Inspection on 09/03/10 for Innage Grange

This is the latest available inspection report for this service, carried out on 9th March 2010.

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

Innage Grange 17/07/06

Innage Grange 26/10/05

Innage Grange 26/04/05

Innage Grange 03/12/04

Innage Grange 09/08/04

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 08/06/2011.

Key inspection report Care homes for older people Name: Address: Innage Grange Innage Lane Bridgnorth Shropshire WV16 4HN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Powell     Date: 0 9 0 3 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Innage Grange Innage Lane Bridgnorth Shropshire WV16 4HN 01746762112 01746765802 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.coveragecareservices.co.uk Coverage Care Services Ltd Name of registered manager (if applicable) Mrs Pauline Tremellen Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 52 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 - Code OP, Dementia - Code DE Date of last inspection Brief description of the care home Innage Grange is a care home registered to provide accommodation and personal care for a total of fifty-two older people - twenty-one of whom may have an associated mental health disorder - with five beds being dedicated to the provision of respite care. Owned by Coverage Care Services Ltd, and managed by Mrs Pauline Tremellan, this Care Homes for Older People Page 4 of 27 Over 65 0 52 52 0 Brief description of the care home purpose built, single storey, brick building, is divided into five discrete units, each providing single-room en-suite accommodation. Two of the units cater for people with dementia, and the remaining three are for elderly frail people. The Units are linked by an internal street setting, incorporating a small shop, a communal space provision for the whole home, a small library and craft room. Each Unit having its own communal, recreational, and dining space. The gardens are well maintained, have sitting areas, and are accessible to individuals of all abilities. Bridgnorth Town Centre is within walking distance of the home allowing relatively easy access to all amenities, including a variety of shops, pharmacy library, and post office. Innage Grange benefits from having its own minibus enabling access to all local healthcare facilities, community amenities, and for social outings. Fees are made available to people wishing to use the service and readers are advised to contact the home directly. Additional charges are applied for hairdressing, toiletries, newspapers, and for escort to routine appointments, e.g. hospital. Care Homes for Older People Page 5 of 27 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 9th March 2010 by one inspector over a period of approximately five hours. A range of evidence was used to make judgements about this service to include discussions with people using the service, the registered manager 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. Two 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 helps us understand the experiences of people who use the service. An Annual Quality Assurance Assessment (AQAA) document was posted to Innage Care Homes for Older People Page 6 of 27 Grange 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. 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 given to prospective clients by the manager upon enquiry. Readers wishing to know more about this information should contact the service directly. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The service has been assessed as giving excellent outcomes to the people living there and we didnt identify any areas that needed improvement. However the manager acknowledges that there is always room for improvement and continues to make plans to improve the home. Care Homes for Older People Page 8 of 27 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 27 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 27 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 completed AQAA told us we complete a full assessment to ensure that the needs of the individual can be met on admission and we review this regularly. We encourage service users and their families to visit the home prior to admission. We like them to chat with other service users and staff and to discuss any concerns that they may have, we also like them to come and have lunch, so they can get a feel of the place. We looked at the records of someone who had recently moved into Innage Grange. There was a completed assessment which identified the persons needs and some issues that needed addressing should they move into the home. This included Care Homes for Older People Page 11 of 27 Evidence: arranging for them to see a district nurse and the audiologist. When we looked at the care plan and daily records for this person, we could see that the home had taken action about these issues and had arranged for the district nurse and audiologist to visit the person once they had moved into the home. We saw that the assessment was detailed and noted that information gathered during the assessment process was detailed enough to allow a good quality care plan to be produced from it. We met the person concerned who told us they were satisfied with the admission procedure and that they had been given the opportunity to view the home before making a decision about moving in. They had lunch with other residents, which their relative who had accompanied them on the day also enjoyed with them. People are provided with a statement of purpose and service user guide which gives them information about the home. The home does not provide intermediate care. Care Homes for Older People Page 12 of 27 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: We examined four care plans during our visit to the home, they reflected the needs of the person involved and we saw that they have been reviewed regularly. Care plans were excellent and written in a very personal way; individual to the person they are written for. Where possible people are involved in their care planning, if this cannot be done, then they are written with the input from the persons representative. We saw signatures from the people involved in the care planning process. This demonstrates to us that people are consulted about their care and their likes and dislikes. They contained risk assessments that are developed to minimise the risk of harm in peoples every day activities, which enable them to live a full and active life without being restricted unreasonably. People consulted as part of the inspection process told us staff are kind and provide Care Homes for Older People Page 13 of 27 Evidence: good care and support in a dignified and respectful manner. People are supported to have contact with other health care professionals, Doctors and other heath care professional visits are recorded along with any treatment given. We saw evidence of audiologist visits, hospital appointments and the chiropodist was visiting on the day of our inspection. We examined the medication and the way it was managed, we found that there were no omissions in the records and that the medication is stored as required. The staff receive medication training. We saw evidence of training certificates on staff training files. Only staff that have been assessed as capable are allowed to dispense medication. They are re assessed every three months to check their competency. Care Homes for Older People Page 14 of 27 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 the home 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: The home is divided into five areas where people live and eat in small groups. Each area has its own comfortable lounge, dining area and kitchen where people who live at the home and their visitors can prepare drinks and snacks. There are several areas throughout where people can sit, which range from busy areas with lots going on to quiet areas where they can sit alone. The AQAA says that, We now have an activities coordinator who works with the service users and discusses with them what they would like to do. This is important for the well-being and keeps any interest they may have alive. Visitors are welcome and are made to feel that this is their relatives home and they must make themselves part of the home. We offer a varied menu catering for all dietary needs and there is a nutritional chart in the care plan, and we provide for service users with diabetes, low-fat diet, low salt diet etc. We provide individual and personal activities. We gain this information through discussion with service users via service user meetings which take place monthly, minutes are always displayed on each unit. We have a varied activities program that is displayed monthly, again these Care Homes for Older People Page 15 of 27 Evidence: activities are discussed with service users and feedback from them is very important. We saw photographs of activities that have taken place, including a visit from the exotic animal man. One person told us of his interest in steam engines and how is enabled to visit local steam rallies. We saw evidence of the residents meetings that have taken place. We noted a suggestion had been made for DVD evenings. We spoke to the person who suggested this, who told us that evenings of this nature now take place. Mealtimes allow people to make choices for themselves, while being supported and enabled. The dining rooms are small and intimate. People living at the home eat in small groups and we observed lunch being served in one of the lounges. There was a relaxed atmosphere. The meal looked appetising and smelt appealing, people are able to choose their meals and an alternative will be provided on request. The tables were attractively set and condiments and drinks were available on the tables. One member of staff told us of how one person regularly enjoys a meal with their family when they visit. Care Homes for Older People Page 16 of 27 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. The service has a complaints procedure which is accessible so that people who use the service have information of how to make a complaint about the home if they need to. Training is provided so that people who use the service are protected from abuse and have their legal rights protected. Evidence: There is a complaints procedure in place which is contained within the service user guide. It was stated on the completed AQAA and confirmed by the manager that there have been two complaints since our last visit. There have been no complaints to the Care Quality Commission. We examined the complaints book, details of the complaint, investigation and outcome were clearly documented. Both of these complaints led to referrals into the safeguarding of adults process, neither complaints/referrals were substantiated. People we spoke to were complimentary about the service provided by the staff. There were no complaints from people consulted as part of the inspection process. Staff confirmed they are trained in adult protection; we saw evidence of training certificates on staff training files. The manager has attended the deprivation of liberties safeguarding awareness day, mental capacity act and adult protection training. Care Homes for Older People Page 17 of 27 Evidence: We examined two care files for people who lacked capacity. We saw completed care plans regarding delivery of care that clearly outlined to staff how to deliver care in the least restrictive way. Care Homes for Older People Page 18 of 27 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 the home 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: During a tour of the building we saw that the home was clean, furnished comfortably and safe. People moving in are encouraged to personalise their rooms. The rooms all have en suite facilities and each group area has a bathroom with an assisted bath. People have free access to interesting and safe grounds, where they can sit and enjoy the garden in nice weather. An infection control audit carried out by Telford and Wrekin infection control officer scored 93 with positive comments about infection control standards at the home. The laundry was clean and tidy. Personal protective equipment was available for staff use to enable them to maintain good infection control and we saw staff using it appropriately. Staff spoken to confirmed that they have undertaken infection control training, we also saw evidence of certificates on staff training files. A new extension is currently being built at Innage Grange which will provide care for 31 people. It will consist of thirty one elderly mentally frail nursing care beds. Care Homes for Older People Page 19 of 27 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: It was stated on the completed AQQA CRB checks are completed and references are sent for. Our interview process is comprehensive and rigorous to ensure we employ staff who are competent to provide the care we expect for our service users. We have 96 qualified NVQ staff. We are committed to providing training for all staff whether this is mandatory or other subjects they want to undertake. We source training from all areas and use the colleges for accredited training as much as possible. We looked at the file of one staff member employed since our last inspection who was on duty during our visit to make sure that pre employment checks had been undertaken. This was so that we could see the home are checking staff as being suitable to work with vulnerable adults. The file was 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 both directly and indirectly staff supporting people throughout our visit, they did this with respect Care Homes for Older People Page 20 of 27 Evidence: and were professional at all times. Training for the staff is good. We looked at training completed by staff and saw the relevant training certificates on staff files. Training included first aid at work, moving and handling, protection of vulnerable adults and infection control. The care staff we spoke with displayed a good knowledge of the people in the home and understood their needs.The manager stated in the completed AQAA that over 96 of the care staff have obtained a nationally recognised care qualification NVQ at level 2 and above. This exceeds national minimum standards. All staff are formerly supervised and appraised; we saw records to support this. Staff spoken to 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 completed work book and spoke to a relatively new member of staff who told us they thought the induction process was there and equip them with the knowledge they required to start the job. Care Homes for Older People Page 21 of 27 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 the home because it is effectively managed in the best interests of the people living and working there. Evidence: The manager was at the home when we arrived, she facilitated the inspection, which was done in an open and helpful way and everything we asked to see was quickly produced. The registered manager is suitably qualified to manage the care home and has a number of years experience in the care sector. She has clear values and works closely with the people who live at the home and staff to achieve a high standard of service at Innage Grange. While taking to the manager it became evident from the way she talked that she was committed to offering the best service possible to the people who live at the home and had a good understanding of the services policies and procedures and was able to implement them. Care Homes for Older People Page 22 of 27 Evidence: The AQAA was well written and was delivered to us within our timescales. In it the manager gave us all the information we needed and gave us examples of good practice to evidence what it told us. She also identified areas that needed improvement and told us how they would implement the improvements. 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. Staff report the care home is managed well and they feel supported by the manager to do their job. This ensures that people living at the home receive consistent care and support of a good standard. It was stated on the completed AQAA that there is a policy in place for the management of peoples money and financial affairs. We discussed the system in place and were satisfied that there is a robust system which protects people who place money and valuables in safe keeping. Quality Assurance Monitoring is a priority to the home to assist with areas of development. Feedback is sought from people who live at the home, relatives, professionals and staff to include individual views. Through this assurance monitoring the home is able to continually plan and improve an evolving service. 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. Some comments we saw in thank you cards from relatives who have had a loved one stay at the home include, Our sincere thanks for the excellent care you gave our mother. We have been so impressed with the level of care that X has been given. It has far exceeded the routine care that might have been expected. The gentleness, patience and thoughtfulness of the staff has helped X in their recovery. Nothing has been overlooked, mentally, physically or emotionally that can make X more comfortable. An article in the local newspaper from a family whose loved one had been cared for at the home wrote Sir Bridgnorth residents are blessed with many excellent amenities and services, but top of our list has to be Innage Grange care home. Our mother passed away recently Care Homes for Older People Page 23 of 27 Evidence: having lived Innage Grange for four years. She was happy, settled and Innage Grange was her home. The burden of stress and worry, and the practicalities that inevitably come when ones elderly parent with dementia or Alzheimers were shared with the wonderful team working at Innage Grange. When she first moved into Innage Grange, Mum enjoyed all the facilities and social activities available to her and at the end of her life she received kindness and care is second to none. Our family will be eternally grateful that fate brought our Mum to live at Innage Grange when she could no longer remain in her own home. Do angels actually exist? Perhaps they do in the form of a dedicated staff who work in care homes such as Innage Grange. Care Homes for Older People Page 24 of 27 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 25 of 27 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 26 of 27 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 27 of 27 - 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!