Inspection on 12/02/07 for Ashton Lodge

This inspection was carried out on 12th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashton Lodge 26/09/08

Ashton Lodge 11/05/06

Ashton Lodge 14/09/05

Ashton Lodge 17/05/05

Ashton Lodge 13/01/05

Ashton Lodge 27/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ashton Lodge Ashton Road Dunstable Bedfordshire LU6 1NP Lead Inspector Mrs Louise Trainor Unannounced Inspection 12th February 2007 08:00 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 Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 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. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashton Lodge Address Ashton Road Dunstable Bedfordshire LU6 1NP 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) 01582 673331 F/P 01582 673331 Resicare Homes Limited Mrs Georgina Thandi Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54), of places Physical disability over 65 years of age (54) Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2006 Brief Description of the Service: The home was situated in a residential street, close to Dunstable town centre. The home was extended in 2005 and now provides 54 beds in single and double rooms, 4 lounges, and a number of communal toilets and bathrooms. The home was arranged with the bedrooms on all three levels and communal areas on the ground floor. For operational reasons the home was divided into three areas, grouping service users according to their needs, but still respecting freedom of movement throughout the home. A pleasant garden was easily accessible and was well used by the service users in the summer months. The home charges between £425 and £495 per week depending on how much care and support the service user requires. This rate was effective from 1st May 2006 and will be reviewed on 1st May 2007. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the third inspection for this service over the past year, and was a Key Inspection. In May 2006 Ashton Lodge had its’ first Key Inspection for the year, this resulted in some Immediate Requirements being left. In October 2006 a Random Inspection took place to monitor the progress of matters that have caused concern. This most recent inspection focused on continued improvements being maintained and also addressed two issues raised by other professionals to The Commission for Social Care Inspection (CSCI), namely Moving and Handling practices and wound care. This report should be read in conjunction with those from the May 2006 and the October 2006 inspections. Standards that were previously met were not addressed in any depth during this visit. This inspection took place on the 12th of February 2007 between the hours of 08:00 hours and 15:45 hours, and was carried out by regulatory inspector, Mrs Louise Trainor. Both the manager and the deputy were present throughout the day to assist where necessary. During this inspection three service users were picked at random by the inspector to case track, this involved the examination of their personal files, observations of care practices and informal interviews where necessary. The three service users chosen all had needs relating to wound care and/ or moving and handling. The District Nurse was also visiting during the inspection, and made time for discussion with the inspector. The personal files of the four most recent staff recruits were also examined, and two staff were briefly interviewed. The inspector would like to thank everyone involved for their support and assistance throughout the day. What the service does well: This home provides a clean, comfortable and homely environment for the service users. All service users appeared clean, comfortable and well cared for. This was reflected in comments made by one visitor to the home that spoke to the inspector. Two of the service users that were picked for case tracking, had been admitted since the last inspection. Both of their files contained detailed pre admission assessments. These had been carried out prior to the admission date, and clearly identified the level of assistance required in all areas of care. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 6 Care plans and risk assessments were clearly documented and demonstrated that service users changing needs were being identified, acknowledged and addressed through regular review. Observations of care practices and discussions with service users indicated that they are treated with respect and dignity. What has improved since the last inspection? The home has recently appointed a full time activity coordinator who had previously worked in the home as a carer and therefore knows the individual service users well. She is aware of their likes and dislikes regarding recreational activities, and her working hours include weekends. The policy and procedures surrounding the recruitment of staff are being closely adhered to, so that service users are protected. The home has purchased three medication trolleys, which are based in different areas of the home. Therefore the administration of medication, each shift, is carried out by the lead carer in each area of the home, thus providing a more efficient service and ensuring it is a more timely process. This is preferable to the previous system where one carer had the task of medication administration throughout the whole of this large home. All prospective service users are being appropriately assessed, by a senior member of the staff team prior to admission. There had previously been some concerns surrounding the lack of reporting regulation 37 notices to CSCI. This home now fully understands this reporting system and is reporting all incidents appropriately to both CSCI and Social services. At the previous inspection it was noted that all the information detailed in the Service User Guide and the Statement of Purpose did not correspond in both documents, in particular there was a discrepancy in the response time of the section regarding complaints. This has now been reviewed and rectified and both documents state a twenty- eight-day time frame for investigation and response. Individual care plans are in place for all service users, and these are being reviewed at monthly intervals to reflect the individuals’ changing needs. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 8 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 Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a detailed Service User Guide and Statement of Purpose in place for this home, so that service users have all the relevant information to make an informed choice about where they live. EVIDENCE: At the previous inspection it was noted that all the information detailed in the Service User Guide and the Statement of Purpose did not always correspond in both documents, in particular there was a discrepancy in the response time of the section regarding complaints. This has now been reviewed and rectified, and both documents state a twenty- eight-day time frame for investigation and response. Two of the service users picked for case tracking, had been admitted since the last inspection. Both of their files contained detailed pre admission Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 10 assessments. These had been carried out prior to the admission date, and clearly identified the level of assistance required in all areas of care. The deputy manager discussed one recent admission, where the home had delayed an admission for a fortnight, until appropriate equipment was in place to manage the individual service users needs. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are in place for all service users, and these are being reviewed at monthly intervals to reflect the individuals’ changing needs. EVIDENCE: All of the service user files that were inspected contained detailed care plans, and monthly reviews were being documented to reflect changes in service user needs. The documentation for the most recent admission, contained in depth information about this service user, both on the homes’ assessment and the Social Services documentation that had been received. Risk Assessments had been carried out, and appropriate pressure relieving equipment had been identified and put in place to any prevent deterioration in wounds, which this service user had on admission. Order forms and receipts were present for this equipment. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 12 Changes in the wound condition were very clearly monitored, and changes in care instructions were recorded appropriately. This service user was informally interviewed, and was fully aware of the content of their care plans, both relating to wound care and other aspects of care. This service user said. “I think the care is ok, and I’m as happy as I can be, but I will be going home soon”. The high number of wounds in this home had been brought to the attention of CSCI over recent months. During this inspection the inspector had the opportunity to discuss this matter with the visiting District Nurse. It is acknowledged that many of the service users in this home do require wound care, however the majority are admitted with these wounds either from home or hospital, and appropriate equipment is ordered on an individual basis. The District Nurse confirmed that the staff here manage the care well, and identify any changes immediately to the nurse that visits daily. She also confirmed that most of the staff are good at carrying out her instructions when appropriate. The example of one service user, who had been very physically unwell, and had developed a small sacral sore, was shared with the inspector. Staff had been reminded of all the contributory factors to aid healing such as a good diet, cleanliness and fluid intake, and staff took notice and the wound healed very rapidly. There are clear detailed records from the district nurse as well as in the service users’ plans, demonstrating that care is consistent, and wounds are being closely monitored and care managed appropriately. It is however recognised that occasionally service users are placed in this residential home when perhaps nursing care would be more appropriate. Since the last inspection, when the storage of medication, and the length of time a medication round took for one carer was highlighted. The home has purchased three medication trolleys, which are stored in different areas of the home. Three staff now undertake the medication rounds in their respective areas of the home, so that the storage and efficiency of administration is improved. Observations of care practices and discussions with service users indicated that they are treated with respect and dignity. Staff were seen assisting service users in a respectful and unhurried way, and interactions were friendly and familiar, often with an air of humour from both parties. One service user said. “They’re very good you know, these girls have got a lot of patience, they always come as soon as I buzz during the night.” Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are choices available for service users in this home. However task orientated care and the lack of understanding, about the importance of choice, by some staff, is somewhat restricting, so that service users are not always being given opportunities to make personal choices. EVIDENCE: During this inspection there were examples of both good and poor practices observed and disclosed by service users in relation to choices. There was a vast choice of breakfast sundries being offered around the dining room. These included toast, cereals, bread and marmalade and yogurts. Service users were still arriving to the table at 09:30 indicating that they had stayed in bed until they were ready to get up. However two service users told the inspector that they are woken at 06:45 each morning, and have no choice but to get up, as they cannot do it alone and they have to fit in with the staff. Two service users told the inspector that they could go to bed when they wished, but others are taken to bed at 18:00 hours, one service user said, “I suppose they have to start early as they have so many people to put to bed”. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 14 There was a choice of chicken casserole or fish in sauce for lunch. This was displayed on a white board in the corridor, however service users in the lounge were not made aware of the second choice unless they expressed a dislike for the first. They were just asked. “Would you like chicken casserole?” A choice of drinks was continually being offered throughout the day. Whilst visiting the High Dependency Unit, where there were ten service users with high needs. It became evident through observations and conversations about the ‘daily routine’, that this unit in particular is based on task orientated care rather than a person centred approach. The home has recently appointed a full time activity coordinator, who previously worked as a carer. On the day of the inspection there appeared to be several service users having 1:1 sessions with games of their choice, however on an overall basis, service users in the main lounge appeared have limited mental and physical stimulation. The inspector recognises that this is a new post for the coordinator and will take time to establish, and is difficult in such a large home. However it is important to find a balance where the majority of service users are encouraged to participate in some meaningful activities each day. One service user said. “We used to have activities, but the ladies left now”. Another said. “It’s a long day and nothing much goes on”. This highlighted that the new coordinator needs to focus on her recent role change, (which service users have not yet recognised) and openly share her enthusiasm and encourage other staff to become more actively involved. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a robust complaints policy in place so that service users and their representatives are confident their complaints will be listened to, taken seriously and acted upon. EVIDENCE: The inspector was informed, by the manager that there had been no complaints to the home since the last inspection therefore the complaints file was not re inspected during this visit. However at the Random inspection in October, the complaints / compliments file was viewed by the inspector. Again there had been no formal complaints, but issues that were raised through a service users questionnaire sent out in July 2006 had been addressed in an action plan. This included things such as: increasing the library selection, producing copies of a rolling four- week menu and additional trips for named service users. Concerns that had been brought to the attention of CSCI since the last inspection relating to wound care in the home and Moving and Handling practices, were addressed during this inspection, and findings have been reflected in other areas of this report. The manager is actively investigating issues relating moving and handling practices at present. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was clean and comfortable and provided a safe and homely environment for the service users. EVIDENCE: There had been a recent complaint made by a health professional visiting the home. Concerns were raised about the strong smell of stale urine in this home. The inspector arrived at this home at 08:00 hours on the day of the inspection. It is expected that in a home where many service users have problems with continence, any unpleasant odours would be at there worst at this time of the day, however this was not the case. This was not a problem that had been identified by CSCI at previous visits to this home, which has always appeared clean, comfortable and homely. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 17 The home is equipped with appropriate aids to help service users maximise their independence, including raised toilet seats, grab rails and alarm call buttons. All the bedrooms were decorated and furnished to meet individual tastes and needs. Many with furniture, personal assets and photographs that reflected the individuals’ life history. The main entrance to the building was only accessible by ringing the doorbell and being granted access by staff. There is visitors book in place, which all visitors are expected to sign. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment policy is sufficient so that service users are protected. EVIDENCE: The files of the four most recent recruits to this home were examined. Each file contained fully completed application forms, two appropriate references, proof of identification, birth/marriage certificates, CRB and Pova first checks appropriately dated, induction contract (signed and dated) and moving and handling assessments. Two staff had started on Pova first checks following consultation with the CSCI. This home is well staffed, boasting nine care staff during the day shifts, and four staff during the night. The care staff are supported by a team of kitchen and domiciliary staff and managers are either present or on call twenty- four hours a day. There is a programme of mandatory training in place, which includes; moving and handling, POVA, fire and first aid. Staff certificates indicate that attendance is good, and many staff are presently doing NVQ training. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 19 Concerns have recently been brought to the attention of CSCI by a Moving and Handling Advisor that had been invited into the home to assess five individual service users for hoists and slings. Information received stated that staff had been observed carrying out ‘drag lifts’ on service users in this home. The inspector spent an hour in the main lounge, at a time when service users were being transferred from the table to comfortable chairs after breakfast. The inspector witnessed seven separate transfers, of different service users. On each occasion the moving and handling belt / sling was used, and service users received verbal instructions and encouragement throughout each procedure. Some time was also spent in the high dependency unit and another lounge where more transfers were observed. Again no transfer was attempted without a moving and handling belt/sling. One member of staff that was interviewed, was able to give a clear account of different methods of using the belt/sling safely and efficiently, however during the day, three staff were seen to be holding it incorrectly, and in two cases of transferring that were observed, the sling appeared to have been placed incorrectly around the service users’ back which caused it to be pulled up under the arms of the service user. But no ‘drag lifts’ were observed. Throughout this period of observation, none of the service users facial expressions or comments indicated discomfort, and two service users told the inspector how comfortable the experience of being lifted was. One service user was heard to say. “Thank -you girls, that was lovely”. After she had been assisted back into her comfortable chair. This service user had very limited eyesight and clearly trusted her carers implicitly. The anomalies that were noted during the observations were discussed at length with the manager, who contacted the Moving and Handling Instructor immediately to confirm the correct positioning and holding position of the belt/sling. The manager is clearly taking this very seriously, and is addressing it as matter of urgency to ensure the safety and comfort of the staff and service users. She is also in communication with the Moving and Handling Advisor to try to resolve this matter immediately. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies, procedures and reporting mechanisms in place to ensure service user’s health, safety and welfare are promoted. EVIDENCE: There had previously been some concerns surrounding the lack of reporting regulation 37 notices to CSCI. This home now fully understands this reporting system and is reporting all incidents appropriately to both CSCI and Social services. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 3 3 Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The registered person should consider a different uniform for the activity coordinator, so that she is easily identifiable to service users. Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ashton Lodge DS0000014990.V328141.R01.S.doc Version 5.2 Page 24 - 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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