CARE HOME ADULTS 18-65
Fraser Drive 9 & 11 Fraser Drive Woodseats Sheffield South Yorkshire S8 0JG Lead Inspector
Ms Shelagh Murphy Unannounced Inspection 09:20 10 November 2005
th Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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 Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fraser Drive Address 9 & 11 Fraser Drive Woodseats Sheffield South Yorkshire S8 0JG 0114 274 5033 0114 274 5033 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) New Era Housing Association Limited Ms Deborah Jayne Bayley Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: Fraser Drive is a purpose built 12-bed home for adults with learning disabilities aged between 18-65 years. Residents live in two separate detached houses that share the same grounds. The home is in a residential area of Sheffield with good access to public services and amenities (e.g. bus services, shops, libraries etc). Each house has 6 single bedrooms, based on the ground floors, a communal lounge and dining room and a domestic style kitchen. Sufficient bathing facilities are provided. The gardens have lawned and paved areas, a variety of seating is provided. There is a small car park. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Shelagh Murphy carried out this unannounced inspection over three hours from 9:20 to 13:15. Carol Loftus, manager was present during the inspection. Opportunity was taken to make an inspection of the home, examine a sample of records and policies and talk to staff and residents. The inspector had the opportunity to speak to 2 staff on duty and speak in depth to 2 residents. What the service does well: What has improved since the last inspection?
The service user plans had been reviewed on a regular basis and ensured the staff knew how to meet the residents’ needs. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 6 The manager and staff had taken action to encourage some of the service users to become more involved in preparing meals and other independent living tasks, such as washing their laundry and cleaning their bedrooms. The manager stated that action to ensure one of the residents whose cultural and religious needs were not being met, had been taken and that she had been supported to meet some of these needs and to re-build family links to ensure their needs in this area could be met. Several rooms in the houses had been redecorated and refurbished. The acting manager has now been employed as the permanent manager and has applied to become the registered manager with the CSCI. The staff interviewed said the new manager was supportive and that staff morale had improved since she took over the post. Some staff have started the LDAF induction and foundation training to ensure they understand the needs of the service users they work for. Practices within the service are being developed to be in line with current good practice in learning disability services. Several staff had been given training to develop person centred plans and one staff member had recently been trained to devise health action plans with service users. Staff sickness monitoring systems had been introduced which had partially resulted in staff sickness levels continuing to fall and this had improved the service users opportunities to take part in meaningful activities on and off site. Fire doors within the home were checked and action had been taken to ensure they all closed properly to protect the health and welfare of the residents and staff in the home. The manager has just started the NVQ4 care management award, this will enable her to develop managerial and practice skills. Health and safety policy, procedures, practices and systems were checked they met the required standards in each area except staff training, action now needs to be taken to address this. What they could do better:
Service users needs assessments need to be filed on their individual plans, to ensure that staff know whether their assessed needs are being met. All of the residents care plans need to be reviewed to ensure all of the information required by the regulations are recorded in them. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 7 The risk assessments need to be devised for the individual residents, these then need to be filed on the individual plans to ensure the residents are protected from unnecessary harm. Medication administration procedures need to be reviewed to ensure all medication records are completed appropriately to protect the service users. Flooring in laundry area needs to be replaced as it is broken and split as at present it poses a potential risk to the standards of hygiene in the home. The toilet in the bathroom used by male service users in House 11 and the downstairs toilet in House 11 need to be changed to meet the service users needs. The manager needs to increase the number of formal staff supervision meetings to ensure the staff team are properly supported. Service users and relatives need to be surveyed and the findings then need to be published and included in service development plans to ensure their views are included in any future development of the service. Staff need to complete all mandatory training at the appropriate frequency to ensure the service users health and welfare is protected. 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. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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 Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Needs assessments were not kept on the service users individual plans as they had been archived. EVIDENCE: None of the service users individual plans contained needs assessments as they had been archived. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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, 8 and 9. All of the residents had care plans; those checked were detailed but did not contain all of the information required by the regulations. There were also some records, which needed to be updated to ensure the resident’s needs were monitored. The individual care plans had been reviewed on a six monthly basis. The residents were being encouraged to participate more in all aspects of daily life in the home. Risk assessments were not available on the individual service users plans that were checked. The manager was advised that they must be drawn up as a priority to protect the residents and staff. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 11 EVIDENCE: Two of the residents’ care plans contained the majority of the information required by the regulations, but were not detailed enough. They had been reviewed on a quarterly basis with the resident and other interested parties e.g. relative’s or health professionals. However, there were a few issues, which needed to be addressed to ensure good practice. These included a record should be made of whether the individual residents weight should be monitored on a regular basis, as this was not regularly recorded in the files checked. The service users appointments with health services were also incomplete in some areas. These actions will ensure that the resident’s individual needs are monitored and supported in an appropriate way. There was evidence that the residents were being encouraged to become more involved in participating in all aspects of life in the home. Two residents told me they were supported by staff to develop independent living skills by shopping for personal goods and services, food preparation, food shopping, cleaning their rooms and washing their laundry. They had also been supported to choose the décor and furnishings in their rooms and to decide on their daily and leisure activities. One resident said he was on a consultation group representing the service users of New Era in the future developments of the service. Risk assessments were not available on the individual residents care plans that were checked. The staff said there were generic ones for all of the residents in the manager’s office. The manager was advised that individual risk assessments relating to all aspects of the residents lifestyle must be drawn up as a priority to protect the residents and staff from unacceptable risks. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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 & 14. All resident’s had some opportunities to access age, peer and culturally appropriate activities to meet their needs. Some resident’s regularly accessed leisure activities. They were also supported to access other community facilities, such as shops, pubs, theatres, restraints and local parks etc on a regular basis. The resident’s were supported to have appropriate relationships with their peers and relatives. EVIDENCE: There were several regular planned activities organised at the home on a weekly basis. Named member of staff at the home are responsible for coordinating the service users leisure and daily activities. The manager reported that there were regular planned activities available at the home. One resident stated that they had a regular day service job and another person said they enjoyed doing cookery with staff. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 13 The manager stated that action to ensure one of the residents whose cultural and religious needs were not being met, had been taken and that she had been supported to meet some of these needs and to re-build family links. The staff reported that other activities were planned for residents on an ad-hoc basis, these included trips out shopping to the pub and for meals, theatre trips and trips to local parks and the countryside. The manager reported that far more activities now took place, as there were more staff on duty on a regular basis, however, there were no central records of this, which made it difficult to measure their frequency. The staff reported that they have access to transport to support the resident’s mobility/transport needs to access the community. Several residents told the inspector that they are, supported by staff to phone and visit their relatives. There was evidence in the care plans checked that relatives and other supporters are invited to care plan review meetings. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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. Residents had care plans, which identified how personal support should be offered to each individual. However, more detail was needed to ensure all staff were aware of how the resident wished to be supported and to ensure continuity of care was provided. The medication at the home was stored appropriately and safely, there were however, some anomalies in the recording of medication administered to residents, which could pose a potential risk and therefore must be addressed. EVIDENCE: Residents’ personal support and emotional needs were recorded in the individual plans checked, but were not detailed enough. The records of the residents’ physical needs, regarding health care appointments also need to be kept up to date to ensure that they are receiving appropriate health care at the frequency required. The residents interviewed said they were quite satisfied with the support they received from the staff, who they described as treating them with respect and protecting their dignity. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 15 None of the residents are able to self medicate and therefore are reliant on care staff for this. The medication was checked and found to be stored appropriately. The recording of medication administered was generally good, however, there were some occasions where staff had not signed for medication administered to the residents. The medication administration record sheets were vague in some cases about whether the medication was to be administered on a daily or as required basis. This was brought to the managers’ attention immediately for action to be taken to address this as this could potentially place residents at risk. An immediate requirement to address these anomalies was issued on the day of the inspection. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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): None checked. None of these standards were checked at this inspection, as they were met at the last inspection. EVIDENCE: Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 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, 27, 29 & 30. Overall, the home provided a lovely, homely environment for the residents who live there. The home was comfortable, generally well maintained, clean and free from odours. A few minor issues were noted and will need attention. The resident’s bedrooms were clean, free from odour and had been personalised by being decorated and furnished to their individual needs and taste. The bathrooms and toilets in the home generally met the residents’ needs. However, one resident needed to have an assessment to identify if they needed specialist toilet equipment to meet their continence needs. The home was very clean and the laundry areas were all appropriately equipped to meet the needs of the residents. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 18 EVIDENCE: Overall the environment within the houses was good, they were well decorated, comfortable, clean, homely and well maintained. There were some minor maintenance issues found during the inspection. These issues have been highlighted below. Several communal areas and bedrooms had been redecorated since the last inspection and were very attractively decorated and furnished. All of the residents bedrooms were well decorated, comfortable and reflected the individual’s needs and personalities. The gardens were attractive and tidy, they were well maintained and were safe for the residents and staff. One of the bathrooms and a toilet area in this house did have an unpleasant odour of incontinence and action to eradicate this smell must be taken as soon as possible. The staff reported that one of the male service users needed to have access to a specialist toilet or urinal to meet their needs, therefore a referral to a specialist to assess his continence needs must be made to ensure this persons needs are identified and then appropriate equipment needs to be supplied to meet these needs. Another bath needed to have the side panel replaced as it had perished. The laundry rooms in each house were found to be appropriately equipped, safe and met the resident’s needs. Staff reported they had been supplied with appropriate protective equipment. The floor covering in house 11’s laundry needed to be replaced as it had split. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 & 36. Overall the residents are supported by very experienced staff who are competent and have the qualifications required to meet their needs. Some mandatory health and safety refresher training needs to be offered to some staff to bring them all up to date. The manager reported that although the frequency of the individual staff supervisions had improved she had still not been able to offer all staff the minimum stated in the standards of six sessions per year. However, two senior support workers were to be recruited and trained to take on some of this responsibility. EVIDENCE: The home had a stable staff team, who know the residents very well and who from observation have developed supportive relationships with residents and relatives. The residents said they liked the staff that worked at the home. 18 staff at the home had completed the NVQ2/3 care awards and three staff were still working towards the award. This is extremely good and exceeds the 50 of the staff team requirement. Some staff had started the LDAF induction and foundation training to ensure they understand the needs of the residents they work for.
Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 20 Practices within the service are being developed to be in line with current good practice in learning disability services. Several staff had been given training to develop person centred plans and one staff member had recently been trained to devise health action plans with service users. Some mandatory refresher training was out of date for some staff and this will need to be provided. The staff supervision records showed that although the frequency of staff individual supervisions had increased since this manager took over that most people had only had three or four supervisions over the last year and staff confirmed this to be the case. The manager said that she would shortly be training senior support workers to take on some of this responsibility. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39 & 42. The residents were benefiting from an appropriate ethos, leadership and management approach by the new manager. Who had recently been employed as the permanent manager and has applied to become the registered manager with the CSCI. There was no regular, formal system in place to seek the views of the residents in self-monitoring or review and development of the service. The manager was well aware that this is an area that needed to be developed in the home. Overall the health, safety and welfare of the residents was promoted but some issues still need to be addressed to ensure, the residents are protected. EVIDENCE: The manager had applied to become the registered manager of the service with the CSCI and had just started the NVQ4 care management award, this will enable her to develop managerial and practice skills. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 22 The staff interviewed said the new manager was supportive and that staff morale and sickness levels had improved since she took over the post. Staff sickness monitoring systems had been introduced which had partially resulted in staff sickness levels continuing to fall and this had improved the service users opportunities to take part in meaningful activities on and off site. The residents also said they liked the manager and observations during the inspection would confirm this. The manager’s approach was one of inclusion of the staff in making a comfortable and safe home for the residents whilst empowering the staff to do more with the residents to increase their independence. The manager said there were no regular or formal systems in place to ensure the resident’s views were considered in the development of their service and their home at a local level. She said that they had devised some customer satisfaction questionnaires for the residents in pictorial formats but these had not been sent to all service users or collated and the results identified and fed back. Action now needs to be taken to address this. Health and safety policy, procedures, practices and systems were checked, The majority of the regulations had been complied with all appropriate certificates for gas, boilers, water and electrical safety were in place. COSHH sheets had been completed and systems were in place to store these substances safely. Checks on fridges and water temperatures had been regularly monitored. Overall the home met the required standards in each area except staff training, recording of medication and individual risk assessments, the manager was advised that action now needs to be taken to address these issues. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CONCERNS AND COMPLAINTS CHOICE OF HOME Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 3 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X X 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20
Fraser Drive Score 2 2 2 Standard No 37 38 39 40 41 42 43
DS0000002959.V261630.R01.S.doc Score X 3 1 X X 2 X
Version 5.0 Page 24 21 X Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 25 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 Regulation Requirement All care plans must be reviewed to ensure they contain all of the information required by the regulations. As a minimum the care plans must then be reviewed every six months. (Requirement first made on 27/4/05) Individual risk assessments must be devised for all of the service users as appropriate to meet their needs. Risk assessments must then be reviewed on a regular basis. (Requirement first made on 27/4/05) The service user identified must be referred for a specialist assessment to meet his continence needs. Medication sheets must accurately record the service users medication and who administered it. Toilet and bathing facilities, which meet the service users assessed needs must be supplied and fitted. The side panel on the bath
DS0000002959.V261630.R01.S.doc YA6YA18YA19 15,17 Timescale for action 31/01/06 2. YA9 17 31/01/06 3. YA19 12, 23 31/01/03 4. YA20 13 10/11/05 5. YA27YA29 23 31/03/06 Fraser Drive Version 5.0 Page 26 must be repaired or replaced. Action must be taken to eradicate the odour of incontinence in the toilet and bathroom identified. 6. 7. 8. 9. YA30 YA35YA42 YA36 YA39 23 18 18 24 The laundry floor covering must be replaced or repaired. All staff must receive appropriate mandatory training at the required frequency. All staff must be supervised on a regular basis. (Requirement first made on 27/4/05) Service users views of the service must be sought and the results published and then action to address any concerns must be taken. 31/03/06 31/07/06 31/03/06 30/06/06 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. 2. 3. Refer to Standard YA2 YA32 YA37 Good Practice Recommendations A review of the activities for three service users identified should take place and any remedial action required should be implemented. 50 of the staff team should have achieved National Vocational Qualifications (NVQ) in care by 2005. The registered manager should hold a level 4 National Vocational Qualification in care and management or equivalent by 2005. Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Fraser Drive DS0000002959.V261630.R01.S.doc Version 5.0 Page 28 - 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!
