Inspection on 11/12/08 for Prudential Care Home Ltd

This is the latest available inspection report for this service, carried out on 11th December 2008.

CSCI 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.

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Prudential Care Home Ltd 35 Ickburgh Road London E5 8AF     The quality rating for this care home is:   two star good 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: Anne Chamberlain     Date: 1 1 1 2 2 0 0 8 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 Adults (18-65 years) 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 Adults (18-65 years) 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Prudential Care Home Ltd 35 Ickburgh Road London E5 8AF 02082111957 02082117406 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) : Prudential Care Home Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 6 The Registered Person may provide the following categories 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: Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of service users who may be accommodated is: 6 Date of last inspection Brief description of the care home Prudential Care Home is registered to provide care for six adults, male or female with mental health disorders. The home opened in 2008. It is a three story terraced house and comprises six bedrooms, a kitchen diner, lounge and office, with adequate toilets and bath/shower facilities. There is an enclosed garden. The home is located in a central location in Upper Clapton, close to all amenities. Care Homes for Adults (18-65 years) Page 4 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is two stars. This means that the people who use this service experience good quality outcomes. This report is written on behalf of the Commission for Social Care Inspection and the terms we and us will be used throughout. This is the first inspection of the home. Prior to the inspection a well completed self assessment document, the Annual Quality Assurance Assessment was received. We inspected against all key standards and the inspection was unannounced. We spent around seven hours in the home, spoke with servicer users and staff and observed part of a staff meeting. We were assisted by the manager. We made a partial tour of the Care Homes for Adults (18-65 years) Page 5 of 28 home and garden and inspected the arrangements for the administration of medication. We would like to take this opportunity to thank the service users staff and deputy manager for their contribution to the inspection. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. The home has a clear understanding of its remit and would only offer a placement based on sound assessment. Evidence: There are currently five people in the home. The deputy manager was very clear about the criteria of need which the home can work with as detailed in the mission statement, i.e. people with severe and enduring mental health needs who may have some forensic history but are currently mentally stable. The deputy manager explained that should a referral be made he would make informal visits to the prospective service user, and laise with the social worker and other professionals involved with the individual. The person would be offered visits to the home and invited to have meals there. Initial assessment would be made appropriate to offering a short term service, but a residential six week assessment would be undertaken before a longer term placement Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: was offered. Files examined evidenced a detailed referrals and careful assessments of need. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care planning and risk assessment are strengths. The home empowers decision making. Evidence: We examined the file of the person who had been at the home the longest and the person who had just come to the home. The care planning in the home was well documented. Care plans are sectioned up, for example income, emotional and mental health, aggression, and are built up from admission. This was evidenced in the files. The care plans were all signed by the service users and the deputy manager and dated. The deputy manager stated that each part of the care plan is evaluated by him every month for the first three months. After that if the service users and their care plans had settled they would be evaluated every three months. At six months a need and risk review would be undertaken. Some of the service users have spent time in institutions of one kind or another where Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: decisions affecting them have been outside of their control. They seek reassurance when taking decisions. The deputy manager stated that the staff advise and facilitate to empower. They help service users to examine their options and reassure them that they have made a properly thought out decision. Risks tend to be around non compliance with medication (leading to relapse), use of illicit drugs, getting into trouble in the community with the police or others. The deputy manager explained that risk assessment is integrated into the care plans and that the strategies to reduce risks are there too. This was evidenced in the files. i.e. the risk is stated under goal and the actions to reduce under plan and intervention. The deputy manager stated that for the service users the main motivator to comply with their own risk reduction is being able to stay on at the house which they like. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Service users are supported to access any appropriate activity they choose. Positive relationships are encouraged and supported and daily routines are individual. Meals and mealtimes reflect choice and variety. Evidence: The service users at the home are assertive individuals who know what they want to do. However they sometimes lack motivation and confidence. The deputy manager said he sees the staff role as supporting the service user to be well enough to identify something they want to do, and then to support them to do it. He felt that the role is not to pressurize service users into having a structured life and taking on activities they are not really interested in. We noted that the policy on community links and social inclusion states that there is no restriction on visits or social contact and that service users are to able to use shops, pubs, the cinema, library and places of worship. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: The AQAA states that transport is always available and the deputy manager confirmed that he has the use of a minibus. One service user has a passion for model making. He is fully equipped to do this with boxes of equipment and we saw photographs of him sitting at a table in his room doing what he enjoys most - making models. The home shares a worker who supports service users in the community. We had a chat with her. On the day of the inspection she had been out Christmas shopping with a resident. She told me that she had taken someone swimming and they had had a capuccino and danish pastry in the cafe at the leisure centre. The service user had told her this was his first capuccino ever and he liked it! She told me she had had a request to buy some electrical items from another service user. She and the manager were working out where these particular items would most likely be stocked. It was clear that they were both keen to assist the service user. We noted that the home has TV, sound system and a really nice private IT corner in the hall with desk chair, computer and internet access. The service users generally have families and friends whom they see. The home supports and encourages the relationships but allows the service user to control the contact. The homes policy on daily routines states that there should be privacy, personal dignity and flexible, adaptable working arrangements. The deputy manager described to us the service users individual daily routines. Within this the home works to ensure that medication is administered at the correct intervals and people have a reasonably healthy lifestyle with personal care, decent meals, fresh air etc. The AQAA states that dietary specifics like halal and afro caribean food are taken into account. The home runs an open kitchen arrangement. Between the fridges, freezers and cupboards it had an excellent stock and variety of foods. There was a pile of sandwiches made and under cling film on the dining room table at the start of the day, in case anyone wanted a snack. A service user helped himself to cereal which was his preference. The deputy manager said that staff will cook for service users or support them to cook, whichever is preferred. There are not set menus and people decide what they want to eat and when. However the home keeps a record of cooked food temperatures and also samples of cooked food (for three days). The records indicated a variety of hot meals had been cooked. The deputy manager said that he enourages service users to come along with him to the supermarket and some do. He encourages them all to make lists of things they want or need and he picks them up with the Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: shopping. We had the strong impression, confirmed by the manager, that there is a generous budget for running the house. Friday is takeaway night and people have whatever they choose. We noted that the policy on meals stated that they should be varied and nutritious and eaten in an unhurried and relaxed way. We looked at the contents of the refrigerator and noted a couple of items which should have had opened on dates and did not, a tub of coleslow and a packet of ham. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Personal support, healthcare and medication administration are delivered to a high standard. Evidence: The main function of the home is to offer a stable consisent environment, supporting service users to be compliant with their medication. Alongside this they offer a therapeutic approach and substantial emotional support. This is mainly provided through intense keywork sessions, which were evidenced on files. In answer to a question the deputy manager was able to describe well the signs which would indicate to him that a particular individual was experiencing a deterioration in mental health. The main medical involvement is with the mental health services but other health needs are addressed, and we saw evidence that an optician is coming to the home, also service users will see the dentist. We inspected the arrangements for the administration of medication. The home keeps a record of medication coming into the home and disposed of. The pharamacisit signs Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: for medication returned to him. Medication is stored in individual locked cupboards for service users. The keys to the cupboards are kept by the senior member of staff on duty. The deputy manager has a second key. There is a specimen signature sheet at the front of the medication folder. There were forms signed by service users giving their permission for medication administration. The medication administration record sheets have a photograph of the service user attached. Medications are generally dispensed in blister packs, although this is variable. We checked the medications for two service users. There were no discrepancies. The deputy manager stated that there have been a few errors in that a signature has been missed. He audits the medications weekly so any discrepancy or error is picked up quickly. This was evidenced. The home does not keep any homely remedies. All staff are able to administer medication as they do medication training as part of their induction to the home. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The home listens to the views of service users and has measures in place to protect and safeguard them. Evidence: The deputy manager has set up a log book for recording complaints. This was appropriately sectioned so that the progress of a complaint could be recorded. The home had a complaints leaflet pinned up on the noticeboard. We pointed out that it did not show the stages and timescales and the manager said he would add these. So far the home has had no complaints. The home is part of a group of four and they all have the same policies and procedures. We viewed the policy on safeguarding. It stated that any safeguarding allegation must be reported to the local authority for any action they want to take. The home has a copy of the local authority policy. We suggested it would behelpful for staff to display the flow chart in the office and the deputy manager copied it and pinned it up on the noticeboard. We noted that the home has a policy on bullying. All service users are quite independent in managing their finances. However a service users did state how helpful the deputy manager had been in assisting him to sort his benefits out. Care Homes for Adults (18-65 years) Page 18 of 28 Care Homes for Adults (18-65 years) 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 environment of the home is clean, comfortable and very pleasant. Evidence: We made a tour of the environment of the home excluding the individual rooms of service users. The home is newly opened and has been totally renovated and refurbished. The standard of decor is very high and the home is comfortably and adequately furnished. The accommodation is on three floors and in addition to the five bedrooms there is a semi basement kitchen/dining room and sitting room, an office and adequate bathroom/shower/toilet facilities. The deputy manager said that they do employ a weekly cleaner but night staff also undertake cleaning. The home was very clean on the day of the visit. There is a covered area of decking outside of the house and the laundry machines are situated there. The home does not have any clinical waste and all service users deal with their own laundry, with help if they need it. Beyond the covered area is garden which is well enclosed with good fences on all sides. It is presently just shingle but clean and tidy. The deputy manager said they plan to get some plants in the Spring. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: As previously mentioned the home has a computer corner which service users can use. Care Homes for Adults (18-65 years) 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff are safely recruited, well qualified, trained and supervised. Evidence: Recruitment is handled by the head office of the organisation. The AQAA states that all staff have references taken up and a Criminal Records Bureau (CRB) check and Protection of Vulnerable Adults (POVA) check undertaken. The deputy manager also stated that this was the case. There was a sheet in each file which verified this. The staff ratio at the home is one staff member and the manager on shift during the week. At the weekend this is a senior carer and a staff member. In addition there is a carer available to support service users in the community. The AQAA stated that the staff team includes a mental health nurse, the deputy manager has the Registered Managers Award (RMA) and NVQ 4 with a diploma in mental health and psychiatry, there is also another NVQ 4 holder and another working towards NVQ4, others hold NVQ 2 or 3 or are working towards them. The staff group is ethnically diverse, reflecting the local population. Staff induction is achieved with DVD instruction followed by tests. We viewed the evidence for staff induction with a pile of DVDs which included Medication, Health and Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Safety, Challenging Behaviour, Infection Control, Fire, First Aid, Food Hygiene, Manual Handling, Abuse, Concerns, Whistleblowing, and Risk Assessment. We viewed two staff files. There was evidence on file of staff induction in the form of a certificate from the makers of the DVDs (BVS). The deputy manager stated that staff renew their core training every year by going through the induction material again. He stated that he is devising tests to go with the DVDs so that there are different questions the second time around. We saw the answers sheets which he was working on. A renewal of induction certificate is issued by the home. Staff also undertake courses on special topics relevant to the work, and we saw certificates on their files. We viewed the evidence of supervision. A senior carer supervises two staff and the deputy manager supervises him and the rest of the staff. Supervision notes were signed and dated by both parties and the content was substantial. The home has only been open a short while but at this stage the frequency and regularity of supervision is satisfactory. A staff meeting was being held on the day of the inspection and we observed part of it. The deputy manager facilitated the meeting encouraging the staff to participate with their views. Good practice was shared and we had the impression of a staff team with high morale. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 run, and quality assurance is integrated into practice. The recording is conscientious and health and safety practices are properly observed. Evidence: The home is very well run. The deputy manager has been acting as manager and is fairly new to the role. However he demonstrated a keen, enthusiastic attitude and leads by example. He is line managed by a very experienced manager within the organisation. There is a structure and systems in place to ensure the proper planning, delivery and recording of every aspect of care in the home. The record keeping was well evidenced clear and comprehensive. The AQAA told us that there is an in house quality assurance questionnaire, and that family and professional feedback are sought. It states that there are monthly residents meetings and we saw the minutes for these. We saw a care worker survey which had been devised. The home has been open for only a few months but we felt that the ethos underlines pro-active quality assurance at every level. The deputy manager Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: stated that the service users are assertive people who would let you know how they feel about things. The home has an environmental risk assessment, a fire risk assessment and a fire safety assessment. The fire alarm system (with call points) is tested every week and we saw evidence that it was last done on 5/12/08. The emergency lighting is tested every month and evidence was seen. The daily temperatures of the fridges and freezers were recorded. The home stores the Control of Substances Hazardous to Health (COSHH) items appropriately in a locked cupboard. They had a folder of data sheets. We checked one product and could not straightaway find the data sheet for it. We asked the manager to check that all the sheets are there for every product and he agreed to do this. We noted two first aid boxes, one in the office and one in the kitchen. Also a fire blanket in the kitchen. There is a total ban on smoking inside the house and this seemed to be fully respected and enforced. There was no smell or evidence of smoking. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 2 3 17 22 42 Fresh food which has been opened and stored in the refrigerator should have an opened on date on it. We recommend that the complaints leaflet show the stages and timescales for complaints handling. The deputy manager should check that he has a data sheet for every COSHH product stored in the home. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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 Adults (18-65 years) 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!