Inspection on 22/06/06 for 330 Guildford Road

This inspection was carried out on 22nd 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

330 Guildford Road 03/10/05

330 Guildford Road 14/07/05

330 Guildford Road 04/11/04

Similar services:

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Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

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

CARE HOME ADULTS 18-65 Guildford Road (330) 330 Guildford Road Bisley Woking Surrey GU24 9AD Lead Inspector Marianne Barham Unannounced Inspection 22nd June 2006 10:25 Guildford Road (330) DS0000013489.V300915.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 Guildford Road (330) DS0000013489.V300915.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. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Guildford Road (330) Address 330 Guildford Road Bisley Woking Surrey GU24 9AD 01483 489208 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) manager.burroughs@careuk.com Care UK Community Partnerships Limited Mrs Gillian Kathryn O`Hara Care Home 6 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (2) of places Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of persons for whom residential accommodation with both board and personal care is provided at any one time shall not exceed SIX (6). The age/age range of the persons to be accommodated will be: 39 – 65 YEARS & 2 MAY BE OVER 65 YEARS 12th May 2006 Date of last inspection Brief Description of the Service: 330 Guildford Road is a large detached property, located off a main road and approximately 1 mile from the village of Bisley. The property is registered to accommodate up to 6 people with learning disabilities, and is owned and operated by Care UK Community Partnerships Ltd. The accommodation is arranged over two floors and comprises of a living room, dining room and a large, separate kitchen. There is a bathroom with toilet and another toilet on the ground floor and a bathroom with toilet plus another toilet on the first floor. There are six single rooms, five of which have a hand washbasin and one having an en-suite bathroom. The first floor of the building is reached by single staircase and there is no passenger lift or chairlift. There are pleasant, well kept gardens to the rear of the property and parking for several cars to the front. The home also has transport available for Service Users. The fee charged is £1187.76 per week inclusive of all facilities and services provided. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 10.25 am by Marianne Barham, regulation inspector. The inspection was undertaken over a period of six hours and all key standards were assessed. The manager, Miss Samantha Moss was not on duty, however the deputy manager of the service next door (also owned and operated by Care UK Ltd), Mrs Trina Neville was able to provide the inspector with all the information and records needed to carry out this inspection. The deputy manager of this home was away on a holiday to Weymouth with two of the service users. The service users living in the home have difficulties in expressing themselves verbally, however limited feedback was obtained from two of them and observations regarding the interaction between members of staff and service users were made. A health and safety assessor from Guildford College was visiting the service during this inspection and also kindly provided the inspector with feedback about this home. All requirements and recommendations made at the last inspection on 3rd October 2005 have been met. What the service does well: The home has a calm, relaxed atmosphere and is clean and comfortably furnished. Members of staff on duty were seen to act very naturally around the service users and clearly knew them very well. This was evident in the way they instinctively understood the wishes and needs of service users who do not communicate verbally. The home has a ‘person centred’ style of care planning, which means that the care and support provided is based on what the service user wants and needs rather than what is easier to deliver, and they are involved as fully as possible in planning their care. The plans are very detailed and give clear guidance to any staff supporting them on what is to be done and how it is to be done. The home has strong links with the local community and makes good use of the facilities and resources available. Service users have a full programme of activities based on their individual needs and choices. Service users spoken with said they liked the home, the staff, their rooms and the food. One said they liked the activities provided when asked. A visiting assessor from Guildford College said that the home is very relaxed and that members of staff are ‘conscientious’ and ‘do an awful lot with the service users’. The visitor also feels that the service users needs always come first and that staff members interact well with service users. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 6 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 Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 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 Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 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, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users individual needs are assessed and they are able to visit the home as often as needed before admission. Service users are still waiting for contracts to be issued by the local authority. EVIDENCE: All service users have a full needs assessment, covering all aspects of everyday living, carried out by the home as well as assessments completed by the Care Manager. The deputy discussed the admissions process that includes several short visits to the home and also overnight stays before admission. Some service users are still waiting for contracts to be issued by the local authority and the home has informed the commission as recommended at the last inspection on 3rd October 2005. The terms and conditions of residence in the home are written in the service users guide. Guildford Road (330) DS0000013489.V300915.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users changing needs and personal goals are reflected in an individual plan, they are supported to make decisions about their lives and to take risks as part of an independent lifestyle. EVIDENCE: All service users have a comprehensive care plan generated from their needs assessment. The plans are very detailed and give clear guidance to staff on how to meet the needs of the individual. A person centred approach is used in planning care and there is evidence of the involvement of the service user and their family in the process. Care plans are reviewed regularly and in detail. The home has developed ways in which to support service users to make choices in their daily lives. These include pictorial menus, activity timetables and the use of independent advocates. All service users have extremely detailed risk assessments in place for activities of daily living with well written instructions to staff on how to Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 11 minimise potential risk without compromising the service users ability to participate in activities. Guildford Road (330) DS0000013489.V300915.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, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users take part in appropriate activities that take account of their needs and preferences, they are supported to maintain their relationships and to be part of the local community. Service users rights are recognised and they are offered a healthy diet that reflects their individual tastes and dietary needs. EVIDENCE: All service users have an individual timetable of activities based on their assessed needs and personal preferences. Good use is made of resources in the local community and the service users are well known in the village. Two service users were on holiday at the time of this inspection and a further two planned to go away the following weekend. Those service users able to give feedback said they enjoyed attending activities. The home respects the rights of service users and makes use of independent advocates and professionals from other organisations such as MENCAP. The Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 13 home encourages service users to maintain contact with family and friends and support plans are in place for this. Service users were observed to taking part in meaningful activities throughout this inspection. The home has a four weekly menu in place that has been devised in consultation with the service users. A pictorial menu is used and updated daily so that service users know what their meals are each day. The kitchen is of a good size and well equipped and all necessary food safety checks are carried out, this includes temperatures for the fridge and freezer being taken and recorded, meeting a requirement made at the last inspection on 3rd October 2005. The dining room is pleasant and comfortably furnished. Service users were observed having lunch of chicken burgers and salad, the meal appeared nicely presented and appetising. Those service users able to give feedback said they liked the food and could choose what to eat. Members of staff were seen to support service users to eat their meals in a caring and dignified manner. Guildford Road (330) DS0000013489.V300915.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 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users receive care and support in the way they prefer and their physical and emotional needs are met by the home. Ageing and death are handled with sensitivity and respect, with the wishes of the service user listened to and acted upon. The policies and procedures for dealing with medicines protect the service users, however it would be good practice to provide instruction on administration of medications labelled ‘as directed’ or ‘as required’. EVIDENCE: Service users preferences in the way they are supported is documented in the care plans. The information is detailed and gives clear instruction on how specific health interventions are to be managed and also their individual health and emotional needs. The home is in the process of introducing Health action Plans for each service user. All service users are registered with a local GP and specialist health professionals are accessed through the GP practice. Chiropodist appointments are made every four to eight weeks, optician annually and dentist every six months. Service users are also under the care of a consultant psychiatrist. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 15 The home has a policy and procedure in place for care of the dying and death of a service user. Individual wishes regarding dying and death are recorded in the care plans. The home has a policy and procedure in place for dealing with medicines that is in line with NMC and Royal Pharmaceutical Society guidance. The medication administration record (MAR) charts are maintained accurately and medicines are stored securely and appropriately. Medication is supplied mainly in blister packs by the local chemist that also carry out staff training and medication audits. Stock checks are carried out regularly and a record of received and returned medication is kept. No service users are able to self medicate. It was observed that some medications on the MAR charts had ‘as directed’ or ‘as required’ with no detail as to when or how often to administer. This was discussed with the deputy and a recommendation has been made that protocols are put into place for these medications to prevent errors. Guildford Road (330) DS0000013489.V300915.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users’ views are listened to and acted upon and they are protected from abuse, neglect and harm. EVIDENCE: The home has a complaints procedure of which all members of staff are made aware at induction. The procedure is also available in pictorial format to make it more accessible to service users and a copy is in the service users guide, given to all service users on admission to the home. There is a complaints book but there are no entries as the deputy informed the inspector the home has never received a complaint. The home also has a whistle blowing policy for staff to raise any concerns they may have. The home has reviewed and updated its policy and procedure on the protection of vulnerable adults from abuse (POVA) to be in line with the Surrey MultiAgency Procedures. This meets a requirement made at the last inspection on 3rd October 2005. All members of staff have received training in POVA and the home has a copy of the most recent (Feb 05) Surrey procedures. Members of staff spoken with were aware of the whistle blowing policy, POVA procedures and how to deal with complaints. Guildford Road (330) DS0000013489.V300915.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, 25, 27 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is clean, comfortable and safe and service users bedrooms are suitable for needs and reflect their individual tastes and interests. The toilets and bathrooms are suitable to the needs of the service users, however they do not protect their privacy as the locks are not working and the toilets need paper hand towels to prevent cross infection. EVIDENCE: A tour of the premises was undertaken. The home is in a good state of decoration and repair throughout, with new carpets having been recently fitted. Service users bedrooms are comfortable and personalised with their own belongings. Those service users able to give feedback said that they liked their bedrooms and had chosen the decor themselves. Communal areas of the home are also comfortably furnished and pleasantly decorated and all areas of the home are clean with no unpleasant odour. One bedroom has an old, worn carpet that is stained and very scruffy looking. A recommendation has been made that it is replaced. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 18 The home has two bathrooms and two toilets, with one of each on the ground and first floor. Both bathrooms had been fitted with paper hand towel dispensers but neither toilet had. A requirement has been made that paper hand towels are provided in the toilets to prevent the risk of cross infection and promote safe hand washing practices. It was also observed that the locks on the bathrooms and toilets were not working and though the inspector can appreciate concern that service users may lock themselves in, locks may be purchased that can be opened from the outside. A requirement has been made that these locks are repaired or replaced in order to protect the privacy and dignity of the service users. The home has recently received planning permission to convert the existing garage and utility room into a large training room with an office above. The home has a well tended, enclosed garden to the rear and parking for several cars to the front. Guildford Road (330) DS0000013489.V300915.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): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The staff team are adequately qualified, competent to carry out their duties and appropriately trained. Service users are protected by the home’s recruitment policy and practices and they benefit from a staff team that is well supported and supervised. EVIDENCE: Four members of the staff team have completed NVQ level 2 and one member of staff has completed NVQ level 3. The deputy is currently undertaking NVQ level 3 and the remainder of the team are undertaking NVQ level 2. The home has a programme of planned training in place and individual training records are maintained for each staff member. These were sampled and found to provide evidence of mandatory and developmental training having been undertaken. Recruitment records were examined. These contained all the necessary checks and information required to protect the service users. There is a recruitment policy and procedure in place that is in line with current legislation and best practice regarding the recruitment of staff. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 20 All members of staff now receive six formal supervision sessions with the manager or deputy each year. This meets a recommendation made at the last inspection on 3rd October 2005. Members of staff spoken with said they enjoy working in the home and receive enough supervision, training and support to carry out their jobs. Guildford Road (330) DS0000013489.V300915.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 and 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a well run, competently managed home and their, views are sought when quality audits are carried out. The home promotes the health, safety and welfare of service users. EVIDENCE: The home manager was not on duty during this inspection, however the deputy informed the inspector that the manager holds a social work qualification and is currently undertaking the NVQ level 4 Registered Managers Award (RMA). The manager is the registered manager of the home next door to this home, also owned by CARE UK, and has recently submitted an application to register as manager of this service as well. Members of staff spoken with and the deputy spoke highly of the manager and said she is approachable and has an ‘open door’ policy. They also said she is experienced and knows the service users well. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 22 The home carries out quality audits and the results are collated and published to service users and their families. A pictorial survey has recently been introduced that is accessible to service users and this has been given to service users and/or their representatives to obtain feedback. This meets a requirement made at the last inspection on 3rd October 2005. The home has policies and procedures in place for health and safety and also fire safety. All necessary safety checks are undertaken and recorded and copies of safety certificates are held on file. All members of staff have received training in health and safety, COSHH, infection control, moving and handling, first aid, fire safety, food hygiene and POVA procedures. There is an ongoing programme of maintenance and repair. A requirement was made at the last inspection on 3rd October 2005 that the Commission must be informed of the date that the home’s insurance certificate is received. This has been met and the inspector was able to see the current certificate is valid until September 2006. Guildford Road (330) DS0000013489.V300915.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 X 2 3 3 X 4 3 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 3 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 3 3 3 X 3 X X 3 3 Guildford Road (330) DS0000013489.V300915.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 YA27 Regulation 13 (3) 16 (2) (j) Requirement Timescale for action 22/07/06 2 YA27 12 (4) (a) 23 (2) (c) (J) The registered person must provide paper hand towels in all communal toilets, bathrooms and the kitchen in order to promote good hygiene practices and prevent cross infection. The registered person must 06/07/06 ensure that all locks on the doors of the communal toilets and bathrooms are repaired or replaced in order to protect the privacy and dignity of service users. 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 Refer to Standard YA20 Good Practice Recommendations It is recommended as good practice that protocols are put into place giving instruction to staff on when and how often to administer ‘as required’ or ‘as directed’ medications in order to minimise the risk of errors occurring. It is strongly recommended that the carpet in the service DS0000013489.V300915.R01.S.doc Version 5.2 Page 25 2 YA26 Guildford Road (330) user’s bedroom (identified to the deputy) is replaced owing to it being old, worn and having unsightly staining. Guildford Road (330) DS0000013489.V300915.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Guildford Road (330) DS0000013489.V300915.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!