Please wait

Inspection on 19/10/09 for Denham Manor Nursing Home

Also see our care home review for Denham Manor Nursing Home for more information

This is the latest available inspection report for this service, carried out on 19th October 2009.

CQC found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is information available for prospective residents and their support needs and wishes are assessed with them before they move to the home to ensure they can be met. People`s faith and cultural wishes are identified at the initial assessment to ensure they can be supported. People living at the home said that their health care needs were met and that they saw a general practitioner regularly. Medication is managed well. One family member commented that `since moving to Denham my father`s condition has improved greatly`. There is a wide range of activities provided by an enthusiastic activities coordinator. People can choose whether they wish to join in and routines in the home are flexible to take into account peoples wishes as to how they spend their day. People`s cultural and faith needs are supported. When asked what the home does well in the surveys many residents spoke of the activities saying how much they enjoyed them. One resident said she had particularly enjoyed a recent trip to Kew Gardens. Meals are taken in an attractive dining room with well laid tables. The standard of food is good and residents said that they enjoyed their meals. People may choose to eat in their rooms if they prefer. There are complaints policies and procedures in place. Everyone spoken to said that they knew who to speak to if they were unhappy and that they knew how to make a formal complaint. The home is an older building set in attractive gardens. Residents are encouraged to personalise their rooms with their own belongings to make them more homely. There is a choice of sitting areas for residents who may wish to sit with others or on their own. The home has been adapted to meet the needs of people with disabilities and those who use a wheelchair. The infection control standards are good and the home was clean and tidy on the day of the unannounced visit. There were no offensive odours. Residents said that the staff were caring and that they were available when they needed them. An experienced manager manages the home. She is in the process of registering with us. There are quality assurance processes in place and residents` views are sought on a regular basis.

What has improved since the last inspection?

The care plans have improved and now contain greater detail as to people`s care needs and wishes. Their dietary needs are addressed and there was no one who required a special diet on health grounds who was not getting it. The home has worked closely with the local Primary Care Trust to implement new nutritional guidelines to provide high calorie meals instead of prescribed liquid supplements for people at risk of losing weight. The management of complaints has improved. Records showed that people who raised a concern had received a prompt reply and action had been taken to address their concerns. The staffing levels have improved since the last inspection and there are more care staff on duty during the day to meet residents needs in a timely way. There is better coordination of training and all staff have a induction programme and training in safe working practices. Some staff have had training in dementia care. New beds have been bought to provide height adjustable beds with specialist base mattresses and integral bed rails to give a higher level of comfort and safety for those who need nursing care in bed.

What the care home could do better:

No requirements or recommendations have been made as a result of this inspection.

Key inspection report Care homes for older people Name: Address: Denham Manor Nursing Home Halings Lane Denham Bucks UB9 5DQ     The quality rating for this care home is:   two star good 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: Chris Sidwell     Date: 1 9 1 0 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: Denham Manor Nursing Home Halings Lane Denham Bucks UB9 5DQ 01895834470 01895832845 denham@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): County & Suburban Care Ltd The registered provider is responsible for running the service care home 53 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximm number of service users who can be accommodated is 53 The registered person may provide the following catergories of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) old Age not falling within any other category (OP) Date of last inspection Brief description of the care home Denham Manor is a care home providing nursing and residential care for up to 53 residents. The home is situated in a pleasant, but relatively isolated country lane, on the outskirts Care Homes for Older People Page 4 of 26 Over 65 0 53 53 0 0 4 1 1 2 0 0 8 Brief description of the care home of Denham. Public transport and other amenities are not easily accessible. The home was registered in 1988 and consists of a two-storey building, with three conservatories. The home has forty single and three shared bedrooms. Some bedrooms have en suite facilities. There is a passenger lift. The home has extensive gardens, which are well maintained. Information about the home in the form of a statement of purpose, a service users guide and brochures can be obtained from the home. Copies of previous inspection reports are also available at the home. 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: two star good 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 was conducted over three days, which included a review of the information we hold about the service and an unannounced visit to the home of six hours on the 19th October 2009. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment (AQAA) which was returned on time. Surveys were sent to the home for distribution to residents, families, staff and visiting health and social care professionals. Sixteen residents or their families and five members of staff returned these. Residents were spoken to on the day of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed and the care of four residents was followed through in detail. The facilities and decor of the home were checked. An examination of key records including care plans, medication records, complaints files, quality assurance Care Homes for Older People Page 6 of 26 audits, recruitment and training files and maintenance records was also undertaken. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The care plans have improved and now contain greater detail as to peoples care needs and wishes. Their dietary needs are addressed and there was no one who required a special diet on health grounds who was not getting it. The home has worked closely with the local Primary Care Trust to implement new nutritional guidelines to provide high calorie meals instead of prescribed liquid supplements for people at risk of losing weight. Care Homes for Older People Page 8 of 26 The management of complaints has improved. Records showed that people who raised a concern had received a prompt reply and action had been taken to address their concerns. The staffing levels have improved since the last inspection and there are more care staff on duty during the day to meet residents needs in a timely way. There is better coordination of training and all staff have a induction programme and training in safe working practices. Some staff have had training in dementia care. New beds have been bought to provide height adjustable beds with specialist base mattresses and integral bed rails to give a higher level of comfort and safety for those who need nursing care in bed. 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. 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. There is information available for prospective residents and their support needs and wishes are assessed with them before they move to the home to ensure they can be met. Peoples faith and cultural wishes are identified at the initial assessment to ensure they can be supported. Evidence: There is information available to prospective residents in the form of a statement of purpose which describes the services offered and a brochure. Prospective residents and their families are welcome to visit the home at any time and to stay for varying periods of time to help them come to a decision as to whether the home is where they want to live. The files of three people who had moved to the home since the last inspection were checked. They had been visited by the manager or senior nurse before they moved and their needs had been assessed with them. An outline care plan had been drawn Care Homes for Older People Page 11 of 26 Evidence: up which was refined as the residents needs and wishes become clearer. The initial assessment took account of peoples faith and cultural needs. The home does not offer intermediate care for those needing intensive rehabilitation. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal, healthcare and medication needs are met in a manner which protects their privacy and dignity. Evidence: The care of four residents was looked at detail. All had care plans in place which had been updated regularly. Peoples risk of developing pressure damage, nutritional deficiencies and of falling had been assessed and appropriate care plans had been drawn up. Two people had been identified as having a high risk of developing pressure damage and they had an appropriate pressure relieving mattress and chair cushion. Peoples risk of developing nutritional deficiency had been assessed. The home has worked closely with the local Primary Care Trust to introduce new nutritional guidelines to reduce the need for people to have nutritional supplements. High calorie foods are provided for those who are at risk of losing weight and peoples weight is monitored carefully. There was evidence in the files that the dieticians and speech and language therapists advice is taken when necessary. Care Homes for Older People Page 13 of 26 Evidence: Peoples risk of falling is monitored and plans to minimise this are implemented. Records of falls are kept. There was evidence in the files that residents see a range of healthcare professionals on a regular basis, including the general practitioner, specialist nurses, opticians and chiropodist. Residents who returned the surveys and those spoken to on the day said that their healthcare needs were met. One family member commented that since moving to Denham my fathers condition has improved greatly. There are medication policies and procedures in place and the staff spoken to were aware of these. The storage facilities were satisfactory. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was not given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident lacked capacity, the doctor and family would be told and a way forward agreed. The storage and management of controlled drugs was satisfactory. The records of two controlled drugs were selected random and checked and found to be correct. Residents were observed to be well dressed, wearing their own clothes and had been helped to maintain their personal hygiene. Personal care is given in residents rooms and staff were observed to be speaking to residents politely and addressing individuals personally. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to choose how they spend their day and to join in a varied programme of activities tailored to their individual likes and dislikes. Meals are varied and nutritionally balanced. People have a choice as to what and where they eat and mealtimes were seen to be a sociable occasion. Evidence: A wide range of activities are provided by an enthusiastic activities coordinator who works five days a week at the home. Residents told us that they enjoyed the activities and could choose whether to participate or not. The activities coordinator had sought information about residents likes and dislikes and tailored the activities programme to their wishes. Records were kept about peoples cultural wishes. Peoples faith needs are supported and the local church holds a bible study group. When asked what the home does well in the surveys many residents spoke of the activities saying how much they enjoyed them. Residents enjoyed a trip to Kew Gardens in the summer. The activities programme has developed over the years and new ideas are continually implemented. The home stated in their self assessment that they were planning a wish come true project for the coming year in which all residents would be supported to realise a wish that was important to them. Care Homes for Older People Page 15 of 26 Evidence: The standards of the meals are good. Everyone who returned the questionnaires said that they enjoyed their meals. The menus are varied and people have the choice of eating in their rooms or in the well appointed dining room. There is a choice of meals and special diets can be provided. Meals are supervised and carers were observed to be discretely helping people who could not eat unaided. All staff are expected to help at meal times, which are seen as an important part of the day for residents. 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. People who live at the home are protected from harm and their concerns are listened to and addressed. Evidence: There is a copy of the complaints procedure displayed in the home and it is described in the Service Users Guide. Everyone who returned the surveys said that they knew who to speak to informally if they had a concern and that they knew how to make a formal complaint. People also said that staff listen and act on what they say. Records of both verbal and written complaints are kept. These were incomplete but copies of responses sent from the organisations head office or regional office were sent to the home during the unannounced visit. These showed that all but one of the complaints had been dealt with promptly and showed that action had been taken in response to them. One was not responded to initially which the regional manager said was due to the sickness of key personnel. The eventual investigation was thorough and a comprehensive response was sent. The regional manager has set up a tracking system to ensure that complaints are dealt with promptly in the absence of key personnel. The home has a copy of the local multi agency policies and procedures to safeguard people living at the home. Most staff have had training in safeguarding vulnerable people either during their initial induction programme or during the last year. There is a clear plan in place to ensure that all staff members have updated safeguarding training this year. There are whistle blowing policies and procedures in place and the Care Homes for Older People Page 17 of 26 Evidence: staff spoken to say that would have no hesitation in reporting any concerns. The staff who returned the questionnaires said that they knew what to do if someone has concerns about the home. Residents spoken to on the day said that the manager was very approachable and that they felt safe in the home. We have not been notified of any safeguarding concerns. 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. The home is set in attractive grounds, is well maintained and residents are supported to personalise their rooms to create a homely place in which to live. Evidence: The home is an older building, which is set in attractive, well-maintained gardens. People with disabilities can access outside sitting areas. Rooms vary in size and people are encouraged to personalise them, and many had chosen to do so. Peoples rooms reflect their diverse lives and interests. There is an ongoing programme of refurbishment of the bathrooms. The home was clean and tidy on the day of the inspection and there were no offensive odours. There are infection control policies and procedures in place. Training records show that staff have had infection control training and they were observed to wash their hands and wear protective clothing appropriately. The home now provides height adjustable beds with integral bed rails for those requiring nursing care to minimise the risk of injury to the resident or staff arising from their care. 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. There are sufficient staff with the correct attitude, knowledge, skills to meet peoples care needs in a timely way. Evidence: The home is on three floors. The staffing levels have been increased since the last inspection. There are two qualified nurses on duty throughout the day and one at night, supported by seven carers between 8.am and 2pm, five between 2pm and 8pm and three between 8 pm and 8am. The manager said that she kept the staffing levels under review. Of the sixteen residents who returned the surveys, nine said that staff were always available and seven said that they were usually available when they were needed. They made positive comments about staff saying they are kind and helpful, plenty of two way communication, a homely atmosphere with loving care and attention, I am well looked after. The annual quality assurance assessment showed that nine of the care staff hold the National Vocational Qualification in Care at level 2. The home does not yet meet the standard that 50 per cent of care staff hold this qualification. The homes training matrix showed that staff have training in safe working practice and that there is a plan to ensure that all staff have regular updates during the year. The training coordinator described training as grouped into two pathways. Pathway one covers induction and all mandatory training in safe working practices. Pathway two covers more specialist topics which include dementia care and specialist healthcare topic such as pressure Care Homes for Older People Page 20 of 26 Evidence: damage prevention. All staff have completed pathway one and a number are following pathway two. The recruitment files of three members of staff who have been recruited since the last inspection were examined. All contained application forms, evidence of the staff member identity and a photograph. Interview records had been kept and gaps in employment history explored. A Criminal Records Bureau disclosure and two references had been received before the staff member commenced work. There was evidence in the files that an induction programme had been started and in most cases completed. 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. The home is well managed in the interests of the residents. Evidence: An experienced manager was appointed in June 2009. She is a registered nurse and has extensive experience managing care homes. She is in the process of applying to register with us. Residents were positive about the improvements in the home since her appointment and one commented there has been a welcome and positive improvement since the new managers appointment. The organisation has a quality assurance system in place. Residents and families views are sought about the care and services offered. Regular residents and family meetings are held and the minutes of these are shared with all. The manager is auditing care plans and medication administration on a regular basis and taking action where necessary. There is a monthly audit which is validated by the organisation on an annual basis. A senior member of the management team visits the home regularly and records are kept of those visits. Care Homes for Older People Page 22 of 26 Evidence: The home does not manage residents finances. There are facilities for the safe keeping of small amounts of money which residents may wish to use. Records are kept and receipts are given. There are health and safety policies and procedure in place. Records are kept of meetings and staff have had training in safe working practices. Maintenance records are up to date and essential equipment such as hoists have been checked. A requirement was made at the last inspection that the use of bed rails should be reviewed to ensure that they did not pose a hazard to residents. This has been addressed and the manager said that most residents and all residents who require bedrails have a profiling bed with integral compatible bed rails. Fire records were up to date and the home has met the requirements of the last fire officers inspection. 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. 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!