Inspection on 23/05/05 for Abba Care Home

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abba Care Home 04/12/08

Abba Care Home 24/09/07

Abba Care Home 13/10/06

Abba Care Home 22/11/05

Abba Care Home 14/03/05

Abba Care Home 10/05/04

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Thames House

Creative Support

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Abba Care Home Wesley Old Hall New Row, Weir, Bacup, Lancashire OL13 8RA Lead Inspector Christine Mulcahy Unannounced 23 May 2005 10:00 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 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 Older People and 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. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Abba Care Home Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wesley Old Hall New Row Weir Bacup Lancashire OL13 8RA 01706 879042 01706 879565 Mrs Rosemarie Nash Care Home only Personal Care (PC) 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) 4 of places Mental disorder, excluding learning disability or dementia - over 65 years of age (MD)(E) 4 Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The Statement of Purpose, Service Users Guide, written policies and procedures and all administative tools and record systems of the home must be reviewed, and revised where necessary, to reflect the change of name. 2 The home is registered for a maximum of 4 servcie users to include: up to 4 service users in the category of MD (mental disorder under 65 years of age excluding learning disability or dementia) up to 4 servcie users in the category of MD(E) - mental disorder over 65 years of age, excluding learning disability or dementia. Date of last inspection 14 March 2005 Brief Description of the Service: Abba Care Home is a detached house set in a rural area. It is set back from the road and situated within 4 acres of fields. It is reached via an unmade road near the village of Wier in Bacup.The home has views of the surrounding hills and valleys of Rossendale. The home is registered with the Commission for Social Care Inspection to provide care and accommodetion to 3 service users with a mental disorder one being over 65 years of age. Accommodation is provided in 3 single bedrooms on the first floor of the home.Within the home there are lounge areas on the ground floor and a recreation room is attached to the back of the house. Sheep, goats and poultry are kept in the fields attached to the home and service users who are interested are encouraged to be involved in the care of the animals. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The summary below is an overview of the findings of an unannounced inspection conducted at Abba Care home on 22nd May 2005. The service was inspected against the National Minimum Standards for Adults (18 – 65) and a number of the National Minimum Standards for Older people (65 years and over.) At the time of the inspection 3 service users were accommodated at the home. The inspector arrived at 10am and the inspection continued until 3.30pm. The inspection involved discussion with service users and a care staff. Observations were made throughout the visit and records were examined. There are various references to ‘case tracking’ throughout this report. With regard to service users’, case tracking’ refers to the process in which the inspector focuses on a small group of people who are considered to be representative of the service users in the home. All records relating to these people are inspected, along with the rooms they occupy in the home. Observations are of the care provided, and the service users are invited by the inspector to discuss their experiences of services in the home and what this means for them. This process does not exclude other service users being included and involved in the inspection process. ‘Case tracking’ is also used as an inspection tool with regard to staff working in the home. In this instance, all records relating to one member of staff was viewed, and staff was invited by the inspector to discuss issues relating to their experiences of working as a carer in the home. The inspection was carried out with the co-operation of service users and a care staff. What the service does well: The attitude of the staff and management is to run the home around the needs of the service users and provide a safe, secure family environment for them. Service user care plans addressed areas of care such as routines, likes and Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 0.doc Version 1.30 Page 6 dislikes, allergies, health needs, personal hygiene and general health. Past interests, hobbies, present needs and wishes were also included in care plans. Service users knew how to complain and who to make a complaint to. They were confident their complaints would be listened to and taken seriously. One said, “I’m very happy here I’ve nothing to complain about.” Service users commented positively about the care received at the home. One service user said “ It’s lovely here, I’m very happy,” another said, “You can get involved in all sorts of things, my family can visit any time they like. What we do is up to us.” It was apparent that a great deal of emphasis is placed on service users social activity and contact with the local community. Staff spoke highly about the recent mental health training attended. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 3,6 YA 2 New service users are admitted only on the basis of a full assessment and can visit the home for a trial run before moving in. Service users had a plan of care for daily living based on the initial assessment. EVIDENCE: Case tracking and discussion with one service user confirmed the service user had been admitted to the home following a full mental health and social needs assessment. The assessment covered the reasons for the referral, the presenting problems, a history of the service user mental health, family history, personal and employment history and the service user current mental health. The assessment had been summarised and included a risk management plan. A social work core assessment form and Occupational Therapist report was also included as part of the assessment. A written contract stating the terms and conditions of the service user residency was available but required the service user signature to confirm his agreement. When asked about his move to the home the service user said, I’m Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 9 very happy here, I came here about 12 months ago but there weren’t any places. Now I can do whatever I want, whenever I want, when I want. Staff are very good and the food is very good.” Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) are: 7. 8. 9. 10. 11. • • • • • • The service user’s health, personal and social care needs are set out in an individual plan of care. Including their physical and emotional health needs. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. 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. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) OP 7, 8, 9, 10 and YA 6, 7, 9, 11, 19, 20 Service user health care needs were identified and met through care plans. Medication was not managed or stored well enough to ensure service users were safe from harm. Some records to ensure the safety of service users who self medicated were not available. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 11 EVIDENCE: Case tracking and examination of service user files showed that care plans were drawn up from the initial service user assessment and reviewed regularly. Future review dates had been set. Care plans used at the home highlighted service user strengths, needs, problems and action and clearly defined the expected outcome for each service user. Some outcomes were to ensure that service users would live comfortably at the home. Care plans also covered areas such as decision-making, risk taking, confidentiality, health care, past interests and hobbies, present needs and wishes and medication. Medicines were stored in a locked kitchen drawer that could be unlocked by using a kitchen knife. The inspector was told there wasn’t a key available as it had been lost. Medicines were placed in medicine pots before the stated time and left on the kitchen table for service users to take with their lunch. One service user administered his insulin by injection. When asked the service user confirmed that the registered manager checked the amount and watched him take his insulin to ensure this was administered properly. Case tracking confirmed a medication risk assessment was not available for this service user. Medication administration record sheets were properly used and signed by staff to record the correct medicine amount given to service users. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 12, 13, 15 and YA 12, 13, 15 Service users had the opportunity to maintain their social interests including keeping appropriate jobs. Staff enabled service users to exercise choice over their lives. The meal served was wholesome, varied, well balanced and appealing. EVIDENCE: Case tracking and discussions with service users confirmed that routines and daily living were based on their wishes. This information was included in care plans. When asked what they liked about Abba Care Home one service user said, “I love animals. We’ve just got two guinea fowl and a peacock and hen, they were a birthday present to me from the owners.” He described how it was his job to look after the other animals and took the inspector on a tour of the small-holding. During this time he collected a number of eggs from the chickens and fed some of the goats. “ It’s lovely here, I’m very happy,” he said. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 13 Other service users were also positive about their social activities. One said, “You can get involved in all sorts of things, I mainly enjoy watching t.v and walking to the pub in the village. My family can visit any time they like. What we do is up to us.” Service users told the inspector about their recent holiday to Jersey with the registered providers. “We went for 5 days, It was good.” Said one service user. Meals were served and eaten in the kitchen diner. Hot and cold drinks were available at regular intervals during the day. The meal served on the day of the inspection was cottage pie. The inspector discreetly witnessed service users eating their lunch and chatting quietly. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP16, 17, 18 YA 22, 23 Service users knew how to complain and who to complain to. They were confident that their complaints would be listened to and taken seriously. Service users were safeguarded from abuse in accordance with written policies. One service user voted in the last general election. EVIDENCE: Examination of records confirmed there had been no complaints recorded during the last 12 months. A complaints procedure was available for service users and their relatives. When asked service users said that they had no complaints. One said, “I’m very happy here I’ve nothing to complain about.” Appropriate policies and procedures were in place to ensure service users monies and financial affairs were protected. One service user said that a solicitor looked after his money for him. Examination of service user records confirmed this. One service user said,” I went to the polling station to vote.” Another said, “We got postal votes but I didn’t bother this time.” A discussion with a member of staff highlighted her knowledge around the homes abuse policy. She described different types of abuse and said, “I’d tell the manager if I thought any of the residents were being abused.” Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP19, 26 and YA 24, 30 Facilities in the home met the criteria for it’s stated purpose. The premise was safe, well maintained, clean and pleasant. Service users lived in safe and comfortable surroundings EVIDENCE: Abba Care Home is set in a rural area and situated within four acres of fields near the village of Wier in Bacup. The home is reached via an unmade road. One service user told the inspector, “The manager takes us anywhere we want to go in her car, sometimes we walk to the village, it’s a good walk!” Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 16 The home offers the use of three lounge areas and a recreation room attached to the back of the house. Access to the first floor of the home was via the staircase. Bedroom doors had appropriate locks fitted. During the inspection all bedrooms were examined and service users were seen using their bedroom space. All bedrooms were single and personalised with service users belongings, one service user commented, “We’ve got everything we want here, Sky T.V in all the rooms!” Bedrooms did not include some furniture noted in the standards due to the small size of each bedroom. However suitable furniture like a table to write on and arm chairs to suit service user needs were provided in other shared spaces of the home, including the recreational area. General maintenance work was ongoing at the time of the inspection and the manager’s husband is responsible for the planned maintenance and renewal programme. Care staff on duty was seen cleaning a number of areas in the home during the inspection. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. Service users benefit from clarity of staff roles and responsibilities. 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 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 27, 29, 30 and YA 34, 35 There was enough staff on duty to meet the service user needs. There were suitable procedures for recruiting staff and ensuring service users were protected from harm. Staff training had taken place and was ongoing. EVIDENCE: When asked service users said that there was always enough staff on duty. One said, “The staff will come to you day or night if you need them, there’s always some one around.” A discussion with the carer on duty confirmed that staff had received appropriate training to care for the service users and meet their needs. The carer was aware of the homes policies and procedures and knew where they could be located. A policy on staff training and development was available and collectively staff had been trained in moving and handling, first aid, fire safety and food hygiene. The carer discussed recent mental health training attended and described some of the course content. “ The course was called Care of Medicines Mental Health and was run by Boots Pharmacy in Manchester. We looked at what Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 18 anxiety is, psychiatric symptoms, psychology and mental health signs and symptoms. We also looked at the different types of mental health medicines and how they work in the body and in the brain, it’s fascinating! I found the course really interesting and it should help me to understand the people here better.” The carer then showed the inspector a completed workbook including the responses to questions and notes made during the course. There had been no new staff recruited since the last inspection and staff record examined confirmed that all necessary employee documents were kept in the home. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home and from competent and accountable management of the service. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP33, 35, 38 and YA 42 The attitude of the staff and management is to provide a safe and secure family environment for the service users. Appropriate professionals handled service users finances. Some health and safety practices ensured service users were not at risk of harm. EVIDENCE: The registered manager has been involved in the management of the home for eight years and maintained overall responsibility for the day-to-day management of the service. She periodically updates her knowledge through various courses. Job descriptions examined outlined the responsibilities of the staff and information on staff training was available for inspection. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 20 A number of equipment maintenance certificates were examined and were up to date. A recent meeting with the local fire officer confirmed that the smoking shed was suitable for it’s use Health and safety practices with regard to medication and risk assessments have been highlighted earlier in the report. Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 x 3 3 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 x x x x x x 3 Score Standard No 7 8 9 10 11 Score 3 2 2 x x Standard No 27 28 29 30 3 x 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score x 3 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 3 34 x 35 3 36 x 37 x 38 2 Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 20 Timescale for action Schedule The registered manager and staff Immediate 3(3)i must encourage and support the Regulation service user who is self 13(2) medicating to retain administer and control his own medication within a risk management framework. Schedule The registered manager must Immediate 3(3)i ensure that the homes policy Regulation and procedure for the storage of 13(2) medication in the home is adhered to by providing a suitable lockable cabinet that can only be accessed by staff using a key. As above The registered manager must Immediate ensure that medicines in the custody of the home are handled and administered according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical society of Great Britain and the requirements of the Misuse of Drugs Act 1971 Regulation Requirement 2. YA 20 3. YA 20 Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 23 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 Good Practice Recommendations Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB 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 Abba Care Home F57 F07 S9594 Abba Care Home V227397 230505 Stage 4.doc Version 1.30 Page 25 - 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!