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Inspection on 12/10/05 for Bluebells

Also see our care home review for Bluebells for more information

This inspection was carried out on 12th October 2005.

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

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

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 inspector found that overall, service users were satisfied with the care provided at the home. One service user said, "staff were really kind" and another commented, "staff were very helpful". Comments received from the relatives of two service users were positive about the care provided and confirmed that that they could visit at any time. Service users enjoy a relaxed environment where routines are flexible and offer choice to service users.

What has improved since the last inspection?

Improvements have been found in reviewing risk assessments following falls and an overall improvement in assessing risk to service users. Staff were now more aware of risk and what action they should take to reduce risks to service users to ensure their safety. Care plans have been improved to ensure the needs of service users are being reviewed and that they receive the care they need. Improvement were noted in the administration and recording of medication held at the home. Discussion with staff confirmed training opportunities had been provided in meeting the specialist needs of service users and comments received would indicate the course was beneficial and has enabled staff to have a better understanding of the needs of service users. The home has improved the staff recruitment procedures to ensure all documents required to demonstrate safe recruitment practices are received prior to staff commencing work. There have been a number of improvements to the overall environmental standards at the home including, replacing of carpets in bedrooms and the addition of the new walk in shower.

What the care home could do better:

The inspection report has identified seven requirements and four recommendations in areas that could be improved. Although there were some improvements noted in service users care plans, the home needs to ensure that care plans fully reflect the needs of the service users. There is a need to ensure that service users are aware of their care plans and have been involved in its development. The home needs to ensure that incidents affecting the welfare of service users are reported to the Commission and that if necessary, incidents are reported to the safeguarding adults team for their consideration and action. There is a need for staffing levels at weekends to be increased at peak times to ensure service users are receiving the care and attention they need. There is a need for the home to ensure that service users are made fully aware of the facilities on offer as part of the initial assessment. Service users views on cross gender care should also be recorded in the care plan to ensure their views are known and respected.

CARE HOMES FOR OLDER PEOPLE Bluebells 152 Moredon Road Swindon Wiltshire SN25 3EP Lead Inspector Bernard McDonald Unannounced 12 October 2005 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. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bluebells Address 152 Moredon Road Swindon Wiltshire SN25 3EP 01793 611014 08708 318894 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) Mr Abitalib Ebrahaimjee Mrs Leslie Ann Hunt Care Home 16 16 Category(ies) of OP Old Age registration, with number of places Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11th April 2005 Brief Description of the Service: Bluebells is a large bungalow in the Moredon area of Swindon offering accommodation and care to 16 older people. The home is close to local shops and services and on a bus route. The home offers a mixture of double and single rooms. There is an open plan area incorporating two lounges and a dining room. These rooms can be used for social and religious activities. The sitting rooms are smoke free. There is wheelchair access to the garden and there were two ramps. There is seating in the garden in the form of plastic benches and chairs. Lighting is domestic in style. The home offers long term and occasional respite care. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 8 hours. The inspector viewed all areas of the home including service users bedrooms. The inspector met with all service users and three care staff. In addition the inspector met with the relatives of two service users to obtain their views on the care provided. Since the last inspection an additional inspection took place to monitor compliance with the requirements made from the last inspection. On the additional visit the inspector found the home had complied with 16 of the 19 requirements that were made. The outstanding requirements had been met at this inspection. A number of records were examined including six service users care plans, risk assessments, health and safety records and three staff recruitment files. The manager was available to assist throughout the inspection. Feedback was given at the end of the inspection to the manager and the registered provider who arrived at the home during the inspection. What the service does well: What has improved since the last inspection? Improvements have been found in reviewing risk assessments following falls and an overall improvement in assessing risk to service users. Staff were now Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 6 more aware of risk and what action they should take to reduce risks to service users to ensure their safety. Care plans have been improved to ensure the needs of service users are being reviewed and that they receive the care they need. Improvement were noted in the administration and recording of medication held at the home. Discussion with staff confirmed training opportunities had been provided in meeting the specialist needs of service users and comments received would indicate the course was beneficial and has enabled staff to have a better understanding of the needs of service users. The home has improved the staff recruitment procedures to ensure all documents required to demonstrate safe recruitment practices are received prior to staff commencing work. There have been a number of improvements to the overall environmental standards at the home including, replacing of carpets in bedrooms and the addition of the new walk in shower. What they could do better: The inspection report has identified seven requirements and four recommendations in areas that could be improved. Although there were some improvements noted in service users care plans, the home needs to ensure that care plans fully reflect the needs of the service users. There is a need to ensure that service users are aware of their care plans and have been involved in its development. The home needs to ensure that incidents affecting the welfare of service users are reported to the Commission and that if necessary, incidents are reported to the safeguarding adults team for their consideration and action. There is a need for staffing levels at weekends to be increased at peak times to ensure service users are receiving the care and attention they need. There is a need for the home to ensure that service users are made fully aware of the facilities on offer as part of the initial assessment. Service users views on cross gender care should also be recorded in the care plan to ensure their views are known and respected. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 7 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. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5. The home ensures service users needs are assessed prior to admission to confirm their needs can be safely met, however more work is required to ensure all service users are fully informed of their move to the home and that care plans fully reflect their needs. EVIDENCE: The inspector examined the records of the four service users who had been admitted since the last inspection. The records demonstrated the home had received a full community care assessment prior to moving to the home. In addition the manager confirmed that she had visited the service users in their own environment to complete the homes initial assessment. Once service users have been admitted to the home an initial care plan had been developed based on the assessment of need, which was being reviewed each month. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 10 Discussion with two service users confirmed they had opportunity to visit the home prior to moving in, however not all service users took advantage of this option. It is common practice for relatives to view the home on behalf of the service user. While this practice ensures that persons acting on behalf of the service user have “checked out” that the home is suited to the needs of their relative, it does guarantee service users has been made aware of decisions that affect their lives. Discussion with one service user highlighted they were not fully informed of the move to the home and “had wondered where they were going” when they moved from hospital, though was quick to confirm they were now more than happy with the move. One service user whose relatives also visited the home thought they had a single room and when they moved and found it was a shared room, initially refused to sleep in the room. A review with the placing social worker agreed to obtain a reclining chair for the service user to use. The meeting agreed that staff should work towards encouraging the service user to sleep in their room. This action was not recorded in the care plan. While the trial placement does enable service users to, “test out” the home, it is evident that service users need to be made aware of the move to the home and facilities on offer. While it is acknowledged this information is contained in the contract and service user guide, it is recommended that this is also incorporated into the home’s pre admission assessment. Discussion with staff confirmed they had received training in the care of the elderly and dementia. Staff were due to attend a challenging behaviour course through the local college in the coming week. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 10. Service users health and personal care needs are recorded and reviewed, however the home is failing to demonstrate service user involvement or agreement in their care plan. Risk assessments are being completed and improvements have been made to the administration of medication at the home. EVIDENCE: The inspector examined the care plans of six service users. Care plans had been improved and were now being reviewed every month and reflected changes in the needs of service users. Less evident was how service users had been involved in developing their plan. Not all care plans were signed and the format being used at the home allowed for service users comments to be incorporated into the care plan but these had not been completed. It is recommended that the home demonstrates how service users have been involved in developing their care plan and that they agree with the contents. Discussion with the relatives of one service user confirmed they had attended a care review meeting. The manager stated that where possible personal care is provided by staff of the same gender, though on occasions staff of the opposite sex have assisted with the personal care of service users. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 12 It is recommended that service users views must be obtained regarding this practice and recorded in the care plan. This will help to ensure that service users are treated with dignity and respect at all times and that their wishes regarding personal care are followed. Risk assessments are now being reviewed as part of the care plan and following a requirement made at the last inspection the home has developed a format for reviewing risk assessments following any fall. Examination of the reviews highlighted that the home was not informing the Commission of incidents that affect the health and welfare of service users and it is a requirement that these are now completed. Staff demonstrated an awareness of the support needs of service users and appeared confident in their ability to meet their needs. Staff were observed interacting appropriately with service users and having jokes and laughs with them. Service users were complimentary about staff, one person said “they were the best” another service user said, “nothing is too much trouble”. These comments were also expressed by relatives met during the inspection. Risk assessments had been signed by staff and discussion with staff confirmed they were aware of the risks to service users. Medication records demonstrated the home was safely administering medication to service users. Records confirmed medication was being accurately recorded when administered and when new stocks are received at the home. The manager confirmed medication training is provided in house to care staff. Deficits found at the last inspection regarding safe medication practices had been corrected. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14, 15. Service users choice and autonomy is respected and meal times offer choice and variety EVIDENCE: The manager confirmed the home does not act as agent on behalf of any service users, as their family or solicitor normally deals with financial arrangements. There is a relaxed approach to routines at the home. One service user confirmed they could choose the times for getting up and going to bed and they could have a nap in the afternoon if they wanted. The main meal of the day is at lunchtime. The inspector observed staff offering a choice of main courses to service users. The lunchtime meal was observed and the inspector found service users had a choice of where to eat their meal. Some service users preferred the dining room while other preferred to eat their meal in their room. The mealtime was relaxed and unhurried and where service users required support with their meal it was provided in a discreet and respectful manner. Service users confirmed the meals were “good” and records show a choice is offered at each meal. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 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 standard(s) 16, 18. The home is making every effort to ensure service users are protected and their views are listened to. EVIDENCE: A shortened version of the complaints procedure is on display on the notice board at the entrance to the home. No complaints have been received since the last inspection. Two service users confirmed they would speak to the manager if they were not happy about something. Another service user said, “everything is great I could not be happier”. Following a requirement made at the previous inspection, the majority of staff have now completed abuse awareness training. Discussion with staff confirmed they found the course both valuable and interesting. Local policies and procedures to safeguard service users are in place and staff have received a copy of Wiltshire and Swindon’s “no secrets” guidance. The inspector was informed that the home had taken action against one member of staff following concerns raised by a colleague. While the action taken appears to be appropriate this matter should also be referred using the safeguarding adults procedures. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 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, 21, 24. The overall standard of accommodation was satisfactory and offered service users a comfortable and safe environment. EVIDENCE: The inspector viewed all areas of the home including all service users bedrooms. Since the last inspection work has been completed on the walk in shower room. This is a welcomed improvement to the home and offers service users a real choice of bathing facilities. However due to a lack of water pressure the shower room is not being fully used. The manager stated that the pressure in the shower drops when the washer and dishwasher are being used. It is recommended that the home complete a risk assessment on the shower room’s use and ensure all staff are made aware of the outcome to ensure the shower can be safely used. The manager did confirm that the water company has been alerted to the problem and were due to visit the following week. Improvements have been made to the outside of the building and the gardens to make them more accessible to service users. One service user stated they would like to plant vegetables and this request will be considered next spring. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 16 The inspector found the home was clean tidy and free from odour. It is unfortunate that the entrance to home does not reflect the improvements that have been made to the overall standard of accommodation. The registered provider and manager stated there are plans to move the entrance to the home and purchase a new door. This has resulted in the hallway carpet not being replaced. The carpet was stained and worn and urgently needs to be replaced, it is a requirement that an action plan is provided with timescales for completing the work included the replacement of the carpet. The inspector met with all service users. Comments received were very favourable about the standard of accommodation at the home. Service users bedrooms had been personalised to reflect personal taste. The relative of one service user confirmed they have brought items of furniture from home following agreement with the home. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 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) 28, 29. The home is ensuring safe recruitment practices are followed but is failing to provide sufficient staff on duty at weekends. EVIDENCE: Examination of the rota showed there are three staff on duty Monday to Friday and two staff at weekends. Discussion with staff identified that the reduced number of staff is having an impact on the care provided to service users making it more task orientated and less personal. Discussion with the manager confirmed she is aware of the shortfall and is looking at adopting a three-shift system at weekends and providing extra cover at peak times. The majority of staff have completed NVQ2 in care and one member of staff is completing NVQ level 3. The inspector examined three staff recruitment records and found that the deficits identified at the last inspection had been corrected. Records contained all the required information including satisfactory criminal records bureau checks and two written references. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 18 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) 35, 36, 38. The home is ensuring staff are appropriately supervised and receive training in safe working practices, however not all safety checks and risk assessments had been completed in the past year. EVIDENCE: Discussion with staff confirmed they are provided with regular formal supervision from the manager a minimum of six times per year. In addition an annual appraisal system is in place for reviewing staff performance and training needs. All new staff receive formal induction training that is skills for care accredited and certificates to demonstrate successful completion were available at the home for inspection. The manager confirmed that the home was holding no money on behalf of service users as all financial matters are dealt with by service users relatives or legal advisors. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 19 Since the last inspection the home has updated the fire risk assessment and weekly checks of the fire alarm system are continuing. The last recorded fire drill was dated 16/7/05 and fire safety training is being provided to staff every three months. Staff training records confirmed the home was ensuring staff have received training in all mandatory course including manual handling, infection control, first aid and food hygiene. The home needs to update COSHH and portable appliance testing. Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 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 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 2 x 2 x x 3 x x STAFFING Standard No Score 27 x 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x 3 3 x 2 Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 21 NO 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. 2. Standard 3&7 7 Regulation 15(1) 15(1)(2) (c )(d) 37 Requirement The registered person must ensure the service user care plan fully relfects their needs. The registered person must ensure service users are fully involved in developing their care plan. The registered person must ensure any incident affecting the welfare of service users is reported to the Commission as per Regulation 37 of the Care Homes Regulations 2001. The registered person must provide the Commission with an action plan detailing the timescale for replacing the front door and replacing the hallway carpet. The registered person must complete a risk assessment on the use of the walk in shower room. The registered person must provide the Commission with an action plan on how it intends to increase staffing levels at weekends. The registered person must ensure COSHH risk assessments are reviewed at least once a Timescale for action 01/11/05 01/11/05 3. 7 & 18 01/11/05 4. 19 23(2)(a) (b) 01/12/05 5. 21 13(4)(a) (b)(c) 18(1)(a) 01/12/05 6. 28 01/12/05 7. 38 13(4)(a) (c) 01/01/06 Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 22 year. 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. Refer to Standard 3 7 Good Practice Recommendations The registered person should ensure service users are fully informed of their move to the home and the facilities on offer. It is recommeded that service users are consulted about their wishes regarding person care being provided by staff of the opposite gender. the outcome should be recorded in the care plan. The registered person should inform the safeguarding adults team of any incident affecting the welfare of service users. The registered person shopuld ensure portable appliance testing is completed at least once a year. 3. 4. 18 38 Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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 Bluebells D51 D01 s3169 Bluebells v246224 121005 Stage4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!