Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 03/10/08 for Avalon Care Home

Also see our care home review for Avalon Care Home for more information

This inspection was carried out on 3rd October 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a warm safe environment for people, it is clean and well maintained and benefits from routine maintenance and good records of health and safety at work compliance. People are always assessed before they come into the home to make sure that the facilities and services offerred can support their needs. The provision of a care plan enables them to participate and be consulted on what care they expect to receive and informs staff of the way people wish to be supported. People receive opportunities to take part in activities. The staff team receive training regularly and the topics consider the needs of those people they care for to ensure they know how to deliver the right care.

What has improved since the last inspection?

There is now a new acting manager at the home. There is improved reporting of incidents and issues affecting people as required by regulation.

What the care home could do better:

There must be sustained improvement in the way staff interact with people using and visiting the service to make sure that they treat people with respect and uphold their rights and best interests. The number of staff needs to be enough to make sure that everyone receives the care and support that they need at all times and there must be improved arrangements at times of peak activity such as mealtimes. The health care of people must be delivered in a timely way, ensuring that changes in needs inform the care plans and that staff have the time to read these plans. People must be referred to National Health Service departments when needs require to make sure they have access to specialists. The staff team needs improved direction and supervision on a daily basis to make sure that they are meeting the aims and objectives of the service. When people complain they must be told the outcome of any investigation to make sure they feel listened to and taken seriously. Where repeated themes emerge about staff attitudes there must be robust measures in place to ensure that people are in safe hands at all times. The practices of the home must be assessed through robust quality assurance systems that identify shortfalls and ensure that action is taken to rectify them.There must be more robust recording of medicines received into the home to ensure there is no misuse and that staff have an audit trail to be able to properly audit medicines as part of your quality systems.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avalon Care Home 116 Clipstone Road West Forest Town Nottinghamshire NG19 0HL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary OLoughlin     Date: 0 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Avalon Care Home 116 Clipstone Road West Forest Town Nottinghamshire NG19 0HL 01623644195 01623429977 avalon@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Care Homes No 2 Ltd Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One named sevice user as applied for in application dated 16/10/05 may be within category PD Service users shall be within category OP Date of last inspection Brief description of the care home Avalon Care Centre is a purpose built two-storey, forty bedded care home for older people situated on the outskirts of Mansfield, close to the former mining village of Clipstone. It is situated on a main road, which has a public bus service, and is approximately two miles from Mansfield town centre to the North East. All bedrooms are single occupancy, with half having en-suite facilities. Avalon is close to local shops, and a pub. There is ramped access to the home and a passenger lift is installed. The range of fees were not detailed in the Service User Guide, however information supplied on the day of the inspection by the temporary manager detailed fees ranged Care Homes for Older People Page 4 of 30 Over 65 40 0 Brief description of the care home between £294.00 and £475.00. No information was supplied as to extra charges. Copies of the last inspection report and the homes statement of purpose are available to people in the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection is about the outcome of the care provided to people using the service. This process considers the providers capacity to meet regulatory requirement and focuses on aspects of service provision that need further development. Two inspectors spent 7.5 hours at the home. The main method of inspection used was called case tracking. This involves selecting the care records and looking at the quality of the care people receive by talking to them, examining their care files and discussing how support is offered to them by staff Care Homes for Older People Page 6 of 30 members. Some of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading records and documents. People living at the home,members of staff and the acting manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided. Prior to the inspection we attended a meeting with Social Services staff regarding recent complaints received about the service and investigations under the safeguarding adult protocols. We looked at what the provider told us they were doing in their Annual Quality Assurance document (AQAA) that they sent to us. A copy of the inspection report was seen in the home and people are informed how to access this in the guide they receive on admission. What the care home does well: What has improved since the last inspection? What they could do better: There must be sustained improvement in the way staff interact with people using and visiting the service to make sure that they treat people with respect and uphold their rights and best interests. The number of staff needs to be enough to make sure that everyone receives the care and support that they need at all times and there must be improved arrangements at times of peak activity such as mealtimes. The health care of people must be delivered in a timely way, ensuring that changes in needs inform the care plans and that staff have the time to read these plans. People must be referred to National Health Service departments when needs require to make sure they have access to specialists. The staff team needs improved direction and supervision on a daily basis to make sure that they are meeting the aims and objectives of the service. When people complain they must be told the outcome of any investigation to make sure they feel listened to and taken seriously. Where repeated themes emerge about staff attitudes there must be robust measures in place to ensure that people are in safe hands at all times. The practices of the home must be assessed through robust quality assurance systems that identify shortfalls and ensure that action is taken to rectify them. Care Homes for Older People Page 8 of 30 There must be more robust recording of medicines received into the home to ensure there is no misuse and that staff have an audit trail to be able to properly audit medicines as part of your quality systems. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they are admitted to the home to ensure that there are suitable facilities, services and skills available to deliver the care they need. Evidence: From information we received within the AQAA it was clear that the acting manager was aware of and working to robust procedures before people were admitted. We examined the way 4 people had been admitted to the home and found that in all cases they had received a full assessment by a trained person from the home. The assessments provided the staff with a picture of what the persons health and personal needs were. Admission only took place after the assessment was completed and staff confirmed with people that the home had the facilities and services to manage their needs. Care Homes for Older People Page 11 of 30 Evidence: The records showed that staff consider the cultural and religious needs of people and provided information to everyone in suitable formats and languages to help them to understand what services were available within the home. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of health, medicines and personal care is not person centred and does not ensure that people receive the care they need. Evidence: The last inspection found shortfalls in the way staff recorded the personal hygiene support they gave people each day. We have received information from investigations undertaken by social services through the safeguarding adults procedures that reflect poor delivery of care and support for people at the home. Relatives have told us that staff do not monitor peoples nutritional needs well, provide inadequate oral care and the management of peoples health does not ensure their wellbeing. A visiting Doctor who attends the home regularly told us that staff always liaise with Care Homes for Older People Page 13 of 30 Evidence: the surgery regarding medical issues and always call for assistance at appropriate times. We examined 4 care files and found that the staff make sure they plan and generally review peoples care in a timely way. All 4 people had been assessed for their nutritional needs and staff recorded their weight each month to inform the support they needed. However, the daily recording of each persons diet and fluid intake was not adequately reflecting what people were eating and could not provide staff with accurate information on which to determine if they were actually eating and drinking sufficiently. Staff had not acted in a timely way where one person had nutritional problems that indicated they needed referral to the NHS dietician. We looked at the personal hygiene support offered to people at the home. Bathing records showed that whilst some people were receiving baths according to their wishes, others were not able to have a bath due to insufficient staff time.Staff said that due to concerns being raised by some relatives, some people are receiving two baths in a week whilst others do not have one at all. Staff told us they did not have time to read care plans. Medicines were stored in line with safe custody regulations and case tracking showed that people received the appropriate medications at times prescribed. The service has its own medicine audit that they complete each month, however, we saw some shortfalls in the recording of medicines into the home and dating liquid medicines on opening, and this would not provide a suitable audit trail for staff to undertake an audit of medicines. There have been concerns raised about staff attitudes through complaints and safeguarding adults investigations in the last year. Relatives of people at the home tell us they feel that staff behave disrespectfully to people. We saw evidence of some good interactions during the day where staff engaged with people when they were providing care. During breakfast staff were overstretched and the mealtime was purely functional so Care Homes for Older People Page 14 of 30 Evidence: that staff could bring people down from their room and then return to get the next person up. There was little warmth in the interactions seen and people at the table looked bewildered. The mid morning drinks were served and again staff appeared to be rushed to assist people to drink, there was no time for them to sit with people and encourage them to drink in a caring manner, we saw how one person who needed assistance to drink had to drink it very quickly. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provision of activities is not person centred in its approach to supporting people that use the service. Evidence: On arrival to the home people were observed having breakfast, some were receiving support with this and others were sitting in the lounge area. The television was on and no-one was watching it. Staff seen carrying out their work were overstretched and the atmosphere chaotic. The meals of the day seemed pleasant but the menu was displayed in the main reception area, in small print and at a high level which people could not read. Staff were observed completing diet records at the end of their shift, using a tick box record that did not clearly record peoples intake to ensure they had received sufficient nutrition according to their needs. Care Homes for Older People Page 16 of 30 Evidence: The staff told us that a part time activities person was employed to arrange activities in the home. We were told that planned trips to Clumber Park and Newark had both been cancelled due to bad weather. The walls were decorated with photographs of previous activities and outings. Each person had a care file that contained information on their social needs, however the information was minimal and did not record what people did actually do during their day. Our observations of the day showed that most people were not involved in any meaningful activity. Two people told us they had waited all day to find out if they were able to go out with staff support, we did not see them undertake this activity. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to but the process of safeguarding people is not sufficiently robust. Evidence: Since the last inspection of the home there have been 4 complaints received by the Social Services that have been investigated under the safeguarding of adults procedures. People have told us that when they report concerns about staff attitudes, no action is taken. We saw the records of investigations undertaken and found that complainants had not received any formal communication about the actions the home had taken in response to their concerns. The acting manager and the area manager told us that they had taken action to ensure staff received supervision and training where required, however staff were working unsupervised in positions of responsibility and records did not reflect any action around training or supervised practice. Staff training records show that 97 of the staff team have received training in how to safeguard people from abuse and whistle blow any bad practice they see, however the Care Homes for Older People Page 18 of 30 Evidence: staff reported to us that one member of staff was ambivalent about the health needs of a person and had not done anything to ensure there wellbeing. The staff had not reported their concerns through the homes whistle blowing procedures. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is suitable for the needs of the people accommodated. Evidence: The environment is well maintained and there are suitable safeguards in place to protect people from any spread of infection. People said they were comfortable and warm. People had access to suitable equipment to manage their needs properly. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of staff numbers severely restricts the safe and timely provision of care in accordance with the needs and wishes of people at the home. Evidence: We found that there has been a high turnover of staff during the last 12 months and difficulties retaining staff. The records of how people are recruited showed that there are robust procedures in place to ensure staff are suitable to work with vulnerable people before they commence work. We saw evidence that staff receive a full induction into their job and ongoing training in areas that reflect the needs of the people they care for. The records of staff duties showed that when staff are absent there is little that is done to rectify the problem leaving inadequate numbers of people on duty to meet peoples needs. Minimal agency staff have been used to cover shortages of staff and this has resulted in long periods where there are insufficient people on duty to meet everyones needs. Care Homes for Older People Page 21 of 30 Evidence: Staff told us they had no time to bath everyone, complete daily records or read care plans to ensure that they knew the needs and wishes of people. We observed how at peak times of activity such as breakfast, there was insufficient staff to provide an organised and enjoyable mealtime for people. The area manager addressed the shortfalls in staffing immediately and accessed 3 extra staff from another facility to come to the home and provide cover. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home lacks consistent leadership and does not sustain the required improvements to ensure people are confident that the home is able to meet peoples needs. Evidence: There have been changes in the management of the home since our last inspection and the present acting manager has now applied to register with the commission as required. The information we have received through the homes Annual Quality Assurance document was not fully completed and did not give us a clear record of the concerns and safeguarding alerts that the management have dealt with. The provider has useful audit tools that are regularly completed to monitor the practices in the home, however our inspection found that action was not always taken to improve or rectify shortfalls when they are identified. Care Homes for Older People Page 23 of 30 Evidence: We found that there was poor management of staffing levels to ensure that staff absences were covered and as a result people did not always receive the care they needed. Records of complaints show that people are not always responded to in a timely way. Relatives tell us that they do not feel that people are cared for in a safe way and have needed to refer problems to the social services to bring about improvements in the care provided. External professionals involved in reviewing care tell us that despite a number of action plans being worked through, intense staff training and audits of care plans the service is still unable to provide a standard of care that ensures the health, safety and wellbeing of the people in the home. From discussion with staff and management we found that some staff can be ambivilent when informed of changes in peoples condition and the culture of the staff team does not recognise the importance of the need to whistle blow on bad practice. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 People must be supported to 10/12/2008 access the National Health Services Dietician when their nutritional assessment determines the need for referral. To uphold their right to access such services and ensure that they receive appropriate assessment and treatment. 2 9 13 All medicines must be recorded into the home and medicine bottles dated on opening. To provide a suitable audit trail of medicines. 10/12/2008 3 15 17 Clear records of actual diet and fluid intake must be held to determine that people are receiving a suitable nutrition to meet their needs. To make sure that staff know when people are not 10/12/2008 Care Homes for Older People Page 26 of 30 eating sufficiently to meet their assessed needs, and gain access to external specialist advice where necessary. 4 15 18 Consideration of the numbers of staff required at peak times of activity must be made. To make sure mealtimes are more organised and enjoyable for people and they receive an unhurried support. 5 16 22 You must respond in writing to people who complain to inform them of actions taken. To make sure people feel listened to and taken seriously. 6 18 19 Where you are not satisfied 10/12/2008 that a person employed is fit to work in the care home, immediate action must be taken and suitable arrangements by training or other methods employed. To ensure that people are safe from harm. 7 27 18 The numbers of staff on duty must be sufficient to meet the needs of the people in the home and have regard for the peak times of activity. To make sure that people receive the care they need. 10/12/2008 10/12/2008 10/12/2008 Care Homes for Older People Page 27 of 30 8 31 13 The staff team must be 08/12/2008 trained to recognise bad practice and report concerns through the whistle blowing procedure. To make sure that neglectful staff attitudes are recognised and dealt with for the protection of the people using the service. 9 33 26 You must review the quality of care provided by the home, using information received from complaints about people using the service. To ensure that suitable sustained improvements are made when shortfalls in care practices are identified through investigations and complaints. 10/12/2008 10 36 12 You must encourage and assist staff to maintain professional relationships with each other and with people living at the home. To make sure that the home is conducted in a manner that makes proper provision for the health and welfare of people. 10/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Obtain more information on each persons social needs before admission. Care Homes for Older People Page 28 of 30 2 8 Look at ways of monitoring if staff are delivering the required personal care to make sure that people are receiving it as planned. Look at ways to improve the way you record diet and fluid intake to make it more useful and accurate as a record. When people ask you to refer individuals to other services you should record fully within the records of that person what action you have taken. Obtain information on dignity awareness for staff training resources. Records of the activities provided and participated in for each person that reflect how staff have considered their individual needs and preferences should be held. All changes in need should be used to inform a revised care plan for people. 3 4 8 9 5 6 10 12 7 37 Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!