Inspection on 08/06/05 for 1 Williams Street

This inspection was carried out on 8th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 Williams Street 04/11/08

1 Williams Street 14/11/06

1 Williams Street 31/10/05

1 Williams Street 10/11/04

1 Williams Street 28/06/04

1 Williams Street 09/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE 1 William Street 1 William Street Fenton Stoke on Trent ST4 2JG Lead Inspector Wendy Jones Unannounced 08 June 2005 09:00 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 1William Street Address 1 William Street Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01782 746361 Choices Houses Association Limited Mr John Richardson Care Home 6 1 6 1 6 Category(ies) of LD registration, with number LD(E) of places PD PD(E) - 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) 1 - Learning Disability minimum age 43 years Date of last inspection 10 November 2004 Brief Description of the Service: William Street is a purpose built residential bungalow standing in it’s own grounds, the service is operated by Choices. The home provides 24 hour care for six service users with a learning disability, five of whom are over the age of 65 years. Facilities comprise of 6 single bedrooms, which are well decorated and furnished, all have wash hand basins. The lounge/dining area is open plan and spacious, and leads onto a domestic style kitchen, a separate laundry/utility room is also provided.Assisted bathing and shower facilities are provided in addition to two separate adapted toilets. The whole bungalow is accessible to wheelchair users.The rear garden is accessed via a ramp, which has handrails; it has seating areas for the benefit of service users, and appeared well maintained. The front driveway of the property provides off road parking.The home is situated in Fenton, with easy access to the main towns of Hanley and Longton, and is in walking distance to local shops, post office, public houses, take away’s and newsagents. All Primary Health care facilities are within four a four-mile radius of the home. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on 08 June 2005. There was two staff on duty and five service users in the home. The inspection included discussion with staff and meeting all service users; inspection of the environment, care records, risk assessments, staff rotas, complaints procedure, fire records, menus and menu planning, activities. What the service does well: The service provided ordinary living for service users in purpose built bungalow, set in a residential area, which provided sufficient communal and personal space. Each of the service users had their own bedroom and were supported to take responsibility for it, all bedrooms had lockable facilities had door locks, and appropriate furnishings and fittings. The service demonstrated a good standard of assessment, care planning, and risk assessment with evidence of regular reviews. Assessments of health care needs were detailed, with evidence that appropriate action had been taken to meet the identified needs. Agreed strategies for the management of challenging behaviour had proven to be effective. Person centred planning had been implemented with evident of some service user involvement this system ensured that service users wishes were respected and known to staff that supported them. Records for in house and external activities were in place, records were available to evidence that service users were consulted about the type of activities they preferred. Participation records showed when service users had been engaged in an activity both in and out of the home. Service users were provided with a choice of well-balanced and nutritious food. Menus were planned over a four-week period. Service users had free access to the kitchen and were supported to prepare drinks and snacks. Fridge freezer temperatures were monitored and recorded daily. There was a complaints procedure in place and had been displayed in the home. Records showed service user views relating to day-to-day decisions were sought on a daily basis and at meetings. Systems for the management and administration of medication were good; administration records were appropriately maintained. Health and safety 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 6 systems were in place, records indicating that daily and weekly audits of health and safety matters were undertaken. Individual and general risk assessments were in place and were subject to regular review. Fire safety checks were appropriately recorded. Fire drills had been carried out. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x Not inspected. This standard will be reviewed at forthcoming inspectors. EVIDENCE: 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) are: 7. 8. 9. 10. 11. • • • • • • The service user’s health, personal and social care needs are set out in an individual plan of care. Including their physical and emotional health needs. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) (7,8,9 older people), 6,7,8 younger adult, The standard of care planning and risk assessments was good. Assessment information was detailed and addressed the identified risks. The health needs of service users were generally well met, but further action must be taken to ensure that service users receive regular health checks. The medication at this home was well managed promoting good health. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 10 EVIDENCE: Each service user file contained a health assessment the OK Health Check; the assessments were revisited annually in line with Person Centred Planning. There was evidence of frequent health monitoring and appropriate action taken to address and health issues identified, this was specifically noted in relation to a service user pressure area prevention, continence, dietary and epilepsy needs. There was evidence of referral to Chiropody, dental and Dietetic services. There was also evidence of specialist health care input and multi disciplinary working. From a sample of records there was no evidence to confirm that two service users had received annual medicals, had received preventative health checks, had visited the GP or had received a medication review in 2005 or 2004. A sample of care records and care plans indicated that service users needs had been properly and thoroughly assessed, care plans and action plans available reflected the assessed needs. Reviews of care plans had taken place on a regular basis with the last review taking place 23/02/05. Records showed that service users were involved in discussion regarding their day-to-day lives; meetings were records for 11/05/05 and 16/02/05. Agenda items included the Residents Charter, Menu planning and food, Activities, Service issues, house rules, fire procedures. Service users were encouraged to participate in household activities and household chores, they were also encouraged as much as possible to take responsibility for their own bedrooms and personal laundry with support. Risk assessments, action plans and protocols to address specific health issues were in place, from discussion with Ms Deaville, it was clear that these protocols were known by staff and had been properly implemented and acted on. Discussion regarding specific health needs of service users identified that staff had some knowledge and understanding of service users needs. The records showed that behavioural management strategies had been developed to better support service users at times of high anxiety and indicated that they had been effective in reducing the incidence of behavioural disturbance with particularly with one service user since the last inspection. The records for medication administration were appropriately maintained, and signed, there were protocols in place for the administration of as required medication. Records of medication stock control, delivery and return were in place. Ms Deaville confirmed that she had undertaken a certificated medication course from Boots Chemist; she also confirmed that an internal 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 11 assessment of competence had been carried out. None of the current service users self medicate. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14,15 (older people), 12,13,17, (younger adults) Service users were supported to access the local community to participate and to be involved in activities of their choice and are of benefit to them. Dietary needs of service users were known and understood and efforts were being made to provide a balanced and varied selection of food to ensure a good nutritional intake. EVIDENCE: All service users had records of preferred activities (Participation Options) for both in and out of the home. During this visit one service user was independently attending a luncheon and activity club for older people. Other service users were engaged in fairly passive activities in the home such as listening to music, watching television. One service user was being supported with work, hobbies and interests on his personal computer. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 13 Access to the local community appeared to be limited at this inspection discussion with staff indicated that staffing constraints had affected the number and frequency of activities out of the home. Service users freely accessed the kitchen and were supported to be as independent as possible with staff support. One service user was observed making his own drinks. Menus were planned over a four-week period, no alternative choice was recorded. Discussion with Ms Deville confirmed that alternatives to the main meal choice were provided but were not recorded. It was recommended as good practice that alternatives to the main meal choices were recorded for each service user. Fridge freezer temperatures were recorded. One service user required a high calorie diet, two service users required staff support to assist with feeding at mealtimes. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18(older people), 22,23 (younger adults). The service has a complaints procedure in place, which provides service users, relatives and others with relevant information. The Adult Protection procedures in a place provided a robust framework for staff to follow to ensure the protection of service user from abuse. EVIDENCE: The complaints procedure was included in the service user guide, statement of purpose and displayed in the home. In the service user guide a more userfriendly version had been developed for the benefit of service users. The procedure provided service users, relatives and other visitors with the information they required to enable them to make a complaint or to contact other relevant agencies such as the CSCI and the Ombudsman. No complaints had been received by the CSCI in relation to this home. Adult protection procedures were in place, providing staff with the information and guidance necessary for them to recognise abuse and to report it. Additional procedures “confidential reporting” were in line with the Public Interest Disclosure Act. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 15 It was understood but not confirmed at this inspection that all staff received this training during induction, and could be referred for an up date periodically after that. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26(older people), 24-28 and 30(younger adult). The home was suitable to meet the needs of service users, with adequate communal space, sufficient bathing and shower facilities and single occupancy bedrooms. The facilities supported the service philosophy of encouraging service users to live as independently as possible. EVIDENCE: The service provided facilities that had been purpose built to accommodate services users of varying needs and abilities. The accommodation was on the ground floor, with wide hallways and doorways. The lounge, dining room and kitchen were open plan providing a spacious and a pleasant communal environment. The drive provide parking space for 3-4 vehicles, the garden and patio area to the rear of the property was accessible to service users, not 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 17 overlooked and provided a safe area for service users to relax and enjoy any nice weather. The carpet in the main hall way/ lobby, was ruffled presenting a potential trip hazard, action must be taken by the service to ensure that the carpet is made safe, or replaced to reduce this risk. Bathing facilities were provided in a large bathroom and a separate shower room. At previous inspection it had been identified that the bathroom was to be redecorated and adapted to create a more relaxing and welcoming environment for service users. It was of some disappointment that this had not occurred, and was hoped that the very positive changes proposed will be completed by the next inspection visit. An additional wc was located in closer proximity to the lounge and dining room. All bedrooms were for single use, had appropriate furnishings and fittings, and wash hand-basins, all exceeded the minimum standards for spatial requirements. Service users had been supported to personalise and own their rooms. Doors were fitted with door locks. It was identified that a special chair used by a service user had broken down the previous evening; staff had reported the fault. Due to the failure of the chair the service user was limited to spending much of the day in his bedroom. The need to pursue the repair was discussed as a matter of urgency, following the inspection the service confirmed that the necessary repairs had taken place within the timescale given. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30(older people), 32,35 (younger adults) The level of staffing disrupts consistency of care to service users, resulting in reduced opportunities for community access. EVIDENCE: There were two bank staff on duty during the inspection, and levels of staff throughout the working day were confirmed as two, with 1 waking night staff. The budgeted weekly hours were recorded as 401, clearly from the information and staff rotas these hours were not been achieved due to 2 staff vacancies, staff sickness and annual leave. Efforts had been made to supplement the staff team by the use of an established bank staff and transfer of staff from other homes. It was understood that a new member of staff was to start at the home the day after the inspection. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 19 The consequences of the reduction in staff numbers, was to limit service users access to community facilities and visits due to reasons of safety and to meet the recommendations of risk assessment. Levels of NVQ trained staff were reported to be high, with 4 at NVQ level 3, 2 at level 2 and 2 undertaking level 2. Both staff on the day of the inspection reported that they had a current first aid certificate. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home and from competent and accountable management of the service. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38 (older people),37,39.42(younger adults). The health and safety of services users was promoted and protected, through appropriate application of policies and procedures. EVIDENCE: The manager of the service had been approved as a fit person by the CSCI. Individual and general risk assessments were in place, which included the control measures to reduce the risk and the action required to address risk areas. All risk assessments were subject to periodic reviews. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 21 Health and Safety checks were carried out daily and records maintained, weekly fire alarm and emergency lighting checks were recorded, there was evidence of servicing of fire equipment. Fire drills were recorded in sufficient numbers to meet the requirements of legislation and good practice. The records of drills showed that all permanent staff had received fire drills, but evidence that there was a need for bank staff and night staff to receive at least two fire drills per year. Records of monitoring were also in place including copies of Regulation 26 visits on behalf of the provider. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 3 3 2 3 3 3 3 Score Standard No 7 8 9 10 11 Score 3 2 3 x x Standard No 27 28 29 30 3 x 2 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 3 34 x 35 x 36 x 37 x 38 2 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard MX 19 Regulation 13 Requirement Action must be taken to ensure that the potential trip hazard caused by the ruffled carpet in the main hall is eliminated, by stretching or replacing the carpet. The repairs to the specialist chair must be pursued for the benefit of the service user The service must ensure that all staff including night and bank staff are involved in fire drills. Timescale for action 15/06/05 2. 3. MX22 MX38 23 13,23 24 hours twice per year RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard MX15 MX29 Good Practice Recommendations Records of alternatives to the main meal choices should be recorded. The staffing levels in the home should be monitored and adjusted to ensure that service users opportunities to access community activities and events is not affected. 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 1 William Street E09 E51 S8217 1 Williams Street V229638 080605 Stage 4.doc Version 1.30 Page 25 - 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!