Inspection on 29/12/09 for Arthur`s Court

This inspection was carried out on 29th December 2009.

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

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arthur`s Court 28/03/09

Arthur`s Court 13/02/08

Arthur`s Court 21/08/07

Arthur`s Court 21/11/06

Arthur`s Court 18/07/06

Arthur`s Court 31/01/06

Arthur`s Court 14/06/05

Arthur`s Court 25/02/05

Arthur`s Court 14/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Arthur`s Court 27 Highfield Road Street Somerset BA16 0JG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shelagh Laver     Date: 2 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Arthur`s Court 27 Highfield Road Street Somerset BA16 0JG 01458442319 01458447254 AC1Europeancare@aol.com www.europeancare.net European Care (UK) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Pauline Purnell Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Persons of either sex, not less than 60 years, who require general nursing care Places for up to 30 clients for nursing care Places for up to ten clients for personal care Registered for a total of 40 places in categories OP and PD Up to four persons in the age range 18-59 years who require general nursing care Date of last inspection Brief description of the care home Arthurs Court is an established care home providing nursing and personal care for up to 40 service users. The care home can be found near to the centre of Street and within walking distance of the shops. The care home is in an area surrounded by domestic housing. There is limited parking on the home premises. The care home can Care Homes for Older People Page 4 of 25 2 8 0 3 2 0 0 9 0 40 Over 65 40 0 Brief description of the care home provide accommodation in single and shared rooms over two floors. The bedrooms and communal rooms can be reached by stairs from the reception area or by passenger lift from the reception area.There are adequate well equipped bathrooms and toilet facilities around the home. There is a choice of communal areas including a large lounge / dining area on the ground floor and a smaller lounge/diner on the upper floor. There is also a conservatory to the rear of the home. The main lounge on the ground floor can accommodate residents who wish to watch television. The care home provides twenty four hour nursing and personal care services to older persons and can offer general nursing services for up to four persons between the ages of eighteen and fifty nine years. The care home aims to provide nutritious meals to suit peoples wishes. The current fees charged are 487 - 640 pounds for nursing care and 361 - 530 pounds for personal care Pauline Purnell is the registered manager. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The home was last inspected on 26th March 2009 when it was rated as good. We received information from three sources that there were concerns about the care at the home and undertook this Key Inspection on 3rd December 2009. The registered manager at the home has been temporarily absent and we were informed of satisfactory alternative management arrangements. The absence of the manager has co-incided with a shortage of trained nurses so that the senior staff nurse who is currently Acting Manager oftens fulfils the duties of both manager and duty nurse. Two inspectors visited the home on one day and were able to speak to the Acting/Deputy Manager and staff on duty. We met with as many people as possible in the home as we toured the building. We reviewed care plans and staff recruitment and training records. We were able to meet with Geraldine Cook, Programme Manager for the South West. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: At the time of the inspection the home was without a full-time manager and two fulltime registered nurses as the Acting Manager was also fulfilling RGN shift hours. This had affected the management and clinical recording in the home. There were aspects of care planning and recording that must be improved. Currently there are two care plans. All people in the home must have a comprehensive care plan that sets out and monitors their needs. When it is identified that people need to have a certain amount of fluids to promote health then this must be managed in an effective way. There should be clear guidance to staff regarding how much fluid is considered adequate. There should be accurate recording of the amount taken. If insufficient fluid is taken then the trained nurse should monitor this and give appropriate instructions. Similarly if information about urine output is required this must be measured and recorded. Qualatative statements such as good or poor can be misunderstood. Staff should receive training in palliative care. Whilst there was some evidence of good care we were concerned that records indicated some staff did not understand the importance of skilled symptom management in some aspects of palliative care. The planning and recording of training for staff needed action. Some staff had not received up-dates in Manual Handling training for two years. Others had not received either initial or up-dated Safeguarding Adults training. Staff were unsure when they had last received fire training. In the files we reviewed records of staff induction, appraisals and supervisions were irregular with incomplete documentation. When action had been taken to address concerns about a member of staff the action taken and outcomes were not recorded. Care Homes for Older People Page 7 of 25 There is an activities programme in place however it should be further developed to met the individual needs and interests of people who live in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a system of assessment at the home which is undertaken to ensure peoples needs can be met. Evidence: We saw in care plans that we reviewed that people had had an assessment before they were admitted to the home. We saw that a senior nurse had visited people in hospital and completed a formal assessment form. The assessments completed were very comprehensive and person centred. We saw that other forms of information such as discharge notes from hospital and and assessments from social workers had been included in files and had been used to ensure that peoples needs could be met by the home. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is evidence that most people are well cared for in the home however the shortage of trained nurses is evident in some areas of recording and monitoring. All people in the home should have a comprehensive and clear care plan in place whether they have nursing or personal care plans. People who require regular fluids must be monitored more closely to ensure they receive the required amount to promote health. Staff should receive training in palliative care in order to understand and respond to the needs of people at the end of their lives. There is a safe system of medication administration in place however practise must improve in the supervision of the medication trolley. Evidence: We asked people we met during the inspection if they were well cared for. People were positive about their care. One relative comes in each day to assist with care. She said Care Homes for Older People Page 11 of 25 Evidence: she was satisfied with everything in the home. People appeared well presented. Those in bed looked restful and comfortable. We looked at seven care plans in varying degrees of detail. There were two schemes of care plans. Those for people assessed as having personal care needs were much less detailed than those for people with nursing needs. We could not understand the benefit of having two systems as those people needing personal care had a range of needs that needed careful monitoring. In one plan a person was identified as needing hourly fluids and being prone to urine infections. The daily fluid records for this person indicated that often intake was below what would be expected. We saw that there were no records for this persons urine output. This means that there was no evidence of how the persons catheter was working over a 24 hour period. We observed another fluid chart in the home and saw that again intake recorded was often around 550-700 mls. Recording was particularly poor in the evening. We saw in one care plan that a person was having regular catheter changes due to blockages and yet the intake of fluid remained low. Care staff need clear guidance from trained nurses regarding the fluid amount targets and reason for monitoring. If a person is not drinking the trained nurses should take some action to increase the amount. We saw assessments of peoples risk of developing pressure damage. We could see that the home had plenty of pressure relieving mattresses. We looked at one chart and could see that a person was being turned regularly. The care plans contained nutritional assessments and regular weights were recorded. We could see that when someone was losing weight the dietitian had been consulted and action had been taken. One care plan gave clear information regarding the presentation of food to encourage eating. There was evidence that when required food supplements were prescribed and given. We saw one care plan for a person admitted for palliative care who stayed in the home for a short period. There was plenty of detailed information available and a clear care plan had been drawn up. Entries in the daily records indicated that staff did not seem to be aware of the plan or the complex needs of this person. Record keeping was generally poor including poor fluid chart recordings. The importance of the availability of ice when a person has a sore mouth and the need for skilled support through the night should be available to all people. Care Homes for Older People Page 12 of 25 Evidence: Another plan for a person who had received palliative care had received support from health professionals and family. There was evidence that the person had been well supported by staff in the home at the end of the life. There was evidence that there were regular visits by Doctors and Community Nurses to attend to peoples needs. There is a medication administration and storage system in place that is monitored by in-house audits and visits from the supplying pharmacy. We were concerned at this inspection to see that the trained nurse administering medication during lunch-time often left the medication trolley unattended including leaving the dining room for short periods. This is poor practise and should be addressed. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to chose how they spend their day. There is a programme of activities that should be developed to encourage more individual interests and choices. People are satisfied with the choice and standard of meals provided. Evidence: People we met during the inspection said that they were able to chose how they spent their days at the home. We saw minutes of a relatives and residents meeting. There is a monthly newsletter published that includes the activities organised for the month. There is something happening each day in the afternoon during the week. Events for November included Arts and Crafts, Bingo and Flexercise. There is a separate folder kept which records the Activities care plan which we did not inspect on this occasion. On the day of the inspection for example there were many people in the lounge but the event was holding peoples attention as the group was too large and people could not all see or hear. The newsletter indicated that Christmas Activities included a Bazaar and trip to Cadburys Garden Centre. Care Homes for Older People Page 14 of 25 Evidence: People we spoke to in the home were happy with the food. We observed lunch when 20 people being served. The menu displayed offered a choice at of starter, main course and dessert at lunch. There was a good choice of hot nd cold and supper. People particularly enjoyed the cottage pie and fresh vegetables. We were told that there was a system in place to assist people in the dining room and those who had chosen to remain in their rooms to eat. We observed one person in their room who was offered a nicely presented soft diet and given patient and appropriate assistance. Another person was assisted by his wife each day. Another person told us the food is fine. Too much sometimes. We met visitors in the home who told us they were welcome whenever they visited and were pleased with the care that people received. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints system in place. There should be a system in place that ensures that all staff have training in the protection of vulnerable people and that it is clear when training occurred and when up-dates are due. Evidence: Prior to this key inspection we received information from three sources that there were concerns about the home. These concerns were referred to the area manager and were investigated promptly. We saw from records during the inspection that action taken following concerns about one member of staff were not recorded. When we looked in staff files there was evidence that training in safeguarding adults had been received by some staff in 2004. There was no evidence in more recent staff files that people had received formal training. Staff said that they would take all concerns to the manager or to the Commission. The manager informed us on return from sick leave that there was a separate folder for all staff training and that training had taken place in August/September 2009. The Deputy Manager was able to give a good account of her duties to safeguard people. At the last key inspection in March 2009 most people who returned surveys to us knew how to make a complaint. People we spoke to said that they would feel able to talk to the deputy manager about concerns. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well maintained and homely environment. Premises are clean and hygienic and free from odour. The absence of mechanical sluices in the home compromises infection control and must be remedied. Evidence: We made a tour of the building and met with people in their own rooms and in communal areas. At the Key Inspection on 28/03/09 we noted that there had been investment in the home and that overall the standard of decoration was good. At this inspection the home was clean, attractive and comfortable. We were concerned that there were still no sluice machines in place and that this had been a requirement at the last inspection. We were told that there had been difficulties installing the correct model of machine. It has meant that staff have had to empty commodes by hand and clean then by hand which is not acceptable. We have asked to be informed as soon as the equipment is working. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a recruitment system in place that includes pre-employment checks. The home must ensure that at all times there are sufficient,suitably qualified, competent and experienced staff are working in the home. The home should ensure that the records of the induction process are completed. There must be a system of training,supervision and appraisal in the home that ensures staff are trained and competent to do their jobs. Evidence: The home is currently experiencing a shortage of permanent trained nurses. At the time of the inspection there were two full-time vacancies for nurses. The situation had been ascerbated as the senior RGN had been Acting Manger while the manager has been sick. The home uses agency nurses but is able to maintain some continuity by using the same staff. We looked at duty sheets and confirmed that there are trained staff on duty at all times. Staff spoken to said that the home always tried to get cover to ensure there were enough staff on duty. We talked to staff who were working in the home. They were very positive and felt that there was good team spirit. Carers said that they knew how short the home was of nurses and tried to support them. One member of staff said that they had had Manual Handling training up-dates last year but no other training recently. Staff could not remember when they had had fire training. Care Homes for Older People Page 18 of 25 Evidence: We were shown evidence that Person Centred Care, People Handling and Dementia Awareness training had been undertaken by some staff but there were no records available to tell us overall which staff had accessed the training. A new member of staff confirmed that she had had induction. We looked at three staff files. Since the last inspection there had been two appointments. We saw the records for one member of staff employed as carer without previous experience. We could see that there had been apropriate pre-employment checks. The record of induction was not completed. The staff member had received training in Manual handling, Person Centred Care and Dementia Awareness. There was no record of training in protection of vulnerable adults or general health and safety training. We saw the staff file of another recently appointed member of staff and found induction records to be incomplete. We were aware that some issues had been raised with staff however there were no records of supervision. The Deputy Manager discussed the many demands on her time as a result of the absence of the manager and the shortage of trained staff. Records of training that had occurred were not easily accessible. At the time of the inspection there was no plan to offer formal appraisals or a system of recorded supervision in the home. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The absence of a full-time registered manager has impacted on the day to day opeartions of the home. There is a system of planned maintenance in the home. Evidence: The registered manager Pauline Purnell is qualified and experienced to run the home. Since September the manager has been unwell. We had been informed of the arrangements to provide temporary management cover by the Deputy Manager and the Area Manager. The absence of a full time manager has coincided with a shortage of trained nurses and this has impacted on the home. Whilst the Deputy Manager has provided staff leadership and has worked very hard to maintain standards in the home some areas such as care planning and staff training now require attention. We understand that the manager will be returning to work in the near future. There is evidence of an organised maintenance programme in the home although some gaps were identified. We saw records of monthly water temperature checks, Care Homes for Older People Page 20 of 25 Evidence: weekly fire alarm and bedrail checks and six monthly servicing of hoists. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be a clear and comprehensive care plan for each person. The care plan is the basis on which care staff provide care in the home. It must give clear instructions to them that can be easily accessed and understood. 01/08/2009 2 38 13 The manager must ensure that the work to the new sluices is completed and includes functioning bedpan cleaning equipment. Current arrangements do not facilitate best practise in infection control. 30/05/2009 Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The home must ensure that when the need for monitoring of fluids is identified this is carried out with care and is supervised by trained nurses. mono It is important that efforts are made to ensure that people receive a required amount of fluid for their needs. Nurses must be able to review the intake and output of people when this is a specified health need. 14/01/2010 2 18 13 All staff must receive training in the recognition and prevention of abuse. All staff must be aware of different types of abuse and must be able to take appropriate action to prevent and report it. 07/04/2010 Care Homes for Older People Page 23 of 25 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 9 11 12 Staff administering medication should ensure the trolley is supervised at all times. All staff should receive palliative care training. Peoples interests should be recorded and there should be opportunities for them to pursue their own leisure, social and cultural activities. All staff should be awareof the home Whistle Blowing policy. 4 18 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 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!