Inspection on 03/07/07 for Chandos House

This inspection was carried out on 3rd July 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chandos House 26/07/06

Chandos House 25/01/06

Chandos House 20/09/05

Chandos House 21/03/05

Chandos House 21/01/05

Chandos House 03/03/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Cherry Orchards Camphill Community Ltd

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

CARE HOME ADULTS 18-65 Chandos House 36 Chandos Road Redland Bristol BS6 6PF Lead Inspector Savio Toson Key Unannounced Inspection 3rd July 2007 09:30 Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 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 Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chandos House Address 36 Chandos Road Redland Bristol BS6 6PF 0117 9243071 0117 9243071 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) Ms Joyce M Dickinson Mr James Dickinson Care Home 10 Category(ies) of Past or present alcohol dependence (10), Past or registration, with number present drug dependence (10) of places Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2006 Brief Description of the Service: Mrs J Dickinson is registered with us as the owner of Chandos House which provides secondary care residential treatment for up to ten males, aged 18 65 years who are recovering from drug and alcohol dependency. The service is committed to the twelve-step programme provided in a holistic environment which uses counselling and a range of other therapies. Residents are expected to participate in the activities programme to assist them in regaining structure and a sense of wellbeing in their lives. This includes group and individual therapy sessions, as well as focusing on life skills. Chandos House is not intended to be a home for life and an average stay lasts no longer than six months. The service is not staffed during the evening or at the weekends. However arrangements are in place to give support in the event of an emergency. The home is a large Victorian house which has four floors. There is no lift facility and but some adjustments have been made to assist wheelchair users. The home is in a residential area, close to local amenities and major transport routes. Fees are currently in the range of £450-£780 a week. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This one day, unannounced key inspection took 6 hours. I worked with evidence from a whole range of different sources, including: • Information provided by the manager in the pre-inspection questionnaire • Information taken from resident survey forms • Information from professionals who visit the home • Speaking with residents • Speaking to a visitor • Looking at a number of residents records • Speaking with care staff • Walking round the home • Examination of some of the homes records • Observing some of staff practices and interaction with the residents. The overall analysis is that the home is a good place in which to live and to work. What the service does well: The resident’s positive wellbeing, empowerment and attitude has to reflect the quality of this service. All the residents spoke well of this home and how the treatment regime had helped them to move on from how they felt when they first arrived. To get this level of positive approval from residents and potential residents is commendable. Residents know that living in the home will involve them in a treatment plan which will assist in improving their well being. Residents work with a small care team which works well in providing continuity of care because they have been together for over two years. Residents are encouraged to be involved in developing daily living skills within the homes communal environment. Residents should be able to see that the service is planned around them and can feel they are treated as individuals. Residents get comprehensive information about the service through a well produced residents handbook. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 1,2,3,4,5. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents get the information they need to decide whether the home will meet their needs. Residents receive a range of support when visiting the home to help decide it the home is for them. Residents are treated as individuals by the staff in this home. EVIDENCE: Potential residents receive the information they need before agreeing to move into the home. Some of the range of information given to residents by the home were viewed and they contained the relevant information. The statement of purpose was easy to follow and the home had produced a glossy good quality resident’s booklet to a high standard. On the day of the inspection visit a resident was visiting the home and said, “ I knew exactly what this home does and that is why I choose it”. The attention given to informing potential residents about the service is commendable. Residents can be given individual care because they have been assessed by the home. The assessments forms which were viewed contained the relevant detail. The residents personal details, social, medical, psychological and drug/alcohol dependency needs are discussed with the staff. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 9 Potential residents are invited to have an over night stay in the home to help them decide if the home is for them. On the day of the inspection site visit a potential resident had arrived for their overnight stay. They became fully involved in the activities and offered support when needed. Good communication between the carers and resident were observed. The potential client felt that he was getting the information he needed. Residents understand the contractual arrangements of their stay in the home because of the written terms and conditions. The terms and conditions, called “residency contract” found inside the residents care folder, were signed by all those it concerned. The document would benefit from being re-written in plain English. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8,9,10 were considered. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents write their own care plans with support from their carer. Residents are supported in making decisions about their lives. Residents are given the opportunity to reflect and discuss the risks that they might be exposed to. EVIDENCE: The resident’s with support from the staff, plan care which is individualised, and based on a full and up to date holistic assessment. The plan is person centred and focuses on the resident’s strengths and personal preferences. It celebrates their individuality and sets out in detail how all their current requirements and aspirations are to be met through positive individualised support. Residents review and update their care plans with staff on a weekly basis, The care plans also contained additional targets set by the resident of further goals they set themselves or reflections on their lives. The care plans also contained regular entries recording the resident’s progress. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 11 The residents, with support from staff, planned their care and therefore made decisions about their life style within the home. And this was clearly confirmed by the residents who spoke to me. As one said to me “the decisions are mine”. Residents are encouraged to contribute and participate in the daily community meeting. Residents select their menu and plan the meals they are going to have for the week. Residents I spoke with confirmed this arrangement. In the evening there are no staff on the premises so residents make their own choices on how their evenings are structured. The residents receive care which includes counselling, group work in a structured and semi structured environment, individual work, social and physical activities. On the day of the inspection site visit several of the residents had gone to the local sports hall. During the morning, residents were involved in therapeutic work and offered other therapies to improve their well being. Residents discuss the risks in their lives on admission and at their weekly care plan review. The risk assessments were contained in the resident’s care plans. The risks which were acknowledged and discussed between carers and resident were relevant to the service being provided in the home. Residents’ surveys confirmed that their rights and confidentiality were respected. Personal files are held securely and staff demonstrated how they respected individual resident’s rights for privacy and confidentiality. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15,16,17 were considered. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to fulfil their potential. Residents are encouraged to be involved in leisure activities and take responsibility for their lives. Residents with supervision have responsibility for serving quality nutritious meals. Residents are encouraged to learn new life skills. EVIDENCE: Residents visit the home before moving in so they know what the treatment regime is going to be and the activities they are expected to participate in. New residents said they knew what to expect and that they choose the home because it provided the structure that they needed for recovery. One resident said that having been in previous rehabilitation facilities, but unlike the other facilities, he felt he was being supported and developed to understand his addiction without feeling as if he is being punished. This is a very insightful perception as to the quality and positive approach of the homes therapeutic regime. Therefore this approach is commendable. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 13 Residents can plan their community involvement especially in the evenings when the home is not staffed by carers. However new residents are “buddied up” with a resident who has been in the home for a while. New residents are discouraged from going into the community on their own for at least the first week of their stay in the home. Residents are encouraged to use innovative methods to access education and work, including supported employment, and paid employment where they have the capacity. The residents confirmed their experience of living in this home was positive and there was evidence that they are enjoying the life opportunities that they experienced. The resident’s can give their visitors a clearly written visiting policy which was contained in the resident’s care plan. While in the home, residents are discouraged from participating in sexual relationships for therapeutic reasons based upon research. Residents described the feeling of being empowered and having their rights protected. Residents are shown every week how to develop their cooking skills. Residents plan their meals for the week. The menu is assessed for nutrition, balance and variety by a carer who has the catering background to do so. Every day it’s a different resident cooking who has to buy the ingredients and prepare the food. On the day of the inspection visit the designated resident had been out to buy the necessary ingredients and was preparing the food, using quality ingredients and the appropriate equipment. Residents confirmed that they were given sufficient money to buy good quality food. This practice is commendable. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19,20 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their physical and emotional health needs met. Residents in this home are respected. Residents who self administrate would be better protected with changes to the medicine administration procedures. EVIDENCE: Residents contribute towards how their needs are to be meet and the carers provided the therapeutic environment within which residents benefit through improving their well being and overall health. Residents could describe how their privacy and dignity was respected. As one resident said “ they (the staff) don’t talk down to you they encourage and help improve our good points” and “that makes a tremendous difference”. Staff explained several ways of how they made arrangements for respecting residents’ privacy. For example a curtained off meetings room, arrangements for using of telephones. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 15 Residents live in a home where the use of medication is based on having to be absolutely necessary. The home has now installed a lockable medicine cupboard in their office to comply with requirements. The medicine policy was viewed and would benefit from being re-written in plain English. The need for a self administration medicine policy was discussed and the need for arranging lockable facilities in residents bedrooms. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22,23, were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents in this home have their complaints and concerns taken seriously. Residents are safeguarded and protected from abuse. EVIDENCE: Residents live in a home where any concerns or complaints would be taken seriously. We received documentation of a complaint, which showed how the service had co-operated to work towards resolving the complaint. The complaint policy, which was viewed, was available to residents. A resident confirmed they knew how to complain and who to go to with their complaint. The complaints procedure would benefit from being re-written in plain English. Resident live in a home where the managers understand how to deal with any issues relating to abuse. This was demonstrated in how a recent issue was dealt with involving a resident and an outside agency. Another previous incident included all the staff going though events with a facilitator and used as a learning opportunity. Staff were also making arrangements for a meaningful update session. The home had and used the local authorities “no secrets” adult protection procedure. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24, 26, 27,30 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, maintained and bedrooms are arranged to individual taste. EVIDENCE: Residents live in a home which was clean, safe and tidy. The environment was homely and adequately furnished. The home has an annual ongoing redecoration programme. And the lounge was due a repaint where one of the walls had missing paint due to water seeping in, from a leak, which has now been repaired. Residents’ bedrooms were arranged according to their individual tastes. One of the bedrooms viewed had a wall in need of repainting and one of the wardrobe mirror doors had come off its hinges. Residents benefit from managers who understand their responsibilities to control infection and diseases within the home. The managers explore any possible infection which a resident needed support with as part of the admission procedure. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33,34,35,36 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive care from staff who are keeping up to date and are on duty in sufficient numbers. EVIDENCE: Residents live in a home where staff have defined roles which collectively offer a range of services. The team has therapists and counsellors, which offer a diverse range of care. None of the residents I spoke with mentioned a shortage or lack of staff. Residents were able to describe how they found the staff accessible and approachable. During the inspection visit the communication between staff and residents was casual and natural. The staff have a range of therapeutic skills including training in counselling and other therapeutic technique. One of the skills carers could offer was shiatsu. Staff understood their obligation towards promoting ethnicity and diversity and discussed the need to refresh their knowledge. And increase their awareness of adult protection. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 19 Residents receive support from a care team, which is effective, has sufficient numbers on duty and the skills to meet the residents’ needs. The home also has a domestic which assists in keeping the home clean and the resident’s appreciated her contribution. Residents are cared for by staff who had the relevant recruitment checks as confirmed at the last inspection. The recruitment and employment records were not viewed because the last person was recruited over two years ago. Residents receive care from staff who receive supervision from internal and external sources. The accessing of external supervision is commendable as this helps the team avoid becoming insular. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,38,39,40,41,42,43, were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home where the manager is suitably qualified. Residents live in a safe home because of the safety checks carried out. This could be further improved with better monitoring of the hot water system. Residents benefit from knowing that their views are important and assist the management team with reviewing and developing the service provided. However, this could be further developed through the use of more detailed monthly reports. EVIDENCE: Residents live in a home where the manager has qualifications in management and therapeutic care. The carers have a range of skills which offer residents real choices of how they want to explore and work with things that concern them. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 21 Residents did not even have to confirm that the carers were approachable. The observed interactions and the way residents described how they worked with carers provided sufficient evidence. Residents described working with their carers as a positive experience. Residents would find most of the policies and procedures, viewed on this visit, more accessible if they were re-written in plain English. Residents receive a reliable service because the records were kept up to date. Residents get the assurance the owner of the home is monitoring the service through monthly assessments of the home. Evidence of how the service is monitored is sent to The Commission for Social Care Inspection on a regular basis. However this information would be improved further if more detail information was included. These reports should also be made easily accessible in the home. Residents are asked for their views of the home and the surveys viewed showed the comments were complementary as to how the home was run. Residents live in a safe home where fire checks, health and safety audits and electrical checks have been carried out. Walking around the home it was noted that the bath hot water tap released hot water exceeding 43degrees centigrade. However, it is recognised that residents living in this setting may choose to bathe in water over 43 degrees centigrade. Consequently, evidence must be available to confirm that the hot water temperature is checked on a regular basis and is regulated as required to ensure that residents are not put at risk. Evidence of individual risk assessments for any residents who may be at risk of scalding themselves must be available and the measures put in place to minimise the risk. This needs to be made good to avoid the potential risk of total body immersion in hot water. Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 3 3 3 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 4 32 3 33 3 34 X 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 3 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 4 4 3 3 3 3 X Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 23 No 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 YA20 Regulation 13(2) Requirement Residents who self administer medication must have a secure lockable storage facility in their bedroom. There must be a policy and procedure in place for self administering of medication Risk assessments must be carried out on residents who wish to self administer medication Timescale for action 01/08/07 Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA40 YA35 Good Practice Recommendations The residents would find documents written by the home easier to read if written in plain English. Residents care will improve when staff complete their equality and diversity training and increase their awareness of adult protection and the procedures in place to safe guard adults Resident’s safety will improve further by the regular monitoring of the hot water system and the adjustment of the temperature as required. Residents will be assured further if the monthly quality audits carried out by the registered provider are more detailed. This information should be readily available in the home as well as being sent to CSCI office. 3 4 YA42 YA39 Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Chandos House DS0000026580.V341435.R01.S.doc Version 5.2 Page 26 - 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!