CARE HOMES FOR OLDER PEOPLE
Garden House Priestlands Sherborne Dorset DT9 4HN Lead Inspector
Mike Dixon Announced Inspection 18th January 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 Garden House DS0000026807.V278975.R01.S.doc Version 5.1 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. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Garden House Address Priestlands Sherborne Dorset DT9 4HN 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) 01935 813188 NO FAX Garden House Rest Home Limited Mrs Gillian Houghton Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: Garden House is a residential home registered to accommodate 15 older persons. It is situated in a quiet residential area of Sherborne and within walking distance of the town centre. Mr Calder purchased the home in 1992 and continues to take an active role in the management of the home. He lives in private accommodation within the grounds of Garden House. In August 2005 a new registration certificate was issued to reflect the fact that the home is under the ownership of Garden House Ltd (the change to a limited company occurred in 1999). Mr Calder is the responsible individual and Mrs Houghton is the registered manager. The home is established in the main house and an extension to the property named Trudys Cottage and is set in landscaped grounds. The front garden is set to lawns and herbaceous borders with mature trees and shrubs and a parking area for visitors convenience. A series of steps lead to the front entrance and a large sliding glass door/window at the front of the house allows access to a raised patio area with garden furniture. The back garden has mature fruit trees, lawns and seasonal flower borders. Once inside the home there is level access to residents rooms and communal facilities. The accommodation is furnished and decorated to a high standard. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was conducted as part of the Commission’s regulatory duty to inspect all care homes twice a year. The purpose was to review the home’s progress in implementing the requirements and recommendations from the previous inspection report. The purpose was also to assess the home’s compliance with the remaining key national minimum standards for older persons that had not been considered during the previous inspection visit. In order to obtain a fuller picture of the home the reader should refer to the earlier inspection report dated 31/8/05 and 19/9/05. An additional inspection visit was carried out by the Commission’s pharmacy inspector on 22/12/05 to review the home’s progress in implementing the requirements and recommendations from her earlier inspection on 19/9/05. During the visit which lasted four and a half hours the inspector spoke with seven residents, the manager and one staff member. He looked round the accommodation and inspected records relating to residents’ care, staffing, medication and health and safety and other documentation relating to the running of the home. What the service does well:
Garden House is fortunate in having both a stable resident and staff group, both of which help to foster a family atmosphere where residents take an interest in each other’s welfare. The emphasis from the management is on encouraging an informal atmosphere and on promoting the comfort of service users. There is a procedure in place for the assessment of prospective residents to ensure that only people whose care needs can be met are admitted. Staff are attentive towards residents’ health care needs and arrange for doctors to visit when residents are unwell. Residents are appreciative of the efforts of the staff and say that they are well looked after. Comments such as “they couldn’t be kinder” and “nothing is too much trouble” reflect the views of the residents that were expressed to the inspector on the day of the visit. There is a varied programme of activities which includes crosswords, card games, bingo, “memory box” sessions and periodic outings. The residents say that these arrangements suit them and meet their expectations. Provision is also made to enable residents to have their spiritual needs met through visiting clergy from different denominations. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 6 The majority of the staff members have attained a nationally recognised qualification, either NVQ level 2 or 3. The manager encourages the staff to undertake training and arranges for health care professionals to carry out training sessions at the home periodically. The manager has achieved the registered manager’s award, equivalent to NVQ level 4. She keeps abreast of both residents and staff members’ views on the running of the home. A formal survey of residents’ views is conducted each year and the results confirm that there is a high level of contentment with the provision of services. What has improved since the last inspection? What they could do better:
There are nine requirements and nine recommendations arising from this inspection, including those that have been brought forward from the previous report. It is a matter of concern that health and safety issues with respect to unguarded radiators and hot water temperatures have not been comprehensively addressed, although they have been brought to the registered persons attention on repeated occasions. The home’s Statement of Purpose and Service User Guide must be amended to comply with regulations. There must be evidence of regular audits of the records of administration of medicines to ensure that they are given as prescribed and accurately recorded. The registered manager should improve the medicines policy for the home to include full procedures for the ordering, administration and handling of medicines. In order to assist with security, it is suggested that temazepam is treated as a controlled drug, including the keeping of a running balance and obtaining two staff signatures for recording purposes.
Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 7 Information regarding service users accessing their personal records in accordance with the Data Protection Act 1998 should be included in the Service User Guide. The wording of the adult protection procedure must be amended as set out and details of the local Social Care and Health office must be included on the policy/procedure to ensure that staff have ready access to the information. The record of fire instruction to staff must include the topic covered and the name of the trainer. The fire risk assessment should be reviewed at least annually to ensure that it includes all relevant aspects and that it reflects the situation and practice in the home. Visual checks to hand-held fire-fighting equipment must be carried out each month and a record kept. There must be improvements to the staff recruitment procedures in order to provide better protection for service users. All staff members should receive moving and handling and adult protection training to ensure that they are fully conversant with current professional guidance/practice. The home’s policies/procedures should be reviewed on at least an annual basis to ensure that the information contained within them is up-to-date. The views of residents’ representatives and external professionals who have contact with the home should be ascertained through the use of periodic surveys (e.g. once a year). Risk assessments conducted in respect of hot water temperatures must be sufficiently comprehensive and up-to-date to take into account the individual circumstances of service users. Remedial action must be taken with regard to hot surfaces of radiators which are located in exposed places, where there is a significant identified risk to the safety of residents. 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. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home has a suitable procedure in place to ensure that only residents whose care needs can be met are admitted. EVIDENCE: No new residents have been admitted to the home for approximately two years. The manager conducts an assessment of prospective residents by visiting them and consulting with other people who have relevant information, e.g. relatives and/or health or social care professionals. A record is made of the outcome of the assessment which is discussed with the person in question. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 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): 8 and 9 The home liaises effectively with the primary health care team and ensures that residents’ health care needs are met. The standard of handling and recording of medication in the home has improved; further development is needed in order to fully safeguard residents. EVIDENCE: Each resident is registered with a general practitioner. The staff monitor the well-being of residents and contact the primary care team when necessary. The manager reported that she was unable to arrange the regular health care checks and reviews of medication to which older people are entitled with the GP surgeries. Doctors visit residents when the latter are unwell and community nurses carry out any nursing tasks that may be required. The staff weigh residents on a regular basis and take action when there are concerns about loss of weight. An example was discussed with the inspector where staff encouraged a resident to regain her appetite to good effect. Residents confirmed to the inspector that their care needs were suitably met at the home and that they had access to health care provision when needed.
Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 11 “they couldn’t be kinder” and “nothing is too much trouble” were comments made which reflected the views of those with whom the inspector spoke. The arrangements for the storage, administration and recording of medication have improved. The MAR (medication administration records) are clearly set out and include all the relevant information. There are now the beginnings of an audit trail to enable the manager to check how well the system is operating. The main matters which remain outstanding are the implementation of a monitoring system, revising the written policy/procedure and securing controlled medication in accordance with guidelines. In order to assist with security, it is suggested that temazepam is treated as a controlled drug, including the keeping of a running balance and obtaining two staff signatures for recording purposes. There are at present no service users who look after their own medication, although this is an option that is made available to service users on admission. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 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 The home offers a varied programme of activities, thus providing a stimulating environment for residents. The home makes arrangements which enable residents to have their spiritual needs met. EVIDENCE: The regular programme of activities comprises the following: a quiz and use of the “memory box” library on alternate weeks, a bingo session once a week and a daily crossword puzzle and a game of cards. The sessions are well attended. There are periodic outings by minibus, most recently there was a trip to the pantomime. Local school children also visit the home regularly to talk with residents and engage in activities. A volunteer continues to visit the home on a regular basis to assist staff and residents with the activity programme. A session of the “memory box” was under way on the morning of the inspection which was enjoyed by several residents. All residents with whom the inspector spoke said that the activity programme met their expectations. There is also the opportunity for the meeting of residents’ spiritual needs. A Holy Communion service takes place once a month and a priest visits the Roman Catholic residents regularly, as requested.
Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 13 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): None of these standards were considered during the inspection. EVIDENCE: Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 14 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): None of these standards were considered during the inspection. EVIDENCE: Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 15 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): 28,29 and 30 The home promotes the achievement of nationally recognised care qualifications and has built a staff team that enjoys the confidence of residents. The home does not carry out all the necessary staff recruitment procedures to provide protection for residents. The home encourages staff to receive training but further work is needed to complete the training programme. EVIDENCE: The manager encourages staff to gain a nationally recognised qualification following completion of a probationary period. Seven of the ten staff members have achieved either NVQ level 2 or 3. As noted earlier in the report, residents have a high opinion of the level of competence of the staff. One new part-time staff member has been recruited in the recent past to carry out light duties at week-ends. The home carried out some of the necessary checks prior to making the appointment, including the taking up of two references, but there were shortfalls with the procedure, including a few that were identified for attention in the inspection report dated 2/3/05. The police/POVA check was completed after the person had been in employment for over a month, there was no record of interview and no health declaration from the staff member; the application form does not provide a section requesting information on the previous employment history of the applicant.
Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 16 The home has an induction programme for new staff but there was little recorded evidence as to what this had comprised for the new staff member who had commenced work in November 2005. However, she had attended a certificated food hygiene and emergency first aid course in December. All staff members are “up to date” with most health and safety topics, the one exception is the training of staff in moving and handling. Although the current group of residents generally require little assistance when transferring, it is important that staff are conversant with current methods/practice. The manager arranges other training sessions “in house” when the need arises. There has recently been a session which was led by a community nurse on the topic of tissue viability and diabetes care. The training needs of individual staff members are considered and reviewed periodically in supervision sessions with the manager. Some staff members have covered the topic of adult protection/prevention of abuse in their NVQ programme. There is a course on this topic that is organised by Dorset County Council which is available to staff from care homes. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 17 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): 31,33,35 and 38 The registered manager is experienced, has some qualifications and enjoys the confidence of residents and staff. Residents’ views indicate a high level of satisfaction with the home; further work is needed to produce a comprehensive quality assurance system. The home has the necessary arrangements in place to safeguard residents’ financial interests. Whilst some measures are in place with regard to the management of health and safety, residents are not fully protected as a consequence of shortfalls with certain aspects of this topic. EVIDENCE: Mrs Houghton, the registered manager, has many years experience of managing a care home. She undertakes day-to-day responsibility for the running of the home, supported by Mr Calder, the registered Responsible Individual for the Company. The manager does not have a formal job description; however, her role is clearly understood by the residents and the
Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 18 staff. Mrs Houghton has achieved the registered manager’s award at NVQ level 4. In order to meet the relevant standard for managers she needs to achieve NVQ level 4 in care; she has registered to do this and anticipates completing the award within three months. The manager conducted a survey of residents’ views about the home in August 2005, the results of which indicated a high level of contentment and no areas of concern. There are a number of components to a quality assurance system and the home is complying with some of them. For example, staff also have the opportunity to share ideas and the noting of minutes of staff meetings is one way in which the home evidences this aspect. The area in which the home is currently weak concerns the updating of policies/procedures to ensure that they are in accordance with guidance and expected practice. It would also be prudent to expand the scope of the annual surveys to include representatives of residents and external professionals who have contact with the home. The home has no involvement with residents’ finances or money, in accordance with its own stated policy. Residents are given the option of having a lockable facility for the safe keeping of valuables if they so wish. The home has a health and safety policy. The management and staff take measures to promote the health and safety of residents, including the recording of accidents and taking measures to minimise a reoccurrence, training in health and safety and fire precautions and the carrying out of risk assessments. There are some shortfalls with the home’s provision. One particular area concerns the very hot radiators, some of which are in exposed positions. Risk assessments regarding this topic are more comprehensive and the manager has begun to take steps to address the matter but the possibility of a resident burning him/herself in the event of a fall against a radiator remains present. Risk assessments regarding hot water temperatures to outlets accessed by residents are still not sufficiently robust. In some areas temperatures exceed sixty degrees centigrade; the recommended maximum is forty three degrees. Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 19 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 x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 4&5 Requirement The statement of purpose and service user guide must be amended to comply with regulations. A copy of the revised documents must be sent to the Commission and be supplied to each service user and/or their representative. Previous timescales not met, most recently 31/10/05. There must be evidence of regular audits of the records of administration of medicines to ensure that they are given as prescribed and accurately recorded. The wording of the adult protection procedure must be amended to make it clear that no investigation of an alleged abuse incident is investigated by the management prior to obtaining the approval of an officer from Social Care and Health. The details of the local Social Care and Health office must be included on the policy/procedure to ensure that
DS0000026807.V278975.R01.S.doc Timescale for action 28/02/06 2. OP9 13(2) 28/02/06 3. OP18 13(6) 28/02/06 Garden House Version 5.1 Page 21 staff have ready access to the information. This was previously a recommendation, the wording has been expanded and it is now a requirement. The record of fire instruction to staff must include the topic covered and the name of the trainer. This requirement has been amended to reflect that it has been mainly met; previous timescale of 31/11/05 not met. Visual checks to hand-held firefighting equipment must be carried out each month and a record kept. Previous timescale of 31/10/05 not met. A new staff member must not commence work at the home before a “POVA first” check has successfully been completed via the CRB and before suitable supervisory arrangements have been made, in accordance with regulations. A record of the outcome of the interview of prospective staff members must be made. The application form must include a section which invites the applicant to make a statement about his/her state of health, or there must be other evidence to demonstrate the mental and physical fitness of the applicant. Risk assessments conducted in respect of hot water temperatures must be sufficiently comprehensive and up-to-date to take into account the circumstances of service users, including communal areas
DS0000026807.V278975.R01.S.doc 4. OP19 23(4) 31/03/06 5. OP19 23(4) 28/02/06 6. OP29 19(1)(5) 31/01/06 7. OP29 19(1)(5) sched 2 31/01/06 8. OP38 13(4) 28/02/06 Garden House Version 5.1 Page 22 to which they have access. Previous timescale of 3/11/05 not met. Remedial action must be taken with regard to hot surfaces of radiators which are located in exposed places, where there is a significant identified risk to the safety of residents. This requirement has been amended to reflect that it has been partially met; previous timescales not met, most recently 31/12/05. 9. OP38 13(4) 31/03/06 Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 23 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 OP9 Good Practice Recommendations The registered manager should improve the medicines policy for the home to include full procedures for the ordering, administration and handling of medicines (see guidance previously provided and enclosed). This recommendation is made for the second time. Information regarding service users accessing their personal records in accordance with the Data Protection Act 1998 should be included in the service user guide. This recommendation has been mainly addressed and is made for the fourth time. The fire risk assessment should be reviewed at least annually to ensure that it includes all relevant aspects and that it reflects the situation and practice in the home. The application form should be amended to facilitate applicants giving a full employment history. All staff members should receive moving and handling training to ensure that they are fully conversant with current professional guidance/practice. All staff members should receive training on the topic of adult protection, preferably from an accredited trainer. The home should keep a record of the content of the induction programme of newly appointed staff members. The home’s policies/procedures should be reviewed on at least an annual basis to ensure that the information contained within them is up-to-date. The views of residents’ representatives and external professionals who have contact with the home should be ascertained through the use of periodic surveys (e.g. once a year). 2. OP14 3. 4. 5. 6. 7. 8. 9. OP19 OP29 OP30 OP30 OP30 OP33 OP33 Garden House DS0000026807.V278975.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Garden House DS0000026807.V278975.R01.S.doc Version 5.1 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!
