Inspection on 20/07/06 for Garden Lodge Care Centre

This inspection was carried out on 20th July 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

Garden Lodge Care Centre 20/11/08

Garden Lodge Care Centre 14/03/06

Garden Lodge Care Centre 26/11/05

Garden Lodge Care Centre 18/01/05

Garden Lodge Care Centre 08/09/04

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

CARE HOMES FOR OLDER PEOPLE Garden Lodge Care Centre Middlemass Hey Liverpool Merseyside L27 7AR Lead Inspector Les Smith Unannounced Inspection 20th July 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 Lodge Care Centre DS0000025345.V304420.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. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garden Lodge Care Centre Address Middlemass Hey Liverpool Merseyside L27 7AR 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) 0151 498 4776 Ashbourne Homes Ltd Care Home 48 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under 65 years old in the residential unit of the home. 14th March 2006 Date of last inspection Brief Description of the Service: Garden Lodge is a residential care home providing 24 hour personal care and accommodation for 24 older people and 24 older people with mental health problems (Dementia) Garden Lodge is owned and managed by Southern Cross Health Care, following a recent acquisition from Ashbourne Homes Ltd. Southern Cross healthcare provide healthcare services across the U.K. The home is located on the edge of a housing estate in the Netherley area of Liverpool. Although the home is some distance away from local shops and amenities, they are easily accessible via a local bus service. The home is a purpose built single storey building that was opened in 1992. There are two separate units, catering for the two different categories of service users. The bedrooms do not have en-suite facilities, however there are sufficient bathrooms and toilets situated throughout the home to meet the needs of service users. Communal space within the home consists of two lounge areas on one unit and two lounges plus a separate dining room on the other unit. Central to both units is a garden area, which is well maintained. Garden furniture is provided and service users use it in the summer. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit on 20th July 2006 and took a total of 8 hours. During the visit time was spent examining records, policies and procedures and a tour of the home was undertaken. Discussions took place with seven visiting relatives, residents, members of staff and the manager. Relatives were unanimous in their praise for the home, the care provided and all made comments to support their view, ‘its brilliant here’, ‘we are just like one big family’,’ we know our loved ones have everything they need’. Members of staff were observed to be going about their work in a cheerful manner and clearly had good relationships with the residents. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 6 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 Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 7 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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have sufficient information to make an informed decision on were they wish to live and may be confident that their needs will be fully assessed and that those needs can be met prior to accepting a place at the home. EVIDENCE: The current Statement of Purpose and Service Users Guide contain all the information required to make an informed decision. Southern Cross Healthcare is currently changing the homes Statement of Purpose and Service Users Guide to new versions and these will be available by 4th August 2006. All residents and their representatives if appropriate will be provided with the new documents as soon as they are finalised. A random selection of residents files were reviewed and contracts or Statement of Terms and Conditions were in place. It is recommended that a system be put in place to monitor the return of a signed copy of the relevant document. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 8 Examination of a selection of residents care files demonstrated that a comprehensive assessment of needs had been carried out prior to admission. The assessments were detailed and provided all of the information necessary to formulate initial risk assessments and an initial plan of care. New documentation has been provided by Southern Cross Healthcare, which is also detailed and comprehensive and includes a detailed dementia specific assessment. These documents provide an excellent assessment tool and will further enhance the assessment process. The home is fully equipped with appropriate aids and has a well motivated and trained workforce equipped with the necessary knowledge and skills to care for residents within the homes registration categories. Garden Lodge encourages prospective residents and their representatives to visit the home as often and as for as long as they wish. Residents are offered the opportunity of a four-week trial to enable them to assess the care before making a final decision. The home is not registered for intermediate care. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 9 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): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning and medication management processes are consistent, promoting the health, welfare and safety of residents. Residents privacy and dignity are respected at all times EVIDENCE: Examination of residents care files demonstrated that care plans were in place and covered all short and long-term assessed needs. Regular reviews of the care plans showed that care plans were modified as changing needs were identified. Short-term plans were removed as and when the assessed need had been shown as met. Relevant risk assessments were comprehensive and detailed and reviewed on a regular basis. The standard of daily reports was good and gave an indication of how the resident had spent their day and details of the care delivered. The care files provided evidence that the multi-disciplinary team was involved whenever required for the ongoing care of residents. Records showed regular assessment of health needs from GPs, continence advisors, district nurses and dentists. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 10 Residents have the choice of remaining with their own GP if possible or registering with a GP at the local health centre. As in other areas of the homes management Southern Cross Healthcare are in the process of replacing previous documentation with their own corporate documents. The new care planning documents now being put in place are comprehensive, detailed and as with the pre-admission assessments will enhance the care planning process considerably. The manager and staff have worked very hard to transfer a substantial amount of information to the new care files. The new files will be brought into daily use week commencing 31st July and it is commendable that all the staff has embraced the new system so enthusiastically. There are currently no residents self medicating at the home but procedures are in place for appropriate risk assessments and storage facilities should anyone wish to manage their own medications. The receipt, storage, administration and disposal of medications comply with requirements and are mostly in accordance with best practice guidelines. The Royal Pharmaceutical Society has advised its members not to issue adhesive labels for medications due to the high potential risk of them being used incorrectly and it is recommended that the use of labels on MAR (Medication Administration record) sheets be discontinued. Both clinical rooms are excessively hot in excess of 250C, which is above the recommended limit for safe storage of the majority of medications. The manager carries regular audits on medications to promote continued good practice. Residents spoken to all confirmed that their privacy and dignity is always respected and maintained. One resident commented ‘staff are very helpful’ whilst another said ‘great here, wouldn’t change a thing’. Observation of care during the day demonstrated a caring staff who always spoke and treated residents with respect ensuring that any personal care was carried out in private. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 11 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from flexible routines and are positively encouraged to make choices in relation to all aspects of their daily life thereby promoting wellbeing for all. EVIDENCE: The home employs an activities coordinator for 16 hours per week. An activities programme is published in the reception area and in various places throughout the home so that residents are kept aware of activities that are available. The activities include bingo, floor and board games, crafts, reminiscence sessions, shopping trips and regular visits by clergy from local ministries. Staff members are encouraged to involve themselves in one to one activities with residents and evidence of this was seen with good levels of staff social interaction particularly with residents suffering from dementia. The commitment of the workforce at Garden Lodge is demonstrated by the recent sponsored event organised and carried out by all staff, which raised over £300 for the benefit of residents’ facilities at the home. The home has recently converted an unused room into a reminiscence room, which is decorated and furnished in the style of 1953 including reproduction copies of newspapers of the day. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 12 The daily routines at Garden Lodge are as flexible as possible and residents are encouraged and facilitated to make choices and exercise as much control over their lives as possible. One resident said ‘I get up when I want and go to bed when I want. If I don’t get up until 1130 I have my breakfast then I have my lunch later when I feel ready for it’ and another said ‘the staff never make assumptions, they always ask me’. Residents have a choice as to whether they wish to have a key to their room and all rooms have a lockable facility were residents can secure any items they wish. Garden Lodge has an open visiting policy and visitors arriving at the home from early morning and throughout the day evidenced this. It was observed that residents were able to see their visitors either in one of the communal areas or their own room according to their own preference. Residents had a general view that the food served at Garden Lodge was good with resident comments ranging from ‘the food is good’ to ‘overall not bad’. The menus are based upon a four-week cycle and are changed in response to requests at residents meetings. The menu of the day is displayed in the reception area and on boards in the dining rooms. An alternative choice is always available for all meals. The midday meal was observed being served and demonstrated a good standard and residents who required assistance received an appropriate level of assistance in a sensitive and dignified manner. The kitchen and food stores were examined and found to be clean and well organised with all relevant records such as food temperatures up to date. The stores were well stocked and local fresh produce is obtained on a regular basis. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of complaints has improved and residents or their representatives can be confident that any complaints will be taken seriously and that systems are in place to protect residents from abuse. EVIDENCE: The home has received one complaint since the last inspection. There has also been one anonymous complaint made directly to the CSCI. The complaint made to the home was resolved in a timely and effective manner. The anonymous complaint has been investigated by the CSCI and found to be unsubstantiated. The central complaints register now meets the requirement from the last inspection that the complaint details, actions taken and outcome are documented. All residents are registered on the electoral roll and assistance is provided as required to enable residents to exercise their rights. The home has policies and procedures in place in relation to Protection of the vulnerable Adult including Whistle Blowing and the ‘No Secrets’ document. Staff training records showed that staff had received training in adult abuse, its various forms, recognition and procedures to follow. This was confirmed by conversations with members of the staff who were able to demonstrate awareness of adult abuse and appropriate procedures. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Garden Lodge is good with a continuing programme of decoration and refurbishment providing a safe, homely and comfortable place to live. EVIDENCE: Garden Lodge is a single storey building of modern design and construction. In addition to the 48 personal rooms divided into two 24-bed units there are two lounge/dining areas on one unit with two lounges and a separate dining room on the other unit. There is substantial evidence of an ongoing programme of redecoration and refurbishment and the manager said that carpets and other floor coverings in the hallways and some of the communal areas are scheduled for replacement by October 2006. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 15 A tour of the home was carried out in the company of the manager, which included the laundry and kitchen. A number of minor items of maintenance were noted such as an extractor fan not working and two lights not working. The low number of minor faults demonstrates that maintenance at the home is effective. The sealant around some of the facilities in bathrooms is in need of renewal. The home is reminded that rooms such as sluices and other store rooms that contain hazardous items such as cleaning materials must be kept secure at all times. The standard of furnishings is good and evidence was seen of significant renewal of furnishings with new chairs in several areas of the home. Lighting is domestic in character and residents in the dementia unit would benefit from a reassessment of the corridor lighting with a view to eliminating the shadows. The manager said this was currently under review. Rooms do not have en-suite facilities but there are sufficient bathrooms and toilets situated throughout the home to meet the needs of service users. Residents’ are enabled to maximise their independence via a range of specialised equipment and relevant aids. Handrails, hoists and assisted bathrooms are available together with a call system available in rooms and all areas of the home. During the tour of the home it was evident that residents are encouraged to personalise their rooms with their own memorabilia and personal possessions. The rooms in the dementia unit had picture recognition on the doors encompassing pictures that had been sourced after consultation with families. Wall decoration in the dementia unit was both pictorial and tactile and included items that were relevant to the residents. The laundry was clean and well organised with appropriate equipment in place. At the time of this visit the home was clean, tidy and free from any odours. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 16 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff members are recruited via robust policies and procedures, are well trained and deployed in sufficient numbers and skill mix to support and protect the residents EVIDENCE: Examination of the off duty rosters showed that there were sufficient staff on duty at all times to meet the assessed needs of the residents. Visitors to the home were highly complimentary about the staff and comments included ‘nothing is too much trouble’,’ it is a long time since she has appeared so happy’ and ‘it is the best she has looked for a very long time’. Out of a total of 27 care staff 12 have NVQ 2 or above with another 14 currently registered and working towards the qualification. Mandatory training is carried out at appropriate intervals in all the required areas and at the time of this visit at least 90 of staff members had received training. A selection of staff personnel files including the two most recent starters was examined. All required items with relevant certificates were seen to be present including two references, copies of Terms and Conditions, PovaFirst clearances and Criminal Record Checks. Staff files have been reorganised since the last inspection and it is expected that the new owners will be putting their own corporate files and documents in place in the future. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 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): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Garden Lodge is well managed with good leadership and open management promoting the health, safety and welfare of service users. EVIDENCE: The manager at Garden Lodge is currently waiting for her application for registration with the CSCI to be completed. During discussions with the manager she was able to demonstrate a good knowledge of the National Minimum Standards and relevant regulations. She has registered for and is shortly to commence working for NVQ 4 and the registered managers award. There have been staff changes since the new manager was appointed but the workforce is now stable and members of staff spoke of their respect for the manager and the clear leadership provided. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 18 Residents meetings are held on a regular basis and every effort is made to include relatives and residents representatives. A recent survey of residents and their relatives has been carried out. Staff meetings are held on a regular basis for both day and night staff. The manager also holds a surgery for night staff every other week and makes unannounced night visits as part of the quality assurance programme. Quality assurance is maintained by regular audits in all aspects of the homes day to day functioning. Senior management staff from Southern Cross Healthcare also carries out unannounced inspections and audits. The home employs an administrator who keeps the records of resident’s monies and a safe is available for security of money and valuables. Receipts are obtained and kept for all expenditure on behalf of residents. Monies held for two residents were checked and found to be correct. Staff supervision is carried out the required six times per year and records seen demonstrated that this is up to date. Formal staff appraisal is carried out yearly. Records were reviewed for the maintenance and relevant safety checks of services and equipment and found to be valid. Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person must ensure that all medications are managed in accordance with the Medicines Act 1968 and in accordance with the Royal Pharmaceutical Society current good practice guidelines. (Refer to temperature of medication storage facilities) The registered person must ensure that; (a) All parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated (c) forward a copy of a satisfactory NEICC periodic electrical safety certificate when available to the CSCI. Timescale for action 14/09/06 2 OP38 13(4)(a)(c) 14/09/06 Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 21 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 OP2 Good Practice Recommendations It is recommended that a system be put in place to monitor the return of signed copies of contracts and Statement of Terms and Conditions. It is strongly recommended that the use of labels on MAR sheets be discontinued in accordance with the guidelines issued by the Royal Pharmaceutical Society. 2 OP9 Garden Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Lodge Care Centre DS0000025345.V304420.R01.S.doc Version 5.2 Page 23 - 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!