Inspection on 18/12/08 for 1 Greville Road

This inspection was carried out on 18th December 2008.

CSCI found this care home to be providing an Adequate 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

1 Greville Road 23/05/07

1 Greville Road 17/01/06

1 Greville Road 05/05/05

1 Greville Road 16/12/04

1 Greville Road 24/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Greville Road 1 Greville Road Shirley Southampton Hampshire SO15 5AW     The quality rating for this care home is:   one star adequate 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: Nick Morrison     Date: 1 8 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: 1 Greville Road 1 Greville Road Shirley Southampton Hampshire SO15 5AW 02380393403 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): HM4011Smart@mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Miss Helen Smart Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 1 Greville Road is a residential home providing care and support to 7 older service users with learning disabilities. The homes standards are measured using the Care Homes for Adults (18-65) because of the complex needs of the service users living within the home. The home is a large domestic style house providing a homely and comfortable appearance inside and out, blending well with other homes in the local area. Each Care Homes for Adults (18-65 years) Page 4 of 28 care home 7 Over 65 0 7 Brief description of the care home service user has a room of their own that has been decorated and adapted to meet their individual needs and characters. The home is situated in Shirley, a residential area of Southampton. It is close to Southampton City Centre, Shirley High Street and a local amenities store with in easy walking distance. The home is local to Southampton Common and Southampton Sports centre where yearly attractions and community events are held. The home is owned by Hyde Housing and is leased to Mencap, a national organisation providing care and support to service users with learning Disabilities. Weekly Fees start at £400.00 and could be more dependent on need. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 18th December 2008 and lasted five hours. During this time we looked around the premises, looked at the files of three service users, spoke with those three people and two others and observed the support they were receiving. We also met with the two staff on duty. The Manager was not available at the home on the day of our visit and we spoke with her by telephone the following day. We spent time observing the interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to the services own self-assessment of the home. Care Homes for Adults (18-65 years) Page 6 of 28 Care Homes for Adults (18-65 years) Page 7 of 28 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 8 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 9 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. Service users benefit from having their needs and aspirations assessed prior to moving into the home. Evidence: The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does its own comprehensive assessment. Records showed that all assessments were in place prior to the person moving in and that service users and, where possible, their families had been involved in the assessment. 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. Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions Evidence: The homes self assessment told us that they were in the process of improving the care planning system so that it would be more person centered and so that service users had more involvement in their own care plans and risk assessments. Inspection of service users files during the inspection visit showed that this work had already begun. Individual care plans were in place for each person living in the home and were clearly related to the initial assessment and the ongoing information the home had gathered on each person over time. Service users were involved in the care planning process and signed their care plans to say they agreed with them. The home has a system in place for each service user to meet with their Keyworker on a monthly basis in order to review the care plan and the events that had happened Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: over the month to see if any changes were needed to the care plan, or if any other action was needed. The home referred to this as positive enabling and good records were kept of the meetings and these showed that care plans had changed in response to issues identified by service users. The format used for these meetings made good use of pictures and diagrams to make it easier for service users to describe how they felt about the service and support they were receiving. In their file each service user had a picture of their Keyworker and a picture of the Manager of the home along with a description of the kind of support they could expect from their Keyworker. From observation during the inspection we saw that people living in the home were supported to make some decisions for themselves. This included the kind of activities they were involved in, how their rooms were decorated and what time they got up and went to bed. We were concerned that decision making in respect of meals was restricted. (See Lifestyle section of this report). Risk assessments were clearly written and reviewed on a regular basis. Staff spoken with were clear about risk assessments for each person and the importance of supporting people in line with the risk assessments. Risk assessments were used to promote independence and support people living in the home to be involved safely in the activities they wanted to do. Some people living in the home were able to go out without staff support and this was supported by risk assessments. 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 benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. Evidence: Each person living in the home had a weekly timetable in place based around their own interests and the things they enjoyed doing. We spoke with one person in-depth about his timetable and he told us that he didnt have to do anything he didnt want to do but was supported to do what he did want to do. This included weekly trips out on his own. He told us that people living in the house all did different things, but some people were more active than others and so had busier timetables. Some people living in the home had external support workers coming into the home to take them out to planned, individual activities such as swimming. This also gave people the opportunity Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: to develop relationships with people other than those living and working in the home. Staff told us that one person who goes out on his own in the local community knows a lot of people. They said when they go out with him they are always surprised at the amount of people who come and say hello to him. Two people living in the home make use of local day services, but the others choose not to. One person uses the day services five days a week and the other only uses it one day a week. People living in the home were supported to maintain contact with their friends and families. The home had recently begun doing some work on supporting people to contact members of their family who they had not seen for a long time and this proved beneficial to them. Records were kept so that staff could support service users to remember birthdays of their friends and families and send a card if they wanted to. Food in the home was of good quality and people spoken with during the inspection visit said they enjoyed their meals. Observation of food storage areas showed that the home made good use of fresh ingredients and fresh fruit was always available in the kitchen for people to help themselves to. Staff supported people at lunchtime where necessary and ensured that mealtimes were relaxed and enjoyable. There was not a written menu of the food planned for the week, but there were sheets where staff recorded what people had had at each meal. On the day of the inspection visit we observed that the decision about what was for lunch was taken by the two members of staff on duty, without reference to the wishes of the people living in the home. The Manager told us this was contrary to the homes policy and should not happen. However, it was clear on the day that service users were not involved in the decision and we have made a requirement in respect of this. Since the inspection visit the Manager has supplied us with documentation demonstrating that service users were involved in menu planning and were consulted about meal choices each day. The Manager also acknowledged that, on the day of the inspection visit, staff had not followed the correct procedures in ensuring that people were offered choices. Care Homes for Adults (18-65 years) Page 14 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. Service users benefit from having their healthcare needs met and are protected by the homes medication policies and practices. Evidence: Care plans contained information on how people preferred to be supported with their personal care. The files of people living in the home demonstrated that healthcare needs were monitored and that people were supported to use healthcare services as necessary. There were comprehensive records relating to each persons health. Each persons healthcare needs were monitored and recorded on a regular basis. Where people had used healthcare services there were records detailing the time and date, the reason why they attended and any outcomes as a result of the consultation. Staff in the home liaised closely with healthcare professionals in the interests of people living in the home. Service users spoken with said staff always supported them to use healthcare services whenever necessary. The system for administering medication in the home was clear and was stated in the homes policies. Staff who were involved in administering medication had received Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: training and demonstrated that they had a good understanding of medication issues. Medication records were clear and up to date and all medication was stored appropriately and safely. There was a comprehensive system in place for monitoring medication with monthly checks by the Deputy Manager and crosschecking to minimise the possibility of any errors occurring. There were also regular audits by the chemist supplying the medication, the last of which said that the home was meeting all the necessary requirements. There were guidelines in place where people had been prescribed as necessary medication and good records were kept. Care Homes for Adults (18-65 years) Page 16 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 policies and practices of the home protect service users and promote their involvement in the running of the home Evidence: The home has a complaints policy in place and service users spoken with said they were clear about how to complain if they wanted to, but had not felt the need to make formal complaints, as issues were resolved in house meetings or in conversation with the manager or their keyworker. No complaints had been received at the home. The complaints procedure was written in an easy read format and service users had their own copy. The organisation also enables people to register a complaint in an easy way simply by using a red card system to highlight that they are unhappy about something. The home has a system in place for recording and responding to complaints if necessary. Each person living in the home had a financial risk assessment in place. As a result, some people kept their own money in their room and others had support from staff to manage and look after their money. There was an effective system in place for staff in the home handling service users money and good records were kept. Inspection of these showed that people had the amount of that they should have and that staff were aware of how to complete the Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: records accurately. Service users money was checked by two members of staff on each handover of shifts. The home has good policies and procedures in place for dealing with allegations or suspicions of abuse. All staff had received training in relation to this and those spoken with on the day of the inspection visit demonstrated that they understood their responsibilities within this. The Manager is aware of the local reporting procedures and how to use them. All service suers spoken with said they felt safe in the home and observation of interaction between service users and staff demonstrated that they appeared relaxed and comfortable with the staff. There was evidence that people living in the home had access to independent advocacy services as and when necessary. Care Homes for Adults (18-65 years) Page 18 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. Service users benefit from living in a clean and comfortable environment. Evidence: It was evident that effort had gone into trying to make this purpose built care home as homely as possible, with pictures, ornaments and domestic style furniture and decor. Individuals had expressed their personal tastes in their own rooms. Service users spoken with said they had everything they needed in their rooms and were happy with how their rooms looked. The home has established cleaning routines, which are being followed, with acceptable standards of cleanliness and hygiene throughout the home. Infection control procedures were in place in the home and staff spoken with were aware of these. Staff had also received training in Infection Control. No issues were identified during the inspection visit in relation to cleanliness or infection control. There were some buildings issues which had been identified during the Providers visits which had still not been addressed. These included the ceiling in the upstairs shower room which is moldy and in need of attention; bathroom tiles that were coming away from the wall and the flooring in the upstairs toilet which needs replacing. Although these issues had been identified they had not yet been actioned. The Commission understands there are currently discussions about the future use of the Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: building and this has had an effect on whether or not the housing association choose to make necessary repairs at present. The Manager should liaise with the Housing Association to ensure that, in the meantime, service users live in a home that is in a good state of repair. We also had some concerns about the safety of parts of the house and these are dealt with in the Management section of this report. Care Homes for Adults (18-65 years) Page 20 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. Service users benefit from being supported by adequate numbers of well trained staff and are protected by the homes recruitment policies and practices. Evidence: There were two members of staff on duty throughout each part of the day and night. In addition the manager was available during the daytime. Service users spoken with said there were sufficient staff available in the home to meet the needs of the people living there and to ensure that they could go out and use local facilities at specific times during the week. Staff also said they felt the staffing was sufficient to meet peoples needs. There was also a cleaner in the home which enabled care staff to concentrate on supporting people. Staff hours were planned aound the needs of people living in the home, particularly in respect of them being able to go and use the community. Staff training was well managed and good records were kept of the training that each member of staff had received, what training they still needed to do and when updates were required. Staff spoken with said the training was useful and relevant to their role and that access to training was good. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: Support and supervision records in the home showed that staff were receiving regular formal supervision sessions. The Manager was aware that staff appraisals were overdue and explained that they were planned for February and March 2009. Staff spoken with said they felt well supported and that the Manager was always available for advice and support in relation to their work. There were clear guidelines in place for staff so that they were aware of what was expected of them. These included Keyworker guidelines and a list of daily jobs that needed to be done. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a well managed home but would benefit further from more attention to health and safety matters and from being involved in plans for improving the service. Evidence: The Manager of the home is registered and has demonstrated that she has the skills, knowledge, qualifications and experience to manage the home. Records in the home demonstrated that she kept her training up-to-date and discussion with the Manager showed that she has a good understanding of developments in services. Staff spoken with said they were well supported by the Manager and that she was available when necessary and helpful. The home has a quality assurance system in place that was based on monthly visits from the Provider, staff meetings, service reviews and issues identified from within the home. Information gathered from these sources was fed into a Continuous Improvement Plan (CIP), which was available in the home. The plan was detailed and Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: was reviewed on a monthly basis by the Manager and Deputy Manager. It identified issues and what needed to be done in response to them. It also highlighted how issues had been identified. Most were highlighted by teh Provider or by staff in the home. There were no items on the CIP that had been highlighted by people who live in the home and the home needs to do more work in ensuring that service developments relate to the views of people using the service. Health and safety issues in the home were generally well maaged and good records were kept of health and safety assessments, issues and actions. Individual service users had risk assessments in place concerning which cleaning materials they could use. Staff had received training in health and safety and there were regular checks of the building. Despite this, we found during the inspection visit that the garden area contained items that needed to be thrown out or stored properly. This included tins of paint, paint trays and brushes, and a ladder. All of these items posed potential risks for people using the garden area and we made an immediate requirement that the home attend to this. On the fire escape we found a paint roller, an old piece of wood, an old piece of metal and an old chair. Further down the steps was a pile of plastic pegs. All these represented a potential risk to people who may need to use the fire escape in an emergency. We made an immediate requirement that the fire escape is o be kept clear. Care Homes for Adults (18-65 years) Page 24 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 25 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 1 17 12 The home must ensure that service users are consulted about meals and given the opportunity to make decisions about what they want to eat So that service users are able to exercise their right to choose their own meals 27/02/2009 2 42 13 The home must ensure that 27/01/2009 all hazards are removed from the garden area So that service users are not at risk of tripping when using the garden 3 42 13 The home must ensure that 27/01/2009 all hazards are removed from the fire escape So that service users are not at risk of tripping should they need to use the fire escape. 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. Care Homes for Adults (18-65 years) Page 26 of 28 No. Refer to Standard Good Practice Recommendations 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!