02/05

Coton Hill House 13/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Coton Hill House Berwick Road Shrewsbury Shropshire SY1 2PG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Karen Powell     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Coton Hill House Berwick Road Shrewsbury Shropshire SY1 2PG 01743235788 01743240002 enquiry@coveragecareservices.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Coverage Care Services Ltd care home 45 Number of places (if applicable): Under 65 Over 65 0 45 dementia old age, not falling within any other category Additional conditions: 45 0 The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 45 Dementia (DE) 45 Date of last inspection Brief description of the care home Coton Hill House provides care for 30 elderly people and 15 people with dementia in single bedrooms with communal sitting, recreational and dining space in five separate units. The care home has large, well-maintained gardens that provide safe and accessible areas for all people living at the home. The home is situated close to Shrewsbury town centre with views across the River Severn. The local transport system has regular bus services for those who do not have their own transport. The home provides visitors with car parking facilities. Coverage Care Services Ltd make their services known to prospective service users in: The Statement of Purpose, Company Brochure and web site which also contain their Care Homes for Older People Page 4 of 28 Brief description of the care home contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in all homes entrance halls with a note stating the document can be made available to copy and take away. Coverage Care Services rates are reviewed annually on 1st April each year and people who live at the home are notified one month in advance. The only additional charges to service users are for toiletries, hairdressing, newspapers and escorting to hospital for routine appointments. This is clearly laid out in the terms and conditions. Care Homes for Older People Page 5 of 28 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 inspection of the service was unannounced and took place on 29th April 2009 by one inspector over a period of approximately seven hours. A range of evidence was used to make judgements about this service to include discussions with people using the service, visitors, the registered manager, deputy and staff. We also examined a number of records to include care records of people living at the home, staff training, staff recruitment and health and safety records. Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting them, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care Care Homes for Older People Page 6 of 28 helps us understand the experiences of people who use the service. An Annual Quality Assurance Assessment AQAA document was posted to Coton Hill House for completion. The AQAA is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale. The registered manager completed this, and some of the information is included in the report. The purpose of the inspection was to assess all 22 Key National Minimum Standards for Care Homes for older people and any further standards necessary. An annual service review was carried out on 31st October 2007 and 23rd July 2008. This did not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection. The reports are available at the service. Information to produce this report was gathered from the findings on the day and also by review of information received by CQC prior to the inspection date. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. Fees are published in information given to prospective clients. The weekly fee range is 437.00 to 462.00. Readers wishing to know more about this information should contact the service directly. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 28 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information and encouraged to make informed decisions about the home before moving in. Pre placement assessments ensure that individual needs are met. Evidence: The home has clear information in the service user guide and statement of purpose to help people understand what services the home can provide. This information forms part of an information pack, which includes photographs of the premises, the results of the latest service user satisfaction survey and information about the service including fees charged. People are only admitted to the home following an assessment of their needs carried out by the registered manager or a suitably qualified health care professional. We case tracked one individual who was recently admitted to the home. We talked to them Care Homes for Older People Page 11 of 28 Evidence: about their experience of the admission, they told us that their next of kin had assisted them with finding a place at Coton Hill House, following a transfer from another care home. The person told us that they knew Coton Hill House from attending the day centre on a regular basis. We looked at the records for this person and found a pre admission assessment from the health care professional involved with their care. We discussed the persons needs with the manager who told us that as the individuals needs had not changed since they attended day care, a visit to the person prior to admission was not carried out. However, where a person is not known to the service a pre admission assessment is always undertaken. The home does not provide intermediate care. Care Homes for Older People Page 12 of 28 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. Staff have the information they need and have a clear understanding of how to offer care to each person, which ensures peoples health and personal care needs are met in a way that they prefer. Evidence: Care plans we looked at for three people were detailed and explained to staff how people preferred their care to be given. The service has begun to look at how the new depravation of liberty legislation impacts on the people they care for. A mental health professional care worker has reviewed several of the care plans and offered advice and guidance as to how the home should address this within individual care plans. This has been carried out by the home to ensure that people are not deprived of their liberties without full assessment and supporting care plan documentation being put in place. Currently there are no authorisations in place for anyone living at the home. The home has also begun to address this topic through staff training. The manager has attended a deprivation of liberties briefing session and has cascaded this information to the staff group. Care Homes for Older People Page 13 of 28 Evidence: Ten staff completed surveys and returned them to us as part of the pre inspection work. They told us they receive enough information about the people they care and support. Three relatives who completed and returned to us surveys as part of the pre inspection work told us that they felt their relatives care needs are met and the care plan is followed. They all stated they are informed of any changes about their relatives health. Since the last inspection and action taken as a result of a complaint received the manager has introduced a relative communication sheet for each person living at the home. This documents a record of contact made with relatives where the home have contacted them to convey information about their loved one. Individuals preferred social activities were documented and when we spoke to the people we case tracked they were able to confirm they were able to carry out the choices they had made. One person told us they like to tend to the garden and has keys to the shed he also maintains. Another person was happy to show us their knitting they had been enjoying doing during their stay. Nineteen people who live at the home completed and returned to us a survey as part of our pre inspection work. They all indicated that they are happy with their care and support, carers listen and act on what they say and there are usually enough staff available to help them. All said they receive medical help when they need it. One person told us I have had excellent support on this matter (medical support) on many occasions. I could find no fault with the treatments I received. Another person told us I have had a lot of problems lately and I am having on going treatment. I can always see a doctor if I need one. Care plans contained a record of input from other health care professionals involved in individuals care. For example the involvement of a social worker requested to re assess someone who the home could no longer offer care to due to their progressing dementia. This had also happened to another individual. We were able to speak to the relatives of this person who told us they were sad that their relative had to move but understood the reasons why. They went on to tell us how pleased they were with the care and support the home had given their relative, and how good the staff were to their loved one. The home has policies and procedures in place for the safe handling of medication. We looked at the medication administration records and storage of medication for the people we case tracked. At the front of each persons medication administration record (MAR) there is a photo of the person so that new staff would know who to give Care Homes for Older People Page 14 of 28 Evidence: medication to. MARs had been signed when medication had been given indicating that medication had been given as prescribed. Only trained carers administer medication at the home. We spoke to a carer who was able to competently explain all procedures and practices relating to the safe handling of medication. Medication receipt and disposal was satisfactory and in line with good practice. We observed people to be treated with respect during the visit with their dignity and privacy being maintained. Personal care was given in bathrooms. The staff group were patient, kind and caring throughout the day. People we case tracked confirmed this is the case at all times. One relative we spoke to told us that staff were always kind and caring whenever they visited their relative. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Coton Hill House are provided with opportunities to experience a meaningful lifestyle that ensures self esteem and well being. People are provided with healthy, well presented meals according to their dietary requirements and choice. Evidence: All three care plans we looked at identified peoples likes and dislikes and preferred routines, this includes nighttime preferences. For example rising and retiring times, requirements such as if someone likes tea taking to them when they wake. People we case tracked and other people we spoke to during our visit told us that their daily routines are flexible and they are able to choose how they wish to spend their day. Individuals told us that their family and friends could visit at any time. This was also confirmed by visitors we spoke to who told us there are no restrictions on visiting. Three relatives who completed and returned a survey to us told us that the home helps their family member to keep in touch with them. For each unit in the home there is an activity plan, which we saw for two different units. We spoke to the activities coordinator who has extensive knowledge and experience in providing activities. It was evident through discussion with her that she views people as individuals and activities Care Homes for Older People Page 16 of 28 Evidence: are tailor made if required. There is an excellent resource that the activity co coordinator has developed which offers carers step by step guidance of how to carry out the activity and where the resources are kept for the individual activity. There are many activities on offer including relaxation, quizzes, film nights, dominos, cooking, gardening and many more. Individual records are kept on a persons involvement in activities. The hairdresser was also visiting the home on the day of our visit, people spoken to say they enjoy this facility. There are lots of photographs around the home of people taking part in activities. Recent St Georges day celebrations took place where photographs showed people really getting into the celebrations. Religious observance is supported and regular visits by the local churches takes place. The home has a resident cockatiel called Nip who welcomes people to the home, he can be located in the homes reception area. There are also two guinea pigs that live at the home and are regular visitors onto the units. The home has links with the local community and attends a dance class once a month. A tea dance was held in March at the home. Bird tables are situated at the front and rear of the home, it was a sunny day the day we visited and some people choose to take a walk in the grounds. A regular newsletter is available for all people living at the home and their families. We saw the February edition which people we spoke to said they enjoyed reading. People living at the home told us they are involved in deciding what activities take place and regular meetings with people who use the service take place to discuss such topics. People we case tracked told us they were happy with the food provided at the home. We spoke to the chef and her assistant who had also completed surveys for us as part of our pre inspection research. Comments include I would like to think that the catering staff have a good rapport with the service users as a sweet trolley is taken round every day, so we get to communicate with them. We have a gold healthy eating award, which offer choices of meals at meal times for the service users. Menus were seen on each table and offered choices and a well balanced diet. The menu reflected what was being served on the day of our visit. Care Homes for Older People Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Coton Hill House have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Staff receive training so that they have an understanding in adult protection to ensure people they support are protected from abuse, ensuring their well being. Evidence: People we spoke with told us they knew what to do if they were unhappy with the service they receive and reported that they have no concerns of complaints about the home. People have access to a complaints procedure, which we saw during our inspection. Nineteen people who use the service and completed and returned a survey to us told us generally they know who to speak to if they had a concern about the service. Ten staff that competed and returned surveys to us told us that they would know what to do if someone living at the home or their relative/advocate had concerns or wanted to make a complaint. Three relatives who completed and returned surveys to us told us they knew who to speak to if they wanted to make a complaint. There have been three complaints since the last inspection, that were dealt with through the homes complaints procedure and which we were also made aware of at the time of each complaint. Two of the complaints led to safeguarding referrals and investigations were carried out, which the home fully co operated with. Both referrals were not substantiated although improvements have been made to the communication Care Homes for Older People Page 18 of 28 Evidence: process at the home regarding relatives and involvement of other professionals when required on a regular basis. We saw evidence of this during this inspection. The remaining complaint was not upheld. People told us they feel safe and secure at the home. Staff are trained in adult protection. The manager told us that she is arranging an update in adult protection training for the management team in the near future. An adult protection handbook has been produced at the home and issued to staff, that is easy to understand with up to date information including new legislation on the deprivation of liberty safeguards. Care Homes for Older People Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Coton Hill House are provided with a clean and homely place to live, which is equipped to meet their individual needs and makes them feel safe and secure. Evidence: We took a tour of the home and found it to be clean and tidy. Ongoing renewal and maintenance of the home ensures that the service provides an environment that is well maintained for people who live at the home. We noted the carpets in Berwick Lodge are looking well worn and the area would benefit from them being replaced. The manager informed us that she has requested these are replaced within this years annual budget. We looked at the bedrooms of the three people we case tracked. These were personalised with their own belongings. They told us I like my room. Another told us I am happy with my room it is always clean and tidy. The home is set in pleasant grounds and in nice weather can be accessed by people if they wish to sit and walk around the garden. Care Homes for Older People Page 20 of 28 Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangement for staffing, their support and development ensures that the needs of the people living at the home are met. People have confidence in the staff at the home because checks are done to make sure that they are able to care for them Evidence: We looked at the files of two staff employed since our last inspection to make sure that pre employment checks are undertaken so that staff are checked as being suitable to work with vulnerable adults. Files were well organised and contained all the checks required under regulation. All people consulted as part of the inspection told us that the staff treat them well and that they are happy with the care and support they receive. We observed staff supporting people throughout the day, they did this with respect and were professional at all times. Staff told us that they are given regular updates about people living at the home during handover on each shift, and supported through updated care plans. Staff we spoke to demonstrated a clear understanding of the peoples needs we case tracked. Staffing levels are determined by the needs of people living at the home, we saw sufficient staff cover on the day of the inspection and staff spoken to on the day told Care Homes for Older People Page 22 of 28 Evidence: us the staff ratio is generally good. Three staff that completed surveys as part of our pre inspection work told us they thought the home could improve by appointing more staff. Training for the staff is good. We looked at training completed by staff and saw the relevant training certificates on staff files. Training included dementia, moving and handling, protection of vulnerable adults, health and safety, and fire safety. The manager stated in the completed AQAA that over 50 of the care staff have obtained a nationally recognised care qualification NVQ at level 2 and above. All staff are formerly supervised and appraised, we saw records to support this. Staff spoken to and those that completed surveys for us said they felt well supported by the manager of the home. The homes induction process, consistent with Skills for Care expectations, is thorough and conducted over a period of time. We saw evidence of this on the file of two new carers appointed since the last inspection. Care Homes for Older People Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in Coton Hill House because it is effectively managed in the best interests of the people living and working there. Evidence: The registered manager is suitably qualified to manage the care home and has a number of years experience in the care sector. The staff receive clear guidance on how to perform their role and there is a clear understanding from staff of what is expected of them. This ensures that people living at the home receive consistent care and support of a good standard. People living at the home are regularly consulted in what they think about the service and any improvements that could be made. We saw evidence of feedback from questionnaires given to people to seek their views. We saw a number of thank you cards from people who had contact with the home. Comments we saw included With grateful thanks for all your care and kindness shown. Thank you for looking after x Care Homes for Older People Page 24 of 28 Evidence: so well. To all the staff thank you for the kindness and care given to our father it is much appreciated. People who are unable to manage their finances are supported through the home. Policies and procedures are in place, which give clear guidance on managing peoples money, valuables and financial affairs. All checks required such as of the fire safety systems; hot water systems, lifting equipment and electricity are in place. People are protected through regular maintenance of systems and equipment and records to show this are well organised. Care Homes for Older People Page 25 of 28 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 26 of 28 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 1 19 To replace the carpet in Berwick Lodge. This would enhance the environment and continue to improve a comfortable palce for people to enjoy living. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!