Inspection on 21/02/08 for Eardley House

This inspection was carried out on 21st February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Eardley House 02/01/09

Eardley House 21/08/07

Eardley House 05/02/07

Eardley House 30/05/06

Eardley House 29/11/05

Eardley House 08/06/05

Eardley House 30/11/04

Eardley House 11/05/04

Similar services:

Maple Lodge

Heathlands

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Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Eardley House Moorland View Bradeley Stoke-on-Trent Staffordshire ST6 7NG Lead Inspector Wendy Jones Key Unannounced Inspection 21st February 2008 09:00 X10015.doc Version 1.40 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 Eardley House DS0000028913.V355724.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 Older People. 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. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eardley House Address Moorland View Bradeley Stoke-on-Trent Staffordshire ST6 7NG 01782 234530 01782 234530 eardley.house@swann.stoke.gov.uk 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) Stoke on Trent City Council Mrs Susan Mountford Care Home 41 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (41), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (41), Physical disability over 65 years of age (41) Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only Care Home only To service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 41 Physical Disability (PD) over 65 years of age (PD)(E) 41 Dementia over 65 years of age (DE)(E) 41 Dementia (DE) 5 Mental Disorder (MD) 5 Mental Disorder The maximum number of service users to be accommodated is 41. 2. Date of last inspection 21st August 2007 Brief Description of the Service: Eardley House is a care home providing both long term and respite care for up to 46 older people with dementia. The home is owned by Stoke on Trent City Council, a unitary authority, and care is directly provided by the councils staff team from the social services department. The home is located on the outskirts of the City of Stoke on Trent, in the village of Bradeley. It has ready access to community facilities and, including shops, pubs, post office and public transport. The home was originally purpose built to the standards current at the time, and consists of two storeys. Because of its large size, and to meet up to date good practice in care provision, it is now divided into four group living arrangements. Each area has its own living/ dining area. Assisted bathing and toilet facilities are strategically provided throughout the home, and other facilities include a smoke room and separate quiet room with a pay phone. All bedrooms are single. None of the bedrooms have en suite facilities. Access to the enclosed rear garden is from two lounge areas with ramps and handrails provided for safety. The garden has a patio area with seating, flowers and a summerhouse. Overall the accommodation is generally comfortably appointed and welcoming, although there are still some areas of the home that Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 5 need decorating. Information about the fees charged was not available during this visit and the reader may wish to contact the service to obtain this. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This service provides for older people who have dementia care needs, it is registered to provide accommodation for 41 people at this visit occupancy was 34 service users. The environment is divided into 4 units. This was a second key inspection site visit of this service undertaken on 21 February 2008 and included formal feedback to the assistant managers. The manager was contacted following the visit to discuss those areas that require further work. In total the visit took approximately 5:30 hours. The purpose of this visit was to assess the services performance following the last key inspection of 2007 where it was identified that it provided poor outcomes to the people who use the service. The report of the last site inspection should be read in conjunction with this report. The visit included checking that any requirements and recommendations of the previous inspection visit have been acted upon. The main areas looked at during this visit include the management of medication, care planning, the protection and safeguarding of residents, management and daily lifestyles. The assistant managers, staff and residents were spoken to during the site visit and a brief tour of the building was undertaken. The manager will be asked to complete an improvement plan following this inspection, which tells us how they intend to make the changes to improve the quality outcomes for the people who live there. What the service does well: Eardley House provides care and accommodation to residents who are described as older people and who may have dementia care needs or mental health problems. Staff have received training in Equality and Diversity and try to ensure that all residents needs are met. Changes have been made to assessment records and care plans to ensure that they properly take into account the diverse needs of residents who may have dementia or mental health needs. The service has confirmed that any concerns that residents have are taken seriously and properly looked into. Information about how to make a complaint is made available to residents and their supporters. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is (poor). This judgement has been made using available evidence including a visit to this service. People who may use the service cannot be sure that they have all the information they need to enable them to make a decision about moving in to the home, nor can they be certain that the service can meet their needs if they require admission to the home in an emergency. This means that the outcomes for people are uncertain and puts them at risk. EVIDENCE: Staff were not able to locate a copy of the Statement of Purpose on the day of the inspection site visit and it remained evident that the service user guide still needs to be up dated as discussed at the last key inspection. The guide should contain information about the fees for the service and the terms and conditions of residency. This is to ensure that prospective residents and their supporters have the information they need to make a decision about moving into the home and the costs and fees they can be expected to pay. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 10 A sample of three care files were looked at during this visit, all residents were recent admissions to the home. There is evidence that the service has sought relevant assessment information from other professionals and social workers prior to admission. They also complete a referral/assessment form; staff confirmed that this is sometimes completed over the phone, usually if the referral is for an admission in an emergency. Assessments from the social work team are included in the care files, but from the sample seen the information is not always up to date. This in effect means that the service cannot always be sure that it can meet the needs of people who are admitted to the service in an emergency. It is recommended that a review of this admission and assessment procedure be undertaken. Standard 6 does not apply to this service, as it does not currently provide intermediate care. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 8, 8, 9 and 10 Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that medication systems have improved since the last key visit, but the service must ensure that the procedures are robust and staff are fully familiar with them to ensure the safety and welfare of service users. Care planning must also be improved to ensure that all relevant information is recorded to so that staff know what the care needs of service user are and how to meet them. Failure to do this places people who use the service at risk. EVIDENCE: At the last key site visit the outcomes for residents were assessed as poor in this area. Since then the service has submitted an improvement plan, which told us how it has taken action to address all of the previous concerns. A review of the sample of care files shows that the standard of care planning for the 3 residents in the sample could be improved. In one example none of the care planning information was completed and the only risk assessment Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 12 related to fire safety. In another the information was not good enough to ensure that staff knew how to meet the care needs of the individual. In one record it stated that the resident is prone to falls, but no risk assessment has been undertaken, staff said that they were not aware that this was an issue. In one record the information was completed properly, and there was evidence of monthly reviews. Although there is little evidence that residents have been involved with their care planning or the routine reviews of their care. A resident said that the staff are supportive and provide good care. Records show that health needs appear to be properly met with evidence of regular referral to the GP and the district nursing team. At the last inspection the medication arrangements at this home were assessed as poor. Since then the service has indicated that it is has implemented changes to improve how it manages records and stores medication. There is evidence of improvement in this area, with a number of innovations noted to ensure that medication is accounted for when received into the home. There is also an account of the medication stored in the cupboard, and transferred into the drug trolley, as well as records of medication returned to the pharmacy. In one example from the sample of records seen, there appeared to be a discrepancy between the medication record and the actual stock of medication in the cupboard. This was felt to be an oversight due to the new systems the service had put in place. An attempt to complete an audit trail for this medication was unsuccessful as, one of the Medication Administration Records (MAR) couldn’t be found. The staff on duty was also unable to resolve this, the manager is asked to look into this. In another example the controlled drug book shows that 8 Temazepam, 10 mgs tablets had been returned to the pharmacy. But in the returns book it stated that 7 had been returned. The running total of medication in this case hadn’t been affected and the manager has been asked to look into this matter, as it couldn’t be explained. It is reported that she undertakes periodic audits of the medication records. The service now has a minimum and maximum thermometer for the medication fridge, but is only recording the minimum temperature. It was noted that the maximum temperature on the thermometer was at 9c exceeding the recommended temperature. It is advised that the service records both the maximum and minimum temperature in future. In addition the room temperature in the room where medication stored was 25c this is the maximum temperature some of the medication can be stored at. The manager has been asked to monitor this and take action if the temperature increases. Medication Administration Records (Mars) show that staff have been signing them on each occasion medication is administered, with one exception. A Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 13 record on the MARS shows that staff have noted this, a check of the Blister pack showed that the medication had been administered. It was noted that some residents have been recorded as refusing some medication on a regular basis, for example Paracetamol, which is prescribed 4 times per day. It is suggested that the service discusses this as part of a medication review with the GP. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service have a choice of main meal and are offered a balanced diet but the service should implement the planned changes to support residents to make an informed choice of meal. It should also continue to improve the range and variety of activities is provides for people. EVIDENCE: This area was not looked into in detail during this visit as the main focus was on those areas that provided poor outcomes for service users at the last visit. But it is apparent that some efforts have been made to change the mealtime for service users to reduce the time between the last meal of the day and breakfast the following day. Teatime is now at 4.30pm, previously 4pm. We are also told that service users have supper later in the evening and can have snacks on request at anytime. The cook stated that they are going introduce a pictorial menu to assist those resident who may not be able to make an informed choice from the written Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 15 menu or retain information when asked what they would like. This should be implemented. There is a three-week rotating menu, and also the service provides a winter and summer menu plan. Alternatives to the main meal are available. The menus appear to be well balanced. The meal of the day is recorded on a chalkboard in the main dining room. Activities in the home are limited and this is an area that continues to need to be worked on. Staff reported that staffing shortages have impacted on this. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that any concerns they may have will be listened to and acted upon by the manager and her staff team, this should give them confidence that their welfare and well being is assured. There has also be some improvement in how the service promotes the legal rights of residents and ensures that they are safeguarded from abuse. EVIDENCE: At the last key site visit the outcomes for residents were assessed as poor in this area. Since then the service has submitted an improvement plan, which told us how it had taken action to address all of the previous concerns. Appropriate action has been taken to ensure that individual legal rights are respected and independent advocacy services have been accessed to support individual residents. A check on the records of one resident show that she had received an assessment under the Mental Capacity Act, this was required at the last inspection site visit. This was confirmed from discussion with the resident. The service does have a complaints procedure in place and information provided in the monthly reports on the conduct of the home state that no formal complaints have been received since the last inspection site visit. We Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 17 haven’t received any complaints since the last inspection visit and the service has demonstrated that it is familiar with vulnerable adults issues. One resident said she knew she could go to staff if she had any concerns. There is evidence in the home, of thank you cards and letters of compliments from families and friends of residents. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. People who use the service have a clean and well-maintained environment in which to live. EVIDENCE: This visit did not include a detailed environmental inspection; general observations are of a clean home that is well maintained. In some areas the environment looks “tired” and would benefit from some upgrading. It is understood that some bedrooms have been redecorated and have had new carpets fitted. New curtains have been provided in some rooms. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that staff are provided in sufficient numbers to met their needs, but because of the high use of casual and bank staff cannot be confident that the care is consistently of good quality. EVIDENCE: This area was not looked into in detail as at the last inspection was assessed as providing good outcomes for the people who use the service. This report should be read in conjunction with the previous one. We are told that the authority is not actively recruiting new staff at the moment because of its wider strategy to improve services to older people in Stoke-on-Trent. As a result of this some local authority homes in the city have closed and others have been recommended for closure. It is the intention of the authority to offer staff from the affected homes the opportunity of working in the homes remaining open, before they advertise any vacancies. As a consequence although minimum staffing levels are being maintained, as reported in the last report there is a high use of casual/bank staff being used. Staff said that this is having an impact on continuity and consistency of care. This has been evident in other areas and was a reason given for some of the deficits in care planning. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 20 Current staffing levels are 5-6 care staff plus 2 assistant managers during the morning and early afternoon shifts, 4 care and 1 assistant manager for the early evening shift there are 3 waking night staff. Service user numbers are currently 34. A catering staff said, “we have had difficulties because of the high use of agency staff, but these have been resolved and some of the care staff are picking up extra hours in the kitchen.” Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service cannot be confident that the management of the home can sustain changes to improve and provide good quality outcomes for them. This means they cannot be sure that their health and safety and best interests are safeguarded. EVIDENCE: At the last key inspection site visit this area was assessed as providing good outcomes for residents and therefore was not looked into in detail during this second key inspection visit. Although basic checks of fire safety records were looked at and found to be satisfactory. Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 22 The service has taken action to respond to the concerns of the last inspection site visit. There continue to be areas that have not yet been fully addressed. As a consequence the judgement for this section cannot be that the service offers good outcomes in this area until such a time that residents can be confident that any changes and improvements can be sustained by the service. The service does tell us of any incident or accident in the home and a number of accidents where residents have been found on the floor or have fallen have been reported since the beginning of December 2007. It is suggested that the manager undertakes an audit of these reportable events to determine any trends or if any action can be taken to reduce the incidence of them. Eardley House DS0000028913.V355724.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X x 2 Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 14 Requirement The registered person must ensure that assessment information for prospective resident is up to date and accurate, before confirming that it can meet the individuals’ needs. The registered person must ensure that care plans and risk assessments are in place to meet all the identified needs of the individual. The registered person must ensure that accurate, complete and up to date records must be kept of all medication received, administered, taken out of the home when residents are on leave and disposed of to ensure that medication is accounted for, is available and is given as prescribed. (Previous timescale not met 30/10/07) The registered person must ensure that residents have the opportunity to engage in a variety of activities. DS0000028913.V355724.R01.S.doc Timescale for action 21/03/08 2. OP7 15 21/03/08 3. OP9 13(2) 21/04/08 4 OP12 16(2)(m) 21/05/08 Eardley House Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP1 OP9 Good Practice Recommendations The resident guide should contain the terms and conditions of residency and the level of fees to be paid. The service should ensure that all residents have a copy of the resident guide. The medication fridges maximum and minimum temperature should be recorded and monitored to ensure that medication is stored within the temperature range recommended by the manufacturer. The manager should undertake to look into the medication record discrepancies identified. Undertake a review of the admissions procedure for persons referred to the service in an emergency. The service should actively recruit staff to ensure the vacancies at the home are filled. The service should take steps to evidence and that it can maintain the current standards and demonstrate how it intends to improve them. The service should audit incidents in the home to ensure that the necessary action is being taken to reduce them. 4. 5. 6. 7 OP9 OP3 OP27 OP33 8 OP38 Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Eardley House DS0000028913.V355724.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!