Inspection on 27/01/06 for Carlton House Rest Home

This inspection was carried out on 27th January 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

Carlton House Rest Home 17/12/08

Carlton House Rest Home 17/01/07

Carlton House Rest Home 20/12/04

Carlton House Rest Home 19/04/04

Carlton House Rest Home 19/08/03

Carlton House Rest Home 14/04/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Carlton House Rest Home 15 Barton Court Road New Milton Hampshire BH25 6NN Lead Inspector Tim Inkson Unannounced Inspection 27th January 2006 09:30 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 Carlton House Rest Home DS0000012377.V280031.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. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Carlton House Rest Home Address 15 Barton Court Road New Milton Hampshire BH25 6NN 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) 01425 612218 herridge19@hotmail.com Mrs Caroline Herridge Mrs Caroline Herridge Care Home 33 Category(ies) of Dementia (33), Mental disorder, excluding registration, with number learning disability or dementia (33), Old age, of places not falling within any other category (33) Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category MD must be at least 55 years of age Date of last inspection 13th July 2005 Brief Description of the Service: Carlton House orginally an hotel and was converted for use as a care home some years ago and has been extended and improved over time. The home provides personal care for up to 33 older people and it is located in a residential area some 400 metres level walk from the centre of the town of New Milton and all the amenities that can be expected in an urban setting. It is a large detached building with accommodation for residents situated on 3 floors. All bedrooms are single and 12 have en-suite WCs, and 6 have either an en-suite bath or shower. The communal/shared rooms are located on the ground and second floors and comprise two lounges ond a large dining room on the ground floor and a lounge on the second floor. A passenger lift provides access to all floors where assisted baths and WCs are available. There is an attractive level garden and patio area that is readliy accessible for use by residents. Other facilities and services provided by the care home include full board and a laundry service. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the home was the second of two that must be undertaken in the 12-month period beginning on 1st April 2005. It started at 09:30 hours and finished at 15:00 hours. The inspection procedure included viewing a sample of some bedrooms (20), an examination of documents and records, observation of staff practices where this was possible without being intrusive and discussion with residents (10), and staff (4). At the time of the inspection the home was accommodating 31 residents and of these 8 were male and 23 were female and their ages ranged from 76 to 105. There was 1 resident from a minority ethnic group. The home’s deputy manager was available throughout the visit to provide assistance and information when required and the registered manager was also available for some of the time. What the service does well: What has improved since the last inspection? The home’s Service Users Guide had been updated to ensure that the information it contained about the service the home provided was accurate. Copies of the guide were also now readily available for both potential and existing residents. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 6 New carpets had been laid in the ground floor communal rooms of the home improving the appearance and comfort of environment in those areas. At the time of the inspection the refurbishment of two bedrooms was almost complete that would result in greatly enhanced accommodation both spatially and in the facilities provided in the rooms concerned. 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. Carlton House Rest Home DS0000012377.V280031.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 Carlton House Rest Home DS0000012377.V280031.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): 1 and 3 The home’s admission procedures included the provision of accurate information about its services and facilities and good assessments of the needs of potential residents before they moved into the home to ensure that the home could provide the care and support that individuals required. EVIDENCE: At the last inspection of the home on 15th July 2005 it was noted that the home’s Service Users Guide required updating/amending because the complaints procedure did not include details about the Commission for Social Care Inspection (CSCI). It was also suggested that to ensure that all residents had ready access to the guide that a copy be placed in all bedrooms. Both of these matters had been actioned by the home. The home had written policies and procedures concerned with the admission of new residents to the home and also concerning the assessment of the needs of potential residents. The records of 3 residents were examined and these included copies of assessments that the home had arranged of the needs of the individuals concerned. On this occasion as at the last inspection of the home on 15th July 2005, it was apparent from discussion with residents and from the documents Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 9 examined that the needs of potential residents were identified before the persons moved into the home. These pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs that were fully documented when they actually moved into the home. There was evidence in these documents that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances changed. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 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 the following standard(s): 7 and 9 There were good plans of care in place that ensured that residents received the help and support that they needed. Good procedures and systems were also in place to ensure that medication was administered safely. EVIDENCE: The home had written policies and procedures concerned with “Assessment and Daily Care Plan” that set out the practice and methods that the home used to ensure that the help residents needed was provided. On this occasion as at the last inspection of the home on 15th July 2005, a sample of the care plans of residents was examined (3). The documents were detailed and the plans were based on the assessments the home carried out in order to identify what help individuals needed (see also pages 9 and 10). The plans set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. Observation and discussion with residents also confirmed that individuals received the help they required and that the equipment was in place as set out in their plans of care. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 11 All care staff spoken to were fully aware of the contents of the care plans that were sampled and the assistance that the individuals concerned required. This included the specific cultural needs of a resident from an ethnic minority group. The care plans documents included recorded assessments of the potential risks to a resident and the home used nationally recognised formats to assess the risk to residents of among other things, pressure sores and malnutrition. A person’s likes and dislikes were noted to ensure that their preferences were met. There was evidence that care plans were reviewed at least monthly. Notes were kept of the help and care provided to residents each day. It was noted that the goals in care plans promoted the fundamental principles/values that underpin social and health care e.g. independence and choice e.g. self administering medication; provision of kettle in residents room to enable the individual to make hot drinks and snacks. Comments from residents about the care and help provided to by the home included: • “They help me get into and out of bed as I can’t do it on my own. Every day, twice a day, they cream my leg”. • “They help me with everything”. • “I am very well looked after, they are so kind”. The home had well-established links with a local mental health unit and received regular support, help and advice from its staff with the management and care of some of the residents in the home. Staff from the home had attended training courses in “dementia care” ensuring that they had the specialist knowledge and skills to meet the needs of residents with enduring mental health problems and cognitive impairments. The home had written policies and procedures concerned with the management and administration of medication. The home’s deputy manager had been delegated the responsibility for the effective management of the medication management system in the home. The home operated a monitored dosage system (MDS) and most medicines were provided by a local pharmacist in blister packs that held 28 days prescribed supply for an individual and were dispensed from these containers. Medicines that could not be supplied in the boxes such as creams, liquids and those that would deteriorate/spoil quickly outside their protective packaging (e.g. effervescent tablets) were dispensed from their original containers. All staff that dispensed medication had attended training in “medication management” All medicines were stored securely in a locked metal medicine trolley and inside a locked cupboard. Some medicines requiring storage at a particular temperature were kept in a speared compartment in a refrigerator. The local primary care (PCT) trust arranged for the “regular” review of residents medication. Good practice noted during the inspection included: • The use of a sealed container for medicines that needed storage in a refrigerator and a record of the operating temperature of the refrigerator Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 12 The ability of residents to manage their own medicines (self medicate) if they wished and subject to a risk assessment • The permission of general practitioners for the use of certain unprescribed or “homely” medications if necessary e.g. cough linctus • Sample copies of the signatures of the staff in the home who dispensed medicines Information and guidance about medication and provided by the local PCT was readily available in the home and included details of medicines that could not be kept in an MDS system and requirements for the management of controlled drugs. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. • Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The home had good procedures in place for ensuring residents could exercise self-determination. EVIDENCE: The home had several written policies that were concerned with the rights of residents. These included: • Residents’ charter • Sexuality • Personal data protection These referred to among other things the right of residents to make their own choices, act independently and enjoy the same rights and freedoms as any person living in the community. The home’s manager said that most residents were assisted to manage their financial affairs by their families or representatives. There was information readily accessible in the home about organisations that could provide independent advice about such matters for residents and their relatives/representatives. One resident spoken to said that she managed her own finances. • “I pay my own bills myself by direct debit straight from my bank account. It takes almost all of my pension”. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 14 Other residents indicated that they were pleased that they no longer had to worry about such matters and said: • “My sons look after my money, they have power of attorney…” • “My daughter sorts my money out she is very good”. The home permitted residents to furnish their own bedroom accommodation if they wanted to do so and several residents spoken to said they had items of their own in their rooms. One resident said: • “It is not like home but it is nice to have my own things” No resident spoken to was aware that they could see any record that the home kept concerning them. It was suggested to the home’s registered manager that a specific policy concerning residents rights to access their records could be developed and reference made to the fact in the home’s “service users guide”. All sensitive information about residents including plans of care was kept secure in locked cabinets. Comments from residents about their ability to exercise control over their daily lives included the following: “I can get up and go to bed when I want. I tend to stay in my room as I don’t mind my own company”. “I could have brought my own furniture in if I had wanted to but I didn’t”. “I can do what I want there is no interference from staff”. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 15 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): 17 The home had good procedures in place to ensure that residents could exercise their civic rights. EVIDENCE: The home’s registered manager confirmed that she arranged for the details of all residents accommodated on a permanent basis in the home to be included on the electoral roll. Some residents spoken to recalled voting in elections or confirmed that they could do so if they wished. • “They took me to the polling station”. • “I know that I am on the electoral roll”. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 16 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): 24 and 25 The home’s bedroom accommodation was furnished and equipped satisfactorily for service users needs. There were good systems and procedures in place to ensure the bedroom accommodation was both safe and comfortable. EVIDENCE: Although the general environment was not assessed on this occasion it was noted that since the last inspection of the home on 15th July 2005 new carpet had been laid in the ground floor lounges and dining room. As at the last inspection there was some discussion with the registered manager about suitable floor covering for the entrance hall and ground floor corridor of the home. The manager expressed particular disappointment with carpet in the latter area, as it was apparently only 18 months old was in a poor state of repair and appearance and without some attention could present a tripping hazard. The manager stated that suitable floor covering would be installed to replace the carpet. The refurbishment of two bedrooms was nearing completion that would result in both having en-suite facilities and additional floor space in a room that had been considered “too small” previously. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 17 Progress was being made with extending the roof space to provide more bedrooms in the not too distant future. All residents spoken to said that they were content with the standard of their bedroom accommodation and the furnishings and any equipment in their rooms. All the rooms viewed varied in size and configuration but all were furnished and equipped as expected by Standard 24 of the National Minimum Standards for care Homes for Older People. They were all naturally ventilated and heated by radiators that were all covered with guards to prevent residents from the risk of burns. The home’s manager said that the home’s hot water system comprised a combination boiler that did not require the storage of hot water and ensured that the hot water at outlets to which residents had access was delivered at a safe temperature of around 43°C in order to prevent the danger of scalding. It was suggested that regular checks were made and records kept of the temperature at the hot water outlets. Comments that residents made about their bedroom accommodation included the following: • “I have a good room, it is too warm sometimes but lovely in the winter. The bed is very comfortable, I sleep well anyway”. • “My room is adequate, it is plenty warm enough. The bed is alright. They change the bedding every week and it is kept clean. I do the dusting and they put the hoover around”. • “Every room is much the same, they keep them nice and clean. My bed is nice and warm and quite comfortable”. • “My room is very pleasant”. • “It is warm enough and I can open the window. I have a light so I can read. They look after the rooms and keep everything clean and so on”. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 18 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): All of these standards were assessed at the last inspection of the home on 15th July 2005 when they were met. EVIDENCE: Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 35 and 38 The home’s manager had the experience and skills necessary to run the home effectively. There were good systems in place for ensuring the interests of residents were safeguarded and that both their and the welfare of staff was promoted. EVIDENCE: The home’s registered manager was also the owner. She had been responsible for the management of the home for some 10 years and had obtained a relevant/appropriate management qualification in 2002. The management structure in the home included a deputy manager who had 21 years experience and had a National Vocational Qualification (NVQ) in care at level 3 and a personnel and human resources “administrator” who was a law graduate was also working towards an NVQ level 4 in care management. The registered manager attended regular seminars and conferences organised by the trading association to which the home/business subscribed enabling her to keep up to date with developments in the social and health care sector. At Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 20 the time of the inspection she was also undertaking a course through a local college in “conflict management”. Comments from residents and staff about the character and abilities of the registered manager indicated that they valued her skills, knowledge and personal attributes. • “She is nice and kind” (resident) • “She is very approachable and listens to what you have to say”(staff member). • “I think she is lovely, she is really easy to approach, supportive, generous. It is amazing what she knows and she is always able to give advice. Some residents behaviour is very challenging and she is just so good with them” (member of staff). • “She is lovely” (resident). The home did not manage the finances of any residents but it looked after money on behalf of a number of residents provided by their relatives and/or representatives and kept accurate records of any transactions where such money was used and the outstanding balance remaining e.g. purchase of; newspapers; confectionary; hairdressing; chiropody; etc. The home had a written health and safety policy as well as a number of specific policies and procedures concerning such matters e.g. • Visitors to the home and health and safety policy for visitors • Stress • Visual electrical appliances and portable electrical appliances • Manual handling • Accidents • Risk assessment • Visual display units There were written risk assessments in place concerning the potential for fire to occur in the home and also of the both the premises and all working practices carried out in the home. There was evidence from both discussions, records and many certificates of qualification/attendance on display in the home, that all staff working in the home had received regular training in health and safety subjects that were relevant to their role in the home. These included first aid, fire safety, food hygiene, moving and handling, infection control and control of substances hazardous to health. The home’s deputy manager stated that a number of staff were undertaking training in “safety compliance” and that both she and the home’s registered manager had attended formal training in “risk assessment”. • “ I have had fire training recently and know all about CoSHH (control of substances hazardous to health), we have information about anything that may be nasty. All our stuff is locked up in cupboards” (member of staff). Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 21 During the inspection the home’s fire safety systems and procedures were activated when a fire alarm “went off”. The staff responded quickly and appropriately. One resident spoken to confirmed that the home’s fire safety system was tested regularly. • “They test the fire alarms and sometimes they tell us when they do”. A report was seen of the local environmental health officer of a visit to the home on 17th March 2005 in which it was stated that the home had “a good appreciation of hazards and had suitable controls in place”. Records indicated that systems and equipment in the home were tested and serviced at intervals and with the frequencies either required according to relevant regulations or with good practice. These included: • Fire safety equipment • Electrical wiring • Boilers and central heating • Portable electrical appliances • Passenger lift • Temperatures of refrigerators, freezers and cooked meats. Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X X X X X 3 3 X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 23 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. 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. Refer to Standard Good Practice Recommendations Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Carlton House Rest Home DS0000012377.V280031.R01.S.doc Version 5.1 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!