Inspection on 04/01/07 for Frank Foster House

This inspection was carried out on 4th January 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Frank Foster House 29/01/09

Frank Foster House 05/01/06

Frank Foster House 30/06/05

Frank Foster House 07/10/04

Frank Foster House 05/05/04

Frank Foster House 22/01/04

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

CARE HOMES FOR OLDER PEOPLE Frank Foster House Loughton Lane Theydon Bois Epping Essex CM16 7LD Lead Inspector Jane Offord Unannounced Inspection 4th January 2007 09:15 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 Frank Foster House DS0000017823.V324514.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. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Frank Foster House Address Loughton Lane Theydon Bois Epping Essex CM16 7LD 01992 812525 01992 814753 frank.foster@runwoodhomes.co.uk runwoodhomes.co.uk Runwood Homes Plc 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) Mr Teshwar Seeratun Care Home 71 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (71) of places Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who only fall within the category of old age (not to exceed 71 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 35 persons) The total number of service users accommodated in the home must not exceed 71 persons The registered person must not admit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 5th January 2006 Date of last inspection Brief Description of the Service: Frank Foster House is owned by a private organisation named Runwood Care Homes Ltd. The home is located in the village of Theydon Bois, Essex. The home was opened in 2002 and was a former local authority home and consists of a two-storey building that has been upgraded and refurbished to a high standard. Frank Foster House provides personal care with accommodation for up to 71 older people, including 35 older people with dementia. There are 71 single en-suite bedrooms on two floors with access provided by two passenger lifts in addition to several staircases. There are a number of communal rooms used for relaxing and dining and a small multidenominational chapel. The home has an enclosed courtyard garden that is accessible to wheelchair users. Frank Foster House is accessible by road and parking is available in the car park. The fees range between £575.00 and £444.44 weekly but do not include, hairdressing, chiropody, newspapers, toiletries or transport. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 9.15 and 16.00. This report has been compiled using accumulated information and evidence found during this visit. The manager was present throughout the day to assist with the inspection process. During the day a tour of the home was undertaken with the administrator but all areas of the home were re-visited later in the day. A number of residents, relatives and staff were spoken with, the serving of the lunchtime meal was seen and part of a medication administration round was followed. Some staff and residents’ files were inspected, the policy folder was seen and other relevant documents and certificates were inspected. Residents were observed using all areas of the home and staff supported them to make choices about what activities they wanted to participate in. The home still looked festive with Christmas decorations up and was clean, tidy and had no unpleasant odours. Visitors came and went during the day and staff welcomed them. Interactions between staff and residents were friendly and appropriate. What the service does well: What has improved since the last inspection? There were no requirements left after the last inspection. Work has continued to maintain high care standards and build on existing good practice. Runwood PLC awarded the home for the ‘Best Activities’ and ‘ Best Home’ for 2006 and nominated them in three other categories. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 6 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. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 7 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 Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 8 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): 3, 6. Quality in this outcome area is good. People who use this service can expect to have their needs assessed and an assurance given that they can be met prior to moving in to the home. The service does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service users guide were both seen and offered a pre-admission assessment of needs. Each new resident has a trial period of four to six weeks to ensure they are comfortable in the home and it meets their expectations. Visitors spoken with say they were welcome to visit the home before their relative was admitted. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 9 The files of four residents were seen and each one had a pre-admission assessment dated before the resident was admitted to the home and signed by a senior member of staff. The assessments covered areas of care such as mobility, continence, personal hygiene, nutrition and medication. There was also information about the resident’s past medical history, their spiritual beliefs and social needs. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9, 10. Quality in this outcome area is good. People who use this service can expect to have their health needs met and a care plan in place to assist staff to do so. They can also expect to be treated with respect but they cannot be assured that all medication administration practice will protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of four residents were seen and all had evidence of regular reviews of the care interventions. Interventions were individualised for the resident’s specific needs. For one resident a problem of ‘loneliness and feeling useful’ had been identified. The intervention included asking them to help with, ‘laying the dinner tables or doing a little dusting in the lounge’. Another resident had a history of falls and the mobility care plan included an intervention, ‘ensure footwear fits properly’. Other areas covered included continence, night needs, personal hygiene, cognition, pressure area care and nutrition. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 11 All the files contained risk assessments for daily activities undertaken by the residents. People who were mobile had an assessment for using the stairs in the home. One resident had a risk assessment for refusing care and any refusals were documented in the daily records. Another had an assessment for wandering at night. Each file contained contact details of health professionals involved with the care of the resident. These included the GP, chiropodist, community nurse, optician, dentist, physiotherapist and, in one case, a cardiologist. There was documentary evidence of multi-disciplinary reviews. Two residents who had had a number of falls were referred to a falls assessor and the advice given was recorded and incorporated in the care plans. One resident needed an extra mattress on the floor beside their bed to cushion a fall out of bed and the other had hip protectors to wear during the day. Further information recorded included regular weight records, residents likes and dislikes, their preferred name and any special equipment needed to manage identified risks such as a low loss air mattress for pressure area care. Daily records showed what care had been given during the twenty-four hours but did not record anything about the mood or general well-being of the residents. The medication policy was seen and gave guidance on all aspects of ordering, storing, administering and disposing of medication. The medication round at lunchtime was observed and it was noted that the medication administration records (MAR sheets) all had identification photographs attached to them. The carer signed the MAR sheet on dispensing the medicine into the pot rather than after it had been administered to the resident. The carer offered residents the choice of taking painkillers that were prescribed ‘as required’ (PRN) and was patient in helping them to take their medicines. PRN medication that had a choice of dose i.e. one tablet or two, had the number given recorded each time allowing an audit trail. The carer did not wash their hand before or after administering topical preparations. The controlled drugs (CD) register was seen and was correctly completed. The CDs were stored in line with legislation and those checked tallied with the records. The carer said there was one resident who self-administered their own insulin daily using a pen syringe. The district nurses had assessed the resident as competent to manage their own injections with supervision from the care team manager on duty. The team managers had not received any specific training to undertake this task. The registered manager said they had been in communication with the health team and social worker about the situation but recognised that their staff should urgently have training to understand the supervisory role they were undertaking. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14, 15. Quality in this outcome area is good. People who use this service can expect to be offered meaningful pastimes, be encouraged to maintain contact with their family and friends and enjoy a well balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of four residents were seen and each one had details of their next of kin and other family members and their relationship to the resident. There was a record of any religious beliefs and whether the resident wished to continue to practice their religion. One record said the resident wished to see a priest each week and another noted, ‘XXXX will be collected each week to attend the Baptist service’. Each file had a record of the residents’ final wishes. There were a number of visitors who came and went in the home during the day. Several were spoken with and all said they were welcome at any reasonable time and that staff were very good at keeping them informed about their relative. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 13 The home employs an activities co-ordinator who plans a programme of activities for the morning and afternoon of each weekday. Activities are organised upstairs in the mornings and downstairs in the afternoons but residents are free to attend either or both as they choose. The pastimes arranged include ball games, movement to music, board games, word search and bingo. One visitor said their relative had won the morning’s bingo and had received a packet of crisps as a prize, and the resident was clearly delighted with the win. The home has a dedicated activities room that is used for arts and crafts and is decorated with memorabilia such as old photographs taken locally, posters of local events, documents from the second world war era like ration cards and ID cards. There is a small quiet room that also serves as a multi-denominational chapel leading off the activities room. Activities are arranged outside the home for residents to participate in such as shopping trips, visits to the local public house for a meal and church services on a Sunday. Residents and relatives spoken with said that Christmas had been great fun with a lot going on for the residents including a Christmas party and entertainers. The kitchen was visited and found to be clean and tidy. All stores were labelled and dated. The records of temperatures of refrigerators and freezers showed they were all functioning within safe limits for food storage. The menus showed there was a cooked breakfast offered three times a week and a choice of main meal and dessert each day. Lunch on the day of inspection was pork with applesauce or a cauliflower cheese flan, with potatoes and mixed fresh vegetables. The dessert was chocolate sponge pudding and custard or a choice of yoghurts or fresh fruit. Residents spoken with said they had enjoyed their lunch. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 14 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): 16, 18. Quality in this outcome area is good. People who use this service can expect any concerns to be taken seriously and investigated, to be protected from abuse by the staff knowledge but they cannot be assured that the home’s written POVA policy reflects the guidelines from the Essex POVA committee. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a robust complaints policy that meets the requirements of the National Minimum Standards (NMS). The complaints log was seen and showed there had been four complaints since the last inspection. One was about the lack of escort with a resident who went to hospital by ambulance, two were about misplaced property and the fourth was about a fall on the main stairs of the home. They had all been investigated and the complainant had a written response within 28 days. There was evidence that practice had been changed where necessary as a result of the outcome of the investigation. A compliments book was also seen and contained many expressions from relatives of satisfaction with the level of service being offered. One addressed to the manager said, ‘I wish to thank you and your wonderful staff for the excellent care and kindness you all gave my parent over the six years they lived with you’. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 15 Residents and relatives spoken with said they knew who to approach if they had any concerns and some people cited the registered manager by name saying he was approachable and they would have no trouble talking to him. One relative said, ‘I feel sure my parent is safe here. It gives me great peace of mind’. The home had a copy of the Essex POVA guidelines but their own policy did not reflect the referral procedures outlined in the guidance. Staff spoken with were clear about their duty of care and confirmed they had had instruction in POVA issues. The home has a whistle blowing policy to protect staff who raise any concerns they have about anything that could be an abusive situation. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 16 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. People who use this service can expect to live in a clean, attractive environment and have their laundry hygienically managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken with the administrator. Everywhere was clean and tidy with no unpleasant odours noted. The building has wide corridors and large windows that give the place an airy feel. Décor and furnishings are attractive and appropriate for the client group. There is a security keypad system in use through the home that allows residents to wander in a secure area if they choose. There is also a secure courtyard that is used in good weather. Relatives spoken with talked of the ‘very high standards of cleanliness’ they observed in the home. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 17 The laundry was visited as part of the tour and was also clean. The dedicated laundry worker explained the system for managing soiled linen to reduce the risk of cross-infection. Soiled linen is brought to the laundry in red alginate bags that are loaded directly into the machines and washed on a sluicing programme. The machines have an automatic product dispensing facility that regulates the amount of product according to the programme selected. The laundry worker demonstrated an awareness of the control of substances hazardous to health regulations (COSHH) and said they had had training in COSHH and Health and Safety. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29, 30. Quality in this outcome area is good. People who use this service can expect to be supported by adequate numbers of correctly recruited, well-trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of three new members of staff were seen and had evidence that POVA 1st and criminal record bureau (CRB) had been undertaken before staff commenced in post. Each file had documentary evidence that identification checks had been made and two references had been taken up. There was a complete work history for each member of staff and the interview questions and responses used for application for the post. Each member of staff had been given a contract detailing the terms and conditions of their employment and a job description for the post they were to undertake. There was evidence in the files of a four-week induction period. During that time training was given about the home environment, the staff team and roles, introduction to the residents and the home’s philosophy of care. Mandatory training in fire awareness and procedures, moving and handling, infection control, care plan use, food hygiene, COSHH and Health and Safety were all covered. Staff spoken with confirmed they had had a full induction programme and spent time ‘shadowing’ more experienced staff initially. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 19 The home employs thirty-eight care staff and of those thirty hold an NVQ level 2 qualification or above. This represents seventy-eight percent of the care staff and exceeds the minimum of fifty percent recommended in standard 28 of the national minimum standards of the care home regulations. Staff spoken with said there were regular training sessions organised and there was an expectation from management that staff attended to keep updated. Recent sessions had included moving and handling, POVA, health and safety and care of people with dementia. The manager said future training would include fire awareness and first aid. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35, 38. Quality in this outcome area is good. People who use this service can expect to be consulted about the care and have their finances and welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post two years and holds qualifications relevant to the position. Staff spoken with said the manager gives clear leadership and is approachable and ready to listen. Runwood PLC nominated the manager in their annual awards for Manager of the Year 2006. The home was also nominated for Best Home Environment and Best Kitchen and won the awards of Best Activities and Home of the Year 2006. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 21 The service consults with stakeholders regularly and minutes of recent meetings were available. They showed a wide number of issues were covered in the discussions. A relatives meeting held in November 2006 discussed clothing and laundry, the smoking room, money, residents’ plants and flowers and dental care. A residents’ meeting held in December 2006 discussed cleanliness in the home, menus and the standard of food and arrangements for Christmas. Residents’ finances are managed safely with good records of transactions and money kept securely in a safe. Three wallets were chosen at random for checking and the contents tallied with the records. Maintenance records showed fire alarms, emergency lighting, nurse call system and water temperatures were tested weekly. An engineers certificate for servicing the passenger lift in December 2006 was seen together with other documents that showed equipment was serviced regularly. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No. 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 OP9 Regulation 13 (2) Requirement The registered person must ensure that the MAR sheets are signed to indicate administration of medicines not dispensing. The registered person must access appropriate training for the staff who undertake the supervision of the resident who self-administers their insulin. The registered person must ensure that correct hand washing procedures are followed in the administration of topical medication. The registered person must ensure the home’s POVA policy reflects the Essex POVA committee’s guidelines and is cross-referenced to them. Timescale for action 04/01/07 2. OP9 13 (2) 13 (4) (c) 31/01/07 3. OP9 13 (2) 13 (3) 04/01/07 4. OP18 13 (6) 31/01/07 Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 24 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 OP7 Good Practice Recommendations The registered person should encourage care staff to complete more informative daily records for residents that give more detail about their mood and well-being. Frank Foster House DS0000017823.V324514.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Frank Foster House DS0000017823.V324514.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!