Inspection on 17/10/08 for 40a Manor Road

This inspection was carried out on 17th October 2008.

CSCI found this care home to be providing an Adequate service.

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

40a Manor Road 02/11/06

40a Manor Road 12/01/06

40a Manor Road 14/07/05

40a Manor Road 20/12/04

40a Manor Road 13/05/04

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Ruskin Lodge

Clover House

Dystlegh Grange

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Springfield Cottage

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 40a Manor Road 40a Manor Road Upperby Carlisle Cumbria CA2 4LJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Kelley     Date: 1 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 40a Manor Road 40a Manor Road Upperby Carlisle Cumbria CA2 4LJ 01228548118 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Glenmore Trust care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The home is registered for a maximum of 5 service users to include: up to 5 service users in the category of LD (Learning disability under 65 years of age) up to 5 service users in the category of LD(E) (Learning disability over 65 years of age) up to 3 service users in the category of PD (Physical disability under 65 years of age) up to 3 service users in the category of PD(E) (Physical disability over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home 40a Manor Road is registered to provide residential care for 5 people with learning disabilities, two of whom also have a physical disability. The home is operated by the Glenmore Trust, a charitable organisation providing services for people with learning disabilities throughout North Cumbria. The house is leased from Impact Housing Association who were responsible for repairs and maintenance. 40a Manor Road is a large detached bungalow, situated in the Harraby area, on the outskirts of Carlisle. There are local shops within easy walking distance and a regular bus service runs into Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 5 3 5 3 Brief description of the care home the city centre. Service users share the purchase and running costs of an adapted vehicle, which accommodates wheelchairs. There are five people resident in the home, all have a single room with washbasin. There is a large lounge, dining room and kitchen with a separate utility. There is also an office/sleep-in room used by staff. Lifting hoists, high/low beds, plus a walk-in shower are provided to promote independence and provide a safe environment. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an inspection where all the key areas of the National Minimum Standards were assessed. People living in the home, their families and staff were asked their opinions of their experiences of the home by the Commission for Social Care Inspection (CSCI). These comments, and observations made by us, have informed the judgments made in this report. We also: Received questionnaires from professionals and people working with the home Interviewed staff Visited the home, which included examing files and paperwork Received an Annual Quality Assurance Assessment report from the manager which is a self assessment report on the homes strengthens and development areas. Care Homes for Adults (18-65 years) Page 6 of 30 We met and spoke to two people who were at home, other people where out at day services. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has well developed procedures for introducing new people. This leads to successful placements where people are assisted to make informed choices and given support to settle. Evidence: Admissions are not made to the home until a full needs assessment has been undertaken, and these were seen in peoples files and included socialwork assessments and risk assessments. Admissions to the home, therefore only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. The manager considers the application together with the staff team, where all information is shared and views are listened to and fully debated, before agreement is given for the admission. Peoples files demonstrated that information and assessments were available at the Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: time they moved in which assisted in ensuring successful placements. These assessments formed the basis of the individuals plan of care and included any potential restrictions on choice, which were agreed by the resident. Since then the plans of care have evolved as peoples needs have changed. The homes literature and information given out to prospective new residents needs to be up-dated and making more user-friendly. The old Statement of Purpose is currently held in each persons file. This serves no purpose and makes the files bulky and should be taken out. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home are given opportunities and support to lead interesting lives and are encouraged to make informed choices. Evidence: The service involves individuals in the planning of their care which affects their lifestyle and quality of life. Staff understand the importance of people being supported to take control of their own lives. To help this a keyworker system is in operation and each person has had a user-friendly style care plan developed. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a can do attitude and risks are managed positively to help people using the service lead the life they want. However, attention is needed to ensure that risks of a more serious nature such as choking have a higher profile in peoples files so that staff are made aware of these risks and what actions to take. Where risk assessments have been included they gave very good instructions and some used a Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: traffic light system to instruct staff as to good an bad ways of coping with these risks. Where actions are taken to restrict peoples liberty to protect them against harm this must be carefully documented and agreed by professionals and family, as appropriate to make decisions in peoples best interests. For example if doors are locked or wheelchair lap belts used to restrict movement. If changes are required the individual will be supported to set new targets and identify new needs they require support with. In this way individuals are encouraged to make their own decisions and choices. Since the last inspection the organisation has introduced new ways of working with people in an attempt to make some of the paperwork easier to follow and be of more meaning for each person. Staff have adopted a way of working and recording called person centred. Peoples files where of two types, one to give staff instructions on how to care for a person and the other was more of a joint document that could be used by both the person and the staff member. Now each person has a scrap book that contains lots of pictures and detailed information about each persons personality, likes, dislikes and hobbies and interests. The staff team now need to go onto the next stage of looking at peoples longer term wishes for the future. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are fully committed to supporting individuals to lead purposeful and fulfilling lives as independently as possible. Evidence: The increased use of person centred plans ensures that each individual has a more tailor made plan which includes details of their background, family, past interests and has good detail on a persons likes, dislikes and their future aspirations. People living in the home have the opportunity to develop and maintain important personal and family relationships. Staff support this with sensitivity and respect of each familys circumstances. Relatives who returned surveys as part of this inspection all commented positively on the support their relative receives from the staff team. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Menus and records sampled demonstrate that meals are of a good quality, and provide good nutritional value. The weekly menu is planned with residents and purchases for the menu carried out with residents who take turns to both cook and shop. Individual shopping is also encouraged to develop independence and daily living skills. People living in the home also enjoyed a variety of take away meals and meals out. Specials diets and healthily meals are offered and conversation between staff and residents demonstrated that they were aware of promoting healthy choices, and help people in an non-judgemental way. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems have been developed to monitor individuals health and medication ensuring that each person has access to services that promotes good health. Evidence: Staff have a good understanding of peoples healthcare needs. The staff team work positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain good health. A feedback card from a healthcare professional stated :The home continues to provide a good service to people with complex needs. Records on healthcare needs are well maintained and kept up-to-date, these are linked to care plans to alert staff on any changes, and include monitoring sheets for specific issues. The home has sensitively handled the ageing process and offered good support to minimise any impact on independence. Residents are registered with a GP of their choice and have access to other members of the Primary Health Care team. Other checks such as opticians and dental checks are Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: also recorded on Healthcare files. The full staff team have completed medicines training to NVQ level 2, and in addition also receive training from the pharmacy supplying peoples medication on the handling of that system. Some medication is used to calm people down, and it is recommended that the recording of this should be further developed to include a brief description of why, the procedure and a best interest meeting as described for other restrictive practices. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safe guarding of peoples rights needs to have a higher profile in the home to ensure that if issues do arise they are competently dealt with. Evidence: The AQAA states that :Manor Road has received 0 complaints this year. The Glenmore Trust has updated its policies and procedures for both staff and service users, and simplified the way complaints are dealt with. There is an easy read version of the complaints policy. Families are encouraged to be open about any concerns they have regarding the support provided, so that these can be discussed to amicably settle any problems before they become complaints. The Glenmore Trust has introduced the Team Teach approach to Physical Intervention. This puts the emphasis on de-escalation rather than restraint and is a more positive approach to management of behaviour. This is judged to be good practice in this area and a significant commitment has been demonstrated in introducing this approach. The Home has induction training that covers basic adult protection issues and the various forms of adult abuse. The manager, who is the key person in managing allegations, has received up-to-date training on local adult protection guidance. This area could be further strengthened by the manager demonstrating that this Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: information is cascaded to staff and that safe guarding has a higher profile in the home. For example, is discussed in team meetings, supervisions and that staff have refresher courses, and the policy for safeguarding people should be reviewed annually. The staff team use a form of constraint with some people by restricting free movement around the home ie by locking doors. This practice should be reviewed in light of the Mental Capacity Act and a best interest consultation with relevant professionals should take place. Careful documentation of this practice is also required along with risk assessments to ensure the rights and safety of people. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, and comfortable environment that match their lifestyle needs, however bathroom facilities need improving. Evidence: Peoples individual bedrooms are of a good size and individualised to each persons tastes and interests. All are of a good size but none are ensuite, they do have hand basins though. The bathroom arrangements meet the needs of those with mobility difficulties.There are two bathrooms, one with an assisted bath and the other with a walk in shower. Staff reported that the shower was difficult to use without the staff member getting very wet. The organisation should look at other products on the market to see if any would be more sutiable. There continues to be a problem with damp and ventilation in the bathrooms and black mold is visible on the walls. The bathrooms also look austere and are not pleasant to use. On the day of inspection the home was orderly and clean, and is well maintained to Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: ensure the safety and well being of people in the home. However some areas looked rather functional and would benefit in making more homely, for example the corridors and communal areas had vinyl floor covering, plain walls, few pictures and the dining room chairs looked worn. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a competent, well-vetted staff team who offer good support to the people living at the home. Evidence: Staff are clear regarding their role and what is expected of them. Relative comment cards stated that staff know what they are meant to do, and that they are able to meet the needs of their relatives. One new member of staff described their induction period and felt this had been very thorough and helped them to settle into the role. This had included a training course, and a shadowing period with weekly supervision from the team leader. They had worked in care previously and felt this was by far the best organisation for training and support. The recruitment procedures are very thorough and interviews and recruitment follow all good practice guidelines to ensure people are well vetted and are suitable for care work. This leads to good levels of confidence and satisfaction from residents, relatives and professionals with the care that is delivered. I feel the care home is very good said one relative. Staff training has a high profile with each person having a training list of completed courses. These records are completed at Head Office by the Training Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Officer. This could be improved by the manager or the Training Officer producing a Training Profile Plan for the home to identify any gaps. Staff interviewed were keen to gain new knowledge and skills that will assist them in supporting residents. Over three quarters of staff have a recognised care qualificationNVQ2 and above. Staff also receive varied training to equip them with skills and knowledge to support people. A rolling programme of training includes first aid, fire wardens, moving and handling, health and safety and physical intervention training. Some staff had received training in person centred planning and in understanding the needs of people with dementia, which they described as being beneficial in their work. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run in the best interests of the people living there, but more checks and audits are required to ensure that a quality service is being offered to people living at the home. Evidence: The manager has the required qualifications and experience to run the home. Currently the manager is in the home on a part time basis and the home has a fulltime Team Leader. Staff and residents spoken to confirmed that they felt that the atmosphere in the home was relaxed and supportive. However more in-depth knowledge would be beneficial on good practice guidance issued by us, CSCI (Commission for Social Care Inspection) and other professional bodies, for example Key Lines of Regulatory Assessment, Guidance logs, Essential Steps to Infection Control, and Safer Food Better Business. The Annual Quality Assurance Assessment,(AQAA) the manager sent into us was not Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: fully completed and was very brief. It is recommended that more evidence is included in this at the next annual review. The home also needs to demonstrate how it monitors quality of its service and how this is service user focused. This should be reflected in the homes business plan. The organisation issues all policies and procedures for the home in line with changes in legislation and good practice guidelines. However many of these are not reviewed on an annual basis. The manager needs to ensure that this is carried out and that these policies relate specifically to the home. The homes Fire Risk Assessment developed in 2002, was found to be out of date the last review being 2004, and was carried out by a manager who had left over 5 years ago. Staff fire training was also not being carried out at the required frequency this potentially puts people at risk. A requirement is made to ensure this happens especially as all staff at some point sleep over in the house, and are in charge in the event of a fire. The home does not provide a qualified first aider for each shift. The manager needs to carry out an assessment to determine if this is necessary or not and make this assessment available to CSCI. This guidance and how to complete an assessment is available through our Guidance Logs on the internet. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 2 The Glenmore Trust must obtain a date from Impact Housing Association for when the damp problem in the bedrooms and bathrooms will be dealt with before it becomes an environmental health issue To make the bathrooms more pleasant for people to use 31/12/2008 2 42 23 All staff must receive fire training and instructions on a regular basis to keep people safe This is to keep people living at the home and staff safe in the event of a fire 01/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The manager should update the homes Statement of Purpose and service users guide and make them more Page 28 of 30 Care Homes for Adults (18-65 years) user-friendly. 2 23 The ways in which restraint is used in the home should be reviewed to ensure that peoples liberty is not being infringed and that these practices are safe. The ongoing problem of damp and black mold in the bathrooms should be resolved to make them more pleasant and healthier for people living in the home. The shower facility should be reviewed with a view to making it easier to use for people. The manager should undertake an assessment to determine the level of qualified first aiders required in the home, as described in the CSCI Guidance Logs. 3 27 4 5 29 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - 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!