CARE HOME ADULTS 18-65
30 Lower St Helen`s Road 30 Lower St Helen`s Road Hedge End Hampshire SO30 0LX Lead Inspector
Mrs Pat Hibberd Unannounced Inspection 19/09/05 0830 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 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 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 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. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 30 Lower St Helen`s Road Address 30 Lower St Helen`s Road Hedge End Hampshire SO30 0LX 01489 787449 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) ILIACE Limited Stewart Charles Akass Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th April 2005 Brief Description of the Service: The Home is one of a number of Homes owned by Iliace a private organisation whose Head office is located in Alton Hampshire. The Home opened in May 2004 and provides care and accommodation for four Service Users with a learning disability.The Home is a four bedded detached property situated within the village of Hedge End. There is a garden to the front and rear of the house which is secured by fencing and a gate. The Home has their own transport.Accomodation comprises of all Service Users having their own bedroom . There is a large kitchen and a lounge /diner . If able Service Users can walk into the village of Hedge End which has a variety of shops . The city of Southampton with its range of shops/leisure facilities is only a short car journey away. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over three hours and was the second unannounced inspection of the 2005/2006 inspection programme. Twelve of the forty-three Standards relating to Younger Adults were assessed on this occasion. Two areas of improvement were identified and required to be addressed by the manager both of which are outstanding from the last inspection. Details can be found at the end of this report. Since the last inspection there has been a new manager appointed who has been in post four months. The inspection included a tour of the Home; including two residents’ bedrooms and the garden. Discussions were held with two residents and observation made of care provided for one other resident. Further discussions were also held with two permanent staff members, one agency staff member and the Home’s manager. Two residents’ files were viewed and care provided by the Home in all areas of their life assessed and discussed with both the manager and staff. Throughout the report reference will be made to “residents” as, following discussions held on the day of inspection this was the term favoured and requested to be used by the resident spoken to. What the service does well:
One resident spoken to described the new manager Stewart Akass as “ very nice” and “ I like Stewart he is a nice man”. They felt happy in their Home and indicated that they felt listened to and supported by their keyworker and other staff. The staff team were seen to communicate appropriately with residents using makaton sign language and verbal communication. They were further able to explain how they supported residents and, how they contributed to their care plan. Staff are keen to ensure residents’ interests are identified and a range of both in house and community activities are provided. The Organisation have their own “activities (DAP) team” who assess and provide an individual daily programme for all residents. Residents spoken to said they enjoyed the variety of activities offered. Activities were not however, inspected on this occasion having been inspected during the last inspection with no concerns identified. The staff receives daily support from the manager, a range of training and regular supervision.
30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 6 Whilst standards relating to lifestyle were not inspected on this occasion having been inspected at the last inspection one resident described a recent trip to Disneyland which they had clearly enjoyed. What has improved since the last inspection?
At the last inspection the previous manager was required to ensure all residents’ care plans include clear guidance to staff to ensure they are appropriately supporting residents. Three care plans have been revised by the new manager and staff with the fourth nearing completion. There was also a requirement that where needed risk assessments must be rewritten. This has been met in part. The manager is required therefore to ensure all risk assessments are updated or undertaken for all residents in relation their day to day living as this is the third inspection when a requirement relating to risk assessments has been made . It was also evident at the last inspection that residents were not always able to have their needs met due to staff shortages. Staffing was required to be reassessed and more staff employed in the Home as needed. There is now an additional staff member for five hours a day for one resident. However, this is only on a months trial. The manager indicated that this is proving very beneficial to both residents and staff with daily monitoring and regular communication with Social Services taking place as to the need to retain the additional staff member. To ensure that residents know who they can talk to if they are unhappy with anything in their life the manager was required at the last inspection to devise a complaints procedure using Makaton symbols. There has been an extremely detailed and comprehensive resident “feedback pack “compiled by the Organisation which is shortly to be piloted in the home. This will be followed up at the next inspection. To enable all residents to have safe access to the garden a requirement was made at the last inspection for the previous manager to seek a professional assessment ensuring any adaptations are made as identified. This has not been achieved. The manager is required to ensure an assessment is sought with risk assessments undertaken in the interim. Incidents that occur between residents were also required to be reported to the Commission and any further action required discussed with Social services to ensure residents are protected. There has been one incident in the home since the last inspection which was appropriately dealt with by the new manager. A radiator cover was also required to be fitted in one resident’s bedroom. This work has been completed. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 7 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. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 8 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 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 9 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): 2 There is a comprehensive assessment process ensuring residents’ needs are identified by the Home prior to admission. EVIDENCE: The Home has an extremely comprehensive process of assessment, which includes four areas of need. The first is a personal profile of the individual, the second skills maintenance, the third work placements and finally behavioural guidelines. There have been no new admissions to the Home since the last inspection. However, the manager confirmed that there are systems in place to ensure a suitably experienced and competent person assesses any prospective resident’s needs. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 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 and 9 There has been some progess made to ensure residents’ needs are assessed, care plans are reflective of those needs and risk assessments are compiled in areas identified. However, until all risk assessments are updated there is no assurance that care needs are being met for all residents accommodated and that they are not being placed at risk. Staff support resident’s to make decisions as to their chosen lifestyle. EVIDENCE: Two residents’ files were viewed and the care was discussed with staff and one resident. Observations were also made about how the care was delivered. The care plans had a range of information relating to the individual and the support required to ensure their needs are being met including some risk assessments which are constantly monitored and reviewed. Time was spent with two residents to enable the inspector to observe practices in the Home. Particular emphasis was placed on staff communication with the two residents in relation to how they were to spend their day and how it reflected identified needs in their care plan.
30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 11 It was evident that staff were aware of residents’ needs and care plans were being implemented with choice and support being offered to enable residents to make decisions. One resident was able to explain how a meeting is held weekly to devise the menus and discuss the day to day running of the home. Discussions with staff further confirmed that they were aware of residents’ needs, were involved in the review of their care and felt confident in the support they provided. They indicated that the new manager had improved communication in the home, care plans were easily accessible, information shared on a daily basis and daily records completed for all residents with shift “handovers” taking place with a view to ensuring continuity of care. In discussion with the agency staff member who was providing one to one support for one resident it was evident that they had been given detailed information relating to the resident’s care needs and felt confident in their role. However, until all risk assessments are devised as necessary or updated where identified the safety of residents cannot be assured. Whilst the manager has undertaken much work in relation to updating care plans and some risk assessments he indicated that risk assessments will be updated and devised as a matter of urgency as he is aware that this piece of work is outstanding from the last two inspections. There is an independent advocate working alongside one resident and available for the three other residents should they require the service. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 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): No Standards were assessed on this occasion. EVIDENCE: 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 13 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): No Standards were assessed on this occasion. EVIDENCE: 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 14 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 and 23 The complaints policy and procedure is accessible and in a suitable format for all residents accommodated. Arrangements for protecting residents are satisfactory. EVIDENCE: The Home has a detailed complaints policy and procedure which is held in the office. An area of improvement identified at the last inspection related to the Home being required to produce a complaints policy and procedure in a format that would ensure it is accessible to all residents. This work has been completed with an extremely detailed and comprehensive resident “feedback pack “ having been compiled by the Organisation which is shortly to be piloted in the home. This will be followed up at the next inspection. One residents spoken to advised that they would talk to the staff or Home’s manager if they were unhappy and was aware of senior managers who also visit the home periodically and with whom they would be happy to talk to. A weekly resident’s meeting is also held during which residents are able to discuss how they are feeling and any changes they would like to service provision. These meetings are minuted and any required action undertaken by the manager. There had been no complaints made since the last inspection. A further requirement identified at the last inspection related to the failure of the Home to report a number of physical assaults that had taken place
30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 15 between residents and towards staff to either the Commission or Social Services under the Protection Of Vulnerable Adults policy and procedure. This has been met with the manager reporting incidents as appropriate to both the Commission and Social Services. The majority of staff have received adult protection training. In discussion with one staff member it was evident that they were aware of the need to report incidents and, to complete incident forms. The majority of forms viewed had been appropriately completed although one did not reflect how an incident had been followed up. The manager indicated that he will be monitoring the forms on a weekly basis in the future to ensure recording is detailed and incidents followed up where necessary. This will be followed up at the next inspection. Further training includes “SKIP” (restraint) training although the manager advised that no incidents of restraint have taken place since the last inspection. There is a system in place for ensuring that resident’s money is satisfactorily managed with the Organisations Finance Manager auditing the Home’s finances six monthly. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 16 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 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 and 29 Residents live in a homely environment with measures in place requiring some improvement to ensure their safety. EVIDENCE: The Home is well decorated with residents confirming that they are involved in the choice of décor in the communal areas and their individual bedrooms. Two bedrooms were viewed which were well furnished, had adequate storage facilities and residents’ personal affects. Routine maintenance is undertaken by the Organisation’s maintenance team. Risk assessments have been undertaken of residents use of the kitchen facilities although the new manager indicated that he will be updating them alongside all risk assessments relating to individuals’ lives. Hot water temperatures are monitored and adaptations have been made to the showers in the Home to ensure resident’s safety. At the last inspection the inspector was advised that residents who have mobility difficulties have use of a wheelchair enabling them to access the community with staff support. However, residents could not access the rear garden independently due to there being insufficient adaptations made to ensure their safe access. Residents were relying on staff to assist them.
30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 18 During this inspection it was evident that no consultation had taken place with a suitably trained professional as required .One staff member and one resident indicated that this can create difficulties as residents with mobility difficulties continue to rely on staff support to safely access the rear garden. This was discussed with the manager and a requirement made for consultation and assessment to take place with a suitably trained professional with any adaptations installed as needed. Risk assessments need to be in place and shared with staff in the interim. A further requirement identified at the last inspection related to a resident who enjoys looking out of their bedroom window which has a radiator immediately below. An assessment had been undertaken which highlighted a risk from the radiator when hot but the radiator remained uncovered. This work has been completed with a radiator cover having been installed. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 19 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 20 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): 33 and 36 The Home benefits from having sufficient staff on duty who are well supported and supervised by the manager to meet the current needs of resident’s accommodated. EVIDENCE: The Home has a rota which clearly indicates staff on duty. There are always two staff on duty during the day and one waking staff member at night. Since the last inspection when staffing levels were required to be reassessed an additional staff member is employed from Monday to Saturday for six hours a day for one resident. Staff indicated that this has proved beneficial and prevented other residents’ activities being cancelled as had happened in the past. One staff member advised that they receive supervision informally on a daily basis with formal supervision taking place at least two monthly and appraisals yearly. Staff felt well supported by the new manager and considered the Home to be running effectively and resident’s needs being met. The manager confirmed that he would be undertaking a supervision and appraisal course in the near future. This will be followed up at the next inspection. Two residents indicated that they were being supported by staff and, that their needs were being met.
30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 21 Due to the home having three vacancies agency staff are used in the Home. The manager confirmed that where possible they would be familiar with the Home and residents. In discussion with one agency staff member they indicated that they were familiar with the residents and their needs and received support from the manager and staff team. The manager advised that he was devising an agency induction pack. In the interim staff confirmed that they share information required at the commencement of an agency staff member’s shift. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 22 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 23 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): 39 and 42 Systems in place to promote the health, safety and welfare of residents require some improvement. Effective quality assurance and quality monitoring systems are in place. EVIDENCE: A risk assessment for the building was undertaken earlier in the year by the previous manager and the training manager for the Organisation. The manager indicated that he will be reviewing the assessment and, ensuring it is shared with staff and regularly monitored. This will be followed up at the next inspection. The Organisation’s maintenance team undertake weekly checks of fire safety equipment, emergency lighting and fire alarms. The manager is advised of any problems with the systems with records viewed confirming that the checks are up to date. Records of fridge / freezer temperature checks were also examined and were up to date. In discussion with staff (including an agency staff member) they were aware of and had received instruction as to what they should do in the event of a fire in
30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 24 the home. One resident indicated that they had been also been instructed to go into the garden if there was a fire. At the last inspection it was understood that fire evacuation risk assessments had been undertaken for all residents. However, the records were not available and the manager indicated that he would be compiling new assessments as a matter of urgency and would share them with staff. All staff receive health and safety, food hygiene, first aid, infection control and moving and handling training although training records were not viewed on this occasion. Staff spoken to indicated that they were aware of their responsibilities in relation to health and safety in the home and had received relevant training and guidance from the manager. There are a number of first aid boxes sited around the Home and gloves and aprons available for the prevention of cross infection. One staff member indicated that they were aware of the need to read the Control Of Substances Hazardous to Health (COSHH) sheets held in the laundry room prior to using products in the Home. Quality assurance systems in place to ensure the needs and views of residents are central to all service provision include regular reviews of their care by staff, management and statutory agencies, staff and resident’s meetings and support from an independent advocacy organisation. As also detailed in previous sections of this report the Organisation have also produced an extremely detailed and comprehensive resident “feedback pack “ which is shortly to be piloted in the home. This will be followed up at the next inspection. The manager will also be devising an annual development plan for the Home which will also be followed up at the next inspection. 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x 2 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
30 Lower St Helen`s Road Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x DS0000059969.V250653.R01.S.doc Version 5.0 Page 26 yes 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 9 Regulation 15 Requirement The Registered Providers must ensure Service User plans are sufficient in detail to provide clear guidance to staff on the actions to meet their health and welfare needs.Service User plans must be kept under review. (Previously required at the last two inspections with timescales of 19/4/2005 and The Registered Providers must ensure an assessment of Service Users with mobility difficulties accessing the garden is undertaken by a suitably trained professional. Any adaptions identified must be addressed . (Previously required at the last inspection with a timescale of 5/5/2005) Timescale for action 19/10/05 2 24 23 19/10/05 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 Good Practice Recommendations
DS0000059969.V250653.R01.S.doc Version 5.0 Page 27 30 Lower St Helen`s Road Standard 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 30 Lower St Helen`s Road DS0000059969.V250653.R01.S.doc Version 5.0 Page 29 - 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!
