Inspection on 18/10/05 for Arranmore Park Rest Home

This inspection was carried out on 18th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arranmore Park Rest Home 05/07/07

Arranmore Park Rest Home 24/05/06

Arranmore Park Rest Home 12/07/05

Arranmore Park Rest Home 02/03/05

Arranmore Park Rest Home 27/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Arranmore Park Rest Home 100 Square Lane Lathom Burscough Lancashire L40 7RQ Lead Inspector Pauline Randles Announced Inspection 18th October 2005 9:20 X10015.doc Version 1.40 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 Arranmore Park Rest Home DS0000061200.V251989.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 Older People. 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. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Arranmore Park Rest Home Address 100 Square Lane Lathom Burscough Lancashire L40 7RQ 01704 895887 01704 895965 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) Arranmore Park Limited Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 34 service users requiring personal care who fall into the category of OP - Old age, not falling within any other category. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 12th July 2005 3. Date of last inspection Brief Description of the Service: Arranmore Park provides 24-hour personal care for up to 34 older people. Arranmore Park is a detached residence, situated close to the village of Burscough in West Lancashire. The home provides both single and shared rooms, many of which have en-suite facilities on both the ground, first and second floor. The home has a passenger lift, two dining areas and three lounge areas. The home also has an enclosed patio area to the rear. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over a period of seven hours. There were twenty-six residents living at Arranmore Park at the time of inspection. This was the first inspection since the new manager had taken up post. During the course of the inspection the proprietor, the manager, three staff, four residents and a relative were spoken to. Eleven comment cards had been returned from residents and three from relatives. A completed pre-inspection questionnaire also helped to inform the findings. Procedures and records were examined, lunch was taken with the residents and the premises were viewed. What the service does well: What has improved since the last inspection? What they could do better: Care planning and risk assessment processes must be improved to ensure that adequate and relevant information is recorded that informs the continuing plan of care. Standard staff rosters must be developed for forward planning purposes and to ensure the hours and roles undertaken are in accordance with Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 6 defined terms and conditions of employment. To ensure compliance with data protection requirements accident report forms must be stored on individual files of residents. In the interests of health and safety an up to date record of maintenance tasks that have been completed must be kept and environmental risk assessments must be reviewed and revised within the required timescales. In addition, easier access to the latest inspection report would be an asset in terms of information provision for residents and their representatives. An extension of the consultation process to include stakeholders in the community will enhance accountability. Following a resident being weighed the information should be recorded on individual files to maintain confidentiality. The manager should complete the registration process and aim to complete the Registered Managers Award by 2007 to ensure that management competence and skills are of the standard required. 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. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. 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. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 The Statement of Purpose provides service users and their representatives with full details of the home’s services and facilities enabling an informed choice to be made about possible residency. Progress had been made in the development of individual files for each resident to improve greater confidentiality of information and easier access. EVIDENCE: The Statement of Purpose had been reviewed as previously required to include information about fire precautions and associated emergency procedures so that prospective residents can be assured that there are adequate systems in place to ensure their safety. The previous recommendation that the latest inspection report be displayed to enable ready access has yet to be met although it is available from the office on request. Personal files had been developed for some residents. These files held all information relating to the resident including assessments of need and terms and conditions of residency. When individual files have been developed for all Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 9 residents it will mean that information is stored and maintained appropriately and readily accessible as required. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 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. 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. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 10 and 11 Some progress had been made in improving the care planning and risk assessment processes. Further improvements to processes are required to ensure adequate and relevant information is recorded. The health needs of residents are effectively met and there is evidence of good joint working with local health providers. Personal care and support is provided in a manner that upholds the rights of the individual to have their privacy and dignity respected. Staff members caring for residents who are close to death are guided by sensitive and detailed procedures. EVIDENCE: Care plans and risk assessments were detailed and had been improved since the previous inspection to include assessment in relation to falls. Care plan daily records were lacking in detail and must be improved in order to monitor the well- being of the resident and inform the care plan review. Care plan and risk assessment procedures are presently being reviewed by the manager. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 11 Discussion with residents confirmed that health care needs are met, for example chiropody and optical needs and this was further evidenced through file records and comments from staff. As noted on one comment card there is a sixteen waiting period between chiropody appointments. The manager confirmed this to be the case and advised that some residents had chosen to make alternative private arrangements. One resident who had recently had hospital treatment confirmed that he had been well supported by the home and that “an ambulance has already been booked for my next appointment in December.” At the time of inspection one resident was experiencing extreme discomfort due to a catheter by passing. A suitable response was provided that resulted in appropriate medical care and treatment following which a relief of the discomfort was clearly apparent. The philosophy of the home supported the rights of residents to have their privacy and dignity respected. A relative said “mum likes to spend private time in her room each day and this is supported by staff.” Staff members described how residents are bathed and toileted in a manner that upholds dignity. Also, staff members were observed to be courteous and respectful to residents during the inspection. The procedure relating to care of residents close to death and dying had been reviewed as previously recommended to cover all elements, outlined in the standard, in order to provide sensitive, good practice guidelines for staff members to follow. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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. Service users maintain contact with family/ friends/ representatives and the local community as they wish. 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. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 Residents are involved in a range of chosen social activities that are provided within the home and through outdoor activities and outings. Personal support and services provided by the home ensure that residents are enabled to exercise choice and that independence is maintained. Meals are of a high standard, wholesome and nutritious meeting the needs and preferences of residents and are served in pleasant surroundings. EVIDENCE: A notice board in the lounge, and entertainment records indicated a wide range of activities had been taking place. These included life long learning opportunities, scheduled daily activities, plus residents’ choice and free time. Residents and a relative spoke about a music hall outing that they had been invited to that was occurring the following week. Staff members spoke about their involvement “we have craft on a Wednesday and exercises on a Friday the residents feel better for joining in.” Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 13 Advocacy information is included in the Service User Guide. A copy of the guide was in each bedroom. Bereavement counselling had recently been accessed for an individual and this was ongoing. Records indicated that the majority of residents dealt with their own finances. The manager confirmed that access to records is enabled for residents. One resident said “ I know I could look at files in the office if I wanted to.” Residents spoken to expressed a high level of satisfaction with the meals provided. Comments made included “ meals are very nice, there is always an alternative.” The cook who was on duty confirmed that items of food are pureed separately, as previously recommended, in order to maintain appeal of the meal and aid appetite and nutrition. Records indicated that a balanced and nutritious diet is provided. It was observed that the mealtime was unhurried and that suitable support was provided for residents as necessary in a pleasing dining environment that provided comfortable seating and wheelchair space. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 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. The Commission considers Standards 16 and 18 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 and 18 The complaints process is consistent and includes clear information provision for service users to enable them to raise any concerns with confidence that these will be listened to and acted upon. Procedures for protecting residents from abuse are thorough and implemented by staff trained in the protection of vulnerable adults. EVIDENCE: The complaints procedure in the procedures manual had been updated to reflect the information provided in other documentation. All residents had a copy of the procedure in their personal Service User Guide and staff, when interviewed, demonstrated an awareness of their role in the process and knew where to find the policy. One staff member said she would sort out “any small things” but would refer other matters to the manager thereby ensuring that any concerns of residents were listened to and an appropriate response was made. The procedure for Protection of Vulnerable Adults remained in keeping with regulatory requirements and included whistle blowing and dealing with verbal or physical aggression towards staff. Six staff members had undertaken protection of vulnerable adults training last month. The policy underpinned by training means that any signs and symptoms of potential abuse will be identified and appropriate action initiated. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 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. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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, 24, 25 and 26 The home is suitable for the purpose providing a clean, comfortable and safe environment for residents. Bedrooms are pleasingly furnished, fitted and personalised. Maintenance records should be kept up to date to ensure maintenance tasks are completed promptly. EVIDENCE: The location and layout of the home is suitable for the purpose. The environment was warm and comfortable and the grounds were tidy and safe. Maintenance tasks had been logged but the record was not up to date at the time of inspection although it was clear that some of the work had been completed. A tour of the environment confirmed that bedrooms were adequately furnished and personalised. Residents said that their rooms were “nice” and a number of residents confirmed that they liked to spend some period of the day relaxing in their own room. All furniture and fittings were of reasonable standard and had been cleaned, repaired and replaced as necessary to ensure that the home continues to be a nice place to live. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 16 Evidence was seen that tests had been undertaken to ensure that risk from the Legionella bacteria had been reduced and the safety of residents maintained. Lighting and ventilation throughout the home was observed to be satisfactory to the needs of residents. Radiators had been guarded to minimise the risk of scalding from hot surfaces. Water temperature checks had been introduced to ensure safe temperatures are continuously maintained. A sluice facility is provided which is separate to general facilities for residents which, to maintain safety, is only entered through a door with a security locking mechanism as disinfectant products are stored within. An inspection had been carried out at the home in relation to compliance with the Water Fittings Regulations 1999. Requirements from this inspection are to be implemented by November of this year. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. 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. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The skill mix and number of staff on duty was sufficient to competently meet the needs of residents. The recruitment and selection procedures of the home require thorough checks to be carried out to ensure that new staff members have qualities suitable to working in the care sector. EVIDENCE: At the time of inspection the home was staffed in accordance with the requirements of the previous regulatory authority taking into account the dependency needs of residents. The manager is drawing up new standard rotas to improve accountability of staff and ensure all staff members work in accordance with their defined terms and conditions of employment. One resident said she mostly gets the same two staff members to attend to her particular personal needs. She said the staff, “are excellent” whilst another resident said, “ I can’t fault them, whatever happens they are there.” A staff member when asked about the approach care staff members take to their work said, “residents are treated as individuals.” The recruitment policy of the home is to start new staff following receipt of satisfactory criminal records bureau check and references to be sure that all staff have a background that is suitable for them to work in care services. Personnel files for four staff that were examined contained all necessary documentation including supervision and training records. Terms and Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 18 conditions of employment had been issued to all staff to meet employment legislation and copies had been retained for inclusion on individual personnel files. Over 50 of care staff held NVQ Level 2 in Care that confirms that they have been observed and assessed to be competent in the provision of personal care services. Training records indicated that staff members had attended a wide variety of training courses in recent months. These included care of the dying and bereaved and protection of vulnerable adults. It had been arranged for four staff to attend advanced medication training on the Thursday following the inspection. The ongoing commitment to training from management and staff enables skills to be maintained and developed to meet the changing needs of residents. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 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. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 The manager has a clear development plan and vision for the home that is supported by the proprietors. Further development of survey systems to include stakeholders in the community will improve the quality assessment process and accountability of the home. Records are not well managed. This practice could potentially place residents at risk. EVIDENCE: Since the previous inspection in July a lot of work had been undertaken by the proprietor in reviewing policies and procedures and in promotion of improvements to practice. The new manager, who had taken up post three weeks prior to this inspection, had begun to review care plan and risk assessment processes and revise the systems used for holding information on Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 20 residents and staffing rotas. The manager had applied for registration with the Commission for Social Care Inspection and had commenced the Registered Managers Award. A detailed job description had been issued to the manager that included her responsibilities under the Care Standards Act 2000 and associated regulatory requirements. As a measure of the quality of service provided Arranmore Park holds a four star RDB rating, which is undertaken independently by assessors visiting the care home. The results of a residents’ survey that took place earlier this year was prominently displayed in the hallway of the home. A survey of other stakeholders in the community had not been undertaken so remains a recommendation. An annual business plan that reflected developments that would benefit residents for example refurbishment of the premises and additional training of staff was examined. One resident said that one of the good things about living at Arranmore Park was that staff members “listen to you.” Residents are encouraged to hold their own money wherever possible or relatives retain on behalf of the individual. In a number of cases the home holds small amounts of money on behalf of the resident. Records of these transactions had been maintained and checked by members of the management team and were open to inspection ensuring the protection of the resident from financial abuse. The manager has had weekly supervision meetings with the proprietors, the content of which, she recorded. Supervision of the deputy manager is to be established by the home’s manager. A record of care staff supervision was held on individual personnel files. The manager demonstrated an awareness of the topics to be covered in supervision that will enable a common philosophy of care and a consistent promotion of good practice throughout the staff team. Records were not adequately maintained at the time of inspection. Care plans and risk assessment records must be reviewed and revised as planned. Also records relating to maintenance, control of hazardous substances, accidents and environmental risk assessments must be reviewed and kept up to date in accordance with appropriate timescales to ensure the continuing safety of people working and living at the care home. To meet data protection requirements accident forms and weight records should be held on individual files of residents. To ensure care services are competent and meet basic national training organisation standards, mandatory staff training relating to moving and handling, food hygiene and health and safety had recently taken place. Also seven staff had been trained in first aid. Electrical, gas and water inspections had been conducted in recent months and the risk of legionella minimised Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 21 through the introduction of a monitoring system as an additional necessary safety measure. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 22 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 2 2 Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 23 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 OP7 Timescale for action 13 (4) (c) Care plan and risk assessment 31/01/06 formats must be reviewed and revised to ensure compliance with regulatory requirements. 7 Staff hours must be incorporated 30/11/05 Schedule into a formal weekly staff roster 4 that reflects number and hours of staff scheduled to be on duty. 17(1) Accident report forms must be 08/11/05 Sch 3 (3) stored on individual files to meet 23 (2) data protection requirements. The record of maintenance tasks undertaken must be kept up to date. 13 (4) (a) Environmental risk assessments 30/11/05 (c) and control of hazardous substances records must be reviewed and revised periodically as required. Regulation Requirement 2 OP27 3 OP19 OP37 4 OP38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000061200.V251989.R01.S.doc Version 5.0 Page 24 Arranmore Park Rest Home 1 2 3 4 Standard OP1 OP31 OP33 OP37 The latest inspection report should be readily available for the information of residents and their relatives. The manager should attain qualifications equivalent to the NVQ Level 4 in management and care by 2007. The views of stakeholders in the community should be sought as to how the home is performing. The weight of residents should be accurately measured on a regular basis and be recorded on personal files. Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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 Arranmore Park Rest Home DS0000061200.V251989.R01.S.doc Version 5.0 Page 26 - 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. 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