CARE HOME ADULTS 18-65
Church View Kirkleatham Village Redcar TS10 5NW Lead Inspector
Neil McKenzie Key Unannounced Inspection 22nd May and 5th June 2006 11:30 Church View DS0000000105.V296969.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 Church View DS0000000105.V296969.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. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Church View Address Kirkleatham Village Redcar TS10 5NW 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) 01642 283320/21 01642 283319 Tees and North East Yorkshire NHS Trust Mrs Marsha Gregson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: Church View is owned and operated by Tees and North East Yorkshire NHS Trust and is registered under the Care Standards Act 2000 to accommodate 8 people under the age of sixty-five with learning disabilities (LD). It is a large detached property in a rural location in its own large garden. The home is divided into two units, upstairs and downstairs each with four single bedrooms, though this division is not rigidly applied. The bedrooms all meet the size requirements of the Care Homes for Adults (18-65) National Minimum Standards and have a hand basin fitted. None are equipped with ensuite bathroom or toilet facilities. Both upstairs and downstairs areas have their own kitchen, bathroom and communal areas. The care needs of the people who live at Church View needs are high and support is provided by the staff team with the support of external professionals and agencies. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection, which was unannounced, took place over two days and comprised a total of 7 inspection hours. The inspector discussed how residents live their lives at Church View with the manager, staff and a relative. In addition considerable time was spent observing residents interacting with staff. A tour of the home was undertaken. Documents looked at included resident files, staff files and procedures linked to the handling or resident money and the handling of medication. As well as the unannounced visit additional data was collected via the preinspection questionnaire and relative survey. What the service does well:
The manager and staff at the home are good at understanding the complex needs of residents and placing residents at the centre of care provided. An example of this is how staff and residents observed chatting and mixing in the recently refurbished kitchens were able to demonstrate individual eating plans that were about recognising special diet needs as well as choice. One resident was about to have a curry, another preferred noodles for tea whilst a third resident required mainly fluids. The complex health and support needs are also well documented and show that the home works well with other professionals to meet resident needs. There are opportunities for personal development and social and leisure activities within the home and further a field. For example, arranging different holidays for different residents. A staff member added that residents are also encouraged to go out and experience more personal activity by allocating two staff members to one resident for half a day per week. The home is good at making relatives feel welcome and a relative stated ‘ it is like home from home, made to feel welcome and pop in any time’. It was observed that the manager and a relative had an open and relaxed manner when discussing matters about the home. Another close relative of another resident had recently moved to Australia and it was evident that contact was encouraged by telephone and plans were in place for a web can link. Staff members receive good training that includes training to help them understand and meet the particular needs of residents. For example, one staff member had included epilepsy in the Learning Disability Award Framework and another was experiencing day training in Autism. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The environment has been improved but could be made more homely for residents by ensuring holes left by unused wall plugs are filled, a bedroom lock broken is replaced, a bedroom sink disconnected is made usable for resident and signs on bathroom doors that appear institutional are removed. The inspector was also of a view that none of the walls in any of the rooms had any wallpaper that could ‘soften’ the appearance of some areas of the inside of the home. The residents would be better protected if the homes manager had access to maintenance plans in the home that show and record when essential servicing and replacement of health and safety equipment is planned to takes place and when it is completed. For example, the Pat testing of electrical items is 5 months out of date and the washing machines that are at least 5 years old had broken panels. The recording of the home’s recruitment process must be made better to ensure that staff is suitable to work with vulnerable adults. At the time of the inspection one staff file had no written references to confirm the suitability of that staff member at the time of appointment. The home uses two CCTV cameras to monitor residents at night when they are in their bedrooms. This is by agreement with CSCI as the residents’ present
Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 7 behaviours which when left on their own could lead to harm. However, one of the residents has not presented the behaviour for five years and the home must review the appropriateness of the CCTV camera with regard to dignity and privacy. A relative expressed concern about staff turn over and held a view that they transfer as soon as they can onto other services provided by the Health Trust. The relative stated, ‘come in today and seen two new staff’. The home should review the levels of staff changes, ‘staff retention’, since it has opened and state how they propose to ensure relatives/residents are aware that new staff have joined the team. The home consults with residents and relatives on a daily basis about life at Church View but it has been two years since the home published a selfmonitoring review with regard to resident, relative and staff views. The home must ensure that when handling money on behalf of residents they counter sign any financial transaction to ensure that residents’ are guarded from financial harm. 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. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 8 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 Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality in this outcome area is good as residents’ benefit from comprehensive assessment of needs and care plans. This judgement has been made using available evidence from 2 resident plans of care and care records. EVIDENCE: Both care plans and care records examined contained detailed assessments of the residents’ needs and these assessments contained evidence of frequent updating as the residents’ needs change. These updates are not only based on information from regular reviews of the original care plan held every 6 months but include information from the day to day work of the home. Each care plan included detail on how best to support a resident with information on how to assist with eating and or going out as example. Evidence was in place in the files examined that relatives had been consulted about the content and in particular any risks for a resident that may require actions by staff. Church View DS0000000105.V296969.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 and 9 The quality outcome in this area is good. Residents’ wellbeing is promoted by their detailed plans of care. This judgement has been made using available evidence from resident files, discussion with staff and observing staff interacting with residents. EVIDENCE: At the time of the inspection Care plans in the home were being transferred to files that had the word ‘patient’ written on the front. The home has since agreed with the Hospital Trust not to introduce these files and maintain files that capture a more personal record of resident’s lives at the home. The way information used to record risks has been adapted to include a more detailed risk assessment format called ‘Samuri’. Staff members interviewed was able to demonstrate how the new recording system provided more detail on risk a resident may face and action required by the home to reduce that risk. However, it was noted that the decision to introduce a CCTV file in to a residents’ bedroom was based on behaviours and risks that are no longer happening.
Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 11 The home uses two CCTV cameras to monitor residents at night when they are in their bedrooms. This is by agreement with CSCI as the residents’ present behaviours which when left on their own could lead to harm. However, one of the residents has not presented the behaviour for five years. The home must now review the original risk assessment and record plans that demonstrate the appropriateness of the CCTV camera with regard to dignity and privacy. There is a lot of evidence from records in care plans that show the home works hard to reflect the wishes of residents and to help them make choices about their care, diet and activities. The nature of the residents’ disability means that seeking their views is difficult but interviews with staff and observation during the inspection demonstrated that staff is good at observing and noting resident preferences when they were expressed. For example, a resident listening to her music in the lounge could do so knowing that another resident could listen to her music at the same time by the use of headphones. As one staff member stated, ‘as key worker I get to look after him on a day to day basis, get to know his little things and ensure he has his routine that he likes’. Church View DS0000000105.V296969.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 The quality outcome in this area is good. Residents are supported to take part in a wide range of activity in the home and further a field. Resident’s dietary needs and choices are well catered for and relatives and friends are encouraged to maintain contact. EVIDENCE: Opportunities for personal development are available at the home and further a field. This included activities such as painting within the home and the planning of resident holidays. A lot of choice as different residents experience different holidays. Two residents are attending an Adult Training Centre due to be closed, a concern for manager and staff, but this has prompted a lot of person centred planning to ensure each resident has continued opportunity for personal development and activity. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 13 Staff interviewed stated that residents are also encouraged to go out and experience more personal activity by allocating two staff members to one resident for half a day per week. Observation at the time of the inspection and comparison of recommended staffing ratios via the Residential Forum confirmed that staffing levels were high and residents were seen returning with staff from supported activity. The home is good at making relatives feel welcome and a relative stated ‘ it is like home from home, made to feel welcome and pop in any time’. It was observed that the manager and a relative had an open and relaxed manner when discussing matters about the home. Another close relative of another resident had recently moved to Australia and it was evident that contact was encouraged by telephone and plans were in place for a web can link. In respect of meals residents are presented with a lot of individualised choice linked to special dietary requirements. Staff and residents observed chatting and mixing in the recently refurbished kitchens were able to demonstrate individual eating plans that were about recognising special diet needs as well as choice. One resident was about to have a curry, another preferred noodles for tea whilst a third resident required mainly fluids. Church View DS0000000105.V296969.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The quality in this outcome is good. Residents receive high levels of support based on individual needs with health care improved by the introduction of personal health action plans. Residents’ well being is promoted by effective storage and administration of medication. EVIDENCE: It was observed that staff work hard at meeting the emotional and physical needs of residents and this is reinforced by the introduction of personal health action plans. These health action plans promote the use of community based health services such as a dentist. At the time of the inspection it was also observed a visit by a doctor based at the hospital checking up on the health of a resident. Speaking to staff it was clear that they knew about how residents receive their personal support and this was recorded in care plans. Medication in the home is securely stored and administered by suitably trained staff. This now includes, by agreement with CSCI pending protocols, the administration of suppositories on sight by qualified nursing staff to ensure dignity and privacy is promoted. The monthly unannounced audit conducted by the Hospital Trust commented ‘good medication information to read’.
Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality outcome in this area is good. This judgement was based on evidence provided by interviews with staff and relative survey and sampling resident financial transactions. Staff understood adult protection issues and relatives confirmed they are regularly posted information on how to make a complaint; and this protects residents. Residents need to be safeguarded from financial harm by ensuring that financial transactions are counter signed. EVIDENCE: Staff interviewed clear about adult protection, had received training in adult protection and knew how to access policies and procedures. A copy of ‘no secrets’ adult protection procedure is available in the home. Relatives confirmed they receive up to date information via the home on how to make a complaint. There have been no complaints and or investigations with regard to Adult abuse since the last inspection. The home must ensure that when handling money on behalf of residents they counter sign any financial transaction to ensure that residents’ are guarded from financial harm. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The quality outcome in this area is adequate. This judgement was in part evidenced by a tour of the premises and the pre-inspection questionnaire. The home has improved its interior but has no evidence of a written maintenance schedule that promotes a homely and safe environment. EVIDENCE: Since the last inspection the home has continued to improve the inside of the home with hallways and dining room areas being decorated, old lampshades replaced and a new carpet. The home has also purchased some new pictures to provide a more homely environment for residents. The environment has been improved but could be made more homely for residents by ensuring holes left by unused wall plugs are filled, a bedroom lock broken is replaced, a bedroom sink that is disconnected is made usable for resident and signs on bathroom doors that appear institutional are removed. The inspector was also of a view that none of the walls in any of the rooms had any wallpaper that could ‘soften’ the appearance of some areas of the inside of the home.
Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 17 The residents would also be better protected if the homes manager had access to maintenance plans in the home that show and record when essential servicing and replacement of equipment is planned to takes place and when it is completed. For example, the Pat testing of electrical items is 5 months out of date and the washing machines that are at least 5 years old appear ‘tired’ with panels’ broken/removed. The home presented as clean and hygienic. Church View DS0000000105.V296969.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 The quality outcome in this area is adequate. Residents are supported by a well-trained workforce but would be protected more if staff files were able to demonstrate that they retained recruitment information relating to staff members appointment. It is recommended by the Trust from a recent audit that staff competency is maintained via regular clinical supervision. EVIDENCE: Observation at the time of the inspection and comparison of recommended staffing ratios via the Residential Forum with the home’s staffing rota confirmed that staffing levels were high and residents were seen returning with staff from supported activity. A relative expressed concern about staff turn over and held a view that staff moved quickly onto other services provided by the Health Trust. The relative stated, ‘come in today and seen two new staff’. The home should review the levels of staff changes, ‘staff retention’, since it has opened and inform relatives/residents the outcome of this review and when new staff have joined the team. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 19 The staff team is made up of qualified nurses and acre assistants with support from domestic staff. Staff meetings take place although it was highlighted in April’s internal monthly audit conducted by the Trust that there should be more clinical supervision. The home has a training programme in place with 50 of staff having a National Vocational Qualification in care. In addition staff interviewed confirmed they receive training that equips them to understand and meet the particular needs of residents. For example, one staff member had included epilepsy in the Learning Disability Award Framework and another was experiencing day training in Autism. The recording of the home’s recruitment process must be made better to ensure that staff is suitable to work with vulnerable adults. At the time of the inspection one staff file had no written references to confirm the suitability of that staff member at the time of appointment. Church View DS0000000105.V296969.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 The quality outcome in this area is adequate. This judgement has been made using available evidence including discussion with the manager, the internal monthly audit and the pre-inspection questionnaire. The home is managed by an experienced and qualified manager who tries hard to seek the views of residents but this would be supported by annual self-monitoring that seeks views of residents, relatives and staff. The home’ maintenance generally works well but the lack of on site maintenance schedule means that the welfare, health and safety of residents are not promoted as well as they could be. EVIDENCE: The home is managed by a qualified and experienced manager who has been in charge of the home since it opened five years ago and therefore knows the staff team and residents needs well. The files demonstrated daily recordings of resident preferred activity and team meetings. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 21 However, views of residents’ should be promoted more by regular house meetings involving staff and residents and the publication of a resident/relative satisfaction survey that informs the way the home is managed. Currently no residents have an independent advocate. Records in the pre-inspection questionnaire with regard to health and safety were on the whole up to date. However, the residents would also be better protected if the homes manager had access to maintenance plans in the home that show and record when essential servicing and testing of equipment is planned to takes place and when it is completed. For example, the Pat testing of electrical items is 5 months out of date and must be made good. Church View DS0000000105.V296969.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 X 2 3 3 X 4 X 5 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 23 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. 2. 3. Standard YA24 YA24 Regulation 23(j) 23(b) Requirement The home must reconnect a basin in a resident’s bedroom to ensure the facility is useable. The home must replace a broken lock to a resident’s bedroom and ensure holes left by unused wall plugs are filled The home must remove bathroom/toilet signs that are not conducive towards a homely environment. The home must ensure that washing machines with broken panels are replaced. The home must ensure that Pat testing of electrical items is completed The home must obtain all appointed staff references and satisfy authenticity and keep as a record in the home. The home must ensure that the transaction of resident monies is countersigned by staff The home must complete a joint risk assessment review with regard to the appropriateness of a CCTV in a resident’s bedroom. The home must ensure that consultation with
DS0000000105.V296969.R01.S.doc Timescale for action 05/06/06 05/06/06 4. YA24 23(a) 05/06/06 5. 6. 7. YA24 YA42 YA34 23© 13© 19© 30/06/06 05/06/06 05/06/06 8. 9. YA23 YA9 16(i) 14(d) 05/06/06 29/07/06 10. YA39 21(2) 24(3) 29/07/06 Church View Version 5.2 Page 24 residents/relatives/staff is part of the process to reviewing the quality of care provided at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA33 Good Practice Recommendations The home should review the levels of ‘staff retention’ with regard to ensuring that residents and relatives are reassured as to when new staff join and leave the team. Church View DS0000000105.V296969.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Church View DS0000000105.V296969.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!
