Key inspection report
Care homes for older people
Name: Address: Ashfield House Ashfield Avenue Raunds Northamptonshire NN9 6DX The quality rating for this care home is:
two star good 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: Irene Miller
Date: 0 9 0 3 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: Ashfield House Ashfield Avenue Raunds Northamptonshire NN9 6DX 01933627280 TBC Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.shaw.co.uk Shaw Healthcare (de Montfort) Ltd Name of registered manager (if applicable) Joan Spicer Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is: 40 The registered person may provide the following catrgroes of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling into any other category - Code OP Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Ashfield House is a purpose built residential home opened in September 2008. Registered as a residential home providing personal care for up to forty older people Care Homes for Older People
Page 4 of 25 Over 65 0 0 40 40 1 0 Brief description of the care home including people with dementia. Accommodation is spread over three floors. All bedrooms are single with en suite facilities, TV and telephone points, within each group there is a large lounge and dining area. There is a passenger lift, which provides people with access to all floors. Ashfield House is situated in the centre of a housing estate on the outskirtsof the town of Raunds. The home is run in partrnership with Northamptonshire County Council and Shaw Healthcare. Fees are agreed as part of the contract with Northamptonshire County Council and are based upon the assessed level of need and includes the cost of accommodation, meals, laundry and personal care. Additional costs include personal items, such as toiletries, clothing, newspapers and private chiropody treatments. 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: two star good 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 focus of all inspections undertaken by the Commission for Social Care Inspection (CSCI) are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of three people using the service were sample checked this involved looking through written information available on their care, such as individual care plans (a care plan sets out how the home aims to meet the individual service users personal, health care, social and spiritual needs). During the course of the visit people using the service were consulted on how they Care Homes for Older People
Page 6 of 25 view the care provided at the home, and discussions with staff gave an insight into the support and training provided at the home. Observations made during the visit gave an indication on the quality of staff interactions with people using the service. Records in relation to the homes management and administration systems, quality assurance, staffing and general policies and procedures were viewed. Prior to this visit the Commission for Social Care Inspection sent out to the provider an Annual Quality Assurance Assessment (AQAA) this document acts as a tool for care providers to self assess their performance against the National Minimum Standards (NMS) outcome areas. The AQAA was returned to the Commission for Social Care Inspection (CSCI) within the timescale set. People using the service, visors and staff were asked to provide feedback on how they view the service provided through the completion of a have your say questionnaire. Comments received within the questionnaires returned to CSCI are contained within the body of this report. Care Homes for Older People Page 7 of 25 What the care home does well: Within the care plans viewed there was instruction for staff to follow on how to provide individualised care. Within the care plan of one person who required additional support with their health care needs there was records of assessments having been carried out on mobility, pressure area care and nutritional intake. There were records of risk assessments having been carried out to identify the risks of the person developing pressure area ulcers due to their frailty, immobility and poor nutritional intake. Pressure area relieving equipment was seen to be in use and monitoring records were in place such as diet and fluid intake and turn charts. Consideration had been taken on the additional support that people needed in the move from Abbott House back to Ashfield House and thought had been given to ensuring that people were provided with accommodation to suit their needs. In discussion with people using the service one person said that they had recently moved into another bedroom, the reason for the move was to enable them to socialise with other people using the service who had similar needs, the person said that they liked to continue to use a typewriter and frequently typed letters to their friends and relatives. The person said that the staff had been very supportive with their move and had taken the time to ensure that all their belongings (some of which were fragile ornaments) were moved safely. People using the service are involved in the running of the home, one person said that they had enjoyed helping out serving teas and snacks to other people using the service this had occurred during a a heavy snowfall when some staff had been unable to make their way into work. In one of the surveys received a comment was made we are very grateful for all the staff do, during the bad weather they really upped their game to make sure we had everything that we needed. Within the care plans there was information available on peoples preferred hobbies, interests and pastimes and within the daily notes there was records of one to one and social activities that people had been engaged in such as attending the coffee mornings, various church services from different denominations. During the visit people were observed spending time socialising with each other and the staff on duty enjoying a chat over a cup of tea. Within the care plans there was details on food preferences likes and dislikes the kitchen was viewed an was seen to be clean and well managed. The daily menus are on display within the foyer area of the home, comments received from the surveys returned to CSCI were praising such as wonderful food they cater for my needs very well I am fussy eater the quality of the food is of a high standard and there is a good choice. The home employs and Activity Person and comments received within the surveys were praising such as activities are well organised the activity person is liked by all she is very good at her job my mother seems very happy at Ashfield House she likes the activities. Within the surveys received by CSCI relatives, carers and visitors commented on how Care Homes for Older People
Page 8 of 25 staff know all the residents personally and there is always a warm welcome to visitors comments on the management style of the home were very positive such as the manager runs a happy home,the administrator always greets you cheerfully and is very helpful,the management always find time to answer questions, the home is managed very well, the home has a safe and happy environment with a family atmosphere. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 9 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 10 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. Pre admission assessment feeds into the care planning processes to ensure that the needs of people are identified and met. Evidence: The homes statement of purpose and service user guides had recently been updated to reflect the current management arrangements of the home and the homes aims and objectives, both documents were available within the front entrance of the home. Within the care plans viewed there were records of pre assessments having been completed prior to admission the assessments had formed the basis of the care plans in place, during the visit people spoken with confirmed that pre assessment visits had taken place. Within each of the care files viewed there was a copy of the homes service user agreement.
Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the health and personal care needs of people using the service are met, however robust medication records and specific care plans in place would further ensure that peoples needs are fully met and their health and welfare promoted and protected. Evidence: We looked at the care plans of two people using the service, one person with a diagnosis of dementia who regularly experiences high levels of anxiety and one person who was physical frail whos healthcare was their primary need. Within the care plans viewed there was instruction for staff to follow on how to recognise signs of increased anxiety and the recommended response alleviate anxiety, the plan giving details for staff to follow to help ease the persons anxiety. During the inspection visit staff were seen to spend time chatting with the person, involving them in activities that were taking place within the lounge. The person appeared relaxed within the company of other people using the service and the staff and there was a relaxed atmosphere.
Care Homes for Older People Page 12 of 25 Evidence: Within the care plan of one person who required additional support with their healthcare needs there was records of assessments having been carried out on mobility, pressure area care and nutritional intake. There were records of risk assessments having been carried out to identify the risk of developing pressure area ulcers due to the persons frailty, immobility and poor nutritional intake. Pressure area relieving equipment was seen to be in use and monitoring records such as diet and fluid intake and turn charts were seen to be in place. It was noted that one person had a urinary catheter in situ and on checking their care records there was no specific care plan in place to address catheter care. However there was some record of the care and treatment of the catheter within the daily notes. The importance of having a catheter care plan in place was discussed with the manager and the staff at the time of the inspection, this was taken on board during the inspection as the staff set about putting together a catheter care plan in place. Records were available of visits by the district nurse and and other healthcare professionals such as the chiropodist, optician and the general practitioner in response to episodes of illness. The home had notified CSCI (by means of a regulation 37 written notification) of a medication error that had occurred and the actions taken by the manager were appropriate to ensure the welfare and safety of the person using the service, the advice of the general practitioner had been sought and medication refresher training had been provided for the member of staff. The medication administration records(MAR Charts) were sample checked there was some instances were people had not received their prescribed medications and staff had failed to indicate on the Mar chart the reasons why the medication had not been administered. It is important that people receive their medication as prescribed and when it is not administered a record must be available to demonstrate the reason why it was not given. Medication that falls under the controlled drugs register (CD Drugs) were sample checked one person was prescribed a night sedative which was prescribed as a variable dose e.g 5ml - 10ml to be given at night, on checking the controlled drugs register the entries showed that the person had been regularly receiving 5ml at night. However more recently the person had been administered 10ml of this medication, there was no record as to why the dosage had been increased. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle within the home matches the needs and expectations of the people using the service. Evidence: Within the care plans viewed there was records of how people were to be supported in the move from Abbott House back to Ashfield House. The care plans detailed peoples medical histories in terms of their physical and emotional needs. In discussion with people using the service one person said that they had recently moved into another bedroom, the reason for the move was to enable them to socialise with other people using the service who had similar needs, the person said that they liked to continue to use a typewriter and frequently typed letters to their friends and relatives. The person said that the staff had been very supportive with their move and had taken the time to ensure that all their belongings (some of which were fragile ornaments) were moved safely. One person spoken with said that they had enjoyed serving teas and snacks to other people using the service during poor weather and a heavy snowfall. Care Homes for Older People Page 14 of 25 Evidence: Within the care plans there was information available on peoples preferred hobbies, interests and pastimes and available within the daily notes there was records of one to one and social activities that people had been engaged in such as attending the coffee mornings, various church services from different denominations. During the visit people were observed spending time socialising with each other and the staff on duty enjoying a chat. Within the care plans there was details on food preferences likes and dislikes the kitchen was viewed an was seen to be clean and well managed. The daily menus are on display within the foyer area of the home, comments received from the surveys returned to CSCI were praising such as wonderful food they cater for my needs very well I am fussy eater the quality of the food is of a high standard and there is a good choice. The home employs and Activity Person and comments received within the surveys were praising such as activities are well organised the activity person is liked by all she is very good at her job my mother seems very happy at Ashfield House she likes the activities. Within the surveys received relative, carers and visitors gave very praising comments such as staff know all the residents personally and there is always a warm welcome to visitors, the administrator gives excellent service to the home, she always greets you cheerfully and always helpful, the manager is the same she runs a happy home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service feel safe and confident that any concerns or complaints they may have will be listened to and acted upon by the management of the home. Evidence: Since the home has reopened no complaints had been received by the Commission for Social Care Inspection and no complaints were logged at the homes level. Within the Statement of Purpose and the Service User Guide there was information on the how people using the service or their representatives can raise any concerns or complaints they may have, direct with the provider and the contact details are provided for the Commission for Social Care Inspection and the Ombudsman. Surveys from relatives identified that they all know how to make a complaint. Training is provided on safeguarding during the staff induction period this training looks at what events constitute abuse and the whistle blowing procedure in reporting abuse. The organisation has demonstrated that they act responsibly in protecting people that use their service and people spoken with during the visit confirmed that they felt safe living at the home, that the staff were approachable and they felt sure that if they did have any concerns or complaints that they would be dealt with appropriately.
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 using the service are provided with a modern, clean and spacious home. Evidence: A limited tour of the building was carried out and all areas viewed were exceptionally clean, bedrooms had been personalised, one person spoken with said that they had recently changed their bedroom, and complimented the staff on the care and attention to ensuring their belongings were moved safely. All bedrooms have en suite facilities and each unit has an assisted bathroom, which is spacious and equipped to meet the dependency needs of residents. The home is fully accessible to people with physical disabilities and specialist equipment and adaptations are provided. All areas of the home viewed appeared clean, the laundry area was viewed which was clean and well managed, hygiene and cross infection control measures were seen to be in operation, and within the main kitchen daily food hygiene control systems were in place. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff take a pride in promoting the rights for people to be treated with dignity and respect. By ensuring police checks are carried out prior to new starters taking up employment at the home people using the service would be further protected. Evidence: The staffing levels on the day of the visit appeared satisfactory to meet the needs of the people living at the home. The staff recruitment files were sample checked there was evidence of interview records being retained and criminal records bureau (CRB) clearances and references having been obtained within two of the staff files viewed. The recruitment file of one new staff member could not evidence that a CRB clearance had been obtained the member of staff had been working at the home for approximately two weeks. Two character references had been obtained from previous employers. In the event that new staff start work at the home prior to obtaining a full CRB clearance the employer must be able to demonstrate that they work under strict supervisory arrangements. This is to protect people using the service from potential abuse. Staff spoken with had a good understanding of the importance of ensuring that people
Care Homes for Older People Page 18 of 25 Evidence: using the service are protected from abuse and staff training is provided on safeguarding people from abuse which includes the different types of abuse that can occur. During the visit staff were observed to treat people using the service with respect, with the rights to choice and individuality promoted. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people using the service. Evidence: The manager has the relevant experience of managing a home and had been in position at Ashfield House since its reopening an application to register as the manager with the Commission for Social Care Inspection (CSCI) is in progress. In the interim period another person from within the company has been registered to manage the home. Through discussion with the manager and observations made during the visit it was evident that she engaged well with people who use the service, relatives and staff and is keen to continue in making further improvements at the home. Monthly unannounced visits take place from a representative from within the company during which health and safety, quality assurance and policies and procedures are
Care Homes for Older People Page 20 of 25 Evidence: looked at. Prior to this inspection the Annual Quality Assurance Assessment (AQAA) was sent to the home for completion, and a timescale given for the return of the completed AQAA, this was returned to CSCI within the timescale. The AQAA provides the opportunity for the home to self assess where they meet the National Minimum Standards (NMS) outcome areas to identify their strengths and areas for further improvement. The information received within the AQAA was detailed and demonstrated that their is a commitment to continual improvement. The systems in place to protect the financial interests of people using the service were sample checked, money held on behalf of people using the service was stored securely and records of all transactions are retained. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for 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 7 13 The use of continence aids and equipment required such as urinary catheters must be detailed within the care plan. This would ensure that catheter care is fully monitored. 12/06/2009 2 9 13 Clear records must be entered onto the medication records detailing the reason why prescribed medications have not been given. This is to ensure that people received their medications as prescribed. 12/06/2009 3 29 19 New staff must only be confirmed in post following completion of a satisfactory police check (CRB). Only in extreme circumstances should new staff commence work prior to this clearance and in such an event the employer must be able to 12/06/2009 Care Homes for Older People Page 23 of 25 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 demonstrate that the member of staff works under strict supervisory arrangements at all times. This is to ensure that people using that service are protected from potential abuse. 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 9 Robust systems should be in place to monitor the use of prescribed medications including controlled medications that have variable dosage instructions. This is to ensure that the effectiveness of the medication is closely monitored and protect people from potential abuse. 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!
