Inspection on 06/06/06 for Bourne House Nursing Home

This inspection was carried out on 6th June 2006.

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

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

Other inspections for this house

Bourne House Nursing Home 22/11/05

Bourne House Nursing Home 01/09/05

Bourne House Nursing Home 28/10/04

Bourne House Nursing Home 19/05/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Bourne House Nursing Home 45 Langley Avenue Surbiton Surrey KT6 6QR Lead Inspector Michael Williams Key Unannounced Inspection 6th June 2006 9:50am X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bourne House Nursing Home Address 45 Langley Avenue Surbiton Surrey KT6 6QR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 399 6022 020 8390 9394 London Residential Healthcare Limited Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Levels as follows: Registered Nurses (RN) Nursing Assistants (NA) No. of Residents 16-20 21-25 26-30 31-35 36-40 8am-2pm 1 RN 3 NA 1 RN 4 NA 2 RN 4 NA 2 RN 5 NA 2 RN 6 NA 2pm-8pm 1 RN 2 NA 1 RN 3 NA 2 RN 3 NA 2 RN 4 NA 2 RN 5 NA 8pm-8am 1 RN 2 NA 1 RN 2 NA 1 RN 2 NA 2 RN 2 NA 2 RN 2 NA The home manager is to be supernumery to the above numbers and work full time. There is to be adequate and sufficient staff and/or contract arrangements in place at all times to ensure a good quality catering, domestic, cleaning, laundry, maintenance and administrative service for all users. A maximum of three service users aged between 55 and 65 years of age in the Dementia and Physical disability categories. A variation has been granted to allow one specified service user in the Mental Disorder - over 65 MD(E) category to be accommodated. This variation remains in force until such time as the needs of the person can no longer be met or until such time as the placement ceases. 22nd November 2005 2. 3. Date of last inspection Brief Description of the Service: Bourne House is a registered care home providing nursing care for up to 40 people who have dementia or a physical disability. The home is a large detached property situated in a residential area of Surbiton, with access to public transport systems, churches of a number of denominations, local shops and leisure facilities. The home is owned and managed by London Residential Healthcare Limited. Accommodation is provided over three floors. Passenger lifts are available in the home. There is a large, well maintained garden to the rear of the premises and parking to the front. Fees as at June 2006 were from £619 to £800 and extras for additional care would be by negotiation with the authorities funding care; residents pay for personal requisites, usually by invoice. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was conducted on 6th June 2006 and included the distribution of questionnaires to relevant parties including residents and their visitors. The visit was from 10 am until 5 pm and most service users were given the opportunity to talk to the inspector; several relatives were visiting on this day and they most helpfully commented on the procedures for admitting new residents. From the owners, ‘RLH’, a senior administrator was on site and contributed to the inspection of this care home. The contribution of those involved is acknowledged. In addition to the observations made during this visit other information held by the Commission was also reviewed as part of this inspection report. What the service does well: What has improved since the last inspection? The procedures for administering medication are much improved not that a monitored dosage system is in place; matron is very pleased with the new system and states that the local pharmacist is most helpful in supporting the home’s medication system including regular monitoring and auditing of medication. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 6 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. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements for ensuring that the pre-admission assessment of needs of service users can be met; this includes suitable information to base their decision about using the home so service users will be assured the home is able to meet residents’ individual needs. EVIDENCE: The relatives visiting Bourne House confirmed that the arrangements for the admission of residents remains satisfactory, this includes opportunities to visit the home, information provided such as the Service User Guide and the preparation of initial care plans. New service are advised about the opportunities for service users to be involved in social and leisure activities that reflect the wishes of service users. Family members and friends are encouraged to visit service users, and made to feel welcome when they do. The food is varied, healthy and a choice is always available. Specialist, religious and cultural diets can be catered for. Areas of strength are very good arrangements for assessing residents and providing information about the home, and there are no matters requiring improvement. so this section, about choice of home, is assessed as good. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 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 the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are all satisfactory so as to ensure the social, and health care of service users can be met. EVIDENCE: To evaluate these standard a sample of case files were checked, several tours were made of the home to observe care practices and visiting relatives were consulted. The previous inspection highlighted the need for relatives representing resident to be more involved in the care planning process and for this to be demonstrated in the care planning documentation. Evidence of this is now in place with signature inserted in the case file records. Where relative have not bee able to attend the home to sign such documents a suggestion was made to record that consultation had taken place as the Matron advised the inspector. Residents have a range of physical ailments as well as mental healthy difficulties and the case files indicate that professional agents such as doctors, medical consultants, psychiatrists and psychiatric nurses are involved as the need arises. One suggestion is made to add a risk assessment and plan of action if a resident’s mental health relapses. Medication, which has been problematic, is now more efficiently managed. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 10 Areas of strength are the satisfactory system for assessment, care planning and review and matters requiring improvement are the suggestion to include contingency plans in care planning, especially where a relapse in mental health might lead to a crisis and readmission to hospital; so this section, about health and social care, is assessed as good. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 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 the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There continues to be good opportunities for engaging in social activities, ensuring that social, cultural and ‘diversity’ needs are met. Meals are varied and nutritious, ensuring that health is promoted and differing tastes are catered for so residents can be assured their social life will be as fulfilling as they might wish. EVIDENCE: Service users presented as being very settled, content and well supported. They were well groomed and seemed very peaceful. A joyous atmosphere prevailed – due in no small part to the hard work of the activities coordinator. Several relatives sitting with the residents said how much the enjoyed the outings organised by the home and visitors reported that they were very happy with the care provided to their residents. It was pleasing to hear examples of the very real benefits of visiting places of interest - one such example was an improvement in appetite. The cook was commended for his meals; all the more commendable because the kitchen is small and storage space in the kitchen smaller still. The meal on the days was choice of Lamb Stew or Salmon salad plus other alternatives; the range is homely appears acceptable to residents. Staff members know how to respect service users and how to uphold their dignity. Care is well planned for and health needs are addressed well. Areas of strength are the activities offered and catering and matters requiring improvement are very few and hard to achieve such as larger kitchen storeroom; so this section, about social life, is assessed as good. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints: The home has a clear and simple procedure for dealing with complaints so service users’ are confident their concerns will be dealt with promptly and effectively. Protection: To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of service users and their property; this includes procedures for passing on concerns to the relevant authorities including the CSCI. EVIDENCE: To assess this standard the record of complaints was checked; relatives offered their opinions about the quality of the service; residents were given the opportunity to express any concerns - sometimes in a non-verbal manner. A number of minor points were raised about the laundry service but relatives confirmed that the home takes a positive attitude to any concerns raised – perhaps inevitably with a matter such as laundry services concerns need to be repeated from time to time the families say. A robust complaints procedure is in place and is clearly being used when the need arises. Two procedures are in place to guide staff when dealing with allegation of abuse, one is the in-house version and the other is the local authority’s. Senior staff were not absolutely clear that such serious matters must be reported to the local care management team before anything other than preliminary enquiries are made to establish basic facts paragraph so paragraph 7.5 of the in-house procedure must make this clear. Areas of strength are the positive approach to complaints and the clear documentation to support practice and a matter requiring improvement is the need for senior staff to be sure they know they must act without delay in referring allegation of abuse - so this section, about complaints, is assessed as good. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives make the judgement that this is a lovely home, one of the best they visited prior to deciding about admission. This is endorsed by the Commission which finds this care home can meet residents needs in a comfortable and safe, clean environment. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 14 EVIDENCE: A maintenance worker is employed in the home and there are regular checks of equipment with relevant records in place to confirm servicing of equipment, such as fire safety equipment, is checked at the required intervals. Furniture provided throughout the home was of good quality; minor damage to the environment was noted such as damage to some door-frames and shower units on baths (which need to be removed if not serviceable or not required. The local Fire Safety officer carried out an inspection of the home in 2005 and found it to comply with fire safety regulations. Records detail that the local environmental health department visited the home to check the kitchen and found that it complies with their catering and hygiene requirements. A sample of bedrooms were viewed. These were naturally ventilated and windows had restrictors. Bedrooms contained radiators with low temperature surfaces that could be individually controlled. Ensuite facilities are available in the bedrooms checked. Some service users had a television in their bedroom and one service user also had a telephone. There were some photographs and ornaments in two service users bedrooms, whilst others contained no personal possessions. As before, these bedrooms did not appear homely. A staff member previously reported that some family members do not always bring personal possessions for their relative and some residents do not like having ornaments and knick-knacks on display. The Commission suggested that, in view of the many activities and outings provided for residents, the home could generate its own mementoes for residents to put on display if they choose. The home was very clean and free from offensive odours. The laundry, in the basement is sited well away from the kitchen and there is a contract for the collection of clinical waste. It was noted however that the laundry lacks enough natural ventilation and needs an extractor fan to make conditions tolerable for laundry workers and to avoid the possibility that staff will prop open the fire door. Policies and procedures are in place to deal with the safe handling of clinical waste. Staff members receive in house infection control training. The home was free of offensive odours at the time of the inspection and visitors confirmed this was usually the case. Areas of strength are the pleasing environment in which residents live and that the property is well maintained; whilst matters requiring improvement are minimal, such as the need to improve ventilation in the laundry and the continuing efforts to make bedrooms more personal and homely, so this section, about the environment and hygiene, is assessed as good. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff members are now robust and now provide the required safeguards to offer protection to people living in the home. There has been ongoing staff training that has allowed staff members to develop the skills necessary for doing their jobs, and therefore meeting the needs of service users. EVIDENCE: The previous two inspections of the home highlighted that pre-employment checks on staff members employed directly from overseas were not being checked against the Protection of Vulnerable Adults list [POVA], nor did they have the prerequisite Criminal Records Bureau [CRB] checks prior to them commencing work. An examination of sample of staff files now indicates that these important checks are now in place and no staff are being employed until thoroughly vetted. Staff also confirmed the recruitment procedures they underwent when appointed. Records available detailed that there has been a large amount of staff training since the last inspection. There were records detailing that staff members have attended ‘Elder Abuse’ training by the Community and District Nursing Association. Records also indicated that all staff members responsible for handling medication have received refresher training in the safe handling of medication. Requirements were made in the previous Commission report regarding poor practice in relation to handling medication and it was therefore recommended that additional refresher sessions in handling medication was needed. As a result of that additional training no problems in respect of Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 16 medication were identified on this occasion and this will be in part due to the new monitored dosage system now in place and with this system the local pharmacist will be supporting the homes medication procedures and will periodic visits to audit medication and medication procedures. Staffing levels on the day of inspection were within the guidelines listed as conditions of registration but the Matron intends reviewing staffing levels at peak periods of activity such as morning and evening; this is important because some visitors perceive that there are insufficient staff in the evening to cater for residents’ needs. A recommendation is made to monitor staffing requirements in methodical manner by for example auditing dependency levels, this will help identify where staff are needed in greater numbers. Areas of strength are the improved recruitment practices, the very professional and positive attitude of staff, staff training, whilst matters requiring improvement is need to review staffing levels; so this section, about staffing, is assessed as good. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff members currently receive good support and guidance, ensuring that the home is run in the best interests of the service users. Health and safety is taken seriously and therefore practices promote and safeguard the health, safety and welfare of people using the service. EVIDENCE: The new Registered Manager, although not present during the inspection visit, has demonstrated competence and good leadership skills as evidenced by the very good outcomes in all sections of this report. Requirements, made at the last inspection, have been dealt with in a timely fashion. Staff members said that they receive good support from the Manager and Matron. Visitors said that the whole management team was approachable and helpful. There have been a number of changes in the person responsible for running the home in the last few years and it is hoped that the appointment of a new manager will provide Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 18 stability and continuity for service users, their family members and staff members. There are good systems in place for monitoring the quality of the service, including monthly, unannounced visits to the home by the Responsible Individual, family meetings and informal feedback from service users. The Registered Manager said that a quality monitoring survey has recently been sent to all family members. The home does not handle money for any service user. There are good arrangements for ensuring safe working practices in the home. All staff members undergo training in safe working practices and safety procedures are posted throughout the home. Risk assessments of the premises and individuals are in place. Accidents and incidents are being recorded and the Commission notified about the more serious incidents. There is a maintenance file holding the certificates for service checks on equipment including fire, hoists, gas and electrical appliances and so forth. Areas of strength are overall management of the home in a professional and proactive manner whilst one matter requiring improvement is the need to consolidate the management of the home, which will take time so this section, about management, is assessed as good. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Care Plans: it is recommended that contingency plans are included in the care plans of any service users where a break down in mental health may lead to a crisis; contingency plans should be clear to all senior staff and agreed with the local mental health team. Protection: it is recommended that the in-house procedures are amended to make clear the need to refer relevant matters (of alleged abuse) to the local care management team without delay, including for example at weekends, and before investigations are started in-house. Maintenance: old shower fittings that are broken should be removed from the bath (mixer taps). Laundry; it is recommended that improvements are made to the redistribution of laundry to residents to ensure it is well laundered, properly ironed and folded and is stored neatly in the correct service user’s rooms. Laundry: it is recommended that some form of mechanical DS0000026244.V294344.R01.S.doc Version 5.1 Page 21 2 OP18 3 4 OP19 OP19 5 OP19 Bourne House Nursing Home 6 OP27 ventilation is installed in the basement laundry. Staffing levels: it is recommended that the dependency levels of residents are audited so as to deploy staff in sufficient number at times of peak activity. Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Bourne House Nursing Home DS0000026244.V294344.R01.S.doc Version 5.1 Page 23 - 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!