Inspection on 29/08/06 for Four Nevill Park

This inspection was carried out on 29th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Four Nevill Park 30/09/09

Four Nevill Park 09/07/08

Four Nevill Park 31/05/07

Four Nevill Park 08/02/06

Four Nevill Park 29/09/05

Four Nevill Park 04/01/05

Four Nevill Park 13/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Four Nevill Park 4 Nevill Park Tunbridge Wells Kent TN4 8NW Lead Inspector Mrs Justine Williams Key Unannounced Inspection 29th August 2006 09:30 Four Nevill Park DS0000023940.V307401.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 Four Nevill Park DS0000023940.V307401.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. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Nevill Park Address 4 Nevill Park Tunbridge Wells Kent TN4 8NW 01892 519520 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) Evesleigh (Kent) Limited Mrs Lynda Wilson Smith Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Four Nevill Park is a large detached Victorian property standing in its own grounds situated in a private road in an elevated position. It is registered for 24 service users and has been developed to offer care for people with a diagnosis of Autism or Aspergers Syndrome. It offers 12 individual units, 8 single bedded semi -independent flats, 2 three bedded flats, 1 five bedded flat and another two bedded semi independent flat. The home is located on the outskirts of Tunbridge Wells; the town centre is a short distance away with easy access to public transport. Shops, pubs, post office and church are within easy walking distance of the home. There are large gardens, mainly laid to lawn, to the front and rear of the home that can be used by service users. There is car parking to the rear of the building. The current fees range from £763.00 to £1872.00 per week. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 30th August 2006 between 9.30 am and 3.00pm by regulatory inspector Justine Williams. During that time residents, staff, the registered manager and deputy manager agreed to speak with the inspector. Some judgements about quality of life and choices were taken from direct observation followed by discussion with staff and evidence seen in records and care plans maintained at the home. Feedback was given to the manager during and at the end of the inspection. This report contains assessments made from observation, conversation and records. As part of the inspection process comment cards were received from relatives and professionals. Comments made included; “I feel that my (relative) is happy and settled at Four Nevill Park in the care of friendly and caring staff.” “Needs more supervision on my (relative) as he comes home covered in some sort of bruises.(accident prone)” “Healthy food was not always available & my (relative) piled on the lbs. After complaining during two of (my relative’s) assessments/annual reviews, I believe they are now more conscious. Staff are not always in view when you visit but I’m sure they are all over the building looking after other occupants.” “Our (relative’s) new flat is lovely” “In my view some way from being ‘best in class’. Over time they have promised much & never quite delivered – however recent changes of ownership and reorganisation of accommodation look promising. Day activities still fall short of other similar establishments in Kent. One of the main strengths dedication of senior care staff also strength is a good mix of young, male & female staff. I hope that KCC provide the funding & support to enable Opus to achieve the successful completion of the latest improvement to the Opus service.” “My client has been a resident of Nevill Park since 1999. The home has gone through many changes, but staff have always managed my clients needs in a professional & appropriate manner. They have facilitated significant progress for my client & given family peace of mind. They have always managed my client’s needs, despite difficult presentation particularly early on.” Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The service users guide has been updated and is available in varying formats. The statement of purpose and guide were updated and reviewed in consultation with the residents. The following issues with medication have been resolved; Medication storage was inadequate being dirty, cluttered and not fit for purpose. No BNF could be found. There was insufficient information on the side effects of medication Ointments were not kept separately. There was no overall monitoring of the medication policy and procedure and no systems to ensure practice is improved upon. Medication had been left in the sink having not been fully administered. Rectal medication was being supplied but had not been used for some time. There was limited evidence that staff had received training in the use of invasive medication. Training provided is not effective judged on outcomes from the inspection. Mandatory training is now provided for all staff, and updates are arranged as needed. All residents have the new care plan format which is very detailed, and of good quality. The manager has found alternative arrangements in many cases and continues to work toward finding an independent person to act as appointee, this will better protect both residents and staff, (some residents have a manager from the Evesleigh care group, which own the home) Staff are aware of the company structure. Refurbishment and redecoration have vastly improved the home and the quality of life for those living there. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 7 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. Four Nevill Park DS0000023940.V307401.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 Four Nevill Park DS0000023940.V307401.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): 1,2 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Prospective service users have written information to assist them and their carers/representatives to choose of the home is suitable for them. Comprehensive assessments are undertaken for new residents. EVIDENCE: The service users guide has now been amended and is also available in ‘widget’ format for those service users who require pictorial communication. The service user guide and statement of purpose have been supplied to the Commission and all residents have a copy of the guide and access to the statement of purpose. Residents were involved in updating the statement of purpose. 2 service users have been admitted recently, both went on a number of trial visits to the home prior to making the decision to move in. The records for one new resident were inspected. A comprehensive assessment had been undertaken and was ongoing. Information had been sought from various health and social care professionals, from family and the resident themselves. The new documentation being used allows for a very detailed and thorough holistic assessment. Four Nevill Park DS0000023940.V307401.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): 6,7,9 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents individual needs and goals and right to make decisions about their lives are reflected in their care plans. Residents are supported to take risks, and these are clearly documented and are comprehensive with the exception of medication risk assessments. EVIDENCE: The care plans are comprehensive and include all aspects of personal and social support. Information and advice from health care professionals is incorporated into the plan. The level of detail was very good, which should enable new staff to gain a good understanding of residents needs, strengths and goals. Detailed information is set out for staff describing specific strategies to manage difficult and challenging behaviour, triggers to challenging behaviour are also clearly documented. Care plans have been agreed with relatives and residents where possible. Evidence of regular reviews was seen. It is recommended that each aspect of the care plan be signed and dated and that changes be incorporated into the care plan itself as they occur rather than Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 11 just on the review sheet, this should ensure that the plan remains concise and up to date. Discussion with the manager, staff and residents made it clear that residents rights to make decisions about their lives and issues that affect them is respected and an important part of the homes ethos. This was supported by the documentation in the care plans. Risk assessments were clear and comprehensive with the exception of medication risk assessments, these are somewhat brief and do not cover all aspects of risk. The manager and staff have undertaken very robust risk assessments and working practices whilst the home has been renovated, and are to be commended on keeping residents informed and safe in this difficult period of extensive redecoration and refurbishment. Four Nevill Park DS0000023940.V307401.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 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents receive support and opportunities to participate in fulfilling activities and paid or voluntary work where appropriate. New monitoring systems enable the manager to encourage healthy eating. EVIDENCE: Those residents who are able have been supported to find and continue to hold down paid or voluntary work. Other residents are given opportunities to attend college for a variety of courses. All residents participate in a range of activities including rock climbing, using local leisure and spa facilities, swimming, shopping, pub and cinema trips. 2 residents commented that they would prefer more activities organised at weekends, though other residents and staff said that they had evening and weekend trips organised frequently. Service users are supported with life skills such as cooking, household chores and daily living tasks to promote and maximise their independence. The extent to which they are supported varies according to individual needs. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 13 Residents receive the assistance and privacy to meet with family, boy and girlfriends, and other visitors. The manager has recently asked residents to supply her with receipts for food purchased in order to better track what residents are eating, this was in response to concerns regarding nutrition for residents living in single flats. Residents are happy with this arrangement, as it does not encroach on their independence, but allows the manager to monitor what residents are buying to cook. Efforts are made by staff to encourage health eating and explore residents perceptions of healthy eating. Residents receive support to cook and shop. Some of the residents particularly those in single flats, have Sunday lunch with other residents, after due consultation with the residents, this is being facilitated. Four Nevill Park DS0000023940.V307401.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 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Residents receive the support they need to meet their personal care and health needs. Some aspects of the medication practices in the home are not sufficiently robust to protect residents. EVIDENCE: The home continues to operate a key worker system. Service users are supported with their medical and health needs. Regular and routine appointments for dentists and opticians etc take place. Specialist services such as the community learning disability team provide a range of individual support i.e. speech and language therapy and behaviour management guidance. The home now has 3 medication rooms, 1 for each floor, 1 has a hand washbasin, alcohol wipes are used in the other 2. The manager was advised to source a copy of the Royal Pharmaceutical Guidelines for reference. BNF’s have been purchased but these are out of date, the manager confirmed that these are on order. The staff are still secondarily dispensing medication, this must cease immediately and advice from the pharmacist should be sought as to other ways to manage medicines for day trips, etc. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 15 The medication rooms were clean and tidy, with records of medicines received and returned from pharmacy. Staff receive accredited medication training prior to being responsible for administering medicines. Comprehensive risk assessment are required for residents who wish to and are able to self administer. Clear and detailed information on when to give PRN or as required medicines is needed for all PRN medicines. Guidance was seen for administering some PRN analgesics. Four Nevill Park DS0000023940.V307401.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 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Service users can continue to feel confident that they will be protected through the prompt and responsive action taken by staff. EVIDENCE: The Pre-inspection questionnaire indicates that the home has received 3 complaints since the last inspection. 1 has been substantiated, all were responded to within 28 days in accordance with the home’s policy and good practice. The manager tracks complaints in order to look for trends or patterns, and this will form part of the quality assurance for the home. Staff receive adult protection training and updates thereafter. The home continues to act as appointee for some of the existing service users, although new residents are not offered this service. The manager has approached the placing authorities for all the residents to take over the financial management but some do not offer this facility. Four Nevill Park DS0000023940.V307401.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 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. The residents benefit from the extensive refurbishment already completed and will continue to benefit when work on the bathrooms is completed. EVIDENCE: The home has undergone total reorganisation and refurbishment and now consists of several shared and single flats. The standard of décor is generally high, and the environment will be further improved when new carpets have been fitted to lounges and refurbishment of the bathrooms is complete. Bathrooms are difficult to clean and keep free from infection risks as tiles and grouting need attention and bath sealant and some areas of flooring is damaged and discoloured. The décor in the bathrooms is in need of updating and renewal. The residents spoken with are very happy with their bedrooms and are enjoying living in their flats, both single and shared. Other areas of the home were clean and pleasant. There are several laundries, one on each floor, which have replaced the single laundry in the basement, some have furniture to be fitted and put together, and all need tidying and putting into order. Four Nevill Park DS0000023940.V307401.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): 32,34,35 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents benefit from being cared for by competent staff, and would benefit further from NVQ qualified staff. Residents are protected by the home’s robust recruitment policy and practices. EVIDENCE: The home has been split into 3 floors for the purpose of staffing, the areas where residents present more challenging behaviour have more staff on duty. Staff are allocated to a floor for the most part in order to provide continuity of care, although some movement takes place. The home does not have 50 of staff trained at NVQ though the manager stated the company is committed to providing NVQ training for staff. The home’s recruitment practices reflect the home’s policy and are robust. Staff files contained the required documentation and checks. The manager keeps a training matrix which is updated on a monthly basis. Core training is arranged for all staff, this includes first aid, moving and handling, fire etc. staff also receive training in the management of challenging behaviour as well as other more specific training in order for them to provide care to their residents. Accredited medication training is sought for all senior staff, and the manager is arranging training for the MDS system they use. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 19 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 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents benefit from a well run, well managed home. Residents will further benefit when the quality assurance systems are fully in place. The safe working practices adopted at the home protect residents and staff. EVIDENCE: The manager is competent, qualified and suitably experienced to run the home and changes and improvements continue to be implemented by her and the staff. The manager clearly has overall responsibility at the home. Some quality assurance systems are in place and the company has a quality assurance manager. The manager must develop an annual plan for improving the quality of care. Regular auditing of all aspects of documentation and systems should be developed. The views of residents and staff are regularly sought through meetings and surveys. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 20 The Pre-inspection questionnaire indicates that the health and safety of residents and staff are being manager through regular servicing and checks of equipment and systems, training of staff etc. The manager has assumed responsibility for fire checks and drills in the maintenance mans absence. The manager carries out environmental and fire risk assessments and reports accidents illnesses etc in accordance with regulations. Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 21 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 3 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 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 22 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 YA20 Regulation 13 (2) Timescale for action The registered person shall make 15/10/06 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. In that 1)Secondary dispensing of medicines by staff must cease 2)risk assessments for self medicating be comprehensive, 3)Clear instructions for the use of PRN medication be developed for all PRN medicines, 3)up to date BNF’s be purchased 4)Royal Pharmaceutical guidelines be sourced for reference repeated from the last inspection. Previous timescale 22/03/06 The registered person shall 15/10/06 having regard to the number and needs of the service users ensure that all parts of the home are kept clean and reasonably decorated, in that 1)Carpets are replaced as planned 2)bathrooms are refurbished as planned DS0000023940.V307401.R01.S.doc Version 5.2 Page 23 Requirement 2 YA24 23 (2)(d) Four Nevill Park (improvement plan required) 3 YA39 24 The registered person shall establish and maintain a system for— reviewing at appropriate intervals, and improving, the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. The registered person shall supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph and make a copy of the report available to service users. The system referred to in paragraph shall provide for consultation with service users and their representatives. 30/12/06 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 YA23 Good Practice Recommendations It is very strongly recommended that the home seek possible alternatives for appointees for service users who have the staff of the home act as their appointee for their finances It is strongly recommended that the home continue to work toward 50 of staff gaining NVQ qualification. 2 YA32 Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Four Nevill Park DS0000023940.V307401.R01.S.doc Version 5.2 Page 25 - 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!