Inspection on 09/05/06 for Hazel Mead

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hazel Mead 27/06/07

Hazel Mead 02/11/06

Hazel Mead 06/09/05

Hazel Mead 28/04/05

Hazel Mead 15/12/04

Hazel Mead 18/06/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hazel Mead 3 Elpha Court South Broomhill Morpeth Northumberland NE65 9RR Lead Inspector Elaine Charlton Key Unannounced Inspection 9th May 2006 09:30 Hazel Mead DS0000040943.V289536.R02.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 Hazel Mead DS0000040943.V289536.R02.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. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hazel Mead Address 3 Elpha Court South Broomhill Morpeth Northumberland NE65 9RR 01670 761 741 01670 761 351 elsie@elpha.totalserve.co.uk 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) Ms Elsie Hazel Mrs Linda Marshall Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2005 Brief Description of the Service: Hazel Mead is a purpose built bungalow providing en-suite accommodation for 5 younger adults with a learning disability. The grounds are shared with Elpha Lodge a care home for younger adults with physical disabilities. The bungalow has level access to all accommodation both internally and externally, and is decorated and furnished to a good standard. The home is close to local facilities and transport networks. Service users also have access to transport shared with Elpha Lodge. Respite care and nursing care are not provided. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced, key inspection, was carried out over two days, the 9 and 15 May 2006 and lasted for 7 hours. The purpose of the inspection was to review progress being made towards requirements made at the last inspection and to look at the key standards. Staff who took part in the inspection included the proprietor, new manager and senior care worker. During the inspection service user and staff records were examined as well as accident records, fire log, service records, staff rotas, and supervision records. A random check of medication was carried out on the 9 May followed by a full audit on the 15 May. All four service users living in the home were also consulted. Before the inspection, questionnaires had been sent out to relatives/carers, service users and a range of professionals who visit the home. All the service users responded as well as 6 relatives and one visitor. Staff are thanked for their participation in the inspection process and for the way they responded, efficiently and quickly accessing records. What the service does well: What has improved since the last inspection? The home was awarded Investors in People in April this year. A new manager has been appointed and has successfully completed the registration process. Three members of staff from the Elpha Lodge Care Homes Limited group have completed person centred planning facilitator training to enable service users to be involved in the care planning process. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 6 A large number of policies and procedures have been reviewed to meet requirements made at previous inspections. Staff recordings in care plans and evaluations have become more outcome focused, benefiting staff and service users. Staff confidence and knowledge has increased benefiting service users and themselves. 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. Hazel Mead DS0000040943.V289536.R02.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 Hazel Mead DS0000040943.V289536.R02.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Person centred planning enables the aspirations and needs of service users to be identified and addressed improving their daily lifestyle. EVIDENCE: All service users said they were consulted about their move to Hazelmead and were given enough information. One service user said they liked having meetings. The service users guide reflects the process to be carried out when assessing a prospective new service user and includes the need to obtain a professional assessment. There have been no new admissions to the home. A copy of the home’s Statement of Purpose is displayed on the notice board in the dining room. One service user has had the opportunity to be involved in preparing a person centred plan (PCP). Arrangements have been made for a facilitator to start work with another service user and introductory visits have already taken place. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 9 The anticipated completion date for all person centred plans is the end of June 2006. The Proprietor and two other members of staff have completed training to become person centred planning facilitators to enable them to support service users to be involved in the process. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are consulted about the running of the home and are being encouraged, through the process of person centred planning to make life plans promoting their growth and independence. EVIDENCE: Six out of 7 relatives/visitors who responded to the questionnaire said they were kept informed. One said they were mostly kept informed. All service users said they were allowed to make decisions. Two added that they sometimes needed assistance to do this. Evidence was seen of a service user asking staff for assistance when making decisions about finances and personal issues. One service user said they could do what they wanted at any time, were treated well and liked having company and family visits. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 11 An increased range of risk assessments were seen. These were evaluated and signed by staff and service users. One service user travels independently on public transport. Progress with PCPs will identify areas that service users may need assistance with to enable them to have more choice about their daily lives. One service user said they would like days out on a 1-1 basis with their keyworker. Care plans for one service user had not been evaluated since February 2006. Those that had been evaluated were more outcome focused. A care plan for challenging behaviour was seen to identify known triggers, warning signs and what actions have been successful in the past when dealing with this behaviour. The service user was positive and communicating well. The staff team have been working with the Behavioural Assessment Intervention Team (BAIT) as part of a skills development programme for one service user. Daily recordings are being made and faxed to the BAIT team. Meetings to monitor progress are being held monthly. Care plans are signed by service users. The service user copy of the complaints procedure was seen in the historical records kept in the office. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities to access employment, education and leisure/social activities are limited and restrict the development of service users and relationships. Menu planning and shopping involves service users enabling them make choices. EVIDENCE: One service user said that everyone sits down together to choose what they want on the menu. Healthy meal options are available and promoted. Service users can make snacks if want to and one service user was heard being encouraged to make themselves a drink. The kitchen is domestic in style. It contains all modern appliances and is kept extremely clean. Food and refrigerator temperatures are recorded regularly. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 13 One service user goes out to work 4 days each week and takes a packed lunch. Service users share shopping tasks, enjoy meals out in the local community and join in with social activities (bowling is an example) where they wish. Service users go to the Dovecote centre and join in activities, which include art, gardening, crafts, music, and shadowdance. Staff were heard asking service users what they would like to do. Service users were mixing with their neighbours from Elpha Lodge and Sydney House. Relationships are friendly. Service users spend time with their families both within the home and by having time away. Daily routines are around individual service user’s commitments. All take part in social activities within the local community in varying degrees. These include visits to the pub, meals out, bowls club and shopping. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff who act as key workers and deliver personal care are chosen by service users. En-suite bathroom facilities ensure that service users care is delivered in a private and sensitive way. EVIDENCE: Care plans show evidence of service users having regular access to GP’s, chiropodists, dentists and opticians. Service users weights are recorded regularly as part of the healthy living process. Staff were taking precautions to ensure a service user enjoying the sunshine in the garden did not get sunburnt. One service user said they enjoyed company, visits from family and meetings that they had in the home. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 15 Staff have completed in-house loss and bereavement training. The manager is trying to identify additional training to support this. A random check of medications held in the home was carried out on the 9 May and tablets held for one service user to use “as and when required” differed in number to those recorded on the medication administration record (MAR). This was the only medication for this service user that was not supplied in a blister pack. On the second visit to the home on the 15 May, a full audit of the medication and associated systems was carried out and no errors were found. Arrangements had also been made for the “as and when required” medication to be provided in a blister pack. Medications are held in a secure manner within the home. There are no controlled drugs in use but facilities are available to store these separately should the need arise. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Inconsistent financial policies could place service users at risk of abuse or allow the miss-administration of their finances. The complaints policy and procedure encourages service users to speak up and to know that they will be listened to. EVIDENCE: Policies, procedures and recording systems are in place and promote the recording and investigation of complaints, concerns and allegations. All staff have had training in the Protection of Vulnerable Adults (POVA). Two out of 7 relatives/visitors said they were not aware of the complaints procedure. A copy is displayed on the notice board in the dining room. The new manager is to send each relative a copy of the procedure with a letter introducing herself. She is also going to look at service users having a “service user friendly” copy in their bedrooms. All of the service users said they knew who to speak to if they had a concern. The complaints register was seen and no complaints had been received by the home or CSCI since the last inspection. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 17 The manager is going to put concerns and complaints as a standard item on the agenda for service user meetings. Inspection reports are freely available in the entrance to the home together with a copy of the Investors in People report (IIP). The home as recently been awarded Investors in People status. Policies for “handling of service users money”, “funding for fees”, and “recording in individual accounts books” still needs to be reviewed to ensure they are consistent. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 18 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and safe environment that is well maintained and protects the health, safety and wellbeing of service users. Cleanliness, hygiene and laundry routines promote the health and safety of service users. EVIDENCE: Each service user has their own bedroom and has chosen how it should be decorated and personalised. All can enjoy television, music and other activities in their bedrooms. One service user said that the home was always clean. Secure storage has been provided for oxygen which is required by one service user. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 19 The storage facility for oxygen needs to be reviewed as this does not allow staff easy access and does not give them protection in bad weather, as they have to stand outside the unit. The proprietor was asked to get Fire Officer approval for the siting of the unit as it is near a fire door for Hazelmead and Sydney House. All rooms in the home are furnished to a high standard. Each bedroom has en-suite toilet, sink and shower facilities and service users are able to lock their bedrooms if they choose. All the accommodation was found to be in an extremely clean and tidy condition on both occasions. Staff have good routines for maintaining this high standard. One service user said that the home was always clean. Service users and staff have access to laundry facilities in Elpha Lodge. Staff spoke about the problems associated with having to take and collect laundry from Elpha Lodge particularly when they are the only one on duty in the home. The location does not make it easy for service users to do their own laundry. Ironing has to be done in the dining room. The ironing board is always left up for this purpose. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 20 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): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by a consistent team of staff who are qualified and undertake regular training to support the health, safety and welfare of service users. The frequency of supervision does not meet the minimum standards and which may place service users at risk. EVIDENCE: Six out of 7 relatives said that there were enough staff on duty. One said there were mostly enough staff on duty. Supervision notes showed that the supervision schedule was not meeting the required 6 times per year. Staff said they received 1-1 supervision from the proprietor. All staff are qualified to a minimum of NVQ level 2 and the new manager has registered to complete her NVQ level 4 and RMA. She has also completed the first unit of this training. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 21 Training over the last year has included epilepsy awareness; first aid; Boots Monitored Dosage System (for medication); risk assessment; and Protection of Vulnerable Adults (POVA). A training programme for 2006/07 still needs to be provided to CSCI. The manager agreed to put together a draft as she has already started putting together a training matrix on the computer. The proprietor and manager were both told that any computerised records needed to be readily available in the home and to be produced in paper format if required. Staffing rotas still do not clearly show which member of staff has been absent, for what reason and who their replacement was. Staff responded confidently during the inspection, were able to get all the information and records requested, and dealt with service user issues in a sensitive and patient way. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 22 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): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality assurance system is not fully developed and does not allow for service users, the Commission for Social Care Inspection and other interested parties to know that comments are welcomed, evaluated and acted upon. Access to health and safety guidance and maintenance of the home promotes the safety of service users and staff. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 23 EVIDENCE: The new manager had received her registration certificate and took over her duties from 15 May 2006. She was to arrange for the previous manager’s registration certificate to be returned to CSCI. Good progress has been made with the review of policies and procedures which were the subject of previous requirements. Three requirements covering financial arrangements for staff and service users are still outstanding. One service user’s care plans had not been evaluated since February 2006. Accident records were up to date. Regulation 37 notifications have been sent to CSCI on a regular basis. The fire log indicated that regular checks are carried out on fire alarms, equipment, and lights. A fire drill had been carried out on the 20 April 2006, involving all service users and staff on duty that day. All staff have had fire instruction training in April. All servicing contracts were available and up to date. Up to date insurance covered is displayed in the home’s entrance. An appointment was made with the manager to review the quality assurance progress on the 15 June 2006. This is not a key standard. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 24 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 2 x Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 25 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 YA2 Regulation 15 Requirement The introduction of PCPs must be completed. Timescale for action 30/06/06 2 YA12 15 (Previous timescale of 30 December 2005, partially met.) Service users choices/wishes and 30/06/06 opportunities must be expanded and clearly identified in the service users plan. (Previous timescale of 28 April 2005, and 30 March 2006, partially met.) Recording systems for the receipt, dispensing and disposing of medication must be reviewed. This requirement had been met at the inspection on the 15 May 2006. The financial policies and procedures identified must be reviewed to protect service users. (Previous timescale of 30 December 2005, not met.) The outside storage facility for oxygen must be reviewed and it’s location approved by the Fire DS0000040943.V289536.R02.S.doc 3 YA20 13(2) 09/05/06 4 YA23 13(6) 30/06/06 5 A42 13(4) 30/06/06 Hazel Mead Version 5.1 Page 26 Officer. 6 7 8 YA36 YA33 YA35 18(2) 18 18(1) The frequency of supervision must be increased. Staff duty rotas must clearly identify staff absences and replacement workers. A training plan for 2006/07 must be developed and must include training in conditions and behaviours associated with a learning disability is planned. (Previous timescale of 30/12/05 not met.) The quality assurance system must be reviewed to ensure that it meets the requirements of Regulation 24. (Previous timescale of 18 July 2005, and 30 March 2006, partially met.) 30/08/06 30/05/06 30/07/06 9 YA39 24 15/06/06 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 2 3 4 Refer to Standard YA5 YA6 YA22 YA24 Good Practice Recommendations Consider the introduction of a service user friendly contract. Service user care plans should be evaluated on a regular basis Manager to send copy of complaints procedure to relatives and review service user access to a “friendly” copy in their bedrooms. Consideration should be given to putting the ironing board away each time it has been used. Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Hazel Mead DS0000040943.V289536.R02.S.doc Version 5.1 Page 28 - 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!