Inspection on 29/11/05 for 45 Horsebrook

This inspection was carried out on 29th November 2005.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

45 Horsebrook 26/09/07

45 Horsebrook 27/09/06

45 Horsebrook 19/11/04

45 Horsebrook 13/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Horsebrook (45) Calne Wiltshire SN11 8HG Lead Inspector Malcolm Kippax Unannounced Inspection 29th November 2005 2:25pm Horsebrook (45) DS0000033510.V270944.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 Horsebrook (45) DS0000033510.V270944.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. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Horsebrook (45) Address Calne Wiltshire SN11 8HG 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) 01249 811222 www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Mrs Jean Caroline Foley Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st July 2005 Brief Description of the Service: 45 Horsebrook is a purpose built care home that was first registered in May 2003. The home provides accommodation for up to six service users. Cottage and Rural Enterprises Ltd (CARE) is registered as the care provider and the property is owned by the Westlea Housing Association. 45 Horsbrook is a semi-detached building on two floors. Each service user has a single room with an en-suite shower and W.C. There is a bathroom on the first floor. The communal space includes an open plan lounge and dining room. Service users take an active role in the household routines. There is a domestic type kitchen with a separate laundry area. The home has its own ‘people carrier’ for trips out. 45 Horsebrook has close connections with ‘CARE Wiltshire’, which is another CARE establishment that is located in the nearby village of Rowde. CARE Wiltshire provides service users with the opportunities for various social, therapeutic and work based day activities. Some administrative and personnel support is also provided through the CARE Wiltshire service Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 2.25pm and 7.00pm. It focussed on a number of key standards that were not looked at during the previous inspection. Two service users had just returned home from their day activities when the inspection began. The other service users came back later in the afternoon. Service users were spoken with in the lounge and in the dining room during the tea meal. One service user was not met with as he was staying with his family at the time. As part of the inspection process, the Commission has received three comment cards from relatives and one from a service user. Records, including health & safety, staff training, medication, and care were looked at. A relief staff member was met with and the home’s manager, Jean Foley, was available throughout the inspection. Jean Foley’s application for registration as manager was being processed at the time of the inspection. Her registration was approved shortly afterwards. What the service does well: What has improved since the last inspection? The views of service users and others are now being sought as part of a new system of quality assurance. This gives service users the opportunity to mention the things that are important to them and to say how they would like the home to be in the future. There has been some additional agency and relief staff time provided, with more occasions when there are two people working in the home. This has meant that service users have received some individual support, which has been needed to help manage incidents in the home. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 6 The recording of medication has improved and the manager intends to assess with service users whether they are able to take responsibility for managing their own medication. 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. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 did not apply at this time. There were no vacancies and there have been no changes in the home’s occupancy during the last year. EVIDENCE: Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 9 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 and 7 Service users are encouraged to make decisions and have opportunities to express their views. Service users have their own personal goals although would benefit from a more planned approach to achieving these. (Standards 6 and 9 were inspected at the last inspection. Standard 9 was met and Standard 6 was almost met). EVIDENCE: Examples of care plans were looked at. These had been updated since the last inspection and some new ‘Action Plans’ have been written. There was a requirement at the last inspection for the service users progress with achieving their personal goals to be regularly and more consistently monitored. It was seen in the action plans that some new goals have been recorded and met, although achieve dates still need to be identified in some cases. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 10 The objectives identified in the action plans reflect the decisions that service users have made about their individual activities and what they want to do. Key workers provide support with decision making and review meetings are held, to which family members and outside professionals are invited to contribute. Service users participate in the domestic tasks and are encouraged to make decisions about the daily arrangements, such as menus and social events. Service users said that they liked the house meetings, when they could discuss things together. Service users are kept well informed of developments through the range of meetings that are held, including those that take place on the CARE Wiltshire site. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 11 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): 16 Service users are encouraged to treat the home as their own and there are opportunities to develop independence and responsibilities. (Standards 12, 13, 15 and 17 were inspected and met at the last inspection). EVIDENCE: When asked about any rules in the home, service users could not think of any, other than the need to respond when the fire alarms were sounded and that staff would knock on their doors when it is time to get up in the morning. During the inspection, service users were helping to prepare the tea meal and said that they enjoy being involved in this. There were rotas in place for the domestic tasks and for helping with food shopping. Service users quickly settled into their own routines when returning to the home. One service user was using the home’s computer. Some service users were sitting in the lounge and watching television. Other service users decided to have a shower and change before the tea meal. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 12 On returning to the home, post was promptly given out to some service users. Service users have keys to their own rooms and also to the front door. They can take responsibility for opening the door to visitors. There is a notice next to the door to remind service users of the need to ask visitors about their purpose and the need to check identity. The service user who completed a comment card said that their privacy was respected. The three relatives who completed cards confirmed that they could visit in private. Horsebrook (45) DS0000033510.V270944.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): 19 and 20 Service users are receiving the support that they need with their healthcare, although the frequency of dentist appointments needs to be checked. Service users may be able to take more responsibility for their medication. (Standards 18 and 20 were inspected at the last inspection. Standard 18 was met and standard 20 was not met). EVIDENCE: A daily handover report form is completed by staff at the end of their work shifts. The examples seen included various health observations, such as ‘ … xxx appears to have a cold’, as well as details of appointments that have taken place. Some items were cross-referenced to a medical file and to the service users’ individual files, where more personal information was recorded. A form used for recording foot care should be initialled by the staff member concerned, rather than just ticked. There was a record that service users had recently attended the surgery for flu jabs and it was also reported that one service user had refused to attend. Three service users had recently had appointments with the dental hygienist. It appeared from the records that a service user may be overdue a check up with the dentist. The manager said that she thought this was not the case but confirmed that she would look into it. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 14 One service user had recently had an appointment with a dietician. Some of the home’s medication records were looked at. It was seen that requirements from the previous inspection have been met. Since the last inspection, the service users’ GP has signed a letter that lists a number of homely remedies that have been approved for use. The medication is stored in a central location. The manager suggested that some service users may be able to take some responsibility for their own medication and to look after a limited amount in their rooms. Following, assessment and with appropriate facilities in place, this would be a positive development in enabling service users to be more independent. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 15 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 Information about how to make a complaint has not been consistently updated. There is staff awareness and written guidance, which help to protect service users from abuse. (Standard 22 was inspected and met in part at the last inspection). EVIDENCE: The home has had recent experience of implementing the vulnerable adults procedure following an incident in the home. The relief staff member met with said that she was aware of the local arrangements and of the referral process once an allegation of abuse has been made. CARE have updated their organisation policy and procedure in respect of abuse. This documentation, dated July 2005, was available to staff in the home, along with a copy of the ‘No Secrets’ booklet, which provides information about the local arrangements for the protection of vulnerable adults. The staff training records showed that all staff members had attended a training course ‘Supporting a Service User who has been abused’. Other relevant training events have been attended at CARE Wiltshire. The manager has recently attended a POVA course. A requirement, which was made at the last inspection concerning the service users’ complaints procedure has been met in part. As reported at the last inspection, the format includes spaces for the procedure to be personalised by Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 16 adding the contact details for the Commission’s local office. A copy of the procedure was seen which now included the correct name and contact details for the C.S.C.I., other than for the telephone number. The manager had given this updated version to service users to keep in their rooms and another copy was kept on their personal files. As reported at the last inspection, there is also a complaints procedure displayed in the dining room. This still needs to have information added about the C.S.C.I. Horsebrook (45) DS0000033510.V270944.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 30 There has been a lack of attention to some aspects of the home environment. The operation of the doors needs to improve. Standards of cleanliness have been inconsistent since the last inspection. (Standards 24 and 26 were inspected at the last inspection. Standard 24 was almost met and standard 26 as met). EVIDENCE: Inspection of standard 24 was limited to following up the recommendations that were made at the last inspection. Some areas of the home do not receive a lot of natural light and the provision of light fittings, to increase light within the home, has been commented on at recent inspections. Light fittings in the hall have been replaced and since the last inspection, those in the communal rooms have also been changed. This has helped to brighten up these areas. While talking about the communal light fittings, a service user mentioned the brightness of the light in her room. At a previous inspection there was found to be a 40watt bulb in one ceiling light. A full review of the light fittings and the strength of light throughout the accommodation has not been carried out. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 18 A recommendation arising from previous inspections had concerned the need to make the fire doors easier to operate. The doors are heavy to use and shut with some force. It was reported at the last inspection that the neighbours can hear the doors closing. Although needing to remain as fire doors, the type of closure used and the way the doors close create an institutional feel to the accommodation. The doors appear not to have received attention since the last inspection. During the inspection, service users again commented on the noise that the doors make and their dislike of the way they operate. The door from the hall to the dining room / lounge is probably most in need of attention because it is in frequent use and in a central location. It was reported in the service users’ daily notes that a relative had spent some time cleaning a service user’s room, as she was not happy with the condition that she found it in. A staff member had explained to the relative that the home had been short staffed at the time. The manager said that the staffing situation had since improved and there was a greater awareness of the support that individual service users need with how they kept their rooms. There was seen to be a satisfactory standard of cleanliness in the home. A hook or rail for the hand towel was needed in the downstairs toilet. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 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, 33 and 34 Service users have not yet benefited from having a full team of permanent staff members to support them. The staff team have not achieved the level of competency and qualification that is expected. (Standards 33 and 35 were inspected and almost met at the last inspection). EVIDENCE: The recruitment procedures and records were not looked at on this occasion, as no new staff appointments have been made during the last year. A staff vacancy has existed since the home opened in May 2003. Initially this was for a support worker and the vacancy is now for an assistant manager. Relief staff and agency carers are covering the vacancy. The manager said that the post was being advertised again in January 2006. The relief staff member met with said that she was working additional hours in the home, which was providing more double cover. The manager confirmed that this was the case and the extra staff hours had helped when incidents had arisen between service users. It was noted in the house meeting minutes that this extra staffing was appreciated. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 20 In each of the comment cards that were returned to the Commission, the relatives indicated that, in their opinion, there are always sufficient numbers of staff on duty. One relative wrote that it ‘depends which staff are on duty’, in response to the question ‘Are you satisfied with the overall care provided’. The staff records showed that LDAF accredited training is available to staff and this was being undertaken by one of the relief staff members. Some relief staff members have achieved NVQ, although two permanent support workers have not. The manager said that four people, including the permanent staff were enrolled and due to start their NVQs in December. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 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 and 42 The service users know the manager well. The manager has relevant experience and is completing an appropriate qualification. The collective views of service users are contributing to a system of quality assurance. Other, more individual approaches are also in place. There are suitable arrangements in place for maintaining health and safety in the home. EVIDENCE: The Commission has received an application to register Jean Foley as the manager for 45 Horsebrook. The ‘fit person’ process had nearly been completed at the time of this inspection and Jean Foley’s registration was approved shortly afterwards. The service users know Jean Foley well, as she has been the assistant manager at 45 Horsebrook since the home opened. More recently she has been in the role of acting manager. Prior to her Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 22 employment with CARE, Jean Foley gained supervisory experience working in a care home for older people. Jean Foley has gained the 325.3 Advanced Management in Care qualification and is due to complete the registered managers award in January 2006. There was a copy of a quarterly Q.A. (quality assurance) newsletter that CARE has produced. This included a list of the ways in which quality assurance is arranged in the home and throughout the organisation. These included person centred planning, staff and service user forums and CARE’s in-house system of quality assurance. Service users from the home have attended annual conferences that CARE has arranged to discuss the future direction of CARE and its services. Records relating to the CARE quality assurance system were looked at. Feedback from service users had been obtained under a number of headings including Relationships; Activities and Choice. Some areas for improvement had been identified. The records gave the impression of ‘work in progress’, with a number of action plans having been written earlier in the year. Some included areas that require ‘on-going’ attention, with no clear achieve by date identified. There was a file that contained records of risk assessments under two sections: ‘General’ and ‘Named Individuals’. This showed that safety was assessed on a personal basis where appropriate and some assessments covered hazards that would affect all service users. A generic risk assessment had been completed in respect of ‘Home alone’ although it was not clear that this did not currently apply to any of the service users. The home’s fire log book was up to date although a record of fire instruction given to agency carers needs to be kept on the appropriate form. PAT testing had taken place in July 2005 and a monthly safety check is made of the electrical items. Various other checks are recorded, including water temperatures in each room. There is a separate file for maintaining COSHH data information. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X N/A X X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 N/A X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Horsebrook (45) Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000033510.V270944.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement The service users progress with achieving their personal goals must be regularly and more consistently monitored. Met in part since the last inspection. The goal ‘Achieve by’ and ‘Met’ dates need to be recorded. The complaints procedure must include contact details for the Commission for Social Care Inspection. Met in part since the last inspection. The complaints procedure in the dining room must be updated and the correct telephone number (01249 454550) included on all copies of the procedure The level of lighting throughout the home must be assessed and action taken to ensure that this meets the required standards. Action must be taken to ensure that doors in the home shut quietly and without undue force. A hook or towel rail must be fitted in the downstairs toilet. The fire log book must include a record of fire instruction that is given to agency carers. Timescale for action 31/12/05 2 YA22 22 30/11/05 3 YA24 23(2) 31/01/06 4 5 6 YA24 YA30 YA42 23 23(2) 23(4) 31/01/06 31/12/05 30/11/05 Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA19 YA20 YA39 Good Practice Recommendations That the foot care charts are initialled, rather than ticked That the ability of service users to manage their own medication is assessed That ‘achieve by’ dates are specified within the quality assurance action plans. Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Horsebrook (45) DS0000033510.V270944.R01.S.doc Version 5.0 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!