CARE HOME ADULTS 18-65
Crawford Care Home Crawford Care Home 3 Alexandra Terrace Clarence Road Bognor Regis PO21 1LA Lead Inspector
Ms B Tye Key Unannounced Inspection 30th September 2006 09:30 Crawford Care Home DS0000065030.V309330.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 Crawford Care Home DS0000065030.V309330.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. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Crawford Care Home Address Crawford Care Home 3 Alexandra Terrace Clarence Road Bognor Regis PO21 1LA 01243 865353 01243 867662 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) Crawford Homes Limited Mrs Deborah Guy Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (1) of places Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: The Crawford is a private care home registered to accommodate up to eleven service users in the category (LD) Learning Disabilities. One service user is accommodated in the category LD (E). The premise is a three - storey middle of terrace property located in the town of Bognor Regis. Its communal rooms consist of a non-smoking lounge, dining area and small lounge at the rear of the premises. The property has a small patio garden, which is regularly used in the summer months. Crawford is near to the main shopping area, library, health centre, front and beach and is adjacent to the town hall. There are bus routes to Chichester, Worthing and Brighton and the mainline Station is within walking distance. Crawford Homes Ltd privately owns the service. The responsible individual is Mr Gajaruban Ragunathan and the registered manager is Mrs Deborah Guy. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 25th September 2006. Prior to the inspection, information held on file was examined including any official documentation relating to the home. On the morning of the inspection, some residents were dressed and socialising with staff in the dining room area, some were out and one was in bed. During the day the inspector spoke privately to three residents, interviewed two staff and spent some time discussing the service with the manager, Darren Ling. Two residents care files were case tracked. Policies and Procedures, Risk assessments, Medication records and all Health and Safety Records were examined. In addition, a tour of the premises was undertaken. Overall quality of care was found to be very good. Administration systems were comprehensive, well ordered and up to date. This is the first inspection of 2006/2007. This is called a key inspection and will determine the frequency of visits/inspections hereafter. What the service does well:
Information held on file was up to date and in good order. The new manager is in the process of implementing detailed practice recording and administrative systems to support care practice in the home. Staff spoken to stated they found the management of the home to be inclusive and supportive. Administration systems were comprehensive, well ordered and up to date. Comprehensive individual plans and 12 week assessments had been developed for each service user, respecting their right to choice and lifestyle. Detailed risk assessments for all aspects of the residents care have been recorded on their files. This enables them to make informed choices and promotes their independence where possible. The home has a complaints procedure in place, which has been produced in symbol form for the residents. Relaxed and confident interactions were observed between residents and staff. All residents feedback they were happy living at the home and were well cared for. Crawford Care Home DS0000065030.V309330.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. Crawford Care Home DS0000065030.V309330.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 Crawford Care Home DS0000065030.V309330.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Detailed pre-admission assessments are completed prior to admission to the home and information gained forms the basis of an on going plan of care. Terms and Conditions were not available for all residents, as some had been archived. It was recommended the manager include these in residents care files so they are accessible. The quality of this outcome area is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: An updated Statement of Purpose is in place and the Service Users Guide is currently being updated to include changes to the service. Each document is provided in a format suitable for residents so they are aware of what the service offers prior to admission. Individual care files for three residents were case tracked. Each contained detailed pre-admission information, which was relevant and detailed. Records showed residents had undertaken intensive pre admission assessments with the manager of the service. Following this, the manager completes detailed risk assessments and ensures relevant community resources are available to meet residents identified needs, in addition to the care provided at Crawford. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 9 Individuals are able to view the home and contribute fully to identifying their care needs and aspirations prior to admission. Terms and Conditions for the home are provided to each resident on arrival. This ensures residents are fully aware of their rights and exactly what the home has to offer them. Some of these had been archived for longer term residents. It was recommended the manager ensures all contracts are available in care files, for accessibility. Crawford Care Home DS0000065030.V309330.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): 67&9 Examination of care records confirmed that the home meets individuals changing needs and personal goals appropriately. Care plans seen were comprehensive and in excellent order. Residents are provided with the opportunity for decision making, in line with agreed risk assessments and behavioural plans. The quality of this outcome area was good. This judgement has been made from available evidence including a visit to the service EVIDENCE: Care records for three residents were case tracked during the visit to the home. Each plan is formed from a detailed pre-admission assessment and twelve week continuing assessment resulting in a 3 month formal review, which involved professionals are invited to. Care files contain comprehensive information relating to the residents assessed care needs including health, personal and social care. Residents have the
Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 11 opportunity to contribute to the care planning process, which reflect their changing needs, through one to one keywork sessions and formal reviews. Each plan contains detailed risk assessments and behavioural plans, including information relating to individuals personal history, mental, physical health and behaviours. Each care file has risk/behaviour management guidelines. In addition, Crawford has a Health and Safety officer who has devised detailed risk assessments for each resident and their environment. This promotes independence for residents in line with assessed risk and agreed limitations and ensures the manager and staff can provide care within safe boundaries. The manager stated the staff team is committed, where possible to providing a holistic approach to individuals and resources provided in house and in the wider community are in line with specialist needs. Observations and care files examined by the inspector supported this. The individualised approach and detailed assessment process within the home promotes residents choice and provides an opportunity for decision-making. The inspector examined the daily recording log which details any significant event, needed to be handed over to other staff at shift change. This ensures consistency for residents in relation to their care needs. Resident’s personal information is held on files in a locked staff office, ensuring confidentiality of personal information, within the home. Crawford Care Home DS0000065030.V309330.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 & 17 Residents are supported and encouraged in terms of personal development and activities both at the home and in the wider community.. Residents spoken to were enthusiastic about the activities they took part in. The menu at Crawford offers a range of healthy balanced meals. The quality of this outcome area was good. This judgement has been made from available evidence including a visit to the service. EVIDENCE: An activities programme for residents is devised a month in advance and displayed in the dining room. Residents go on weekly outings as a group and daily as individuals. Activities include visits to the library, local shops, walks to the beach, theatre trips, the zoo, pubs, restaurants, local markets and community events. Crawford has an activities co-ordinator who is provided with a monthly budget to arrange activities for the residents. There is a large communal board in the
Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 13 dining room, displaying artwork for the coming month based on the themes of activities residents will be participating in. Residents spoken to by the inspector all confirmed the staff support them to pursue a range of activities and interests. Information in care plans seen, supported this. All activities undertaken by the residents are risk assessed in full and agreed with the resident concerned. This information is held in residents care files and ensures each residents welfare is paramount when undertaking activities in the home and wider community. It was noted the home achieves a good balance between promoting safe boundaries for residents who participate in activities whilst encouraging independence. The home has a 7- seater vehicle to transport residents as needed. Residents and information seen on care plans confirmed family contact is promoted. Some residents have home visits on a regular basis. Visitors are welcome to the home and a policy is in place to support this. Dietary needs are catered for in line with assessed needs. All information relating to nutrition is recorded on individual care plans. The inspector examined menus for the home. Residents confirmed they liked the food and were consulted on about what they liked to eat. The kitchen area was clean and tidy. Food is stored appropriately and it was noted there was fresh fruit and vegetables, to ensure residents benefit from a healthy balanced diet. Food and hygiene certificates for staff are on display, colour coded boards are used and anti bacterial soap was available at sinks demonstrating an awareness of infection control. Crawford Care Home DS0000065030.V309330.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 & 20 Care records were examined and showed that the health needs of residents are met and reviewed on a regular basis. Medication is stored and labelled appropriately. All staff have received recent training to dispense medication appropriately. Overall the quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service EVIDENCE: Healthcare records were examined as part of case tracking. All were found to be detailed and in good order. Holistic needs are incorporated in each plan so in addition to physical health; emotional and psychological aspects of care are identified and reviewed regularly. Residents are registered with the local GP and have access to all NHS entitlements. Records of all dental and GP appointments are held on file. Individual files show residents have access to community health specialists, to ensure all aspects of their health needs are met both by the home and wider community. Crawford has good links with the Community Learning Disability Team who offer advice when required.
Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 15 Detailed behaviour management plans and risk assessments have been undertaken for each resident. These enable staff to ensure that residents maintain their independence within agreed limitations. Policies and procedures relating to all aspects of healthcare and medication are in place and up to date. Each resident is assigned a key worker who provides a one to one session on a weekly basis, or more often if required. These meetings provide residents with the opportunity to talk through all aspects of their care needs and make supported changes where needed. All information from these sessions is recorded in their on going care plan. Records showed that staff have undertaken relevant training to dispense medication safely to the residents. Medication at the home was inspected and found to be stored appropriately. Crawford Care Home DS0000065030.V309330.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The inspector concluded that the home has effective systems in place to protect the residents from abuse, neglect and self-harm. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: The home has a detailed procedure for complaints, which is included in the Service Users Guide and Statement of Purpose, providing residents with clear information about how to complain. All complaints information is printed in a format suitable for residents to ensure they are clear about their rights within the home. Residents spoken to felt listened to and able to speak to the manager or staff about issues of concern. Residents have regular informal meetings, which provide them with a forum to talk about issues of concern. In addition to this, the key worker system gives residents with the opportunity to talk on a one to one basis. The complaints log was seen, there have been three minor complaints at the home since the last inspection. All of these had been resolved appropriately. Staff have completed the Protection of Vulnerable Adults training in June 06 and as part of LDAF induction training. This reduces risk within the home and ensures staff were clear about reporting procedures should suspicion of abuse arise.
Crawford Care Home DS0000065030.V309330.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The home offers a comfortable and clean living space for residents. Residents rooms contain personal possessions and all those seen were clean and homely. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: Crawford currently provides a homely, comfortable environment. The home is due to undergo a major redecoration in October. All communal areas are being redecorated, existing bathrooms are being re-fitted, laminate flooring is being laid in the dining room and downstairs corridor. Some rooms are being recarpeted and new lino is being laid in the kitchen. There is a comfortable lounge with TV, play station and stereo equipment. The dining room is the most used communal area in which all residents have access to drink making facilities. There is also a small quiet room at the rear of the kitchen where some residents go to listen to music. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 18 Residents rooms were a good size and furnished in their individual styles with personal possessions and pictures. All bedrooms have locks on the door to ensure privacy. There are suitable toilets and washing facilities throughout the building. Following the building works in October, the home will have a hydrotherapy bath in situ, to meet the assessed needs of residents. A laundry room provides a large washing machine and tumble dryer. Residents do their own washing with assistance by staff if required. Staff clean the house regularly with support from residents. This encourages a sense of ownership and promotes independent living skills. Infection control training is provided to staff and policies and procedures were evidenced. This reduces the risk of infection spreading throughout the home. Staff certificates for food hygiene courses were displayed in the kitchen area. A fire alarm and emergency lighting system is in place. Records showed these are checked and serviced on a regular basis to ensure the safety of staff and residents. The inspector viewed detailed risk assessments for all aspects of the environment, which ensures potential hazards are identified and minimised where possible. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 19 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): 34 35 & 36 The staff employed to work at Crawford have all been recruited and trained to meet the assessed needs of the residents. Residents benefit from a well supported and skilled staff team. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: Feedback from residents, staff interviews and observations led the inspector to conclude that the staff functioned effectively as a team to ensure the residents needs are met appropriately. Two staff files were examined, they contained all the relevant checks and information needed to meet the standards. All staff have CRB checks which reduces risk to vulnerable residents and ensures staff are able to competently fulfil their roles. The home currently has a full staff compliment and does not use agency workers. This provides consistency of care to residents. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 20 Records show that staff receive regular supervision and support. This gives staff members the opportunity to reflect on their practice and identify areas of personal development. Staff attend regular meetings which are recorded. This forum enables them to have input about decision making processes in the home and discuss issues relevant to practice as a team. Staff have undertaken either LDAF training and/or a full induction within the home. The manager has devised a proposed training schedule for staff for 2006/07. This includes specialist training in line with the needs of the resident group. Over 50 of the staff team have completed or are undertaking NVQ Level 2 & 3. The manager has completed Level 3 & 4 NVQ training and Level 3 in Management. He has an award in Care Management and is currently undertaking the Registered Managers Award. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 21 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 & 42 Good practice in the home was evident. This was supported by efficient administrative systems, which promote the health, safety and welfare of the residents. There is currently no annual Quality Assurance monitoring system in place. A requirement has been made in respect of this. The overall quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service EVIDENCE: The inspector concluded that the overall conduct and management of the home served the best interests of the residents and the staff who work there. Crawford has a designated Health and safety officer who is responsible for safety keeping records up to date. The home has detailed risk assessments for individuals and their environment. These are updated on a regular basis, ensuring residents can maintain their independence within agreed limitations. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 22 The inspector examined all safety records at the home including, fire records, training, incident and accident logs, water temperatures, maintenance book and the financial records. They were all up to date and in good order promoting the welfare and safety of the residents. The inspector found all incidents had been recorded fully in the homes log, individual files and the Commission had been notified of these as appropriate Good practice in the home was evident. This was supported by efficient administrative and daily recording systems. The manager has set up effective monitoring systems to ensure staff are consistent in their practice and recording. The manager of the home attend regular meetings with the Registered provider to discuss and monitor issues of on going practice in relation to staff and residents. The home has up to date policies and procedures in line with current legislation to safe guard the rights and interests of the staff and residents. The manager has also devised a handbook of the homes policies and procedures in a simple format specifically for the residents. This enables them to be clear about practices in the home. Discussions and observations confirmed staff are given clear direction in their roles and good working practices are promoted through staff support and training. An annual Quality Assurance system has not yet been implemented in the home. This would provide residents and their families with an opportunity to feedback and contribute to the way the home is run. A requirement has been made to ensure this is implemented at the earliest opportunity. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 23 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 4 3 X 4 X 5 2 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 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 3 X X 3 X Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 24 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 YA39 Regulation 26 (4) Requirement To ensure a quality assurance and monitoring system is in place and an annual report of findings is published. Timescale for action 25/12/06 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 YA5 Good Practice Recommendations To ensure terms and conditions for all residents are accessible for inspection. Crawford Care Home DS0000065030.V309330.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Crawford Care Home DS0000065030.V309330.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!