Inspection on 03/12/07 for Hasbury

This inspection was carried out on 3rd December 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 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

Hasbury 02/12/08

Hasbury 10/07/06

Hasbury 09/02/06

Hasbury 09/05/05

Hasbury 25/01/05

Hasbury 03/08/04

Hasbury 10/02/04

Hasbury 03/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Hasbury 154 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN Lead Inspector Kulwant Ghuman Key Unannounced Inspection 3rd December 2007 14:00 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 Hasbury DS0000016907.V353092.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. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hasbury Address 154 Middleton Hall Road Kings Norton Birmingham West Midlands B30 1DN 0121 458 5336 0121 243 5336 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) Mrs Rajwantee Chundoo Mr S.V. Chundoo Mrs Rajwantee Chundoo Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2006 Brief Description of the Service: Hasbury is a large, extended, detached house, which is set back from the road with car parking spaces to the front of the building. Located on Middleton Hall Road between the shopping centres of Cotteridge and Northfield, public transport passes the front of the home. Accommodation for the service users is on two floors with a passenger lift to enable access. There is a mixture of five double and fourteen single bedrooms. There is a dining room, and a sitting area that is divided into two by a dividing wall. The garden is large, with covered patio, lawn, plants and shrubs. There is a path around the garden. The property is well maintained and decorated to a high standard. The information provided to the Commission regarding the home did not include details of the range of fees charged by the home. Individuals need to get this information from the home. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this key, unannounced inspection over one day during December 2007. Prior to the inspection the manager completed the Annual Quality Assurance Assessment and returned it to the Commission providing the inspector with additional information about the home. During the fieldwork visit the inspector spoke to the manager and deputy manager, four of the twenty-three people living in the home and sampled two files belonging to staff employed in the home and two individuals living in the home. Other documentation sampled included health and safety documents. A tour of the building was also carried out. There had been no complaints received by the Commission about the home and no adult protection concerns had been raised. What the service does well: The home continues to be provide a warm, comfortable and homely environment for people to live in. Written information is available for people thinking about moving into the home. The needs of the people moving into the home are assessed before they move in and a plan of care formulated. The health and social care needs of people living in the home are well met by the home and through liaison with other professionals in the community. There are good relationships and interactions between the people living in the home and the staff working in the home. Management of records in the home was well organised and information was easily accessed. The views of people living in the home and their representatives were taken into consideration when making decisions about the home. An activities co-ordinator ensured that a variety of activities were organised. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home did provide people with good information about what services they could expect to receive in the home. Some additional information was needed to ensure people could make informed decisions. Assessments were carried out on individuals before being admitted to the home. EVIDENCE: At the time of the inspection the statement of purpose was being updated but a copy was sent to the Commission after the inspection. A copy of the service user guide was provided and a copy. The service user guide states the aims of the home are to provide ‘personal and nursing care to elderly people’. This could be a little misleading as the home does not provide ‘nursing care’ but any nursing care tasks are provided through the district nursing team. This should be clarified so that people are aware that long term nursing care cannot be provided at the home. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 9 In addition to the service user guide and statement of purpose a copy of the conditions of residency was also provided to the Commission. The conditions of residency did indicate that a top up to the fees could be charged but the fee levels and rate of top up were not included in the information. This information should be available to people who were considering whether to move into the home or not so that they could make a fully informed decision. Also the room sizes were not included in this information. This should also be available. The file belonging to one of the people who had recently moved into the home was looked at and although there was basic information available from an agency making referrals to the home and information from the hospital on discharge, the social workers assessment had not been received and the records for the day visit were not found at the time of the inspection. There was evidence available in the home that assessments were carried out for other people admitted to the home at their pre-admission visit. People living in the home were given contracts of residency and service user guides were available in bedrooms. No one had been admitted to the home for intermediate care. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of the people living in the home were well managed. Advice was sought from other professionals when needed. EVIDENCE: Service users long-term assessments covered several areas of need such as mobility, personal cleaning and dressing, eating and drinking. Each area that was identified as needing some assistance had a corresponding care plan. There were some good details on both the assessments and care plans however, they could be further improved with more detail, for example, was a face cloth used to wash hands and face, was hair washed at the same as having a bath or in the sink. The inspector acknowledged that the current staff team were aware of the needs of the people in home however, new staff would need to have the information available so that they provide the individual with person centred care. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 11 On one of the files sampled the mobility care plan was not accessible but all the others were on the file. Care plans were reviewed on a monthly basis. It was advised that a basic care plan was written up with the information gleaned from social work assessments, relatives and the homes own preadmission assessments when individuals moved into the home to give the staff a working document to follow. The detailed care plan could then be formulated as more information was gathered about the individuals needs. There were risk assessments in place including moving and handling, nutrition and skin integrity. It was advised that the cross referencing of the care plans to risk assessments could be clearer to ensure that staff knew where to find the appropriate information. Likes and dislikes of the people living in the home in respect of food were recorded and given to the cooks so that they could be aware of when they needed to provide alternative meals to what was on the menu. The home kept very good records of contacts with GP’s, nursing staff, hospitals and families where needed. The weights of people living in the home were recorded on a regular basis. The daily recordings were very repetitive and gave little insight into what the individuals had done during the day. Generally the records indicated whether they had eaten well and that assistance had been given. Records needed to be clear for example, if an individual was ‘shouting out’ they needed to identify what was being shouted out about. The management of medicines in the home was generally good. There were a couple of gaps noted on the Medicines Administration Record(MAR) and some homely remedy painkillers were not recorded. One of the controlled medicines record did not tally but this was because one table had been returned to the pharmacist and was recorded on the returns record but not on the register. The staff were observed to knock on bedroom doors before entering and privacy screening was available in shared bedrooms. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home organises meetings through which the views of residents’ has been sought for example choice of activities and meals, this is so that people enjoy a better quality of life. The home supports individuals to maintain contact with family or friends so that important relationships are maintained and information is shared about life in the home. EVIDENCE: There did not appear to be any rigid rules or routines in the home and the people living in the home were free to move around as they wished and had access to their bedrooms at all times. It was evident that there were good relationships between the staff and people who lived in the home. Visitors were welcomed into the home and considered to be part of the larger family. Social activities were recorded on the files. The home had registered many of the people living in the home with ring and ride to enable them to go out more Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 13 easily. A trip had been arranged to see the Christmas lights in Birmingham city centre and while they were out a fish and chip supper was had. The activities record showed that there had been regular trips out to coffee shops, parks and garden centres. There were tea dances, birthday celebrations and a garden fete in the home during summer. In addition there were board games, movie days, bingo and weakest link games. There were some one to one sessions also recorded in the activities and this was good as not everyone was interested in-group activities. The people living in the home were able to spend time in their bedrooms or sit in the lounges. One person liked to spend a lot of time in the bedroom and had got dressed early for bed and was lying in bed and appeared to be very content. She stated she did not particularly like the television or radio but liked to ‘rest her eyes in the bedroom’. There was a relatives’ suggestion book in operation and this was used for suggestions from the relatives. One of the recent issues had been the replacement of the electric kettle in the dining room that was used by relatives to make drinks. Another suggestion was that instead of the proprietors buying individual presents for the people living in the home a Wi was bought for them to be able to use. There was a relatives’ meeting held once a year where issues were covered. It was pleasing to note that the meetings also looked at what had been discussed at the previous meeting and what progress had been made. There was evidence that a couple of meetings had been held with the people living in the home that discussed the menus and outings. It was also very nice that the relatives of people living in the home were also invited to birthday celebrations and Christmas. The people spoken to during the day said that they were happy with the food received. There were experienced people undertaking the cooking and ensuring that the likes and dislikes of the people living in the home were taken into consideration. Choices were available at all meal times. Four meals are provided through the day. Meals can be eaten in the dining room or in bedrooms if preferred. There were food records available in the home but the recordings needed to be tighter in terms of identifying who had had what to ensure that choices provided were fully documented. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager was very proactive in dealing with any issues that were raised and ensured that individuals were always informed in writing of the outcomes of the investigations or actions to be taken in response. This ensured that the people living in the home and their representatives were able to raise minor issues that arose with the knowledge that they would be addressed. EVIDENCE: No complaints had been received by the Commission regarding the home and only one complaint had been received by the home regarding a radiator not working in one of the bedrooms. This was resolved appropriately. The home had a complaints log where all issues raised by people living in the home or their relatives were recorded. All the issues raised and their resolutions were recorded. The complaints procedure was available in the service user guide. There had been no issues of adult protection raised at the home or concerning the home. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean and well-maintained home, residents’ bedrooms are individually furnished with their personal possessions around them. Specialist equipment can be provided for residents who need help with mobility with handling aids. EVIDENCE: During the inspection a tour of the building was carried out. The home was well maintained and safe for the people living there, visitors and staff. There was an ongoing refurbishment programme in place. Carpets in some bedrooms had been replaced, the garden area had been re-structured and Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 16 some large trees had been removed, new fencing to both sides of the home had been put in place where needed, there were plans for a new conservatory. These had been somewhat delayed due to obtaining building permission and getting quotes for the work to be carried out. A new cooker and mobile hoist had been purchased for the home. Windows at the front of the home had been replaced. The home’s main office was located on the 2nd floor but there was a small staff station on the ground floor. The communal areas in the home were comfortable and homely. The bedrooms seen during the inspection showed that the rooms were comfortable, tastefully decorated and individualised to the occupants choosing. People in shared rooms were given the opportunity to move to a single room when one became vacant. Screening was available in shared rooms. There were a number of communal toilets and bathing facilities throughout the home that had appropriate adaptations to enable individuals to be assisted safely. It was noted however, that none of the toilets or bathing facilities had an emergency call system fitted. This needed to be attended to. There were other adaptations in the home including handrails, electric beds, hoists and passenger lift. The home was found to be clean and hygienic and there were no odours evident providing a pleasant environment for everyone. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff were able to meet the needs of the people living in the home and there were adequate numbers of staff on duty. The recruitment procedures needed to be tightened up. EVIDENCE: The staffing levels were appropriate to meet the needs of the people living in the home. There were 4 care staff on duty during the mornings and 3 care staff during the evenings. In addition there was always a manager, cook and domestic staff on duty. In addition there was an activities co-ordinator in place who worked at the two homes owned by the providers and ensured that activities were being organised. There had been little turnover of staff at the home and this provided for a good continuity of care for the people living in the home. Staff at the home were representative of the local community and a broad age range. There was only one male carer on the staff group however, the number of males living in the home was also small. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 18 Two staff files were sampled to assess the recruitment processes in the home. All the required documentation was found on the files however, in both instances the POVA checks had not been received until after the individuals had started their employment. The staff-training matrix showed that the majority of staff had completed NVQ level 2 training and some had started NVQ Level 3 training. The Annual Quality Assurance Assessment (AQAA) stated that all staff had had mandatory training however the staff training matrix showed that mandatory training had been undertaken however, there were some individuals that were in need of training in moving and handling, health and safety, food hygiene, adult protection and first aid. The matrix did not indicate when individuals were receiving training updates. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home ensures that individuals are safeguarded and that the views of people using the service are taken into account when developing the service. EVIDENCE: The manager of the home has good skills in record keeping and showed a good knowledge of the needs of the people in her care. A quality assurance system has been implemented and this ensures that the home’s policies and procedures are adhered to and that the views of the people living in the home and their representatives are taken into account when making decisions about the service. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 20 The manager stated that she had completed the Registered Managers Award. Administration assistant hours had been increased in the home to enable all administrative tasks to be completed in a timely manner. The manager confirmed that the home does not hold any monies for the people living in the home. There were no significant health and safety issues arising during the inspection. The only issues arising were some gaps in medication records and staff being employed prior to their POVA checks being returned. Fire records sere checked and found up to date. Information provided by the home in the Annual Quality Assurance Assessment indicated that all maintenance and service checks for equipment in the home were up to date. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 21 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 2 3 2 x 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 22 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 manager must ensure that medication records are accurately completed and all medicines in the home are accounted for. This will ensure that the people living in the home receive their medicines as prescribed. The emergency call system must be extended to cover the toilet and bathing facilities. This will ensure that the people living in the home and staff working in the home can summon assistance if required. People must not commence working in the home until appropriate clearances have been received. This will ensure that the people employed in the home are suitable and appropriately vetted. Staff must receive training in food hygiene, first aid and moving and handling and DS0000016907.V353092.R01.S.doc Timescale for action 14/01/08 2 OP22 OP38 13(4)(c) 01/06/08 3 OP29 19 14/01/08 4 OP30 18(1)(a) 01/06/08 Hasbury Version 5.2 Page 23 updates as appropriate. This will ensure that the people living in the home are cared for people with the appropriate skills and knowledge. 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 OP1 Good Practice Recommendations The information provided to people considering whether to move into the home should include information regarding fees, clarity that nursing care is not provided in the home and the room sizes. This will enable people to make a fully informed decision about moving into the home. Initial care plans needed to be drawn up with the information gleaned from the social worker, relatives and the home’s own pre-admission assessments. Long term care plans needed to have detailed information on how the care needs of individuals was to be met by the staff. This would enable the people living in the home to be assured that they would receive person centred care. All risk assessments needed to be accessible on the files and cross-referencing of risk assessments and care plans should make it easier to identify the appropriate information. This would ensure that the needs of the people living in the home would be met safely. Food records should be completed on a daily basis and show what each individual has eaten and indicate where a special diet has been provided. The training matrix must be updated to indicate that the appropriate mandatory training and updates have taken place. DS0000016907.V353092.R01.S.doc Version 5.2 Page 24 2 OP7 3 OP8 4 5 OP15 OP30 Hasbury This will ensure that the staff receive the required training to carry out their roles safely. Hasbury DS0000016907.V353092.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Hasbury DS0000016907.V353092.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!