Inspection on 23/06/06 for Aspinden Wood Centre

This inspection was carried out on 23rd June 2006.

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

Other inspections for this house

Aspinden Wood Centre 27/10/08

Aspinden Wood Centre 07/03/08

Aspinden Wood Centre 08/12/05

Aspinden Wood Centre 21/06/05

Aspinden Wood Centre 25/01/05

Aspinden Wood Centre 13/07/04

Aspinden Wood Centre 25/03/04

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

Hartley House

Brook Drive, 124

Rugby House Project

City Roads Crisis Intervention

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

CARE HOME ADULTS 18-65 Aspinden Wood Centre 1, Aspinden Wood Road London SE16 2DR Lead Inspector Pam Cohen Unannounced Inspection 23rd June 2006 10:00 Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 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 Aspinden Wood Centre DS0000007058.V300144.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aspinden Wood Centre Address 1, Aspinden Wood Road London SE16 2DR 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) 0207 237 0331 Equinox Care Home 24 Category(ies) of Past or present alcohol dependence (16), Past or registration, with number present alcohol dependence over 65 years of of places age (8) Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Eight of the service users may be over 65 years of age Date of last inspection 8th December 2005 Brief Description of the Service: Aspinden Wood Centre is a care home providing accommodation and personal care to 24 people with past or present alcohol dependence. The home is part of Equinox Care, a voluntary organisation. The home is a detached, two-storey building with off street parking at the front, and a small, well maintained and pretty garden at the back. It is in Bermondsey, South London, close to local shops, social and leisure facilities, and public transport links. All service users have single rooms with sinks, and there are ample communal spaces including a “dry” and a “wet” lounge, a service users’ kitchen and a large pleasant dining room and conservatory. On the day of the inspection there were no vacancies. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 23rd June. The manager and the deputy manager assisted throughout, and the inspector was also able to talk to the area manager and the finance director of the organisation. She also spoke privately to staff and service users and was invited to see a service user’s room. The cost of the service for the year since April is £604.17 per week. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Prospective service users have access to all necessary information and their assessment process is well managed. EVIDENCE: The home has a service user guide with all necessary information although the service should ensure that all parts are kept up to date. The manager described a good system for assessment of prospective service users which was backed up by documentation. After initial referral there is a visit to the centre by the prospective service user where an assessment of their needs is made. The home then obtains multidisciplinary assessments and there is a team discussion about how the new service user would fit in with the other service users. If someone cannot be accommodated the manager sends out a letter setting out the reasons why not. All service users have a signed copy a license agreement. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Service users are well supported to make decisions about their lives and are consulted about some aspects of life in the home. However, documentation about their support needs and about the risks involved in their everyday life is not good. EVIDENCE: Although it is clear from speaking to staff that they are knowledgeable about service users’ wishes and needs, this is not reflected in documentation. Four service users’ files were seen and the individual plans showed significant shortfalls. There was evidence of good key worker sessions, where the service user and their key member of staff discuss issues. There were also monthly summaries. The support plans, however, did not show what support is needed, were not detailed enough and did not cover all necessary areas. One service user who had been at the home for 3 weeks had no individual plan. It is of concern that there were no risk assessments on service users’ files, concerned with life at the home. This means that people’s individual areas of risk, in terms of sensory impairment or schizophrenia, were not looked at nor were strategies devised to minimise risk. It is clear that there is much challenging Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 9 behaviour amongst service users, but again there was no assessment or strategies to minimise risk for service users or staff. The individual support plans were also static. There is a format for deciding, with the service user, the goals they wish to achieve and how to achieve them, but this was not being used. There is some service user involvement in terms of meetings with staff both in a group and singly, and service users are consulted on such matters as the change of use of the lounges. There is also a suggestions box. However service users do not have the opportunity of a more structured involvement in drawing up policies and procedures, involvement in recruitment of staff and selection of other service users, or having their views listened to by way of questionnaires or other monitoring tools. The service manager said that a service user involvement manager is to be recruited centrally and it is hoped that this post will support homes to involve service users more. There was evidence that staff support service users to be as in control of their lives as much as possible. A member of staff described the negotiations he has with a service user to try and limit his alcohol intake and manage his finances well. One service user said that “Staff help you to look after yourself, we come to some good agreements” and another said that she was “Allowed to have opportunity to do things-not pushed into things “ Most service users manage their own monies, with staff support and information is provided on advocacy services. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot yet be sure that they will be supported in their preferred lifestyle as their wishes are not yet properly assessed and sufficient, appropriate activities offered. Service users can be sure that they will be supported within their personal network. Food provision is generally good. EVIDENCE: There are initiatives at the centre to support service users to develop a rewarding lifestyle that suits them. Groups have been set up for women, for gardening, and for general discussion with staff. There is a strong Irish presence in the service user group and appropriate cultural opportunities are accessed both in the home and in the community. Religious observance is also supported both in the home and outside. There is some entertainment in the home, and some trips out, both singly and in groups. About six service users are also able to have a holiday during the year. However more work still needs to be done. This is one of the areas which is not addressed in enough detail in individual plans, and so staff cannot be sure that they have the information needed to help develop each individual’s opportunities for social inclusion. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 11 Work then needs to be done to develop individual and group activity programmes to an appropriate level. Service users are supported to keep contact with family and friends. The service user guide shows that in general visitors are restricted to between 9am and 9pm. The manager said that this was because of disruption in the evening from service users and their visitors. However visitors can come after those hours and stay overnight, after consultation with staff. There is a service users’ kitchen where they can prepare breakfast and snacks throughout the day and people were seen making good use of this. Main meals are cooked for service users and served in the dining room. The menu showed a choice of lunch but in fact the alternative for the day was not stocked in the kitchen. However the cook said if asked she would provide an omelette, salad or jacket potato and a service user confirmed that if he did not like what was on offer he would be cooked something else. Service users were noncommittal about the quality of the food and one service user said she would like to see more vegetarian food on the menu. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are offered the support which they are able to accept or reject as they wish. Their health care is well monitored. They cannot always be sure that medication recording is accurate. EVIDENCE: Service users said that staff treat them well and with respect and it is clear that they are able to follow the lifestyle they wish, but with encouragement from staff to modify harmful behaviour. There is a good key worker system which ensures consistency of support for service users. Service users’ files showed that their health is monitored and appropriate referrals made to health care professionals as needed. Medication administration was generally good but there were gaps in the records with no explanation why. There was an instance of pills signed for and not given and there was an instance of the number of pills received by the home, not being recorded. A recently admitted service users records did not yet have a photo on. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Service users can be confident that all measures have been taken to protect them from abuse or neglect. Complaints documentation must be available at all times. EVIDENCE: There is an appropriate complaints procedure and good investigation of a service user complaint was seen. However it could not be evidenced that all complaints had been recorded and fully investigated. The home works to the organisation’s vulnerable adults policy as well as to Southwark’s. The response to a recent incident showed that the policy is understood and adhered to. All staff are sent on training given by Southwark about protecting vulnerable adults. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,26,28, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is suitable for its purpose and service users are happy with the environment. There does need to be a proper programme of maintenance. EVIDENCE: The building is modern, and although not homely in design has been made as homely as possible. It is comfortable safe and clean, however it is not well maintained; bathrooms and toilets in particular are in need of refurbishment. The Service Manager said that their Landlord is responsible for this; nevertheless all efforts must be maintained to ensure that the home is in good order. All service users have their own room with a basin en-suite. One service user showed the inspector his room which was comfortable and appropriately furnished. He and other service users all said that they liked their rooms. Service users can lock their rooms and all have a lockable space within the room. There is a good range of communal space inside and out. All systems to maintain hygiene in the home are in place and clinical waste is disposed of properly. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by well trained and supervised staff who are deployed in sufficient numbers. EVIDENCE: Staff were seen to interact well with service users and are motivated and enthusiastic in their work. Training is available to help them in working with the individual and collective needs of service users. For example the key worker of a service user with a hearing disability is learning sign language. More than 50 of basic grade staff have, or are working towards the NVQ award. The number and skills mix of the team is appropriate for the needs of the service users, although when a more extensive social programme is implemented extra staff hours may be needed. Files showed that staff liaise appropriately with relevant professionals such as Occupational Therapists or psychiatrists. The staff group does not reflect the cultural composition of the service users as the staff are predominantly Afro-Caribbean and the service users white. However the organisation is open about the issue, has discussed it with service users and is doing everything possible to change this, within the provisions of the Race Relations Act Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 16 A new member of staff described his recruitment process which was in line with equal opportunities policy. He also described the checks that were made before he could start work and these were as required. Individual training needs are assessed at annual appraisal and the training needs are sent to the Head Office to be used in drawing up a training programme. The manager also has a budget for implementing this training locally. At the last inspection some training needs were identified in the areas of mental health and physical impairments and both these areas of training are being implemented. Staff reported that they are supervised formally monthly and that they have yearly appraisals; documentation confirmed this. They spoke of a supportive working atmosphere with team meetings every week. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38, 39,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a well managed home with an inclusive ethos. Their views are not at the moment being sought for ongoing quality monitoring. Not all systems are in place to ensure service user and staff safety. EVIDENCE: The registered manager is an RGN. She has 4 ½ years experience in managing the centre and was a deputy manager for 9 months before that. She is in the process of finishing her NVQ 4 in management. The process of inspection showed that she is competent to run the home. She has an experienced and enthusiastic deputy who used to work at the centre and so knows it well. The manager is working with her staff to create an atmosphere which is includes and respects service users and staff. There are well-minuted staff meeting and service user meetings, where all aspects of day-to-day life are discussed. The management team try to ensure that there is positive feedback to staff from service users and line management and have been delegating areas of responsibility down to staff. Staff are also working to include and Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 18 learn from service users. Every two weeks a talking point is held where staff and service users together, discuss areas of common interest. The home is not yet undertaking quality monitoring of the service. The service manager said that a post has been set up centrally, and when recruited to, the job description will include working with homes on quality assurance. There is a service plan, with local and central objectives which would be improved by involving service users and stake holders. Most Health and safety systems were seen to be in place. However some water in taps used by service users was too hot and it was found that water temperatures are not being monitored and regulated. The COSHH cupboard was not labelled, there were some liquids being used in the cleaning of the home which were not labelled and not all chemicals had a data sheet available. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X X 2 X Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(1) Timescale for action The registered person must 27/06/06 ensure that a care plan and risk assessments are drawn up for service user SF. This is a re-worded previous requirement. Timescale of 31/01/06 was not met. The registered person must 31/10/06 ensure that all individual support plans describe in detail what support is needed in all areas of personal, social and health care. Also that they have developmental aims which are monitored and reviewed. The registered manager must 31/10/06 ensure that service users’ care plans include statements of how each individual service user will be offered opportunities to be involved in the activities of the day to day running of the home, and that there are adequate monitoring and recording systems in place to demonstrate that these opportunities are being offered, taken up or refused. This is a previous requirement. Timescale of DS0000007058.V300144.R01.S.doc Version 5.2 Page 21 Requirement 2 YA6 15(1) 3. YA8 16(2)(m) Aspinden Wood Centre 4. YA9 5. YA12 YA13 6. YA20 7. YA20 8. 9. YA22 YA30 10. YA39 31/05/05, 31/08/05 and 28/02/06 not met. Enforcement action may be considered if this requirement is not met. 13 The Registered Person must ensure that staff are trained to minimise risk by supporting service users to keep themselves safe, and recording assessed risk together with strategies to minimise this risk. This is a re-worded requirement. Timescale of 31/01/06 not met. 16(2)(m) The registered person must ensure that service users’ preferred leisure activities are assessed and their wishes used to develop an appropriate programme of activities. 13(2) The Registered Person must ensure that the reasons for all non-administration of medication are documented on the back of the MAR chart, together with the action taken if there are any prolonged periods of non-administration. Timescale of 28/02/06 not met 13(2) The Registered Person must ensure that all receipts of medication are logged, including items that come in mid-cycle. Timescale of 28/02/06 not met. 22(1)(3) The registered person must ensure that all complaints are recorded and investigated. 23(2)(n) The Registered Person must ensure that light cords are kept clean, and suitable pendants fitted so that service users can use them easily. Timescale of 28/02/06 not met. 24(1)(a)(b) The registered person must DS0000007058.V300144.R01.S.doc 31/10/06 31/10/06 31/08/06 31/08/06 31/08/06 31/08/06 31/12/06 Page 22 Aspinden Wood Centre Version 5.2 11. 12. YA42 YA42 13(2) 13(4)(a) ensure that there is a quality monitoring system that is analysed and reported on annually. The registered person must 27/06/06 ensure that water temperatures are monitored. The registered person must 31/07/06 ensure that all areas of COSHH legislation are adhered to. 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 2. 3 4 Refer to Standard YA1 YA6 YA17 YA39 Good Practice Recommendations It is recommended that the service user guide is updated regularly to ensure that all information is up to date. It is recommended that service users are regularly consulted about all their needs in key work sessions, and plans revised accordingly. It is recommended that consideration be given to the provision of more vegetarian food. It is recommended that service users and other stakeholders are involved in drawing up the centre’s annual plan. Aspinden Wood Centre DS0000007058.V300144.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aspinden Wood Centre DS0000007058.V300144.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. 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!