Inspection on 06/03/06 for Gilby House Care Home

This inspection was carried out on 6th March 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gilby House Care Home 31/07/09

Gilby House Care Home 19/05/09

Gilby House Care Home 16/10/07

Gilby House Care Home 15/01/07

Gilby House Care Home 01/11/05

Gilby House Care Home 29/11/04

Gilby House Care Home 26/05/04

Gilby House Care Home 02/03/04

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

CARE HOME ADULTS 18-65 Gilby House Care Home High Street Winterton Scunthorpe North Lincolnshire DN15 9PU Lead Inspector Stephen Robertshaw Unannounced Inspection 6th March 2006 09:30 Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 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 Gilby House Care Home DS0000002787.V272271.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 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. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gilby House Care Home Address High Street Winterton Scunthorpe North Lincolnshire DN15 9PU 01724 734824 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) Prime Life Limited Ms Diane Lawrence Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (22) of places Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service accommodated is over the age of 65 years (SM). This individual can continue to be accommodated in the home until there is a change of their individual circumstances which means the home can no longer appropriately meet their assessed needs. 1st November 2005 Date of last inspection Brief Description of the Service: Gilbly House is registered to provide nursing care to adults who experience mental health problems. The home is situated in Winterton, a village close to Scunthorpe. The home is a converted Victorian building in the centre of the village. There have been more recent extensions to the premises. Its location gives service users good access to local shops, pubs and other facilities within the village community. There is also a regular bus service in to the town of Scunthorpe. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Gilby House was unannounced and took place on 06th March 2006. The registered manager of the home was not available on the day of the inspection, however, one of the company’s senior managers was in attendance to offer support to the staff and service users in the absence of the homes manager. The service users spoke very positively in respect to the care that they received at the home. The environment was generally good, however, there were areas that required urgent attention and the Prime Life representative was made aware of these by the inspector. What the service does well: The service users living at the home have their needs fully assessed before they arrived there and were given the opportunity to visit the home before they made a decision to move there on a more permanent basis. There are clear records of the outside professionals that are supporting the staff at the home to meet the needs of the service users and the service users stated that they are always treated with dignity and respect at all times, they also confirmed to the inspector that their privacy is also maintained at all times. Service users are given opportunities to go out as a group particularly in the summer season. The home has its own transport and the company provides another bus and a driver once a month to assist in transporting service users to activities. The service users social, emotional, communication and independent living skills are maintained and developed at the home. The home continues to exceed the standard for maintaining service users contact with their families and friends. Prescribed medication is well recorded, monitored and administered at Gilby House. The staff induction and foundation training meets the required standard and all new staff to the home. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 6 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. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 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 Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 4 The service users are provided with the opportunity to visit the home before they agree to move there on a more permanent basis. EVIDENCE: There were eighteen service users living at the home at the time of the inspection. The inspector observed all of the care file information in relation to three of the service users. All of these included full assessments of service users individual needs that had been completed shortly before they had been admitted in to the home. The assessments were a combination of the homes pre-admission and care management assessment of needs completed by the funding authorities. Service users spoken to by the inspector stated that the home met all of their needs and that the staff were very supportive and understood their needs. The home has the capacity to meet the assessed needs of the service users. This information was supported through the recorded information read by the inspector, direct observation of staff interactions with the service users, discussions with service users and observation of staff training records and interviews with the staff. Specialist training in relation to mental health is available to the staff. Service users spoken with by the inspector stated that they had been given the opportunity to visit the home to meet the other service users and the staff before they had to make a decision whether to move in to the home or not. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 The individual needs of the service users are met in the home and choices are available to them throughout their daily lives. EVIDENCE: The inspector observed the care files for three of the service users. These had all been evaluated on a regular basis to make sure that the service users needs had not changes or to identify that any new needs could be met by the services provided through the home. All of the care plans seen by the inspector had been signed by either the service user or their representatives to acknowledge their agreement to them. Several of the homes service users have a forensic history. Many of the staff working at the home do not have any information in relation to the service users history. This could place staff working with these service users at risk and also other service users at risk. The management of the home should relook at their policies and procedures for confidentiality and identify why this information is or is not disclosed to the general staff group. The outcome of this should then be discussed with the staff team and be recorded. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 10 Service users spoken to by the inspector stated that they were able to make decisions in relation to their daily living and personal development at the home and that where appropriate they were given support by the staff to achieve their aims and objectives. Service user care plans and records of service user meetings also supported that they are given the opportunity to make decisions in relation to how services are delivered at the home. Individual care plans were supported by risk assessments where this was appropriate. The risk assessments had not been evaluated on a regular basis. In relation to the earlier comments generally the staff working in the home were not aware of the risk assessments in relation to the forensic care service users. A risk assessment must be created in relation to the piece of carpet that is placed outside bedroom number five as this could create a risk to the health and safety of service user using the corridor. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,14,15,16 and 17 Service users are supported and encouraged to maintain and develop their personal lifestyles. EVIDENCE: The care files observed by the inspector, discussions with service users and interviews with staff supported the evidence that the service users are supported and are given opportunities to maintain and develop their social, emotional and independent living skills. This includes service users being supported to attend adult education. The service users care files also recorded all of the activities that the individual service users had been involved in. service users stated to the inspector that they were happy with the range and frequency of the activities that were made available to them. Gilby house has its own transport and the company provide the home with an additional bus and driver once a month to support the home and the service users to access the wider community. The company has also produced an activities calendar for the homes in the group suggesting what activities could be made available to the service users. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 12 The home exceeded National Minimum Standard 15. The service users are given very good support to maintain and develop their relationships with their family and friends. This information was supported through written records of service users contact with their families and friends. Service users stated to the inspector that when their families lived a long distance from the home then the staff would transport them to see them. The service users confirmed to the inspector that they have freedom of movement in the home and out in the community. Risk assessments and care plans observed by the inspector supported when freedom of movement was restricted for individual service users. There is a dedicated smoking lounge however service users are permitted to smoke in the dining room when meals are not being eaten. Service users should be dissuaded from smoking in this area as the dining room smells of smoke and is off putting for some service users and staff at meal times. Choices are available at meal times however service users complained that the meals provided were ‘not very good’ in relation to the quality of the meals provided. They also said to the inspector that the ‘meals are very basic’. Menus indicated that they might not be very nutritious for example one lunchtime a ‘cooked breakfast’ was provided and the teatime meal was a burger. Following lunch the homes domestic staff helped to wash up the dirty dishes. However they did not change from the apron that they wore when earlier cleaning the bathrooms. This practice must stop immediately to control the spread of infection. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21 The service users personal and healthcare needs are met through the services provided at the home. EVIDENCE: Direct observations and discussions between the inspector and service users confirmed that their privacy, dignity and respect are upheld at all times in the home. Service users stated that when they are seen by other professionals in the home or in the community they are always seen in private. The service users care files identified when they had been seen by professionals such as dentists, GP’s, psychiatrists and community nurses. The home provides nursing care to service users with mental health problems. The nursing and care staff are supported by professionals that are based in the community to ensure that the needs of the service users are met. The inspector observed the medication being administered to individual service users and all of the appropriate legislation and good working practice guidelines were followed by the staff involved. The medication is only administrated by the qualified nurses at the home. All of the records for the medication were up to date and were accurately recorded. Individual care files Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 14 that were observed by the inspector included the last wishes of the service users in the event of their deaths. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The safety and welfare of the service users are protected in the home. EVIDENCE: The home has a complaints procedure that is displayed around the home. The service users spoken to by the inspector stated that they knew how to make a complaint in relation to the services and care that they receive at the home and confirmed that none of the individual spoken to had made any formal complaints. No complaints had been recorded in the home since the last inspection. The staff training records and interviews with staff confirmed to the inspector that they receive appropriate protection of vulnerable adults training. The staff that were interviewed were also aware of how to report suspected or alleged abuse in the home. The policies and procedures for the protection of vulnerable adults were the latest edition of those produced by Prime Life for their homes. A copy of the local authorities policies and procedures for the protection of vulnerable adults were also available at the home. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 The general environment of the home is adequate however there are areas that require urgent attention to appropriately meet the needs of the service users. EVIDENCE: The inspector toured the premises and generally the service users stated that they were happy with it. The grey corridor carpet was in needs of urgent attention to be either cleaned or be replaced due to damage through drinks being spilled on it. Also on one of the corridors there was a damp patch that had been painted over but the damp had continued to come through. On the opposite side of the wall was a shower in room one. It is possible that the shower tray or the bathroom tiles need attention to reseal them. This may eradicate the damp problem. Several service users invited the inspector to see their rooms. These had all been personalised to their own tastes and preferences. The service users stated that they were very happy with their individual rooms and the furniture and fittings that they were provided with. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 17 The bathrooms and toilets are well spaced throughout the home and were close to the communal and bedroom areas. There were very bad odours from the drain in the shower room next to the laundry. This has been a longstanding problem at the home. The shower room floor also required either a very thorough cleaning or replacement. The remainder of the bathrooms and toilets in the home were very clean and odourless. The home provides a range of rooms for the service users to choose from to socialise with their families and friends. There is a smoking lounge and a no smoking lounge however service users and staff also smoke in the dining area when meals are not being served. This leaves an offensive smoke odour and smoke cloud when meals are served therefore smoking should be restricted from this area. The windows in the home were very dirty both inside and outside. The working mechanisms for the windows in the smoking lounge were covered in cobwebs. The inspector pointed these out to the staff on duty. The service users care files showed that they had individually been assessed for their mobility needs and appropriate aides and adaptation were introduced to them to meet their needs. The home is generally kept clean and tidy. The management employ one person as a domestic. They are responsible for cleaning the corridors and communal areas and the care staff and service users are responsible for keeping the service users rooms clean and tidy. The home also employs one member of staff to work in the homes laundry. The washing machines are programmable to disinfection and sluicing standards. The home also has a smaller domestic laundry for service users that are able to wash their own clothes to do so. The washing machine in this area is also programmable to disinfection and sluicing standards. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34 and 36 Service users believe that the staff can meet their needs and are very supportive of them. EVIDENCE: The staff that were interviewed by the inspector stated that they had received terms and conditions of their employment before they commenced work at the home. The home does not make use of volunteers work with the service users. New staff undertake induction and foundation training that meets the requirements of the Sector Skills Council workforce strategy targets. The services training programme also ensures that all of the staff are up to date with their mandatory training. Service users stated to the inspector that there were always enough staff on duty at the home to meet their individual needs and that the staff were very responsive and friendly towards them. The manager’s information file shows how staff are allocated to the home in response to the number of service users resident and their individual needs. The last inspection showed that appropriate safety vetting was not completed before staff began working at the home. At this inspection all new staff had received the appropriate POVA first and CRB clearances before they began working with the service users. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 19 Staff interviewed by the inspector stated that they receive regular supervision, however there were no records in the home that supported that the staff receive regular formal recorded supervision to ensure that they are meeting the needs of the service users or to determine what individual staff training needs were. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41,42 and 43 The management of the home supports the welfare and safety of the service users. EVIDENCE: Several of the management standards were not assessed, as the manager was not available on the day of the inspection. A senior manager from Prime Life became available during the day during a routine visit to support the staff and service user group in the absence of the registered manager. Prime life complete monthly regulation 26 visits to the home and the visits are recorded. The homes quality assurance and monitoring system was not available to inspect, however there were several cards and letters from service users families thanking the management and staff for the care that they had provided to their loved ones and complimenting on the good quality of the services. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 21 The homes policies and procedures are produced corporately. The home had the latest edition that was produced by the company. The home receives a monthly audit of its finances through the corporate body to ensure that it keeps within its viability. Most of the homes health and safety requirements were met. However the floor in the medication room was identified at the last inspection still requires attention. The torn area of the floor had been stapled leaving raised metal edges that could produce injuries. An alternative safe repair of the floor must be introduced or the flooring should be replaced altogether. The management of the home need to discuss with the local authority how to dispose of the recycled waste from the home. Currently the home only has access to a small domestic box that is inadequate for its needs. Most of the required safety and maintenance certificates were in place. The home does not have an up to date certificate to verify the safety of the electrical systems. Although there were no obvious concerns the management should ensure that they are appropriately insured if this certificate is not in position and up to date. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 22 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 X 2 3 3 3 4 3 5 X 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 2 25 3 26 3 27 2 28 2 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 4 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 X X X 3 3 1 3 Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 23 Yes 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. 2. Standard YA42 YA42 Regulation 12 16 Requirement The registered person must ensure that the floor in the medication room is made safe. The registered person must ensure that the odour problems in the shower room are controlled appropriately. The registered person must ensure that the home has a current safety certificate for the electrical systems in the home or ensure that the homes insurance is approved in the knowledge that the certificate is not issued. The original timescale of 26 May 2004 has not been met. Timescale for action 01/08/06 01/06/06 3. YA42 23 01/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The registered person should make sure that all of the staff understand the possible risks to them or others when working with service users with a forensic history. DS0000002787.V272271.R01.S.doc Version 5.1 Page 24 Gilby House Care Home 2. 3. 4. 5. 6. 7. 8. 9. 10. YA9 YA17 YA24 YA24 YA27 YA28 YA28 YA36 YA42 The registered person should ensure that individual service users risk assessments are evaluated on a regular basis. The registered person should ensure that a nutritious menu is provided for the service users. The registered person should clean or replace the grey carpet in the homes corridor. The registered person should repair the damp to the wall outside bedroom one. The registered person should either industrially clean the floor in the shower room next to the laundry or replace the floor. The registered person should stop service users and staff from smoking in the dining room. The registered person should make sure that the internal and external window areas are cleaned. The registered person should ensure that the care staff receive regular formal recorded supervision and a record is maintained in the home. The registered person should make arrangements for the appropriate disposal and collection of recyclable waste from the home. Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Gilby House Care Home DS0000002787.V272271.R01.S.doc Version 5.1 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!