Inspection on 08/08/06 for Frome House

This inspection was carried out on 8th 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 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

Frome House 13/12/05

Frome House 17/06/05

Frome House 18/01/05

Frome House 17/08/04

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

CARE HOMES FOR OLDER PEOPLE Frome House Cranleigh Court Road Yate South Glos BS37 5DE Lead Inspector Melanie Edwards Key Unannounced Inspection 8th August 2006 09:30 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 Frome House DS0000035230.V305093.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. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Frome House Address Cranleigh Court Road Yate South Glos BS37 5DE 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) 01454 866046 01454 866822 terri-bryant@southglos.gov.uk South Gloucestershire Council Mrs Teresa Bryant Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate 31-service users aged 65 years and over requiring personal care only. 13th December 2005 Date of last inspection Brief Description of the Service: Frome house was purpose built in the 1960s to provide accommodation, personal care and support for 31 older people. It is operated by South Gloucestershire Council. The home is situated off a busy main road in a residential area of Yate, South Gloucestershire. It is a short walk to shops and is within easy reach of the towns main shopping centre where there is a full range of community facilities. There is a regular bus service to Yate town centre and to the centre of Bristol. The accommodation consists of a two-storey building that is fully accessible to residents. There are ramps, a passenger lift and a staircase. All the homes bedrooms are single. Each bedroom has a wash hand basin. The home has gardens that are well maintained and are easily accessible. The fees to stay at the Home are £497 a week. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Seventeen of the twenty-six residents living at the Home were consulted to find out their views of the care and the service provided. One care assistant, the registered manager, and the cook were consulted about their roles and responsibilities, their training needs, and how they assist and support residents. Staff were observed while they were helping residents with their needs. A selection of records that relate to the day-to-day running and management of the Home were inspected. A selection of care records were also looked at in detail. The majority of the environment was seen and the only areas that were not viewed were a small number of resident’s bedrooms. The Home was operating within the required conditions of registration set down by the Commission for Social Care Inspection. The conditions of registration detail the type of care and the needs of residents as well as the numbers of residents who may stay at the Home. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Frome House DS0000035230.V305093.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 Frome House DS0000035230.V305093.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,6 Overall quality in this outcome area is excellent. Residents’ needs are met to a high standard. Residents’ needs are also assessed in detail by the Home. Residents and prospective residents are provided with the necessary information about the Home to make an informed choice about the service. These judgements have been made using available evidence including a visit to the service. EVIDENCE: All of the residents consulted were asked about how the staff assist them and how well they feel their needs are being met. There were numerous comments of a commendably high level of satisfaction expressed by residents. Examples of comments made included, ‘it is a very good service, you couldn’t wish to be in a better place’, `I had arthritis and could hardly move and they bent over backwards for me’, ‘the home is very well run and every body is very very helpful’, `its very nice you couldn’t wish to be in a better place, it’s the attitude of the staff’, `we couldn’t be anywhere better I’m very well looked after’, Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 9 ‘when I was ill they couldn’t do enough for me’. These comments demonstrate residents feel very satisfied by the care they receive. They were also reflective of comments made by all the residents and visitors, who were consulted, and the comments written in the feedback forms sent to the Commission for Social Care Inspection. To find out how the Home assesses needs, three resident’s assessment records were reviewed. There was information included in the assessment records demonstrating an assessment of the residents physical, communication, and mobility needs had been carried out. There was also an assessment for each resident of their nutritional preferences and their manual handling needs. Mrs Bryant explained that assessments of residents skin vulnerability, and the risk they may face of developing pressure sores are carried out with the close involvement of district nurses. The completion of these assessments helps demonstrate residents’ needs have been identified and addressed. The assessment records had been reviewed on a regular basis helping to demonstrate residents’ needs are monitored by the Home. Care staff and Mrs Bryant were helping residents with their needs in a gentle and respectful manner. As already stated all of the residents who were asked expressed a high degree of satisfaction with the care and the service they receive. There were no residents in the Home at the time of the inspection admitted solely for intermediate care. Frome House DS0000035230.V305093.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Overall quality in this outcome area is good. Residents’ needs are set out in an individual plan of care, and their needs are met, and residents’ medication is handled and administered safely in the Home. Residents are treated with respect and dignity. These judgements have been made using available evidence including a visit to the service. EVIDENCE: All of the staff on duty were observed helping residents with their needs, and speaking to them in a very polite and respectful way. Staff were also observed knocking on bedroom doors before entering them. All of the residents who were consulted spoke extremely positively about the attitude of staff as has already been referred to. All the residents said that staff are very polite, kind and courteous to them. Three care plans were read to find out how residents are supported to meet their needs. The care plans seen were reasonably informative and detailed how to meet the care needs of the residents. Care plans included guidance for staff to follow to support residents with physical, social and communication needs. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 11 The three care plans that were inspected had been reviewed regularly, which helps to demonstrate staff monitor residents changing needs. There is a medical health record maintained with the care plans for each resident. This records when residents see the doctor, the optician the dentist and the chiropodist, the reason for the referral and if treatment was required. There was further evidence written in daily records that showed residents see the optician and the chiropodist on a regular basis. There was information in the daily records that staff were monitoring and observing the health of residents and call the doctor, if they were concerned about the resident. Staff and Mrs Bryant were also observed spending time with residents when they were upset in mood and needed extra support. This helps to demonstrate how residents are supported with their psychological needs. A district nurse was in the Home during the inspection attending to one resident. They commented very positively about the good communication and general standards of care from staff at the Home who contact the nursing team if concerned about residents’ health care needs. To find out if safe medication practices are carried out, the practices and procedures for administration, and storage of medication were checked with the help of one of the duty managers. Medication supplies are stored in secure cupboard in a secure clinic, and in a locked moveable metal trolley. All senior staff administering medication will attend regular training to enable them to do this safely. Four resident’s medication administration charts were looked at. There was a photograph of each resident with his or her chart. This should ensure medication is administered correctly to the resident named on the chart. The administration charts were legible. The resident’s medication charts had been signed by staff and the reasons for an omission of medication had also been recorded. This demonstrates the resident has had the medication that they need. The stock of medication held in the Home was satisfactorily organised. Medication that was no longer required was being returned to the pharmacist. This helps ensure residents’ medication supplies are kept in good order and can be easily monitored. Frome House DS0000035230.V305093.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Overall quality in this outcome area is good. Residents are able to take part in a range of social and therapeutic activities and they are also supported to maintain contact with family and friends. Residents are also provided with a varied and well balanced diet. These judgements have been made using available evidence including a visit to the service. EVIDENCE: There is a range of organised social activities for residents to take part in, and these include bingo, a regular exercise group, and trips to areas of interest in the community. There is a trip planned to Weston-super-Mare next week, and a number of residents said how much they were looking forward to this. One resident had gone to Dorset for the day with a support group that they attend outside of the Home. There is also a newsletter published regularly for residents, keeping them well informed about life in the Home .One resident kindly showed the inspector a recent article that they had written for the newsletter. This demonstrates how well involved residents feel they are in the day-to-day running of the Home. A group of residents were observed listening to a singer who regularly visits the Home to entertain residents. Residents looked as if they were enjoying the music. Residents were observed walking Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 13 around the Home, and approaching staff, they looked very relaxed and settled with staff and in their surroundings. Residents were observed receiving visitors, and the Home clearly operate a relaxed and flexible visiting policy. Staff and Mrs Bryant were observed talking with visitors and welcoming them, in a warm and courteous manner. This should help to ensure residents keep in close contact with their families and friends. There is a good-sized dining room for residents to take their meals in. Tables were covered with linen tablecloths. The Home operates a rotating menu. The menu choices were checked and were well balanced, and traditional. Residents can make a choice of what meal they would like to have. The daily menu is written on a large notice board in the dining room to assist residents. Residents seemed to enjoy the mealtime as a social event. A portion of the lunchtime meal was sampled; this consisted of a choice of pasty and chips with salad, or sausage egg and peas with boiled potatoes. There was a choice of baked apple with custard or homemade rice pudding for dessert. The meals were tasty, and well cooked. All the residents consulted spoke positively about the quality of the cooking in the Home and the range of options that are available. Frome House DS0000035230.V305093.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Overall quality in this outcome area is good. Residents’ complaints about the service are listened to and acted upon. There also systems in place to protect residents from abuse and harm. These judgements have been made using available evidence including a visit to the service. EVIDENCE: There is a copy of the complaints procedure on display in the reception area. This includes up to date contact information for the area office of the Commission for Social Care Inspection. A copy of the complaints procedure is included in the service user guide and all residents and representatives are given a copy when they first come to the Home. The complaints book record was reviewed and there had been no complaints recorded since the last inspection. All of the residents consulted said they felt very able to speak to any of the staff if they had any concerns. They said staff would respond promptly and take their concerns seriously. Many residents said they would go to `Teri’, the registered manager, and they said she would try and sort their concerns out, `immediately’. Residents are protected from the risk of harm or abuse by staff following the South Gloucestershire Council’s `protection of vulnerable adults from abuse’ policy. There was also evidence in the staff-training plan that staff attend regular training on the protection of vulnerable adults from abuse, to help ensure residents are protected. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Overall quality in this outcome area is good. Residents live in an environment that is clean, satisfactorily maintained and suitable for residents to live in and there are the necessary adaptations and equipment in place to meet residents’ needs. These judgements have been made using available evidence including a visit to the service. EVIDENCE: Frome House is a purpose built Home set in its own grounds. The gardens are satisfactorily maintained and there are seats and an area where residents can sit and walk safely. Residents were observed walking and sitting in the grounds. There is wheelchair access to the Home and the gardens. There is a lift servicing the upper floor. The Home is a two-storey building, and residents have access to all areas. There are adaptations in place to assist residents and visitors with disabilities throughout the Home. There are a dining room and Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 16 three smaller lounges. Residents were observed sitting in the lounges and dining room, looking very relaxed and comfortable in their surroundings. There are bedrooms situated on the ground and first floor. The décor and domestic style furnishings and fittings in rooms, lounges and seating areas helped to minimise the institutional effects of the environments design. Bathrooms include specially adapted baths to assist residents who may have reduced mobility. There are toilets situated in readily accessible parts of the Home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimize risk from cross infection in the Home. The Home looked clean and tidy in all of the areas that were viewed and domestic staff were carrying out their duties during the inspection. Bedrooms are not en-suite but they do have hand washbasins in them, for residents’ personal use. There are sluice washer disinfector facilities on each floor. These are separate from residents’ toilet and bathing facilities to minimise any risk of cross infection to residents. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Overall quality in this outcome area is good. Well-trained competent staff care for residents. There are also a sufficient number of staff on employed at the Home to meet residents needs. These judgements have been made using available evidence including a visit to the service. EVIDENCE: Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 18 The staff duty record for the previous three weeks was checked to see out if residents are cared for by a sufficient number of staff to ensure their needs are met. There is a minimum of four care staff on duty as well as at least one manager working during the day with extra staff available at busy periods. There are two care staff on duty at night. To observe staff carrying out their duties, time was spent sitting in the communal areas while staff assisted residents. All the staff were polite and courteous in manner. Staff were observed helping residents with their care needs, and assisting them with their lunchtime meals. Residents needing extra help to eat their lunch were being supported by staff in a discreet manner. Staff were also asked about how they help residents with their needs. The staff consulted demonstrated a good understanding of how to support residents with their needs. Based on the evidence from the inspection the number of staff on duty is meeting residents’ needs well. The staff-training file was looked at to find out if staff attend a range of training opportunities. These consisted of the care staff and managers. All of the staff concerned had attended recent training and update sessions on topics and matters relevant to the needs of residents in the Home. Training sessions staff had attended included courses in understanding dementia to further assist staff in understanding the changing needs of some of the residents in their care. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38 Overall quality in this outcome area is good. Residents’ benefit from the leadership and management approach of Mrs Bryant, and the Home is run in their best interests. Staff are well supervised in their work and practice. Also residents’ health and safety is promoted and protected in the Home. These judgements have been made using available evidence including a visit to the service. EVIDENCE: Residents are cared for by a management team consisting of the Manager, Mrs Terri Bryant and four duty managers, who have a number of years of experience between them. Managers are working towards obtaining various management awards. Mrs Bryant has been a registered manager at the Home for a number of years and has worked in care settings for over twenty-two Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 20 years .All of the residents consulted spoke very positively about Mrs Bryant and the way she runs the Home and helps residents. Examples of comments made by residents included, ` Teri’s a very good manager’, it’s a very well run Home’. Many residents also commented, that if they had any concerns they would see Teri and she would, `immediately’ try and sort them out. Residents also reported that residents meetings are held reasonably regularly in the Home, and they said this was an opportunity to express their views about the Home to Mrs Bryant or other senior managers. Residents’ records are kept securely locked away in filing cabinets in the Home’s office, and are available to staff if they should need them. The records seen were legible, up-to-date and generally in satisfactory order. This helps to demonstrate good organisation and management of the Home. Mrs Bryant said that staff meetings are held regularly, records were briefly looked at on the inspection. There are separate meetings held for cooks, managers, domestic and care staff. The staff consulted also said that they are provided with regular support and supervision of their work and practices. One manager’s supervision records were checked. The records demonstrated they are being well supported and guided by Mrs Bryant in their work. This benefits residents if staff are well supervised and supported, as this will have a positive impact on the quality of care and the service. The monthly monitoring visits of the Home that must be carried out by a representative of South Gloucestershire City Council are being undertaken as is required by law. There are detailed and informative records of these visits being sent to the Commission for Social Care Inspection. The records demonstrate that the designated individual responsible for the visits spends time consulting with residents and their representatives and observing staff carrying out their duties. Residents are also being consulted on a very regular basis by staff at the Home about their views of the service, as part of the overall quality monitoring of the Home to maintain and improve standards further. Records were seen that demonstrate residents are being regularly consulted. Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 21 The environment looked satisfactorily maintained throughout. The fire logbook records showed fire alarm tests are being carried out. There are also fire drills carried out on a regular basis to help protect the health and safety of residents and staff. Currently day staff attend fire drills on a regular basis. However while the night staff do undertake fire safety training they do not take part in fire drills. It would benefit residents and staff health and safety if night staff were to attend regular fire drills. The kitchen was tidy and organised when viewed. The Home has also recently been granted a South Gloucestershire Council award for its high standards of health and safety practices in the kitchen. The staff are to be commended for this achievement. Staff are provided with regular training in health and safety matters including first aid, food hygiene and moving and handling practices. This should help protect residents’ health and safety if staff are knowledgeable and well trained in these health and safety principles and practices. Frome House DS0000035230.V305093.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 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 2 Frome House DS0000035230.V305093.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 OP38 Regulation 23.4(e) Requirement All night staff must take part in fire drills. Timescale for action 08/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Frome House DS0000035230.V305093.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Frome House DS0000035230.V305093.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!