Inspection on 03/05/05 for Beaumont House

This inspection was carried out on 3rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Beaumont House 23/02/10

Beaumont House 29/09/09

Beaumont House 16/03/09

Beaumont House 29/09/08

Beaumont House 22/04/08

Beaumont House 05/12/07

Beaumont House 25/06/07

Beaumont House 04/07/06

Beaumont House 12/12/05

Beaumont House 08/12/04

Beaumont House 04/08/04

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 BEAUMONT HOUSE 26 Church Lane Whitefield Manchester M45 7NF Lead Inspector Lucy Burgess Announced 3 May 2005 rd 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 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. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beaumont House Address 26 Church Lane, Whitefield, Manchester, M45 7NF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 796 9666 0161 796 7722 Bankfield Premier Care Ltd Mrs Glenys Gardner CRH-PC Care Home Only 37 Category(ies) of OP Old Age registration, with number of places BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Within the maximum of 37 there can be up to 37 OP Old Age. The service should at all times employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection 8th December 2004 Brief Description of the Service: Beaumont house is a residential care home for up to 37 older people. The home is part of a group of four homes (Bankfield Premier Care) in the Bury/North Manchester area. Beaumont House is a detached home and set in its own well-maintained grounds. It is situated close to local amenities and accessible for local transport as well as the Metro and major bus routes between Manchester and Bury. The Home comprises of four large lounges and a smaller lounge and two dining areas. There are also 37 single bedrooms all with en-suite toilet. They are individually decorated and furnished and include a nurse call. The Home is two storeys with an extension to the rear and side. The home is divided into two units, one on the ground floor and one on the first floor. Communal areas are found on each floor and access is available via a passenger lift. Respite/short stay care may also be provided if a place is available. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over two days for a period of 13 hours. The inspector took the opportunity to look round the home, view records and policies as well as talk with a number of residents and staff. Discussion and feedback was also held with the Manager and senior staff. The home is registered to provide accommodation for 37 people. There were 36 residents at the home at the time of the inspection. As the inspection was announced a completed pre-inspection questionnaire was received along with feedback surveys from 2 GP’s and 3 relatives. What the service does well: What has improved since the last inspection? The home has recently undertaken some recruitment and new staff have been employed, therefore providing sufficient numbers of staff on duty to support the needs of the residents. Training opportunities have been provided. New staff have been completing the induction and formal training has been planned in areas relevant to service users needs and the development of documentation. Courses included dementia, care of the dying, moving and handling, abuse, care planning and risk assessments. At the last inspection it was noted that activities were not always held, therefore offering little stimulation for residents. Recently the home has organised coffee/drinks afternoon, these are held twice a week and have been attended by a number of residents and enjoyed. Another resident invites friends to the home and enjoys a weekly bridge afternoon, space has been made available within the home for them to sit and play. A number of the BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 6 residents do not wish to participate preferring to spend time doing their own thing. Individuals are encouraged to follow their preferred routines. 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. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 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 standard(s) None EVIDENCE: This area will be addressed at the Unannounced Inspection. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7 to 11 Care Plans and risk assessments are in place for each of the service users. Information seen did not fully reflect the needs of the service users. Records had been reviewed regularly but not updated. Care practices ensured that residents were treated with respect and their dignity upheld. Storage of medication was found to be satisfactory however errors were found with the administration records. EVIDENCE: Plans of care were examined for a number of service users with various support needs. Records provided a basic picture of the service users and what their needs are, however this did not clearly identify how needs were to be met. The level of detail found depended on who had completed the records. Risk assessments had also been completed in several areas including moving and handling, pressure care and nutrition. These too did not fully reflect the current needs of service users. Three moving and handling assessments seen identified each of the service users as medium to high risk although the individual level of ability varied significantly with regards to their mobility. Assessments should be carried out by a suitable trained person ensuring that individual support needs and level of risk are clearly identified. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 10 Additional records are held with regards to daily diary sheets, weights and personal care. Concerns were identified in relation to the weighing of residents and action taken. Residents had been weighed regularly however where there had been significant weight loses no information was recorded to say what action had been taken. Nutritional review forms were on file although no nutritional assessments had been carried out. One file stated that fluids were to be pushed and that the service user was mentally aware however from observations the service users was not fully aware nor had any records been made of fluids taken. The regular monitoring of residents weight and diet is essential to ensure that their nutritional needs are met and prevent any deterioration in health. Records showed that access to other services including sight tests and a visiting chiropodist were made. A number of service users are also supported by other health professionals including CPN’s and district nurses. Details of the support and reason why this is provided should also be documented with the care plan. Support and advice is requested for those individuals with deteriorating mental health. The medication system was inspected. Generally a safe system was found. The administration of medication needs to be monitored to make sure that service users have taken their tablets and records need to be completed in full. No issues were found with regards to the storage and administration of controlled drugs. A recent pharmacy inspection had also taken place. Thermometers are to be provided within the medication rooms to monitor the temperature as the rooms were found to be very warm. Evening medication for one service user was been administered at a different time than that prescribed. To ensure the effectiveness of medications they must be given at the time prescribed by their doctor. A discussion with the residents found that they feel they are treated with respect and their right to privacy is upheld. Staff spoken to gave examples of how privacy and dignity were promoted. Support and advice is also offered to family when a service user is very unwell or dies. One service user who has been receiving respite expressed that he was happy and quite settled. He stated that ‘the staff work as a team of professional carers’. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12 to 15 A number of activities are provided within the home. Attendance varies due to individual preferences. Service users are also encouraged to follow their own interests. The home has an open visiting policy for family and friends and contact is encouraged. A choice of meals are provided, with a hot meal served for both lunch and tea. Alternative choices are available and snacks and drinks are also served. EVIDENCE: Dining rooms are provided on each of the floors. Tables are nicely set with napkins and cruets. Hot and cold drinks were served. Residents stated that they were able to eat in the dining room or their own room. The inspector observed lunch being served. On the first floor, due to individual levels of mobility, moving around the dining room was not easy. The layout should be considered so that residents are not disturbed during meal times. Meals are prepared and cooked in the kitchen on the ground floor. A heated trolley is used for serving from the small kitchen areas provided on each floor. There was a choice of main meal and dessert available. The cooks provide homemade cakes and deserts. Special diets are also catered for and staff were aware of what a diabetic resident could have to eat. Residents said that they enjoyed the meals and that sufficient portions were given. One service BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 12 user explained that an alternative would be provided if requested. Provisions are available on each floor for drinks and snacks. A choice of activities are provided and include drinks afternoons, move to music, nail care and from time to time a visiting entertainer. One service user invites friends to the home for a bridge afternoon. A room has been provided on the first floor for activities. Feedback received from the service users was mixed. Some would like more choice whilst others preferred a more relaxed quite environment. Those residents able to pursue their own interests away from the home are encouraged to do so. This includes visiting family, shopping or attending church. The home welcomes visitors to the home at any time. Relationships with family and friends are encouraged. The local clergy also visit residents each week. Resident wishing to take part in the recent election were supported in doing so and postal votes were provided. In the main service users finances are managed by families or designated representative. Allowances held within the home are banked in a client account and interest accumulated is shared. Records are held of all transactions. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 to 18 Satisfactory arrangements are in place in relation to the protection of service users as well as responding to their concerns. Polices are in place outlining the appropriate response for allegations of abuse, outstanding training has been identified in this area. Development of policies have been identified with regards to bed rails and risk management to ensure safe practice with service users. EVIDENCE: Clear policies and procedures are in place covering these standards. The complaints procedure is displayed in the hallway, therefore accessible to both service users and visitors. Two complaints had been recorded in the communication diary however had not been transferred to the complaints file, nor had the investigation and outcome been recorded. Feedback received through the CSCI questionnaires found that people were aware of the complaints procedure. A copy of the Local Authorities Vulnerable Adults procedure has been accessed. The team have some knowledge in relation to the procedure to follow however staff training in relation to Vulnerable Adults has yet to be undertaken by all staff. Each member of the team including new staff have been schedule to attend further training which will include this area. The home also has further written policies and procedures for adult protection these include dealing with whistle blowing, aggression and missing person. Two policies still need to be written in relation to risk management and bed BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 14 rails, these should identifying how risk is to be managed ensuring service users are protected. As identified earlier in the report, service users are generally supported by family or a designated representative in relation to their finances. Some service users do have personal allowances held by the home. Transaction are fully recorded. The majority of residents have a family member or person who will advocate on their behalf. The home would also provided information and advice with regards to advocacy services if required. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 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 standard(s) 19 to 26 Comfortable accommodation is provided, which meets the needs of older people. The home employs a maintenance man who carries out all general maintenance and redecoration. The home also employs a number of ancillary staff who ensure a safe, clean, comfortable environment for those that live there. A number of communal areas and bathing facilities are available on each floor. Sufficient aids and adaptation have also been provided in order to meet the needs of the service users. EVIDENCE: Beaumont House is a large detached property offering pleasant accommodation for the residents. The lounge and dining areas were clean, well decorated and comfortably furnished. Residents make use of all areas. The home also provides an enclosed garden to the rear of the home. This is well maintained and seating is available for those service users who wish to sit outside. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 16 Communal toilets and bathrooms were clean, spacious and suitably adapted for disabled access, however two bathrooms are unsuitable for use and consideration is being given to providing walk-in shower facilities offering service user a choice of bathing facilities. Appropriate hand washing facilities are provided for staff in relation to cross infection. A separate laundry is provided with designated laundry staff. This was well equipped although hand washing provisions were not available. These should be provided to prevent cross infection. The home provides all single private bedrooms each having an en-suite toilet and wash hand-basin. Locks are fitted to the bedroom doors and a lockable space is also provided for the residents’ personal use. Rooms had been nicely personalised with belongings and furniture from home. The home is equipped with suitable aids and adaptation to assist service users movement around the home. Hand rails, grab rails, hoist, bath lifts, call bells and a passenger lift are available to offer support and aid mobility. Those service users needing support also have the provision of wheelchairs. When transferring staff must ensure that footplates are used to prevent injury. An ongoing programme of maintenance is carried out and tasks recorded. The home employs a handyman who addresses all work identified. The handyman also carries out checks to ensure a safe living environment. These include regular checks of the fire alarm, lighting, heating and water temperatures. An inspection was also carried out by the Fire Officer in November 2004. Action identified had been addressed. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 to 30 Sufficient staff are provided ensuring the needs of service users are met. Ongoing training has been provided for some members of the team further sessions are to be planned. Arrangements are in place the induction of new staff. All relevant information is gathered in relation to the recruitment of staff. Criminal records checks required for new staff had not been received. Immediate action was identified to ensure the safety and protection of the service users. EVIDENCE: Personnel files were seen for those staff recently recruited. Generally all information had been gathered. Immediate action was identified with regards to the Criminal Record Checks. New employees must not commence employment until the relevant check has been carried out and placed on file. Staffing levels had improved with sufficient numbers provided to meet the needs of service users. Newly employed staff were completing their induction training and expressed that they were enjoying the work and felt fully informed. Recent training had been undertaken by several members of the team including medication, moving and handling, abuse and infection control. Further training has been planned for all staff and dates scheduled for attendance. Topics include dementia care, care of the dying, abuse, moving and handling, challenging behaviour, risks and care planning. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 18 On completion this will hopefully enhance their knowledge and understanding as well as the support offered by staff. Training needs have been identified with regards to the provision of NVQ training and infection control for the remaining care staff and domestic staff. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None EVIDENCE: This area will be addressed at the Unannounced Inspection. BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 x x x x x x x x BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 21 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 2 Regulation 5 Requirement That contracts are signed by service users and/or their representative and copies placed on file (previous timescale of 28th February 2005) That comprehensive assessments are completed on new service users given explicit details of the support required (previous timescale of 28th February 2005) That plans are developed to provide a clear plan of support needs and how these are to be met That risk asessments are developed for all identified areas and reviewed and updated on a monthly basis (previous timescale of 28th February 2005) That the nutritional needs of service users are fully assessed and monitored That serivce users are weighed on a regular basis and acurrate records made That accurate records are made with regards to the adminstration of medication That service users are observed taking medication ensuring that F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Timescale for action 1st June 2005 2. 3 14 1st June 2005 3. 7 15 31st July 2005 31st July 2005 4. 8 13 5. 6. 7. 8. 8 8 9 9 12 12 13 13 31st July 2005 1st June 2005 1st June 2005 1st June 2005 Page 22 BEAUMONT HOUSE Version 1.30 it has been taken 9. 10. 11. 9 16 18 13 22 13 That medication is administered at the time prescribed by the GP That all complaints are recorded with the complaints file and include details of all action taken That policies are devleoped in relation to bed rails and risk management in order to ensure the protection of service users (previous timescale of 28th February 2005) That footplates are used when transferring serivce users by wheelchair to prevent injury That call bell leads are available in all bedrooms and accessible to the service users should they require the assistance of staff That paper towels and soap are provided in the laundry to prevent cross infection (previous timescale of 31st January 2005 not met) That CRB checks are carried out on all new employees and any furhter staff employed do not commence until the appropriate check has been completed That training is provided in infection control for those staff yet to completed including ancillary staff That further training is carried out with regards to NVQ 1st June 2005 1st June 2005 31st July 2005 12. 13. 22 22 13/22 13 1st June 2005 1st june 2005 1st June 2005 14. 26 13/23 15. 29 19 Immediate 16. 30 18 31st July 2005 31st August 2005 17. 30 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 12 Good Practice Recommendations That service users are consulted with regards to the choice of activities offered F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 23 BEAUMONT HOUSE 2. 15 That consideration is given to the 1st floor dining room to prevent residents being distrubed whilst having meals BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Turton Suite Paragon Business Park Chorley Old Road Horwich, Bolton, BL6 6HG 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 BEAUMONT HOUSE F56-F06 S8399 Beaumont House V212623 030505 Stage 4.doc Version 1.30 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!