Inspection on 13/06/06 for 191, Kneller Road

This inspection was carried out on 13th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

191, Kneller Road 17/09/07

191, Kneller Road 08/12/05

191, Kneller Road 07/06/05

191, Kneller Road 04/11/04

191, Kneller Road 25/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 191, Kneller Road Whitton Middlesex TW2 7DY Lead Inspector Simon Smith Unannounced Inspection 13th June 2006 2.30pm 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 1 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 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 2 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 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. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 191, Kneller Road Address Whitton Middlesex TW2 7DY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8898 5431 020 8898 5431 The Regard Partnership Limited Mr John Webster Ms Jackie Reid Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate one named service user over 65 years of age. 8th December 2005 Date of last inspection Brief Description of the Service: 191 Kneller Road is home to five adults with learning disabilities. The home is owned and operated by the Regard Partnership. The Regard Partnership operates a number of other, similar services in the surrounding area. The home’s fees currently range from £1495 to £2130 per week. The home is situated in a pleasant residential area and has good access to public transport networks and shopping and community facilities. A good standard of decoration has been achieved throughout the home and the property has a well maintained garden. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a range of sources when making judgements about the home. These included two visits to the home and discussion with residents, the manager and staff. Surveys were given to residents, relatives, staff and professionals who visit the home, including agencies that fund and monitor residents’ care. A sample of records was examined at the home, including staff and residents’ files. The inspector was made welcome during the visit and wishes to thank all those who gave their views about the home. Three residents completed surveys with staff support and returned them to the CSCI. Four relatives, four members of staff and a professional who visits the home also responded. All relatives returning surveys said that staff communicate clearly with them and that staff understand residents’ needs. Relatives also confirmed that they are satisfied with the care provided by the home. None of the relatives had needed to make a complaint. Comments made by relatives included: “Quite a few of the staff have worked there for many years and they know their clients well” “We have been extremely happy with (resident’s name)’s care and well being” (Resident’s name) “has always seemed happy and content” (Resident’s name) “is well looked after and is always happy”. Staff confirmed that they had been appointed following an appropriate recruitment procedure and were enthusiastic about their roles. Staff said that the manager gives them good support and that they are encouraged to attend relevant training. The visiting professional stated that staff communication with her is “excellent” and that she is informed of any changes in residents’ health. The home met 22 of 28 National Minimum Standards assessed at this visit. Six Standards were almost met and six Requirements were made. The home had taken action to ensure that all Requirements made at the last inspection were met. What the service does well: Promotes residents’ participation in their community. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 6 Supports residents to access social and leisure opportunities. Supports residents to develop and maintain positive relationships with their friends and families. Liaises well with other agencies where necessary. The manager has much experience in her role and knows the home and residents well. There is a stable staff team that provides good continuity of care for residents. Staff work to clear roles and responsibilities and communicate well with one another. 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. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. Clear information about the home is available to residents and other stakeholders. Residents’ individual needs are assessed. Residents are issued with a written agreement that sets out the terms and conditions of their placement. EVIDENCE: The home has produced a Statement of Purpose, recently reviewed, which gives details of the services and facilities provided and the aims and objectives of the service. The manager reported that she plans to review all residents’ assessments to ensure that these documents accurately reflect residents’ strengths and needs. The manager advised that this work forms part of a review of all documentation relating to residents, including care plans (see Standard 6) and risk assessments (see Standard 9). 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 9 One resident had moved to the home in March 2006. There was evidence that the home had obtained all available information about the resident before he moved in and that the admission was appropriately planned and managed. A three month review has been arranged to assess the suitability of the placement and to plan a programme of day services. The home has also sought advice on the management of specific issues through a referral to the community team for people with learning disabilities. Appropriate contracts were in place on the sample of residents’ files examined. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. 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. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. The home records residents’ needs and strengths and works with residents to identify goals that are important to them. Residents who exhibit challenging behaviour must have a care plan to enable staff to work consistently in managing the behaviour. Staff understand residents’ individual needs. Residents receive good support to make informed choices about their lives. There is a commitment to supporting residents in taking manageable risks, although some risk assessments required review. EVIDENCE: An individual care plan is in place for each resident. Care plans aim to reflect the individual skills, strengths, needs and goals of residents. One resident 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 11 exhibited challenging behaviour during both visits to the home but there was no evidence of a care plan to manage this behaviour. See Requirement 1. This issue is addressed further in the Personal and Healthcare Support section of this report. As highlighted in the previous section of this report the manager advised that all documentation relating to residents, including care plans and risk assessment, is currently under review. The manager advised that all but two staff have attended training in person-centred planning and it is hoped that future care plans will reflect this model of care planning. In the case of the resident who had recently moved to the home, an initial care plan had been drawn up by the manager, which was dated the day following admission. The care plan recorded the resident’s daily living skills, goals and the support needed to achieve these. The plan will be developed further following the resident’s forthcoming review. The manager and staff demonstrated a good knowledge of residents’ individual needs and a commitment to supporting residents in making informed decisions about their lives. Staff interacted positively with residents during the inspection visits and encouraged residents to make choices where possible. Observation during visits confirmed that residents are able to choose the way in which they spend their time at the home and residents’ programmes reflect individual needs and interests. Residents are able to access advocacy services if they wish to do so (see also Standard 15). Discussion with staff demonstrated that the home has a commitment to supporting residents in taking manageable risks. Risk assessments have been developed for specific activities undertaken by residents, although some require review. See Requirement 2. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. Residents are encouraged to involve themselves in the routines of the home. Residents are involved in their local community. Residents receive good support to maintain relationships with their families and friends. The home’s menu reflects residents’ preferences. EVIDENCE: Residents access a range of day opportunities appropriate to their needs and preferences and are involved in their local community. The manager stated that the resident who moved to the home recently has been encouraged to get to know his local community with support from his keyworker. The resident went out with his keyworker during the inspection. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 13 Residents attend at least one holiday each year. Two residents planned to go on holiday in the week after inspection, staying at a hired cottage in Hampshire. Residents are supported to maintain relationships with their friends and families. Two residents have regular social contact with advocates. The manager advised that a recent bereavement has affected one resident’s family contact but that staff are providing support to enable the resident to maintain contact with other family members. Interactions between staff and residents was positive during the inspection. Residents have unrestricted access to all communal areas of the home. Residents’ wishes and needs are clearly identified in their individual plans. Staff used appropriate forms of address when speaking to residents. The advertised menu indicated that the home provides a varied and wellbalanced diet. Staff cooked the evening meal during the inspection but some residents chose to involve themselves in mealtime routines, such as laying the table. The food prepared by staff during the visit was appetising and was well received by residents. Staff on duty encouraged residents to eat together but supported the wishes of those who wished to eat alone. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. Residents receive personal support in the way they prefer. Residents’ healthcare needs are met. Guidelines must be developed for staff to work consistently and effectively with residents who exhibit challenging behaviour. Residents’ medication is appropriately stored and accurately recorded. EVIDENCE: All residents are registered with local general practitioners and access other community healthcare resources as necessary. Staff demonstrated a good knowledge of residents’ individual needs and preferences. A standard format is used to identify and record residents’ healthcare needs and preferences relating to their care. Residents choose their rising and retiring times. Staff support residents to maintain their personal appearance in a manner which reflects their personality. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 15 As highlighted in the ‘Individual Needs and Choices’ section of this report one resident exhibited challenging behaviour during both visits to the home but there was no evidence of a care plan to manage this behaviour. It is important that staff are consistent when working with residents who challenge the service and the home should seek the input of appropriate healthcare professionals when developing guidelines to effectively manage challenging behaviour. The manager reported that the home has a good relationship with the local healthcare services and that community practitioners provide valuable support to the staff team. The community nurse gave positive feedback about the home, reporting that staff work well with healthcare professionals and external agencies. There is an appropriate system for the storage and administration of medication. All medication coming into or leaving the home is recorded. There are clear protocols governing the administration of medication. Individual medication records include residents’ photographs. Staff stated that medication is checked at every handover. Inspection of medication records for four residents revealed no gaps or errors. No residents self-medicate. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. Appropriate procedures are in place for the management of complaints. Training and guidance is provided for staff in the recognition, prevention and reporting of abuse. EVIDENCE: The home has an appropriate Complaints procedure. There have been no complaints made about the home since the last inspection. The service works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’. The Regard Partnership has a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. The manager reported that all staff had attended Protection of Vulnerable Adults (POVA) training in 2005. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to the home. The home is safe and reasonably decorated. The communal rooms of the home are comfortable and homely. Some areas of the kitchen require cleaning or repair. EVIDENCE: The home is situated in a pleasant residential area and has good access to local community facilities, open spaces and public transport networks. The communal rooms on the ground floor of the home comprise a large living room with dining area and a conservatory. There is a large, well maintained garden, which is well used by residents. There are enough toilets and bathrooms to meet residents’ needs. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 18 Staff advised that the kitchen will be refurbished in the near future. The extractor hood above the cooker needed cleaning and the extractor pipe was broken and needed replacing. See Requirement 2. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. The home has a stable staff team that provides good quality care to residents. Staff are appointed following an appropriate recruitment and selection procedure. Staff attend training appropriate to their roles. Staff should receive individual supervision more often. EVIDENCE: The home benefits from a stable management and staff team. The manager advised that no new staff have joined the service since the last inspection and that one member of staff has been promoted to senior support worker. The manager reported that the home recruits and shares bank staff with other Regard Partnership services locally. Staff interacted positively with residents during the inspection and demonstrated a good knowledge of them and their needs. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 20 A clear shift plan was observed to be in place, listing residents’ appointments and activities and identifying the member of staff responsible for support. Records demonstrated that monthly staff meetings are used effectively to address important issues within the service. The last staff meeting on file took place on 5 June 2006. Records for three members of staff were examined. All provided evidence of a robust recruitment procedure and confirmed that the home carries out appropriate pre-employment checks on staff, including Criminal Records Bureau disclosures. Files demonstrated that staff attend training appropriate to their roles but two of the three examined did not adequately demonstrate that staff had received regular individual supervision. See Requirement 4. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. The home has a skilled and experienced manager. Residents’ meetings should take place more often. The home must formalise the way in which residents’ views are sought and recorded. Health and safety records were comprehensive and up-to-date. Residents’ financial records were clear and accurate. EVIDENCE: The manager has a good deal of experience in her role and has a commitment to the continuous improvement of the service. Staff reported that the manager 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 22 is approachable and provides good support and leadership to the team. The manager provided a positive role model for staff in her interaction with residents during the inspection. Inspection of health and safety records provided evidence that: • • • • • • The fire alarm and emergency lighting system was checked in September 2005. Fire fighting equipment was checked in May 2006. The water tank and supply was checked and treated in July 2005. The Landlord’s Gas Safety Record was obtained in dated March 2006. The boiler was serviced in July 2005. The Certificate of Employers Liability Insurance is valid until March 2007. Cash records and balances for three residents were checked and found to be accurate. Staff checked all residents’ cash balances at handover. Discussion with the manager and staff confirmed that there is commitments to running the home in the best interests of residents and to ensuring residents’ wishes are met wherever possible. For example keywork meetings are held monthly. These meetings enable a resident and their keyworker to set and monitor individual goals. However the home must formalise the way in which residents’ input is recorded to demonstrate how residents are involved in the life of the home and consulted about decisions that affect them. Records indicated that residents’ meetings should take place more often (see Requirement 5) and the home must be able to demonstrate that there is a Quality Assurance system that effectively records residents’ views about the service and identifies areas for potential improvement. See Requirement 6. 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 3 X 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA6 & YA19 Regulation 12(1) 13(4) 15(2) Requirement Ensure that residents who exhibit challenging behaviour have a care plan addressing this issue to enable staff to work consistently in managing the behaviour. Care plans should be developed with the input of healthcare professionals where necessary. Ensure that risk assessments developed for activities undertaken by residents are regularly reviewed. Clean the extractor hood above the cooker and replace the extractor pipe. Ensure that staff receive individual supervision a minimum of six times per annum. Ensure that residents’ meetings are held at least once each month. Develop and implement a Quality Assurance system that effectively records residents’ views about all aspects of the service and identifies areas for DS0000017376.V300345.R01.S.doc Timescale for action 15/08/06 2 YA9 13(4) 30/08/06 3 4 YA30 YA36 23(b)(c) 12(5) 15/08/06 30/08/06 5 6 YA39 YA39 12(2)(3) 12(2)(3) 24 30/08/06 30/09/06 191, Kneller Road Version 5.2 Page 25 potential improvement. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 191, Kneller Road DS0000017376.V300345.R01.S.doc Version 5.2 Page 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!