Inspection on 30/11/06 for Autumn Lodge

This inspection was carried out on 30th November 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 but made no statutory requirements on the home.

Other inspections for this house

Autumn Lodge 09/02/06

Autumn Lodge 11/08/05

Autumn Lodge 07/03/05

Autumn Lodge 23/08/04

Autumn Lodge 23/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Autumn Lodge 41 Moss Lane Orrell Park Liverpool Merseyside L9 8AB Lead Inspector Les Smith Unannounced Inspection 30th November 2006 09:30 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 Autumn Lodge DS0000025326.V296923.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. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Autumn Lodge Address 41 Moss Lane Orrell Park Liverpool Merseyside L9 8AB 0151 525 0555 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) Mr Delpinto Mrs Delpinto Mrs Kathryn Delpinto Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To provide care for thirty-three older persons (aged over 65 years) and one named person with dementia, excluding learning difficulty or mental disorder over 65 years of age 5 day care places for older people over the age of 65 years in addition to the 33 places for Older People over the age of 65. 9th February 2006 Date of last inspection Brief Description of the Service: The home is situated in the Orrell Park district of Liverpool and is easily accessible by public transport. Gardens are at the rear of the home and there is car parking to the front aspect. Registered with the Commission for Social care inspection to provide personal care for 33 older people. All accommodation is provided in single rooms. A passenger lift and wide corridors facilitate access to all areas of the home. The home has aids in place to promote the independence of residents such as assisted baths, grab rails and staff call system. The home is managed by an experienced manager and has a stable well-qualified workforce. Fees at Autumn Lodge range from £307.50 to £355.00 depending upon type and source of funding. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place over a period of eight hours in the presence of the registered manager. During the visit care records and associated documents, staff files, management records were examined. Discussions were held with the manager, residents and visitors to the home. The home has a very homely atmosphere and staff were observed going about their duties in a cheerful manner and clearly had a good rapport with the residents. Residents and visitors spoken to were very complimentary about the home making comments such as, ‘nothing is too much trouble for the owners and staff’, ‘the residents are well cared for by everyone’, ‘I am very satisfied with every aspect at Autumn Lodge’ and ‘Autumn Lodge is an excellent home’. Meals were seen to be well presented and appetising and the mid-day meal was clearly enjoyed with discrete assistance being offered to those residents who needed it. Maintenance of privacy and dignity was observed at all times and staff were seen to encourage residents to make choices whenever appropriate. Resident’s health needs are well met and access to other health care professionals and services is promoted. What the service does well: What has improved since the last inspection? What they could do better: A Statement of Terms and Conditions containing all appropriate information must be provided for all funded residents and signed copies kept on file at the home. The Statement of Purpose and Service Users Guide requires revision to reflect up to date information. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 6 Care plans and risk assessments need to be kept up to date and reflect the current situation in relation to residents changing needs. The recruitment process is not robust. Steps must be taken to ensure that all the required information and documentation including criminal record checks are obtained before new members of staff are employed at the home. 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. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have sufficient information to make an informed decision on were they wish to live and may be confident that their needs will be fully assessed and that those needs can be met prior to accepting a place at the home. EVIDENCE: The home has a Statement of Purpose and Service User Guide but the documents have not been reviewed since 2003 and need to be updated to reflect the current position at the home. It is recommended that following revision, copies be distributed to current residents or their representatives. A selection of residents files were examined and it was noted that only privately funded residents have a contract with the home. A Statement of Terms and Conditions for funded residents must be provided. All care files examined contained a pre-admission assessment and funded residents files also contained the care assessments made by Social Services. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 9 The manager using the care management plan as a guide to needs carries out pre-admission assessments. Assessments are carried out with the involvement of the prospective resident, family, social services if relevant and any other health care professionals involved in providing care. The pre-admission assessment are sufficiently detailed to enable staff to prepare a plan of care and obtain any necessary services or aids and have them in place for the day of admission. Prospective residents are positively encouraged to visit the home to assess its’ suitability for them. Whilst visits are made at any time the manager encourages a full day visit when the individual has the opportunity to have a meal and participate in activities and have social interactions with current residents. The home has all appropriate aids such as hand and grab rails, assisted baths, raised toilet seats and other appropriate aids in place and a trained workforce demonstrates the ability of the home to meet the assessed needs of residents. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and medication management processes need to be more consistent to promote the health, welfare and safety of residents at all times. Residents privacy and dignity are respected at all times EVIDENCE: A selection of care plans and related documentation was examined. Care plans were seen to be in place for all residents but did not always reflect the current assessed needs. The home uses a commercially produced care planning package which provides good documentation although significant input is required to keep the system up to date. One file examined showed via the daily reports and associated documents that care needs had changed but the plan of care had not been amended to reflect these changes. It is essential that care plans are updated to always show the care required to meet assessed and changing needs. Another file showed that relevant risk assessments had not been completed. The promotion of independence requires an element of risk and comprehensive Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 11 risk assessments provide evidence that the risk is minimised and being managed effectively. Daily reports were mostly comprehensive and gave a good account of the care given and how the resident had spent their day. Supporting documentation such as activity records and relatives communication sheet were in place and being used effectively. The care files provided evidence that the multi-disciplinary team was involved whenever required for the ongoing care of residents. Records showed regular assessment of health needs from GPs, district nurses and dentists. Residents have the choice of remaining with their own GP if possible or registering with a GP at the local practice. The home has changed the medication administration system since the previous visit and this has resulted in a significant improvement but some areas still require strengthening to meet best practice guidelines. Photographic identity should be provided to minimise risk of administration errors although the use of agency staff is minimal. Medications received into the home must be signed for and provision for this is available on the new MAR (Medication Administration Records). Changes to the MAR sheets must be supported by written confirmation of the change from the prescriber. Medications and particularly creams need to checked as to whether they need to be kept in a refrigerator as several were seen being stored inappropriately. All staff responsible for medication administration has undergone appropriate training. Residents and relatives spoken to spoken to were all very complimentary in relation to the service and care at the home making comments ‘couldn’t be any better’, ‘the staff will do anything for the residents and even the visitors’, ‘mum is looking very well and is very happy here’. Observation of the service and care delivery throughout the day of this visit showed a commitment to respect for the individual and maintenance of privacy at all times. The home has policies and procedures in place for death and dying and the caring and sensitive way in which staff deal with residents and relatives at what is a very difficult time is evidenced by the letters and cards received at the home. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from flexible routines and are positively encouraged to make choices in relation to all aspects of their daily life thereby promoting wellbeing for all. EVIDENCE: The daily routines at Autumn Lodge are as flexible as possible and residents are encouraged and facilitated to make choices and exercise as much control over their lives as possible. During conversation residents made it clear that they are encouraged to make choices such as time to go to bed or get up in the morning and that those choices are respected. The home employs an activities co-ordinator and provides a good level of activities and social interaction for residents. Activities on offer include bingo, board games, knitting circle, library (large print), painting and crafts. The home also provides opportunities for outings such as shopping trips and theatre for those residents who wish to participate. There is a need to provide more one to one activities for those residents who for whatever reason cannot or do not wish to participate in the group activities. The activities co-ordinator also produces a monthly newsletter for residents detailing what is happening at the home such as new members of staff, birthdays and forthcoming activities. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 13 Visiting at the home is unrestricted and residents are able to receive their visitors in their own room or any of the communal areas as they wish. Residents are positively encouraged and facilitated to maintain their links with friend, family and the local community. A bright and attractive dining room provides a good environment for residents to have their meals but residents also have the option of having meals in their own room if they want. A varied menu based on a four-week cycle is regularly reviewed to reflect seasonal fruit and vegetables and takes account of residents’ wishes. An alternative choice is always available and the mid-day meal was well presented and obviously enjoyed by the residents. Staff members are available to assist residents as required in a discrete and sensitive manner. The home caters for special diets if required for medical or cultural reasons. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents or their representatives can be confident that any complaints will be taken seriously and that systems are in place to protect residents from abuse. EVIDENCE: There has been one complaint made directly to the home, which has been resolved promptly within the appropriate time scales. There have been no complaints to the CSCI since the previous visit. The home positively encourages residents and their representatives to express their concerns and comments made in relation to the complaint procedure confirmed this ‘I only have to ask and it is done, the staff and owners are very cooperative’. Whilst there is evidence that complaints are dealt with effectively in a timely manner it is strongly recommended that full details of any investigation and the outcome together with details of actions taken be clearly documented to demonstrate a clear and transparent process. All residents are registered on the electoral roll and are eligible to vote at elections. If required the home provides transport to take residents to polling stations. The home has policies and procedures in place for the protection of vulnerable adults. The home is currently providing training for all staff in this important area, which will be completed by the end of 2006. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Autumn Lodge is good providing a safe, homely and comfortable place to live. EVIDENCE: Autumn Lodge is well maintained both internally and externally and benefits from an ongoing programme of redecoration and refurbishment. All rooms and communal areas are pleasantly decorated and residents confirmed their involvement in choosing colours and wallpapers if they so wish. Furnishings are of a good quality and ongoing refurbishment is clearly evident to maintain the high standard. The responsible individual is continually looking for ways of improving the homes environment and an underused bathroom has recently been converted into a walk-in shower. The homes commitment to residents is demonstrated by the attention to detail that makes life easier for the residents e.g. the conversion of cistern handles to push button flush mechanisms. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 16 There are sufficient bathrooms and toilets situated throughout the home to meet the needs of service users. Residents’ have access to all areas of the home and are enabled to maximise their independence via a range of specialised equipment and relevant aids. Handrails, assisted bathrooms and a passenger lift are available together with a call system available in rooms and all areas of the home. During the tour of the home it was evident that residents are encouraged to personalise their rooms with their own memorabilia and personal possessions. The laundry and kitchen were both clean and well organised with appropriate equipment in place. Relevant COSHH documentation for laundry chemicals was available in the main office but a copy should be kept in the laundry for use of the staff working in the area. At the time of this visit the home was clean, tidy and free from any odours. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff members are well trained and deployed in sufficient numbers and skill mix but the recruitment procedures are not as robust as they should be to support and protect the residents EVIDENCE: Staff members are deployed in sufficient numbers and skill mix to meet the assessed and changing needs of the residents. The home has achieved the 50 target of staff holding at least the NVQ 2 qualification. A total of 9 staff members have NVQ2 with 4 holding NVQ3 and a further 4 members of staff are studying for NVQ2. The home has policies and recruitment procedures in place but examination of staff personnel files showed that much of the required information and documentation had not been obtained. The four files examined all lacked appropriate criminal record check or PovaFirst clearances. None of the files contained any proof of identity documents and one file showed that only one reference had been obtained. The lack of a robust recruitment procedure was highlighted and an appropriate requirement was made at the previous visit, which has clearly not been met. Residents are potentially at risk of harm without a robust recruitment procedure and priority must be given to rectifying this situation. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 18 The home has implemented a training programme for all staff since the last visit and all relevant specialist areas are included in addition to the mandatory topics such as fire awareness and prevention, which supports a well-trained and competent workforce. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents at Autumn Lodge benefit from an experienced and competent management that promotes and protects the health, safety and welfare of residents. EVIDENCE: Discussions with residents, their representatives and members of staff showed that the home is managed in an open and transparent manner. The manager operates an open door policy and is approachable at any time by residents or staff. Leadership and guidance from management supports a committed team focussed upon providing quality care for residents as evidenced by the clear rapport between the residents and staff. The home distributes questionnaires to both residents and their representatives to assess the service provided and suggestions for improvements are taken seriously. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 20 Monies held on residents behalf were checked and found to be correct in accords with the records held. Receipts for any expenditure held on residents’ behalf are held with the account records. There are no monies held in a bank account for residents. Staff supervision is in place with the manager supervising staff on a daily basis with encouragement and advice whenever appropriate. There is a need to place staff supervision on a more formal basis with appropriate records kept. It is strongly recommended that supervision be developed to include more than observation of professional practice and encompass additional areas such as career development. Records for the home and residents are held securely in accordance with the Data Protection Act 1998 and residents can have access to their records at any time they wish to see them. Mandatory training in manual handling, first aid, and food hygiene has improved significantly since the previous visit. Contracts and service certificates were seen for fire alarm, emergency lights, fire extinguishers and lift. Valid gas safety and periodic electrical certificates were also seen. Autumn Lodge DS0000025326.V296923.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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 3 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 3 Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5, 6 Requirement The registered person shall ensure that the homes Statement of Purpose and Service Users Guide is reviewed and revised to make sure that residents and their representatives have the up to date information required to make an informed decision in relation to choice of home The registered person shall ensure that all residents have a contact (if privately funded) or appropriate Statement of Terms and Conditions. The registered person shall ensure that care plans are kept up to date so that staff have all the information required in respect of current assessed care needs The registered person shall ensure that appropriate risk assessments are carried out in a timely way to eliminate as far as possible unnecessary risks to the health and safety of residents. Timescale for action 31/01/07 2 OP2 5 31/01/07 3 OP7 15 31/01/07 4 OP7 13(4)(c) 31/01/07 Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 23 5 OP29 19(1)(b) The registered person shall ensure that all the required information and documentation is obtained before a person can commence employment at the home in order to support and protect the residents. (Previous requirement of 31/03/06 not met) 31/01/07 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 Refer to Standard OP1 OP16 OP36 Good Practice Recommendations It is recommended that following revision a copy of the Service Users Guide be distributed to all current residents or their representatives It is strongly recommended that full details of investigation and actions taken following a complaint are documented to demonstrate a open and transparent process It is strongly recommended that staff supervision be developed from observation of professional practice to include additional areas such as career development. Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Autumn Lodge DS0000025326.V296923.R01.S.doc Version 5.2 Page 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!