Inspection on 02/07/09 for Rivermead Care Home

This is the latest available inspection report for this service, carried out on 2nd July 2009.

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

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

Other inspections for this house

Rivermead Care Home 06/07/07

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Rivermead Care Home 123 Scarborough Road Norton On Derwent Malton North Yorkshire YO17 8AA     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: Pauline ORourke     Date: 0 2 0 7 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 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) 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 27 Information about the care home Name of care home: Address: Rivermead Care Home 123 Scarborough Road Norton On Derwent Malton North Yorkshire YO17 8AA 01653696942 01653691894 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.barchester.com Barchester Healthcare Homes Ltd care home 69 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 69 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admisson to the home are within the following categories: Dementia Code DE; Old age, not falling within any other category - Code OP and Physical disability - Code PD Date of last inspection Brief description of the care home Rivermead is a nursing home currently providing care for up to a maximum of 69 older people. The home is located in Norton, which has local amenities. Norton is very close to the market town of Malton, which has more services and rail links. The home has two distinct units. Those with general nursing needs are on Westow Unit (up to 30 Care Homes for Older People Page 4 of 27 Over 65 0 69 0 69 0 69 3 0 0 1 2 0 0 9 Brief description of the care home people) and those people with dementia and mental health needs are on Malton Unit (up to 39 people), which has access via a door with a keypad. This building is purpose built on one level, with well-maintained gardens for people and their families to enjoy. The service provides information about the home to prospective residents within a Welcome Pack. 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 quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 27 The key inspection has used information from different sources to provide evidence for this report. These sources include: Reviewing information that has been received about the home since the last inspection. Information provided by the registered person in an Annual Quality Assurance Assessment form (AQAA) A visit to the home by one inspector that lasted for seven hours. During the visit to the home twelve people who live there, four staff and six relatives were spoken with. Care records relating to eight people who live at Rivermead, six staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Rivermead for the people living there. Information about the home is available in a Service User Guide and the weekly cost of staying at Rivermead is between six hundred and thirty six pounds and nine hundred and ten pounds. The amount payable is dependent on a financial assessment. The Registered Manager was available throughout the day. 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: 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. Care Homes for Older People Page 8 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who decide to use this service can be assured their needs will be assessed to make sure that staff at the home, are able to meet those needs. Evidence: The case files for four people from the Malton Unit and four people from the Westow Unit were seen. Each file contained a comprehensive assessment of need. Prior to moving in to the home the registered manager or the head of one of the units visits each person. An inital assessment is carried out and this information is expanded on once someone moves in. The assessments cover all areas of personal care pertinent to the individual and their social interests to ensure that they can be cared for holistically. The assessments are also used to ensure that the staffing group has the skills needed to provide the level of care required if the person chooses to move in. If possible people are encouraged to have a trial period of a month to see if the placement is suitable, before they decide to move in permanently. Care Homes for Older People Page 11 of 27 Evidence: People are provided with information about the home in the form of a Statement of Purpose and Service User Guide. These documents are available in large print and will soon be available in braille. The manager indicated that they are looking at other formats that this information could be provided in to ensure it is accessible to more people in the community. Several people spoken with said that they had received information about the home before moving their relative in. 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 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 Rivermead have a detailed care plan in place and their personal, social and health care needs are well met. Evidence: The pre-admission information is used to develop a care plan pertinent to the individual and the eight case files seen each contained a detailed care plan. The care plans contained details such as: support with personal hygiene, support with communication, continence, nutritional assessments, moving and handling, mental health issues, pain, fears for the future and social interests. There was evidence that the care plans are reviewed each month, or more frequently if the persons condition changes. People spoken with were aware that staff kept records about the help and support they required. People spoken with said that they were kept fully informed of any changes or concerns about their relative in the home. Evidence was available that people get the medical support they require either from the doctor, district nurse, tissue viability nurse, optician, dentist or chiropodist. Advice is also sought from the dietitian when required. Where people have been identified as Care Homes for Older People Page 13 of 27 Evidence: being at risk from pressure sores the appropriate equipment has been provided. There is a clinical development nurse within the Barchester Organisation who looks at how the care provided can be improved and whether the trained staff need any further training to ensure their skills remain up to date. People spoken with said that they could see the doctor on request. The medication is provided by Boots in a monitored dosage system. The medication records seen contained a photograph of the person the medicines were for. The records checked were accurate and up to date. A medication round was observed and the trolley was always locked when the nurse was giving medication out. In each case file as well as in the medication records there was a list of household remedies that each person could take in addition to their prescribed medication. This list has been approved by their doctor. There was evidence of weekly audits carried out, this enables staff to monitor if any mistakes have been made and inform staff where these may have been made. There was also a list of specimen of staff signatures so that where errors may have been made they can be traced back to a specific member of staff. Throughout the visit people were seen to be treated with dignity and respect at all times. People spoken with said the staff are always willing to help and They dont have a lot of time but they do try and spend time with us On the Malton Unit the staff were observed interacting with people in a calm and assured manner. Relatives spoken with said that staff were always attentive and ensured people were dressed smartly and in their own clothes. People spoken with on the Westow Unit said that staff are very busy and dont always seem to have time to ensure people are clean and tidy Staff spoken with said that they spent time with people when they could although they were often busy helping people with their personal care. 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 are able to make choices about their life style and are helped to join in activities that they wish. They receive a varied and nutritious diet. Evidence: During the inspection it was clear that people can follow their own routines during the day. Staff were seen supporting people in their choices and the support provided is based on a person centred approach. Care plans identify peoples preferences as to how they like to spend their times including rising and retiring times. The care plans also contained information about the gender of carer preferred for personal care. One person spoken with said they could do what they wanted and staff didnt mind A wide range of activities are provided to all the people in the home. These include a gardening club, a baking group, musical sessions, quizzes, bingo, and in the Malton Unit there is a rummage box and drawers of clothes that people can investigate. There are two activities organisers employed and this allows for activities to be provided in groups or with individuals. The home also has its own mini bus and trips out are organised when weather and staffing permit. People in the home are also encouraged to retain their contacts in the local community. People are encouraged to attend regular meetings where they can voice their opinions on how about the home is run Care Homes for Older People Page 15 of 27 Evidence: and the activities provided. These meetings are attended by the chef and the heads of units. This means that they hear first hand what people in the home want and think. During the visit people were taking advantage of the fine weather and sitting outside. Staff were observed making sure they had plenty of drinks and were suitability protected from the direct sunlight. One person spoken with was concerned that the activities didnt always take in to account the sight and hearing difficulties of people in the home. This was discussed with the manager who said staff try to include everyone in the activites whatever their ability. Visitors are welcomed at any time and several visitors spoken with said we can come anytime and the staff are always welcoming and the staff are always patient and supportive of my relative here and they keep me informed at all times if there are any changes to their health Visits can take place in peoples own rooms or in the communal areas of the home. The kitchens were visited during the inspection and the storage facilities were found to be ordered and clean. The cooks speak to people living in the home on a regular basis to check the quality and choice of food provided. There is a choice available at each meal. Breakfast can be cooked to order or a continental style. The lunch meal is a choice of two main courses, if someone wants something different to this then it is provided, tea is a snack type meal. Drinks and snacks are available throughout the day and the afternoon snacks were a combination of healthy fruit and a variety of cakes. People said that this was usual and the standard of food was quite high. One person did say that they didnt always find the food was hot enough when delivered, this was discussed with the manager. Everybody in the home has an initial nutritional assessment and their weight gain/loss is monitored closely. Where necessary specialist nutritional advice is sought. The cooks have introduced a high calorie homemade drink from natural products for people who are on the move a lot and burn a lot of energy and they have been successful in helping people maintain their body weight without using prescription products. The garden is also starting to produce fruit and vegetables that are being incorporated in to the meals, it is planned that this will be expanded to include soft fruits for use in the home. Staff were observed assisting people at meal times in a sensitive way. Staff in the dementia unit eat their meals with the people living there and this allows for more social interaction. People are able to choose where they take their meals. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel their complaints are taken seriously and there are systems in place to protect them from harm. Evidence: There is a clear and readily available procedure for making a complaint. This document is kept in the entrance hall and is contained in the Statement of Purpose which is in each bedroom. There is also an observations box in the entrance to allow people to leave suggestions, praise or complaints. One complaint has been received by the manager in the last twelve months, none have been received by the Care Quality Commission. Whilst this document is available in large print a discussion was also held on providing it in other formats that will allow more people to access it. Information is also available about advocacy services that can be accessed if people are unhappy with anything. People spoken with during the inspection were clear they would take any concerns to the manager or to a head of unit and there was confidence that any issues raised would be dealt with quickly and appropriately. There is a clear Safeguarding policy and all staff receive training in these procedures during their induction then they have annual updates. Training has also been provided through North Yorkshire County Council for all staff. Staff spoken with were clear about their responsibilities if they suspected any form of abuse occurring within the home. They were also aware of the whistle blowing policy although refresher training should be provided in this policy. All staff are subject to rigorous checks through the Care Homes for Older People Page 17 of 27 Evidence: recruitment policy and dont start work until a Criminals Records Bureau disclosure or a POVA FIRST check has been carried out. 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. The standard of the environment within the home is good providing people with a comfortable and homely place in which to live. Evidence: Rivermead is a well maintained and clean home. It is divided in to two units, Malton Unit which specialises in the care of people with a dementia and Westow Unit that provides nursing care. Malton Unit has recently been extended to include a further ten en suite bedrooms and a new day space giving the unit three separate communal spaces. A life skills kitchen has been included in the re-fit and the decor around the unit is designed to promote memories and to allow people to interact with it. Westow Unit was seen to be well maintained and comfortable. There is an on-going programme of refurbishment and as rooms become vacant they are redecorated. The maintenance of the building is carried out by the property services team. Equipment used in the home is serviced at prescribed intervals and evidence was seen that gas and electrical systems had been serviced in line with their requirements. A tour of the home found it to be clean and odour free. There is a dedicated housekeeping team who work to a cleaning schedule to ensure all areas of the home Care Homes for Older People Page 19 of 27 Evidence: are cleaned on a regular basis. There is an effective laundry system and staff are trained in the correct system for handling soiled laundry. The grounds were well kept and free from hazards. Care Homes for Older People Page 20 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. People receive good quality care from trained, well-supported and well-motivated staff. Evidence: Each unit has its own staffing levels and staff team. On the Malton Unit there are two trained staff and six carers on duty for the morning and this level drops slightly to two trained and five carer on an afternoon and evening. On the Westow Unit there are two trained staff with four carers on a morning and two trained staff and three carers on an afternoon and evening. Each unit has one trained staff and two carers throughout the night. The home is supported by a separate housekeeping team, cooks and a laundress. People spoken with said that the staff are very discreet when necessary and they are always polite but you can have a laugh with them without them being cheeky another said the staff usually come very quickly when you call for assistance but sometimes they assess the urgency of the call when they are very busy another person who had been transferred using the hoist said they always take their time and make sure I am comfortable so I feel safe when they are moving me The nursing staff are supported to develop areas of expertise in their skill base to the benefit of the home. A clinical development nurse determines if there is any training Care Homes for Older People Page 21 of 27 Evidence: required by the nursing staff through a clinical development audit. Over 50 of the care staff have obtained their National Vocational Qualification Level 2 in care and staff spoken with said that the manager encourages them to do training. All of the staff on the Malton Unit have completed training in dementia care. The manager has a training matrix available so that she can monitor when people are due their statutory training in fire, first aid, food hygiene, infection control and manual handling. All staff have regular supervision and training needs are also identified at this time. All staff are properly recruited. Six staff files were seen and they each contained an application form, two written references, criminal records bureau disclosure, and training records. Staff spoken with confirmed they did not start working at Rivermead until their CRB disclosure had been received by Barchester Healthcare. Care Homes for Older People Page 22 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 live in a home that is well managed and systems are in place to protect their health and safety. Evidence: The registered manager is an experienced registered nurse and has her registered managers award. She provides clear strong leadership and is supported by a deputy manager. The manager has a clear vision for the home and encourages staff to undertake training on a regular basis. Staff spoken with said the manager is usually approachable although can be a little abrupt on occasion and she is a good manager and you can talk to her about anything Staff said she operates an open door policy and this was also confirmed by relatives. The registered manager and deputy manager are also supported by the two heads of unit who staff also feel able to talk to if they have any concerns. Barchester Healthcare has a comprehensive quality assurance system and information is gathered by a variety of means. In house surveys and audits are carried out on a Care Homes for Older People Page 23 of 27 Evidence: regular basis, and there are also monthly internal audits carried out and these are directed by the Director of Care and Quality and a monthly supervisory visit is carried out by the Regional Operations Director. Minutes of resident and staff meetings feed in to the development plan for the service. Other audits include, the care planning paperwork, nutrition, medication, pressure relief care and infection control. The cook speaks to people in the home on a regular basis to check the quality of the food remains high. Information gathered through the quality assurance system is used to inform the annual development plan for the whole service. The service no longer looks after personal monies for people in the home. Information provided in the Annual Quality Assurance Assessment told us that all the safety checks for equipment is up to date. Some of health and safety records were checked and they were found to be up to date. Risk assessments for fire, the environment, COSHH and people who live in the home are in place and reviewed on a regular basis. All accidents and incidents are recorded and when necessary they are reported to the Care Quality Commission. 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. 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 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!