Inspection on 26/10/05 for Bowley Close, 6

This inspection was carried out on 26th 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 found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bowley Close, 6 21/06/05

Bowley Close, 6 14/01/05

Bowley Close, 6 22/07/04

Bowley Close, 6 22/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Bowley Close, 6 Farquhar Road London SE19 1SS Lead Inspector Ms Lynn Hampton Unannounced Inspection 26th October 2005 08.40 DS0000007065.V256752.R01.S.doc Version 5.0 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 DS0000007065.V256752.R01.S.doc Version 5.0 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 Adults 18-65. 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. DS0000007065.V256752.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bowley Close, 6 Address Farquhar Road London SE19 1SS 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 670 8432 Choice Support Care Home 4 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places DS0000007065.V256752.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 PEOPLE WITH LEARNING DISABILITIES AND PHYSICAL DISABILITIES 21st June 2005 Date of last inspection Brief Description of the Service: 6 Bowley Close is a purpose built bungalow located in a quiet cul-de-sac close to the centre of Crystal Palace. There are several other care homes grouped together in the close, which opened in 1989. All are managed by a voluntary organisation, Choice Support. The home is near local facilities, including shops, cafes, pubs, a park and a sports centre. There are excellent local transport links, and the Close benefits from free on street parking for visitors. However, the locality is very hilly, which can make pedestrian travel difficult for older people and/or people with mobility problems. The home provides long-term accommodation and support for a maximum of four adults with learning and physical disabilities. The overall aim of the service is to provide care and support to enable service users to continue to make informed choices about the service that they want and their life. Each service user has their own bedroom, and shares communal facilities. At the time of this inspection, all the residents were male, as has been the case in recent years. DS0000007065.V256752.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in the early part of a weekday morning, 26th October 2005, and lasted nearly four hours. During the visit the inspector met three care staff. A range of documents was examined and a tour of the building took place. The inspector met and spent time with all four residents, most of whom were getting up and having breakfast. Residents were not able to communicate verbally with the inspector, but some were able to show their preferences and mood in gestures and body language. What the service does well: What has improved since the last inspection? 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. DS0000007065.V256752.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000007065.V256752.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): N/A These standards were not assessed at this inspection. The finding of the previous inspection was that the standards were met. EVIDENCE: All the current residents had been at the home for several years and therefore there were no recent assessments of prospective residents. At the last inspection (June 2005) the inspector discussed referral and admission procedures with the manager and staff, and found that standard 2 was met. DS0000007065.V256752.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Service users have individual plans that reflect their needs and personal goals. However, documentation at the home would benefit from clarification and simplification. EVIDENCE: The home maintains several different case files on each service user, in addition to planning sheets, diaries, activity planners and other recording documentation. While these records show that users are consulted about, and are involved in developing their individual plans, it was confusing to have so many different files. It was sometimes difficult to locate specific information. For example, the Service User file contained financial assessments, but the Service Delivery Plan file held information about benefits. Similarly, copies of letters inviting people to Reviews, and copies of health assessments were on the Service User file, while the minutes of the Review, and a Health Care profile were on the Service Delivery Plan file. DS0000007065.V256752.R01.S.doc Version 5.0 Page 9 Choice Support has implemented a standard system of recording throughout all of their care homes, and individual homes will not be able to make major changes individually. Therefore, a new Requirement made that Choice Support review the systems in place to ensure that they support the care planning process, and promote quality of service delivery appropriate to each individual home. Case files indicated that Reviews are regularly held that involve the resident, advocates, relatives and any health or care professional involved in the residents’ care. Health and care issues are kept under review, and Service Delivery Plans are comprehensive, covering health, friends, family as well as progress in relation to care plans. DS0000007065.V256752.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 16, 17 Service users have individual programmes of activities, although these would benefit from updating, review and monitoring to ensure that planned activities take place. There is a range of social events for service users to participate in at home as well as in the community. Meals are varied and prepared to a high standard. EVIDENCE: Service users each have an individually tailored programme of activities that reflects their interests and needs. The inspector saw a number of documents that indicated the planned weekly activities, including individual timetables displayed on the wall of the staff office, the duty rota (which has space on the form, so that staff deployment can be linked to activities), and Weekly Planners held on Service Delivery Plan files. However, all of these timetables differed from each other: the planner on the Service Delivery Plan appeared to be the most recent, and was dated July 2005 (the planner on the wall was undated). The manager must ensure that records available to staff clearly show the latest activity planners, and that they are reviewed regularly. DS0000007065.V256752.R01.S.doc Version 5.0 Page 11 The planned activities set out in the timetables were varied and interesting, and included community participation such as attending church, shopping, going to the pub and meals out. ‘In-house’ activities, such as involvement in preparing food and drinks, or sensory sessions were seen to be scheduled almost on a daily basis. However, the inspector had difficulty establishing whether scheduled activities had actually taken place. Goal record sheets on one file examined only went up to January 2004. Some Data Collection and Participation Monitoring sheets on the Daily Working file were dated April 2003, and several were not filled in. Participation Index Charts had been completed, but these indicated that activities were not taking place as scheduled. For example, one residents timetable indicated that he was to go to the pub twice a week, but the Participation Monitoring sheets had recorded that this had happened only three times in two months. As noted in ‘Individual Needs and Choices’ above, some confusion in recording may arise due to duplication in documentation – for example, IPP Goal Monitoring Sheets duplicate areas of activity monitoring that are covered in the Participation Monitoring Sheets. However, the manager must ensure that activities are recorded and monitored, with action taken to ensure that they take place in line with care plans. Case files contained information relating to residents’ ability to give consent, which is good practice. There was information on files relating to how residents’ birthdays are celebrated, and invitations pinned in the diary from other Choice Support homes inviting residents to parties and events. During the inspection, the manager of another home dropped in to say hello to residents and staff, as she had once worked at 6 Bowley and was visiting a nearby home. Food storage was seen to be of a good standard in the home. The menu was examined and seen to provide a good range of nutritious meals, including homemade soup, lamb chops, fish, and roast dinners. Fresh fruit and vegetables were available in the kitchen, and bran is added to cereals for the residents. Staff were seen to offer appropriate support to residents during breakfast, and to ensure that they were offered drinks throughout the day. Staff and one of the residents went food shopping during the inspection, and ensured that ingredients for the planned evening meal were available. DS0000007065.V256752.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Service users receive personal care in the way that they prefer and require, and this is undertaken to a high standard. Health matters are attended to, and service users benefit from appropriate policies and procedures relating to administration, storage and recording of medication in the home. EVIDENCE: Two of the three care staff on duty during the inspection were relatively new to the team, although one had worked in another Choice Support home prior to this. All staff were able to talk knowledgeably about residents and their needs. Interaction between staff and residents was observed to be appropriate and caring. Although residents had limited verbal communication, the shift leader introduced the inspector to them individually and explained the reason for the inspection visit, which is good practice. Residents were dressed in clean, ironed clothes and shoes that were modern and stylish. Staff reported that they had the equipment that they needed to support residents in personal care, and were seen to wear PVC gloves as appropriate. Residents are checked in respect of their continence throughout the day (up to 6 times) and it is ensured that they are clean and dry at mealtimes, which promotes their dignity. Staff clearly took pride in the high standard of personal care in the home, and this is to be commended. DS0000007065.V256752.R01.S.doc Version 5.0 Page 13 However, it was noted that there had recently been a change in the type of incontinence pads provided to the home, and that the new type were insufficient for the residents - the new pads leak, and staff were concerned that this undermined the dignity as well as hygiene of the residents. It was reported that the manager was negotiating to have the previous supply of pads reinstated, and progress in this matter will be checked at the next inspection visit. The inspector observed medication being administered, and examined records. Administration was good, and a monitored dosage system is in place. There were no gaps in recording, and charts indicate whether service users have any allergies. DS0000007065.V256752.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Systems are in place to protect service users from abuse, although the Complaints Log should be clearer and kept up to date. EVIDENCE: A Recommendation was made in the report of the last inspection, that the manager redesigns the complaints log to make it easier to record the necessary information. The inspector was shown the Complaints log, which is an A3 size book, laid out with ruled columns headed ‘Details of Complaint’, ‘Investigation’, ‘Action Taken’ and ‘Outcome’. The layout did not leave a lot of space for details of the complaint to be entered. One complaint had been made since the last inspection visit, which concerned overflow of sewage from the flat above 6 Bowley. This had been recorded on 1/7/05. The log showed that the Complaints Officer had been asked to investigate, but the outcome was not recorded. Staff confirmed that the problem had been resolved. The previous Recommendation remains in force, and the manager must ensure that outcomes are recorded promptly. DS0000007065.V256752.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 29, 30 Service users live in a comfortable, safe and clean environment, and their bedrooms suit their lifestyle. Some repairs are needed to kitchen fittings, and access to the garden could be improved. EVIDENCE: The inspector was shown around the home by a member of staff, with residents being consulted as far as possible for permission to enter their rooms. Each resident has their own individual bedroom, and these were seen to be spacious and personalised to reflect the tastes and personality of the individual resident. Each person has their own personal supply of toiletries, which includes razors and oral hygiene equipment. Rooms were furnished with double beds and adequate storage for clothes and belongings. Clothes were stored neatly. Furniture, fittings and decoration were of a high standard, and one resident had a large aquarium in his room. There was adequate communal space in the home – a kitchen; lounge/diner; laundry room; a bathroom/toilet; a shower/toilet, and a further separate toilet in the hallway. The home was clean throughout. DS0000007065.V256752.R01.S.doc Version 5.0 Page 16 The lounge has a range of comfortable chairs and sofas that would accommodate all the service users, as well as a sensory area in one corner that one resident chose to spend time in during the inspection. The lounge carpet was stained and had a burn mark from an iron, but staff told the inspector that new carpets had been ordered and were to be replaced soon. The inspector found a leak from a pipe in one of the toilets – this was responded to immediately and a repair request was made. The oven door in the kitchen was loose, and fittings in the kitchen did not appear sturdy enough for the intended use. Cupboard doors in the kitchen and laundry area wear showing signs of wear, and hinges were coming loose. There was a burn mark on the counter top in the kitchen. Repairs are to be addressed, and consideration given to upgrading fittings in the home to meet the needs of the service users. A walled garden runs around three sides of the home. There is a paved patio area on one side, which leads onto a grassed area with planted borders. Residents are able to access this area safely with minimal staff supervision, and staff reported that residents make use of and enjoy the area throughout the year. It was also reported that new garden furniture was being purchased for their use. Residents were seen to walk along the garden during the inspection – it was a fine day, but had been raining and was muddy underfoot. A recommendation is made that a path or stepping-stones be considered for the garden, to provide a drier walkway when being used through the year. DS0000007065.V256752.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 An effective staff team, who have access to relevant training, supports Service users. All vacancies have been recently filled, promoting continuity of care, and staff were clear about their roles and responsibilities. EVIDENCE: The home is staffed during the day with a minimum of two care workers, and Waking Night staff are on duty overnight. Two new members of staff have recently joined the team, and the inspector was informed that there are no current vacancies. Gaps in the rota arising from sickness, study or annual leave were seen to be covered by permanent staff working extra hours, which ensures continuity of care. New staff confirmed that they had an induction when they started working in the home, and had the routines and care practice explained to them. Staff were able to talk knowledgeably about residents and their support needs. Staff confirmed that they had access to a good range of training. Records held in the home indicated that staff are due to attend a range of statutory training, which includes First Aid, Food Hygiene, Moving & Handling, Medication, Vulnerable Adults, Health & Safety and Epilepsy. The Manager is undertaking relevant courses, and has study leave once a week. Requirements and a Recommendation relating to training, made in the report of the last inspection, DS0000007065.V256752.R01.S.doc Version 5.0 Page 18 are met. In addition, documents in the office indicated that the staff team were to participate in a research programme, called ‘Active Support Training’. This aims to increase service user engagement in meaningful activity, which would clearly act to the benefit of residents. DS0000007065.V256752.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 The service users benefit from a well run home, which is user-led. The application for registration of the manager is outstanding. Records relating to Health & Safety were in good order, although use of footrests on wheelchairs should be reviewed and risk assessed. Monthly visits are undertaken to monitor the quality of care in the home. EVIDENCE: Staff reported that the manager had an open, approachable style and was available for them to talk to if needed. Records of accidents and incidents in the home are well kept and demonstrated that the manager conscientiously reports relevant events to the Commission as is required. Monthly visits are undertaken by managers of other Choice Support homes, to monitor the quality of care in the home and make regular contact with residents. Although the manager was confirmed in post in October 2003, an application to register had not been submitted at the time of this inspection. This must be done as a matter of priority. See Requirements. DS0000007065.V256752.R01.S.doc Version 5.0 Page 20 Comprehensive Health & Safety records were in place that included statutory checks on electrical equipment and gas servicing. The home’s Certificate of Insurance had recently been renewed, and Fire equipment had been tested in March 2005. A Health & Safety inspection had been carried out in the home the day before this inspection visit. A record of temperatures of cooked roast meats is maintained to ensure food safety. Staff were seen to assist residents use their wheelchairs without footrests being in place. A member of staff reported that one resident propels himself in his wheelchair, using his feet, and would be unable to mobilise independently if footrests were in place. This should be risk assessed, and, where staff are pushing residents in their wheelchairs, footrests must be used to prevent injury to residents’ feet and legs. DS0000007065.V256752.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 2 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 X 3 3 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 3 3 X 3 2 X DS0000007065.V256752.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 15(1)(2) Requirement The Registered Person must, in consultation with care managers, review record keeping and documentation used for care planning in Choice Support homes. The outcome of the review, with timescales for any action to be implemented, to be notified to CSCI in writing. The Registered Manager must ensure that records relating to service users’ activities are accurate, updated regularly and are monitored, with action taken to ensure that they take place in line with care plans. The Registered Person must address the following repairs: • Repair leaking pipe in toilet • Repair oven door in kitchen • Repair cupboard doors and hinges in the kitchen and laundry Timescale for action 01/05/06 2 YA12 15(1)(2) 01/12/05 3 YA27 23(2)b,c,d 01/02/06 DS0000007065.V256752.R01.S.doc Version 5.0 Page 23 4 YA28 23(2)b,c,d The Registered Person must give review the suitability of the kitchen, its fittings and storage, to ensure that it meets the needs of the service users. The outcome of this review, with timescales for any action to be taken, is to be submitted to the CSCI in writing. The Registered Person must ensure that the application for manager registration is submitted without delay. 01/05/06 5 YA37 8 01/12/05 6 YA42 13(5) The Registered Person must 01/12/05 ensure that footrests are used on wheelchairs when being used to move service users, and that use of footrests is risk assessed. 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 YA22 YA28 Good Practice Recommendations The manager should redesign the complaints log to make it easier to record the necessary information, and ensure that this is kept up to date. The Registered person should give consideration to providing a pathway in the garden, to enable residents to walk in the garden area throughout the year DS0000007065.V256752.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000007065.V256752.R01.S.doc Version 5.0 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!