Inspection on 10/03/09 for Cedar Lodge Cedar House

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Excellent service.

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

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cedar Lodge Cedar House South Road Norton Stockton on Tees TS20 2TB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Stephen Ellis     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Cedar Lodge Cedar House South Road Norton Stockton on Tees TS20 2TB 01642530750 01642530752 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dolphin Property Co Ltd Name of registered manager (if applicable) Amanda Jayne Hatch Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of services users who can be accommodated is: 52 The registered person may provide the following category of service only: Care Home with nursing - Code N To service users of the following gender: Either Whoes primary care needs on admission ot the home are within the following categories: Old age not falling within any other category - Code OP, maximum number of places - 52 , maximum number of places 52 Date of last inspection Brief description of the care home Cedar Lodge is a well-equipped, purpose-built, 2 storey building with a large garden to the rear and car parking space to the front. This care home is registered to provide personal care and/or continuous nursing care, plus accommodation and meals, in two semi-independent units. One (Cedar House) is for up to 13 people (younger adults) requiring neuro-psychiatric care. The other is for up to 39 older people, with or without continuous nursing care needs. Cedar Lodge is situated in the well-established village Care Homes for Older People Page 4 of 27 care home 52 Over 65 52 0 Brief description of the care home of Norton in Stockton-on-Tees, close to the village centre. All bedrooms are large, single rooms, with en suite toilet and wash hand basin. The fees vary between £420 and £584.80 per week, but the actual amount payable depends on peoples individual circumstances. The fee covers all accommodation, meals and personal care (plus nursing care for those people in receipt of continuous nursing care at the home). Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out on 10th March 2009. The last key inspection was carried out on 19th May 2008. This current inspection benefited from information received prior to the fieldwork visit, including the homes annual quality assurance assessment (AQAA). The process of the inspection included discussions with 10 people who use the service, 3 visitors and 7 staff, plus direct observation of activities and lunch with a small group of people who use the service. There was also a tour of the building, sampling rooms and facilities, plus an examination of a selection of records, including plans of care, staff files and reports. The weekly fees charged vary between £420 and £584.80, but the actual amount payable depends on peoples individual circumstances. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs assessed and their wishes and views are respected wherever possible. Intermediate care is not provided. Evidence: The plans of care of 4 people who used the service were examined and these showed that full assessments of need were carried out prior to admission. These covered all the activities of daily living and included inputs from health and social care professionals where appropriate. People who use the service said that they felt the home met their needs very well and that these were well understood by the staff team. Typical comments included: I am very well looked after here. The staff are kind, helpful and caring. This is a very nice place and they put you at your ease; my son helped me choose it and Ive no regrets. The manager confirmed that full assessments were carried out prior to admission, unless it was an emergency, when assessments would be completed as quickly as possible within a few working days of Care Homes for Older People Page 11 of 27 Evidence: the person being admitted. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people who use the service receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Four plans of care were examined and these were impressive, being comprehensive and detailed concerning health and personal care needs. They included pre-admission assessment, all of the activities of daily living, photograph of the person using the service, signed consent to care plan, named nurse, key worker and named carer (as appropriate, depending on whether the person was in receipt of nursing care), wishes concerning personal finance, psychological assessment, continence assessment, pressure sore risk and prevention assessment, nutritional screening tool, body map, manual handling risk assessment, dependency rating scale, falls risk assessment tool, daily journal, inputs from optician, dentist, district nurse, doctor, chiropodist and social worker, blood pressure, pulse, weight record, plus brief life history and property list of personal items. Plans of care were being regularly reviewed and evaluated, normally at monthly intervals, but more often if the needs of the person using the service required Care Homes for Older People Page 13 of 27 Evidence: it. People who use the service said that their health and personal care needs were well met. Typical comments included: I always receive the medical support I need and I always receive the care and support I need. These observations were backed up by comments received from 2 relatives who were visiting. Another person who uses the service said: I have to give them every credit. When my husband died recently, the care and support was over and beyond the call of duty. The staff were so kind and helpful. The manager was extremely efficient and genuine. The care for my husband and myself has been very good, with all health care needs attended to very well. Indeed, the service has demonstrated good practice in end of life care, following the gold standard framework, as recognised by the Primary Care Trust (PCT). There were good arrangements observed for the safe storage, administration and disposal of medicines, confirming the findings of a recent PCT pharmacy inspection. Members of nursing staff take the lead responsibility for medicines for people in receipt of nursing care, but all care staff members undergo safe handling of medicines training. People who use the service may self-administer and there were lockable drawers available in bedrooms for this to happen. However, in practice, most people who use the service delegate this responsibility to the staff at the home. All staff members responsible for medication have completed training in the safe handling of medicines or equivalent and the manager and deputy carry out regular audits. Over 85 of care staff members have achieved National Vocational Qualifications (NVQ) in Care at level 2 or above, helping to reinforce good social care principles, such as respecting peoples privacy and dignity. Staff practice in the safe administration of medicines was observed and found to be good. People who use the service were very positive and complimentary in their comments about the quality of care experienced and how they were treated with respect. They also felt that their privacy was respected. Typical comments included: The staff are very helpful. The staff always listen to me and take what I say seriously. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to choose their lifestyle, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet peoples expectations in a positive way. People receive a healthy, varied diet according to their assessed requirement and choice. Evidence: People who use the service and relatives confirmed that they experienced supportive, caring relationships living at the home, which helped to promote autonomy, independence, dignity and choice. There is a dedicated, part time activities coordinator who helps organise and deliver a diverse programme of social and recreational activities. People who use the service commented positively about the atmosphere in the home that supported their needs for social and recreational activities, whilst respecting peoples individuality and personal choices. Visitors to the home said they were always made welcome and the home clearly valued their involvement and the contact with the wider community. A welcoming atmosphere was evident. The interests and hobbies of people who use the service are recorded and the home tries to ensure that the programmes of activities and social events are suitable. The home takes a holistic view of the people who use the service and encourages them to pursue Care Homes for Older People Page 15 of 27 Evidence: their individual interests, such as contact with friends and family, social and cultural involvement and religious activities where desired. Typical comments received included: There are usually activities arranged by the home that I can take part in. I prefer to stay in my room and enjoy reading my paper and doing the crossword and word searches. The activity programme includes skittles, ten pin bowling, nail care, foot spa, snakes and ladders, bingo, recall and reminiscence, music and movement, (on the younger persons unit: pool, cinema, swimming and outings to football matches), raffles, occasional outings to places of local interest in the homes minibus, plus visiting entertainers most months and for special events, such as Valentines Day, St Patricks Day and Red Nose Day. A hairdresser visits each Monday and is very popular. There is a quarterly group magazine, in which each service is mentioned, with photographs and stories of people who use the service. People said that they did not have to take part in anything if they did not want to and they could choose how they spent their day, including when they got up and went to bed, and what clothes they wore. People who use the service were also satisfied with the quality of the meals, saying that the catering was good and there was always a good choice of menu. As one person said: The meals are good here, but if you dont like whats on the menu, you can have an alternative. People were able to take their meals in the dining room or, if they preferred, in their own room. The meal sampled on the day was appetising and nutritious. Dining areas were observed to be pleasantly decorated and well equipped with dining furniture. A relaxed atmosphere was evident. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a robust, effective complaints procedure and are protected from abuse. Evidence: People who use the service said that they were confident about raising any concern or complaint with members of staff. These views were reflected in comments received from relatives who were visiting. Typical comments included: I know how to make a complaint. I know who to speak to if I am unhappy. People said that staff members were approachable and friendly and knew that any complaint would be taken seriously. Staff members confirmed that they listened carefully to any concern or complaint and would always try to resolve matters speedily and effectively, in line with the homes complaints procedure, available in the service users guide. Any complaint is recorded by the service, along with all actions taken to resolve matters to the satisfaction of the complainant. All staff members are carefully recruited after full pre-employment checks have been completed, including enhanced criminal record bureau checks and the taking up of two references. All staff members undergo training in safeguarding adults procedures, whereby any suspected abuse or neglect is reported and investigated, in line with the local multi-agency safeguarding procedures, led by the Local Authority for Adult Social Care. Staff files confirmed that staff had undergone rigorous recruitment procedures and staff comments confirmed awareness of local safeguarding procedures, plus whistleblowing about suspected abuse. Care plans Care Homes for Older People Page 17 of 27 Evidence: showed that risk assessments were carried out to minimize the risk of harm befalling people who use the service, by offering clear guidance to staff about how best to act to protect and promote peoples safety and welfare. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: People who use the service said that they liked the premises and felt that they were well-equipped, safe and hygienic. Typical comments included: The home is always fresh and clean. There is always a welcoming atmosphere. The home was observed to be well decorated and comfortably furnished. There are a number of attractive design features, including indented door ways off corridors, to create more space and facilitate safe opening of bedroom doors. Bedroom door closers were observed to be of very good design, allowing people to have their doors open if desired, without compromising fire safety. All members of staff have completed training in infection control and hygienic practices were observed, such as the use of paper towels and liquid soap in communal bathrooms and toilets, plus alcohol gel throughout the home for hand hygiene. All bedrooms are spacious, well-equipped singles with en suite facilities. These were observed to be personalised. People who use the service expressed satisfaction with the homes facilities, aids and adaptations, such as assisted bathrooms with hoists. There are a number of spacious communal areas on both floors, including lounge and dining areas. Accommodation is provided on ground and Care Homes for Older People Page 19 of 27 Evidence: first floors and there is good access around the building for people with mobility problems. To the rear is a garden with ramped access and raised borders, gazebo, and outdoor seating and tables. Maintenance records were sampled and confirmed that procedures are in place to ensure the home is safe and maintained to an acceptable standard. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of people who use the service. Evidence: People who use the service said that they were well satisfied with the care and support provided by members of staff. Typical comments included: I am very well looked after here. Over 85 of care staff members have achieved National Vocational Qualifications (NVQ) in Care at level 2 or above, which is commendable. On the day of inspection there were 43 people being accommodated, with 6 people on the Cedar House younger adults unit (non-nursing), and 37 on the older persons unit, including 21 people in receipt of residential care and 16 people in receipt of nursing care. During the day (8 am to 8 pm) on the older persons unit, there is at least one registered nurse on duty, plus 5 care staff (8 am to 2 pm) and 4 care staff (2 pm to 8 pm). At night, on the older persons unit, there is a registered nurse plus 3 care staff. There is a senior carer on each shift on the older persons unit, thoughout the day and night. On the younger adults unit, there is a minimum of of 2 care staff on duty throughout the day and night, plus a unit manager on duty during office hours 5 days per week (who is supervised by the homes registered manager). A key worker system is in operation, whereby named members of care staff have special responsibility for particular people using the service. Each person in receipt of nursing care also has a Care Homes for Older People Page 21 of 27 Evidence: named nurse allocated to them. In addition, there is a part time activities coordinator (20 hours per week). The hours of the registered manager are not included in the care hours available. The deputy manager (a registered nurse) takes the clinical lead with regard to medicines at the home and shares some responsibilities with the registered manager for auditing care plans. The deputy has 12 hours of supernumerary time (time not counted as direct nursing care hours) each week to carry out such duties. The home employs a full time administrator and a separate maintenance officer. There are dedicated catering and domestic staff deployed in sufficient numbers for the smooth running of the home. Staff members confirmed the good induction and training they had received, including all mandatory training plus NVQ in Care. Typical comments included: I feel I am well supported to do my job, with good training and supervision. We all work well together to deliver the best care we can. All care staff members have either achieved NVQ in Care, or are registered for the award and are working towards it. Staff files provided evidence of training and qualifications obtained. Training needs analysis is carried out at regular intervals and monitored by the homes manager. A full staff training and development programme is in operation, including dementia care and awareness. Staff files also confirmed the good recruitment practices, whereby new staff are only taken on after thorough pre-employment checks, including enhanced criminal records bureau checks, protection of vulnerable adult checks and the taking up of 2 references, including one from the last employer. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, with effective quality assurance systems, developed by a registered, qualified manager and wider management team. Evidence: People who use the service said that they had full confidence in the management of the home. They described management and staff as being approachable, willing to listen and help wherever possible. Typical comments included: The staff and manager are always willing to listen and try to help wherever possible. The registered manager is well qualified and experienced as a registered nurse, and holds National Vocational Qualification (NVQ) in Management at level 4. She has an open door policy and was described as being accessible and communicative, welcoming contact from people who use the service and their representatives. The service is well supported by operations managers from the registered provider, who visit weekly and also carry out monthly quality audit checks and visits to the home under regulation 26 of the care homes Care Homes for Older People Page 23 of 27 Evidence: regulations, providing reports of their findings. Feedback from people who use the service and their representatives is actively sought through face to face consultations and written surveys, including regular feedback requested from visiting health and social care professionals and relatives. The provider publishes a quarterly group magazine for the people who use its service, which is focused on their interests. Staff files confirmed comments received from members of the care team, that staff felt appropriately supervised and supported. The home endeavours to ensure that each member of the care team receives one- to-one supervision sessions 6 times per year, including an annual appraisal of their performance. Health and Safety matters are taken seriously by the home, as evidenced in records of staff meetings, training and maintenance. Staff confirmed that they had undergone mandatory training in Health and Safety issues, including infection control, fire safety, control of substances hazardous to health and first aid. The home complies with the requirements of the local Environmental Health Authority. A sample of maintenance records showed that the services and eqipment in the home are subject to regular testing, audit, repair and replacement, including laundry and kitchen items. The majority of people who use the service either manage their own personal monies or receive assistance from their families. A minority receive help from the Local Authority financial protection teams or independent power of attorney. Where the home does assist people with looking after their personal monies for essential purchases, such as hairdressing or toiletries, individual accounts are kept, along with receipts, and transactions are witnessed by 2 signatures. Since the last inspection in May 2008, the registered providing company has changed (from Express Care Limited to Dolphin Property Company Limited), although the responsible individual and managing director, plus majority of company directors involved, plus registered manager and majority of staff have not changed. The registered provider continues to be linked to the parent company: Executive Care Group. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!