Inspection on 15/12/08 for Church View

This inspection was carried out on 15th December 2008.

CSCI found this care home to be providing an Good 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

Church View 18/12/07

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Church View Church Lane Murton Co.Durham SR7 9PG     The quality rating for this care home is:   two star good 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: Nicola Shaw     Date: 1 5 1 2 2 0 0 8 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 29 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 29 Information about the care home Name of care home: Address: Church View Church Lane Murton Co.Durham SR7 9PG 01915268877 01915268899 churchviewmurton@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross OPCO Ltd Name of registered manager (if applicable) Ms Samantha Jane Barclay Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 42 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Dementia Code DE(E), aged 65 years and over, maximum number of places 18 Old Age, not falling within any other category, Code OP, maximum number of places 24 Date of last inspection Brief description of the care home Church View is a purpose built care home that provides accommodation for forty-two older people. The home is situated on a main street that runs through the village of Murton. The home is built on two levels. The ground floor provides accommodation for twenty people with general personal care needs and the first floor provides accommodation for twenty-two people with dementia care needs. On each floor there Care Homes for Older People Page 4 of 29 care home 42 Over 65 18 24 0 0 Brief description of the care home are communal lounge areas and separate dining areas. All bedrooms provide en-suite toilet facilities. Outside the home has a well kept garden area and private car parking spaces. Public transport can be accessed within walking distance of the home. At the time of this inspection visit the accommodation fees for this home were: General residential care £434.50 per week Dementia care £455.50 per week Private clients £484.00 per week. Care Homes for Older People Page 5 of 29 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: two star good 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: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations-but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the inspection visit: Care Homes for Older People Page 6 of 29 We looked at: Information we have received since the last inspection on 8th January 2008. How the service has dealt with any complaints and concerns since the last visit. Any changes to how the service is run. The providers view of how well they care for people. The visit: An announced visit was made on 15th December 2008. During this visit we: Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had knowledge, skills and training to meet the needs of the people they care for. Checked what improvements had been made since the last visit. We told the manager what we found at the end of the visit. What the care home does well: What has improved since the last inspection? There is now a DVD available telling people about the home which will further help prospective service users decide if its the right place for them. Care plans are improving and include information about the service users preferred routines. The manager has also arranged for staff to complete training about what to Care Homes for Older People Page 8 of 29 write in care plans so that they know how to complete these accurately. Care plans are also now regularly reviewed and this involves the social worker and relatives. The complaints procedure has been up-dated to include the right information about who is managing the home. Further safeguarding training has been arranged for all staff so that they know what to do should they witness or suspect abuse. The manager has reviewed staffing levels and as a result of this has increased the number of staff on duty at night. She is also in the process of looking at the staff training files to make sure that training is kept up-to-date. 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 9 of 29 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 29 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. Good information is available to help prospective service users make an informed choice about where to live. The admissions process ensures that people are adequately assessed prior to care being offered. This means that service users are offered the right type of care at the home. Evidence: There is a range of information available for people to read about the service including the Statement of Purpose and Service User Guide. These contain up-to date information about the homes manager and responsible individual. A personalized home brochure is also available for all prospective service users and contains useful information, for example, about type of activities and meals available and Care Homes for Older People Page 11 of 29 Evidence: arrangements for health care professional visits. The brochure is written in plain English with pictures to help people understand the information. The manager now has a DVD about the home, which is sent to prospective service users in addition to the homes brochure. For prospective service users, funded by the local authority, the manager obtains a copy of the needs assessment and care plan from the care manager so that she can decide whether Church View is able to meet their needs. Where possible a day visit is arranged for a prospective service user so that the manager can assess their needs in the care home environment. Sometimes, if an admission takes place in an emergency, then the manager arranges for a multidisciplinary discussion with the appropriate health care professionals and social worker in order to find out as much as possible about the persons health and social care needs, before they are admitted. The manager informs staff of the needs of any new service user and allocates a keyworker who is then responsible for developing the care plan. Care Homes for Older People Page 12 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is generally good information in the care plans about the health and personal care needs of the service users. This ensures that everyone receives care and support in a way that they prefer. Staff care practices preserve the dignity and privacy of the people who live here. And medication administration procedures protect the service users. Evidence: A range of standardized assessments are in place that lead to the care plans being developed. These cover a number of areas such as communication, mobility and falls prevention, eating, drinking and nutrition, personal cleansing and pressure area care. The care plans we looked at generally provided good information about the service users health and personal care needs. Some provided clear guidance to staff on how to support the service users. For example, in one there was good information about a Care Homes for Older People Page 13 of 29 Evidence: persons personal care routine and details of the assistance they required. It was also recorded in the care plan what this person could do for themselves, therefore promoting their independence. However, in another care plan we looked at some of the information had not been up-dated to reflect this persons current care needs. For example, the care plan stated that they required prompting to use the toilet, suggesting that they were able to do this independently, yet it also stated that they needed two staff to assist with all transfers. There are regular care plan review meetings which include the social worker and family. Service users weights are monitored each month. Daily records are maintained, however, there were some gaps in these and some entries did not provide information about the care which had been provided. The manager is aware of the shortfalls with some of the care plans and is in the process of arranging care planning training for all staff. Service users have access to all NHS facilities. There are regular visits from GPs and other health professionals, including opticians and chiropody services. We spoke to a visiting district nurse who said that the staff are very responsive. They commented that the staff always contacted her if they had any concerns about a service user and were excellent with one person who had a pressure sore. Medication is stored in a locked, secure room. The staff monitor the temperature of the medication room and the medication fridge to make sure that medicines are stored correctly. Senior staff order the medication from the prescriptions to ensure that service users are provided with the correct medication. Staff confirmed that they had completed training in the safe handling of medication. There were no gaps on the Medication Administration Records, (MAR), which we looked at which demonstrated that service users are receiving their prescribed medication. The manager and senior staff do regular audits of the medication to make sure that it has been given to service users as prescribed. Care Homes for Older People Page 14 of 29 Evidence: There is a small stock of controlled drugs. These are stored securely, however, some of the staff were confused over the correct way to record this medication when it has been returned to the pharmacist. Some staff were adding the number of tablets returned to the pharmacist to the current balance and therefore medication in stock did not balance with the records. This was rectified by the manager at the time of the inspection, who also confirmed that additional training would be provided to all staff in this area. During our visit time was spent with the service users who have dementia and live on the first floor of the home. Staff were respectful in their approach towards the service users and ensured that their privacy was respected. Personal and intimate care tasks were carried out in the privacy of the service users own bedrooms. Staff referred to the service users by their preferred name and it was clear there was a good rapport between the staff and service users. Service users said they (the staff) treat you with respect. The manager is introducing a shining through award which is to be given to a member of care staff each month in recognition of good care practice and in order to boost staff morale. Care Homes for Older People Page 15 of 29 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. Service users enjoy a variety of activities, and are able to maintain family and other contacts if they want to. This ensures service users have opportunities to lead a fulfilling lifestyle and do not become socially isolated. Service users are able to exercise control and choice over their lives, as far as is possible, which enables them to remain independent. Service users receive a varied menu, which promotes their general health and wellbeing. Evidence: The range of activities available to service users is displayed throughout the home. These include exercise and movement, music and classical dancing, bingo, group dominoes and cards as well as activities involving reminiscence. On the day of our visit there was a trip arranged to a tea dance and service users were busily getting ready for this event. Families were also invited to take part in this activity. Care Homes for Older People Page 16 of 29 Evidence: There is a designated activities coordinator, who works 20 hours per week. A monthly newsletter is also published to keep service users and their relatives informed of events in the home. The manager is in the process of negotiating the use of the local community centre so that the home can hold events, such as race nights and dinner dances, there. When we visited she had purchased some eggs, in an incubator, which were due to hatch, so that service users could watch and enjoy the chicks being born. It was excellent to note how the home supports one person to maintain links with their local Church, an activity clearly very important to this person. Although there are social care plans, some of those we looked at were not person centred and did not provide information about the service users likes and interests. The manager is aware of this and has plans in place to review all care plans to address this issue. Service users were offered a choice of where to have their lunchtime meal and are able to spend time where they wish. One service user, preparing for their 100th birthday, was offered the choice of when to have their hair done for this event. Night care plans have also recently been introduced so that staff know each service users preferred night time routine. Service users who are able to are encouraged to look after their own financial affairs. Throughout our visit friends and relatives were seen to freely come and go. We spent time with people on the first floor of the home whilst lunch was served. Tables were nicely presented with napkins and table cloths. Those service users who needed support were offered this by staff. However, the same member of staff did not help the same service user throughout this process, which is not good practice. There is a choice of main meal and the manager is in the process of developing picture menus to help service users with dementia choose what they would like to eat. We spoke to the cook who was clearly knowledgeable of those service users who have special dietary needs. We had tea with service users on the ground floor. Again, tables were nicely presented and service users were offered a choice of what to eat. Care Homes for Older People Page 17 of 29 Evidence: Service users said: the tables are always nicely set you can have as much to eat as you want Care Homes for Older People Page 18 of 29 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. The home has a good complaints procedure so people know that their views will be listened to and acted upon. And staff training helps to ensure that the service users are protected from abuse. Evidence: The home has a complaints procedure, which has recently been up-dated to include details of the new manager. This is on display throughout the home and in the Service User Guide. There have been two complaints in the last year. We looked at the complaints record, which showed that these had been thoroughly investigated by the manager. The manager also told us that she has recently asked those people who have made a complaint to complete a survey about if they were happy with the outcomes of the investigation and whether there were any outstanding issues. She reported the responses to be very positive. There has been one safeguarding referral made in the last year, which demonstrates that staff know the procedure to follow to ensure service users are fully protected. All staff receive basic awareness training in safeguarding adults and how to deal with complaints during their induction. Currently all staff are undertaking more in-depth Care Homes for Older People Page 19 of 29 Evidence: training in safeguarding adults. Relatives and service users we spoke to said that they would feel able to make a complaint if they were unhappy. Care Homes for Older People Page 20 of 29 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. Service users benefit from a clean, homely and well maintained place to live. Evidence: When we visited the home was clean and tidy with no unpleasant odours. There were lots of Christmas decorations throughout the home in preparation for the forthcoming festivities. Service users said its always nice and clean. The first floor of the home has been adapted to help people with dementia find their way around. For example, toilet doors are painted a bright yellow colour so that they can be easily found and handrails are a different contrasting colour to the walls so that they can easily be seen. There are old photographs of the area, which provide interest along the corridors. The information on the notice board was also in large print so that people can easily read it. The home was purpose built and therefore all bedrooms have ensuite facilities with a toilet and sink. One service user showed us their bedroom which was personailsed with photographs and ornaments reflecting their interets and tastes. They said staff always keep my room neat and tidy. Another service user said I love my room. Care Homes for Older People Page 21 of 29 Evidence: The grounds are neat and tidy and can be easily used by visitors and service users in the warmer weather. There is a choice of bathrooms and bathing facilities, including walk in showers. In the past there has been a problem with the lift to the first floor not working. Relatives said this problem has now been resolved. The manager also said that beams in the lift are to be changed to prevent people from getting trapped in the doors. Eleven staff have completed training in infection control. All staff have completed awareness training about this during their induction. Care Homes for Older People Page 22 of 29 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. Staffing levels are sufficient, which ensures staff provide person centred care. Staff training is satisfactory and includes specialist training in order to meet the diverse needs of the service users. This ensures staff can effectively meet the care needs of people with dementia. Staff recruitment procedures fully protect the service users. Evidence: On duty when we visited was the deputy manager, one senior care and four care staff. Additional staff also came in to accompany service users to the tea dance. The manager has reviewed staffing levels during the night and as a result of this will be providing an additional member of night staff. Relatives we spoke to said that there are generally enough staff on duty. There has been a high turnover of staff. The manager is aware of this issue and plans for the next twelve months include providing staff with full support to maintain high morale and improve retention. Staff said that they were starting to feel valued. Care Homes for Older People Page 23 of 29 Evidence: All of the service users spoke positively about the staff and there was clearly a good rapport between the service users and staff. Relatives said: staff are very kind with mam and staff are friendly and approachable. The manager has identified where there are gaps in staff training and has developed a training programme to address this. For example training called Yesterday, Today, Tomorrow, (this is specialist training in dementia care), has been arranged. Sixty percent of the staff have the NVQ level 2 qualification in care and a further twenty percent are currently undertaking this. In addition to on going health and safety training, for example, fire safety and moving and handling, the manager provides in-house training for staff. Recently this has included awareness sessions about best practice when supporting people with personal care. The district nurses have also provided training about continence. All new staff complete a two week induction training programme. Staff files showed that the companys recruitment procedures are followed. This includes obtaining two written references and an Enhanced Criminal Records Bureau check to ensure that the prospective staff member is suitable. Care Homes for Older People Page 24 of 29 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. Good management systems ensure the health, safety and welfare of service users. There is a good quality assurance system. This is based on the views of service users, where they are able to communicate their wishes, so that they know their rights and views will be listened to. Evidence: It was evident that the new manager, in the short space of time that she has been at Church View, has worked hard to improve the service for service users. She provided us with good information, before we visited, about what has improved in the home in the last year and it is clear she knows what needs to be done to improve things further. The new manager has worked for the company for three years and has a number of Care Homes for Older People Page 25 of 29 Evidence: years experience of managing care homes. She has completed the Registered Managers Award and has submitted her application to become the registered manager for this home. Relatives said about the new manager that they found her to be pleasant. Service user satisfaction questionnaires are used to obtain feedback about the service. These are sent out four times throughout the year and information from these used to improve the service. There is a comprehensive internal audit system. This involves a monthly audit carried out by the manager which includes staff training, pressure sores and service user weights, care plans, health and safety issues, the environment and medication. We looked at how the home manages the service users personal allowance. Good records of this are maintained and receipts are obtained for any money deposited or withdrawn. Each week the manager checks that the records are correct. The home carries out internal maintenance checks and has contractors to service equipment. Maintenance staff carry out regular checks of fire fighting equipment, alarms and emergency lighting. A fire drill is carried out every month so that staff know exactly what to do if there is a fire. Detailed records are maintained of all accidents, which includes the follow action taken by the manager. The manager also closely monitors the occurrence of accidents and incidents in order to identify if there are any themes or trends. Care Homes for Older People Page 26 of 29 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 27 of 29 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 1 7 The development of care plans should continue as planned to ensure service users health and personal care needs are fully addressed. It is recommended the development of the care plans continue to contain further information about the service users likes, interests and social histories. This is to ensure that their social care needs are fully addressed. It will also help staff to understand the needs of people with dementia. It is recommended that only one staff member should assist the same service user throughout their meal. This is to preserve the service users dignity throughout this process. 2 12 3 15 Care Homes for Older People Page 28 of 29 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 29 of 29 - 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!