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Inspection on 18/05/05 for Cale Green Private Nursing Home

Also see our care home review for Cale Green Private Nursing Home for more information

This inspection was carried out on 18th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Staffing levels in the home have recently been increased and residents and staff felt this had benefited the quality of care provided. Eight out of ten residents were complimentary about the staff team and about the service they received. The home has shown a strong commitment to tackling suspected abuse and responding to complaints. Residents were complimentary about the activities provided in the home and `Bingo` was mentioned frequently. Residents were also positive about the meals provided. One visitor said he and his family were made welcome in the home.

What has improved since the last inspection?

Staff were motivated and enthusiastic about working at the home and the home`s vetting procedures for new staff complied with the regulations. Fire safety doors had been put on all bedrooms and these had electronic openers linked to the fire alarm. Some bedrooms had privacy locks on the doors. A separate nursing office has been created on the first floor providing privacy for staff, residents and relatives to discuss concerns.

What the care home could do better:

The assessment processes used before and after admission to the home need improving, as does the quality of information recorded on resident`s care plans. The Intermediate Care service provided at the home was dependent on the nurse in charge identifying goals for the residents to regain their independence. The placing care managers had not provided clear information about what was expected from the short term stay in the home. Medication practices do need to be improved, as does the safe handling of laundry. Areas in the home do still need redecorating and re-carpeting following the fitting of fire safety doors and some of the bedroom doors still need privacy locks. The passenger lift broke down twice on the day of inspection and repair men had to be called out. The majority of residents spoken with were complimentary about the staff but two residents expressed concerns about the attitude of some staff. One resident said he had to wait a very long time for the toilet and another resident said staff passed comments like `you are not the only one living here`. Training in medical conditions such a diabetes and stroke had not been provided which could result in nursing needs not being met.

CARE HOMES FOR OLDER PEOPLE Cale Green Private Nursing Home Adswood Lane West Stockport Cheshire SK3 8HZ Lead Inspector Tracey Rasmussen Unannounced 18th May 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. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cale Green Private Nursing Home Address Adswood Lane West Stockport Cheshire SK3 8HZ 0161 477 1980 0161 480 4928 smallwoodhomes@btopenworld. Smallwood Homes Ltd 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) Debra Pengelley Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physsical disability (10), Physical disability of places over 65 years of age (50), Terminally ill (2) Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date Implemented: 15th October 2002 1. No service user may be received in the establishment who is less than 30 years old, male/female. Date of last inspection 26 January 2005 Brief Description of the Service: Cale Green nursing home is a care home that provides 24 hour nursing care and accommodation to 50 adult service users. Many of the service users accommodated at the home have high physical dependency needs. The home is privately owned by Smallwood Homes Ltd. Cale Green nursing home is situated in Cale Green on Adswood Lane West, about one and a half miles from the centre of Stockport. Local bus services are available. A small drive way leads to a car park and the main entrance to the home. The home is a two storey purpose built building which has been extended to provide 43 single bedrooms and three shared rooms. Eleven rooms have ensuite toilet facilities. Assisted bathing facilities are available on both floors. There are lounges on both floors the ground floor also as a separate dining area. A wide variety of adaptations and aids are provided to assist in the nursing of the service users and this includes a passenger lift and hoists. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over almost eight hours by two inspectors. Since the last inspection in January 2005, four further visits have been made to the home. These have been in connection to an investigation of a complaint. The complaint listed a number of areas of concern including the alleged abuse of five residents. This was investigated and two staff members were disciplined for abuse of two residents. Other aspects of the complaint listed issues in relation to work practices, fire safety and cleanliness in the home. These were not upheld. The complaint was upheld in relation to medication practices, staff vetting procedures and staff attitude to one resident. As a result of the lengthy investigation the manager has not had time to address a number of the requirements made at the last inspection. A tour of the two floors in the home took place and care and staff records were seen. Ten of the fifty residents, one relative (visitor) and five staff were spoken to. Five resident and five visitors questionnaires were left at the home. One visitor’s questionnaires had been returned. This contained positive responses. The home now offers an ‘intermediate care service’ for people who require some care and support for short periods due to sudden illness or following recovery from an illness. One resident living temporarily at the home was under the age of 65 years. She was complimentary about the home but felt she was too young to be there, saying that there were very limited care options and choices for younger people in the Stockport area. Verbal feedback of the findings from the inspection was given to the manager of the home at the end of the visit. What the service does well: Staffing levels in the home have recently been increased and residents and staff felt this had benefited the quality of care provided. Eight out of ten residents were complimentary about the staff team and about the service they received. The home has shown a strong commitment to tackling suspected abuse and responding to complaints. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 6 Residents were complimentary about the activities provided in the home and ‘Bingo’ was mentioned frequently. Residents were also positive about the meals provided. One visitor said he and his family were made welcome in the home. 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. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 6 Residents do not have detailed assessments so the home cannot confirm it can meet the individual needs. Despite the lack of clear guidance resident’s receiving intermediate care do regain their independence and confidence. EVIDENCE: A range of care records were inspected and these contained pre admission assessments. These had been completed but lacked detailed information for example, a resident’s hygiene needs were recorded as “needs help”. Admission assessments had not been completed fully and there were examples of conflicting information with the pre-admission assessment. One preadmission assessment recorded the need for a diabetic diet but the admission assessment did not record this. The lack of clear detailed assessments could result in residents not receiving the care they need. The home now provides six beds for an intermediate care service (Step-up and Step-down). Admission documentation and care planning information was more detailed for these residents. The nurse responsible for the intermediate care residents had only just commenced in post. Discussion with the nurse Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 9 identified that the intermediate care service was commissioned by the local PCT. Clear objectives or outcomes for the residents receiving the intermediate care service had not been provided by the PCT and the nurse stated she was still trying to identify the community support links to ensure a multidisciplinary approach to each of the intermediate care residents. In the interim, the nurse had developed care plans for each resident and was working towards promoting their independence. The manager stated that they had also struggled to get community care assessments for the intermediate care residents. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 10 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) 7,8,9,10 The care planning documentation was insufficient to meet the health, personal and social care needs of residents and all residents stated were not treated with respect and dignity. Medication practices did pose a potential risk to residents and staff. EVIDENCE: A range of care planning documentation was inspected and a number of issues were identified including poor recording, conflicting information and inadequate identification of care needs; one resident had a chronic illness; a care plan for this was not recorded. Another care plan required random blood sugar testing this had not been done. Care plan interventions were vague. Care planning records for each resident were poorly organised, however some newer residents to the home did have better organised files. Two residents said that they had not seen a chiropodist although three other residents said they had. One resident’s records indicated there had been a substantial weight loss over an eight week period but no action in response to this provided. This issue was identified at the previous inspection. These issues could result in inadequate care being provided. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 11 Residents were nicely dressed and co-ordinated and attention had been paid to nails and hair. Eight out ten residents spoken to were very complimentary about the service they received and about the staff. One resident said “it is nice here, being looked after. I had a bath last night, my washing is done and my meals are cooked”. Two residents however were not so positive, they reported that some care staff are rude and say comments such as ‘it’s the wrong time’ or ‘we are busy’ or ‘there are other residents you know’ when they ask to go to the toilet. One resident said he was made to wait for nearly an hour and half before staff provided assistance. Similar issues were investigated earlier this year in response to a complaint. The medication practices were unsafe. Records for receipt and administration were not maintained consistently, labels had been used on medication administration sheets, there was some overstocking of medications and the downstairs medication room was left open. Stocks of old medication were piled on the medication room floor and these were easily accessible to anyone walking past the room. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 Resident’s family and friends are welcome and residents do have some choice in what activities they join in and what meals they wish to eat. EVIDENCE: An activity coordinator works in the home four days a week and residents said they joined in various activities. Bingo on Fridays was mentioned several times. A karaoke sing along was undertaken at the time of the visit. On the ground floor the lounge was left unattended for a period of time in the morning, when a staff member did come in she did not chat with the residents. Residents on the first floor watched breakfast TV and sat discussing a pop star’s recent diagnosis of cancer. Other residents spoken to had a morning paper delivered every day and enjoyed reading novels. Care plans for the social aspects of the service were not specific to each resident. One resident under the age of 65 years was complimentary about the home but felt she was too young to be there, saying that there were very limited care options and choices for younger people. Residents said they could have visitors when they wished and visitors were seen throughout the day. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 13 There were mixed views offered by residents about the food in the home. The majority of comments were positive. One resident said that the “food was lovely” and another resident said “nice meals, cook is very clever, we have had some nice changes on the menu”. A choice of meal is provided and a dining room is available on the ground floor, although residents on the first floor chose to eat from small tables in the lounge. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 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 Residents are protected from abuse and can be confident that complaints will be treated seriously. EVIDENCE: The home does have a complaints procedure in place. Since January 2005 the CSCI has investigated one complaint concerning a number of issues in relation to care and nursing practices and standards of the hygiene in the kitchen. The complaint also resulted in the protection of vulnerable adults procedures being activated and this resulted in one staff member being dismissed. Throughout the complaint and abuse investigation the management of the home was very cooperative in pursuing the allegations. The manager was investigating a complaint at the time of this visit. Staff were aware of the policies, procedures and practices to be used if abuse is suspected. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,22,24,25, 26 Residents live in a clean home that needs some refurbishment. Aids and adaptations are available to meet resident’s needs. EVIDENCE: The home has recently up graded all its internal doors to fire safety doors with magnetic door openers linked to the fire safety system. These doors have also been widened to give more manoeuvring space especially for people in wheel chairs. Not all doors had been fitted with locks. There was enough equipment to meet resident’s needs, however the passenger lift in the home broke down twice at the time of the visit and residents and staff said it had broken down recently on two other occasions. Engineers had been called to repair the lift each time but the repairs appeared not to be sustainable. Residents said they were happy with the rooms and they had had some limited choice in the decoration of the room. Bedrooms were nicely personalised. Two bedrooms had had recent maintenance work and needed redecorating. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 16 As a result of the refurbishment of the doors some carpets need replacing and some areas still need redecorating. Some carpets in communal areas were also showing signs of fraying and will eventually pose a trip hazard. Records of routine maintenance were inspected. Recent tests on hot water temperatures were not as detailed as they had been previously. The home was clean and four domestics were on duty in the morning. laundry waiting to be washed was piled on the floor. Some Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Residents are cared for by staff trained in care practices and who are correctly vetted before the start of their employment. EVIDENCE: Staffing levels in the home had been increased recently and residents requiring intermediate care had a dedicated nurse and care worker during office hours Monday to Friday. The files of 3 three new members of staff were inspected. Criminal Records Bureau checks and 2 written references had been obtained before employment commenced. These were in place on the files. Staff had had training in health and safety, cross infection and abuse. Many staff had achieved an NVQ in care and other staff interviewed had just commenced their NVQ training. The manager was undertaking an NVQ 4 in management. Training in specific illness and diseases had not been undertaken which could result in resident’s specific nursing and care needs are not met. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 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) 31, 32, 33, 38 The home is managed appropriately, and residents do have a say in the way the home is run although quality monitoring has not been undertaken recently. Some health and safety practices do not promote the welfare of residents and staff. EVIDENCE: The manager has had to deal with a number of serious decisions and problems since the last inspection, which has required a lot of time and effort to support staff through a difficult time. The manager admits this has impacted on her ability to address a number of the issues identified at the previous inspection. Staff meetings and residents meetings have happened, but quality assurance audits have not been undertaken. Both residents and staff said they could discuss concerns with the manager and felt that she was approachable. Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 19 Generally health and safety standards were maintained. Staff used moving and handling equipment correctly and wheel chairs had foot plates on. Areas that need looking at include making sure the medicine room and laundry rooms are kept locked; that laundry is not left on the floor and that domestic staff receive training moving and handling Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x 3 x 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x x x x 2 Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 15 Requirement Timescale for action 1/7/5 2. 3, 4 14 15 3. 6 12 14 15 12 14 15 4. 7 8 The registered person must ensure that comprehensive preadmission assessments are obtained from the placing authority before the admission of a new resident. The registered person must 1/7/5 ensure that the homes own assessment is reflective of the factual information obtained prior to admission. The regsistered person must 1/7/5 ensure that any resident referred for intermediate care has a clear care plan with defined objectives for the resident to try to acheive. The registered person must 1/7/5 ensure that care plans are comprehensively recorded to reflect all the needs of the service user. (Timescale of the 28/02/05 was not met). The registered person must ensure records are maintained which detail the actions taken following continuous or sudden weight loss or gain of a service user.(Timescale of the 28/02/05 was not met). The registered person must F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc 5. 6. 8 12 13 15 15/6/5 7. 9 13 30/6/5 Page 22 Cale Green Private Nursing Home Version 1.30 8. 10 12 9. 22 16 23 16 23 16 23 16 13 30 10. 11. 12. 24 24 26 38 18 13. 14. 13 38 ensure that the management of medication promotes the safety of residents and complies with the Royal Pharmaceutical and The NMCs guidance. The registered person must ensure that all residents are treated in a manner which respects them and promotes their dignity.(Timescale of the 28/02/05 was not met). The registered person must ensure that the lift is maintained operational and any repairs undertaken are sustainable The registered person must ensure that all rooms that require it, are refurbished. The registered person must provide privacy locks on all service user bedroom doors. The registered person must ensure that soiled laundry is contained in appropriate containers. The registered person must ensure that staff receive training and information about the different disease processes. The registered person must ensure that all areas that may pose a potential risk or hazard are maintained securely locked. 15/6/5 15/6/5 1/7/5 1/7/5 16/6/5 1/7/5 1/6/5 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 27 Good Practice Recommendations The registered person should ensure that there are enough nurses employed in the home to ensure continuity of care to residents admitted for Intermediate Care in the absence of the Intermediate Care nurse. F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 Page 23 Cale Green Private Nursing Home Commission for Social Care Inspection 2nd Floor Heritae Wharf Portland Place Ashton under Lyne OL7 0QD 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 Cale Green Private Nursing Home F54-F04 Cale Green S17291 V226181 180505 Stage 4.doc Version 1.30 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. 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