Inspection on 02/03/07 for Genesis Residential Care Home Ltd

This inspection was carried out on 2nd March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Genesis Residential Care Home Ltd 02/03/09

Genesis Residential Care Home Ltd 16/11/05

Genesis Residential Care Home Ltd 18/06/05

Genesis Residential Care Home Ltd 10/01/05

Genesis Residential Care Home Ltd 05/08/04

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

CARE HOME ADULTS 18-65 Genesis Residential Care Home Ltd 44 Albion Road Great Yarmouth Norfolk NR30 2JD Lead Inspector Debby Allen Unannounced Inspection 2nd March 2007 09:45 Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 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 Genesis Residential Care Home Ltd DS0000061007.V332255.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Genesis Residential Care Home Ltd Address 44 Albion Road Great Yarmouth Norfolk NR30 2JD 01493 853992 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) Genesis Residential Care Home Ltd Mrs Diane Bryant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2005 Brief Description of the Service: Genesis is a care home providing accommodation for seven people with a learning disability and associated mental health problems. It is owned and managed by Mr & Mrs Bryant. The home is located between the town centre and sea front of Great Yarmouth. The accommodation comprises of two terraced houses with seven single bedrooms situated on the three floors with a lounge, dining room and kitchen on the ground floor in Number 44 and one lounge and kitchen/diner in Number 43. Access to the seven bedrooms is by the stairs. There are two small front patios and enclosed covered conservatories. A connecting doorway to both houses is accessed at the rear. There is parking in the public car park at the rear of the building. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This inspection was unannounced and took place over a period of six and a half hours. On the day I met with six service users, the manager, responsible individual and two staff members. A tour of the premises was also carried out and care plans, staff files and records required for regulation were examined. The home was found to be clean, tidy and tastefully decorated and provided service users with a comfortable and homely environment. Six completed Service User Comment Cards were received prior to the inspection. Two requirements have been made as a result of this inspection. What the service does well: What has improved since the last inspection? Arrangements for the safe collection and disposal of clinical waste have now been made. The infection control policy has been reviewed and staff have been updated. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. Prospective service users receive the information they need to make an informed choice about where to live and have the opportunity to visit the home before moving in. Prospective service users have their individual aspirations and needs assessed and know that the home they choose will meet these. Each service user is given an individual written contract, together with the service user’s guide and statement of purpose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of care plans and records were looked at, including those for the person who moved into the home most recently. Copies of the home’s terms, conditions and contract were also seen during the inspection. The records examined showed evidence of a good assessment and preadmission process and included an Occupational Therapist’s report for the ‘Assessment of Independent Living’. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 9 The assessment information had been used to create detailed, but easy to understand, pen-pictures and care plans that ensured service users had their wants and needs met. Discussion with one service user confirmed that they had met the manager and visited the home before moving in. They also said that they were “really lucky to be able to live at Genesis because it was where they wanted to live”. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is good. Service users know their needs and personal goals are reflected in their individual plans. Service users make decisions about their lives, with assistance as needed and they are supported to take risks as part of an independent lifestyle. Service users are consulted on, and take part in, all aspects of life in the home. Service users’ information isn’t currently being stored appropriately and therefore maintaining confidentiality can’t be ensured. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans that were looked at contained thorough risk assessments, detailed pen-pictures, service users’ likes, dislikes and support requirements, weekly schedules and daily notes. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 11 It was evident that a great deal of time and effort had been taken by the staff and management in getting to know the service users and their wants and needs and this was reflected in the very clear pen-pictures. The risk assessments that were looked at were very positive and, again, indicated that a lot of time and care had been taken to compile them in order to enable service users to live their lives as independently as possible. Two service users spoken to confirmed that they had been involved in working out and agreeing their risk assessments and that staff helped them to do what they wanted to do. The information that was seen in the care plans matched up with things that the service users spoke to me about during the inspection, which confirmed that their needs and personal goals were being individually addressed. Although it was evident, by the good standard of record keeping and daily notes etc, that the current storage system works very well for staff by enabling them to access and update service users’ information quickly and easily, the room in which the information was stored appeared to be frequently used as a ‘through route’ or waiting/reception area. Concern was raised that service users’ personal information could be easily accessed and read by unauthorised people. A requirement has therefore been made that the service users’ information currently stored on the desk is made secure. Perhaps consideration could be given to replacing the existing desk with a roll-top/bureau style, which can be locked – therefore ensuring confidentiality is maintained. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. Service users are provided with opportunities for personal development and are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community and are supported to have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. This judgement has been made using available evidence including a visit to this service. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 13 EVIDENCE: Discussions with service users on the day of inspection confirmed that they were encouraged and supported to live their lives as independently as possible and there was substantial evidence available of service users leading quite varied lifestyles, according to their personal needs, wants and choices. One service user commented on how they liked to take their dog for a walk along the sea-front, another described how they liked to go to church with their friend (who didn’t live at Genesis) and a third person told how he liked to spend time visiting his girlfriend or having her visit him. Some of the responses in the service users’ comment cards that were returned prior to the inspection included: …has a dog of their own. …likes to make a flask of tea to take up to their room at night. …enjoys doing their own laundry. …enjoys the holidays. …the home is close to their church and the theatre. …enjoys cookery and I.T. courses. During the inspection a group of service users and staff were observed taking a walk into town and later, one person went to the local shop, alone, to buy a few things for the home. Also, during the course of the day, two service users were seen individually returning home from their day services. The above comments and actions were supported by information contained in individual risk assessments and care plans that were seen. The service users who went into town said they had lunch at the market that day, which they enjoyed and everyone spoken to said they really enjoyed their meals at Genesis. The menu suggestions were looked at in the food diary and they showed choice and variety that was wholesome, nutritious and appetising. A daily record of meals chosen by individuals was also seen, indicating that service users were being offered genuine choices. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Quality in this outcome area is good. Service users receive personal support in the way they prefer and require and their physical and emotional health needs are met. Service users are protected by the home’s policies and procedures for dealing with medication. The ageing, illness and death of a service user are handled with respect and as the individual would wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a clear and comprehensive care plan and ‘pen-picture’ which outlines how they like to be supported and what their individual needs are. Daily care notes showed that service users’ wishes are being respected. One service user said he liked the fact that he could go to bed and get up when he wanted. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 15 Records looked at also showed various involvement from professionals such as Occupational Therapists, Community Nurses, GPs and Dentists. The home uses the Boots Monitored Dosage System (MDS). None of the service users are currently self-medicating, although a system is in place if this should change and the manager confirmed that risk assessments would be drawn up and service users supported accordingly. The Medication Administration Record (MAR) sheets were looked at and found to be in good order with no errors or omissions. Overall, a very good medication system was seen and individual service users’ folders contained the following: Individual Medication Risk Assessments. Healthcare Policy. Medication Policy and Permission – signed by the service user. Information regarding the individual’s prescribed medication. Information regarding Homely Remedies for the individual. Record of Medical Contacts. All the comment cards returned by the service users stated that they saw their GP and dentist and one person spoken to told how he regularly saw his community nurse. Other records seen showed how service users have been supported during times of ill health and this information indicated that people were treated with dignity and respect. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has had one formal complaint since the last key inspection and good evidence was seen, which confirmed the complaints procedure was followed appropriately and a full investigation carried out. The complaints book was looked at and all comments recorded were deemed to have been dealt with appropriately. The risk assessments, care plans and ‘pen-pictures’ that were looked at, provided good evidence of service users being protected. Policies and procedures in respect of money handling and whistleblowing were also seen to give clear guidance for protecting service users. Staff spoken to on the day had a clear understanding of adult abuse and protection and have received training in the Protection Of Vulnerable Adults. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 Quality in this outcome area is good. Service users live in a homely, comfortable and safe environment, which is clean and hygienic. Service users bedrooms suit their needs and lifestyles and promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs and shared spaces complement and supplement their own rooms. Specialist equipment is available, as required, to maximise service users’ independence. This judgement has been made using available evidence including a visit to this service. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 18 EVIDENCE: Genesis is made up of two separate houses and each has its own individual lounge, kitchen, dining area and conservatory. Due to its age, the building appeared ‘tired’ in places but this did not detract from the comfortable and homely atmosphere and the proprietors are constantly striving to further improve the environment in general. Service users’ bedroom were seen to be very personal and reflected individual likes and preferences. Three comment cards returned by service users stated that they liked their rooms and one person said their en-suite bedroom was good. The tour of the premises also confirmed that the toilets and bathrooms offered sufficient privacy for people using them. Service users were observed choosing to use the communal areas and appeared very comfortable in them. The service users observed on the day were able to safely access all parts of the home as and when they wished and a hand rail has been added to the stairs to provide assistance for service users who need it. Overall, the home was found to be clean, tidy and hygienic, with no unpleasant odours. Adequate laundry facilities were observed and the manager has appropriate arrangements in place for the collection and disposal of clinical waste. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is good. Service users benefit from clarity of staff roles and responsibilities and are supported by an effective staff team, who are competent and qualified. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Staff support and supervision sessions have not been recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken to on the day were very clear about their roles and responsibilities within the home and service users spoken to said they knew what the staff did and what their jobs were. Copies of job descriptions were seen on the staff files. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 20 The home does not have a large turnover of staff and those spoken to said they felt the team worked well together and that they had a good mix of skills and experience between them. Information seen in the staff files also supported this. Two staff files were fully examined and found to contain appropriate references and disclosures from the Criminal Records Bureau (CRB). Training records were seen, which confirmed that staff are provided with good and regular training and updates. The home has recently implemented the ‘Passport to Care’ induction and a number of existing staff, as well as new staff, are in the process of completing this. One staff member spoken to said they were finding it very useful. Staff spoken to confirmed that they receive regular support from the manager and deputy but formal 1:1 supervision sessions were not found to have been recorded and so a requirement has been made for this to happen at least six times per year. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 & 42 Quality in this outcome area is good. Service users benefit from a well run home and the ethos, leadership and management approach. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures and the record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. This judgement has been made using available evidence including a visit to this service. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager of Genesis has many years of experience in the care industry and has completed an Advanced Care Management Course as well as the Registered Manager’s Award. The manager oversees the home on a daily basis and is supported by the deputy and the Responsible Individual. It was evident on the day of inspection that the manager runs the home with an ‘open door’ policy and is very approachable. Staff spoken to said they felt very supported and could talk to the manager or deputy at any time. Three service users said they were very happy living at Genesis, they like and trust the manager and can talk to her about anything – especially if they have a problem. Equal opportunities was something the manager clearly promoted in every aspect of running the home and some evidence of this could be seen in the staff files. Staff and management meet with the service users on a daily basis, as part of an ongoing quality assurance process, and discuss ‘life in general’. Evidence of service users views was seen in the records kept. The home has a good system in place with regard to policies and procedures and they are regularly reviewed and updated as required. Service users rights and best interests were seen to be protected by good record keeping but, as described in Individual Needs & Choices (standard 10), some of the service users’ records are not being stored securely and a requirement has been made for this to change. Staff training certificates were seen to include Food Hygiene, Fire Training, Health & Safety, First Aid, Infection Control, Boots MDS and POVA/Abuse. The regulated checks for fire, environmental health, water, electric were found to be satisfactory, with relevant risk assessments in place. Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 X Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? 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 YA10 Regulation 17 Requirement The Registered Person must ensure that records and information relating to service users is stored securely in the home and that confidentiality is ensured. The Registered Person must ensure that all care staff receive formal supervision sessions, and a record kept, at least six times per year. Timescale for action 01/05/07 2. YA36 18 01/06/07 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 Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Genesis Residential Care Home Ltd DS0000061007.V332255.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!