Inspection on 14/02/06 for Hillcroft (Caton Green) Nursing Home

This inspection was carried out on 14th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillcroft (Caton Green) Nursing... 01/05/07

Hillcroft (Caton Green) Nursing... 11/08/05

Hillcroft (Caton Green) Nursing... 25/02/05

Hillcroft (Caton Green) Nursing... 15/07/04

Hillcroft (Caton Green) Nursing... 04/03/04

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Chirnside House

Keer Sands Residential Home

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Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hillcroft (Caton Green) Nursing Home Caton Green Road Brookhouse Lancaster Lancashire LA2 9JH Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 2.00 14 February 2006 th 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 Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 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. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hillcroft (Caton Green) Nursing Home Address Caton Green Road Brookhouse Lancaster Lancashire LA2 9JH 01524 770334 01524 771472 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) Hillcroft (Caton Green) Limited Mrs Valerie O`Connor Care Home 35 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (16) of places Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered within the Commission for Social Care Inspection.. The home is registered for a maximum of 35 service users to include up to 19 service users in the category DE (dementia) and up to 16 people in the category OP (older persons 65 and over) 11th August 2005 Date of last inspection Brief Description of the Service: Hillcroft (Caton Green) Limited is the second smallest of the four homes operating within the Hillcroft Limited group of homes and is situated near to the small village of Caton, approximately 10 miles north of Lancaster. The home is a detached dwelling, built in a Victorian style, originally used as a maternity home but its use was changed to that of a nursing home in more recent times. The home is situated in its own quite extensive grounds and is built over two floors. Additional accommodation has been built on. The home has two main areas – The Manor and The Croft. The home is reasonably close to local shops and amenities in the nearby village but, because of the needs of the residents, there would be very few people who could access these independently. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced so the registered manager and staff at the home were not aware of the inspection. The purpose of this inspection was to assess the service against the key National Minimum Standards, which remain outstanding and also review actions taken following the recommendations made in the previous inspection report. A number of residents were spoken with, although only two were able to express a verbally their view of the home. Residents were seen to be relaxed and comfortable and the care staff were respectful and kind in their dealings with them. A visiting relative was also spoken with. Both qualified and care staff on duty were also spoken with. A selection of documents held by the home were examined, including medication records and staff files. The home was toured and found to be well maintained, pleasant and providing a comfortable environment for the residents to live in. A number of rooms had been personalised with familiar and treasured possessions. Feedback received from comment cards were generally positive about the care provided – one comment card stated that their relative was fairly new in the home but found it to be “super”. Another comment card stated that they were “happy at the treatment of my relative. The staff are very helpful and thoughtful and my relative seems quite content”. Another comment card raised a concern over medication and an incident which were discussed with the registered manager. From this discussion the inspector is confident that the concerns will be looked into and addressed. What the service does well: Both the General Manager and the individual home’s manager remain committed to making sure that the needs of the residents are met and the standard of care and the environment is kept at a high level. Support continues to be provided to relatives by means of a support group. The company recognised that a number of relatives were interested in the care provided to their residents, and provided this practical way so that people could meet informally. This support group meetings on a 6 monthly basis. As mentioned in this report, this group not only provides support to others who may be finding it difficult to accept their relatives have dementia or now need the care provided by the home, but also provides advice and information. The company pays for a place for the group to meet, along with food and drink. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 6 The registered manager stated that the Christmas support group was very well attended and enjoyed by those who were there. There continues to be an ongoing commitment to training for all staff at the home. The environment is maintained to a high level, monitoring of the standard of the environment takes place by one of the Directors of the Company, the General Manager and the full-time Housekeeper. What has improved since the last inspection? What they could do better: A requirement has been made over the water temperatures in the home as, when tested, there did not appear to be any hot water in either sinks or Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 7 bathrooms even though these were ran for a number of minutes. From discussion with the registered manager this is something the staff are aware of and know to run the taps. However, given the fact that no hot water could be raised, it was felt that further investigation may be warranted to see if the current situation can be improved. In the meantime the registered manager is to speak with the handyman to make sure the water temperature is to the required safe level. A requirement was also made to ensure that residents doors are closing properly and providing the required level of safety to the residents, specifically noted was Room 38. Recommendations are made as follows : The issue raised over medication timing is to be looked into by the registered manager and an outcome forwarded to the Commission. Unless a risk assessment states otherwise, privacy screens should be in residents rooms so that they can be accessed easily by staff. Training in abuse awareness should continue so that all staff receive this training. Following this inspection, it was established through discussion with the registered manager that the Commission had not been informed of a recent incident – advice was provided to the registered manager. 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. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 8 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 Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were assessed at the previous inspection and found to be met EVIDENCE: Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Standards 7, 8 and 10 were assessed at a previous inspection and found to be met. Systems are in place to ensure medication is safely administered to residents by people who are qualified to do so. EVIDENCE: Medication is administered by the qualified staff on duty. Records examined during this inspection were appropriately and accurately documented. Stocks of medication were stored in a secure cabinet which was clean and tidily maintained. Medication records included consent forms, homely medication records and photographs of the individual residents on their record sheet. One comment card expressed concern that they felt their relative’s medication was not always given at the time it is prescribed. This was raised with the registered manager who is to look into the concern raised. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed and met at the previous inspection EVIDENCE: Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Standard 16 was assessed and met at a previous inspection There are good systems in place, and training provided, to ensure that residents are protected from abuse. EVIDENCE: There is a thorough recruitment procedure for the home which means only staff who are suitable to work with vulnerable people are employed. The home has a comprehensive vulnerable adult abuse procedure which has been used, when needed, in the past. Any incidences or concerns are passed to the Registered Manager who is responsible for taking the appropriate action. An overview and monitoring of concerns or complaints is carried out by the General Manager as part of the home’s quality monitoring process and who would also deal with any formal appeals, if needed. Most staff have been provided with abuse training, although some staff confirmed they had not done the formal training as yet. It was advised that all staff be provided with training in abuse awareness and refresher training provided to longer-serving members of staff. Discussions with both qualified and care staff on duty confirmed that there is a good understanding of what Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 13 would constitute abuse and all would contact either the registered manager or the senior member of staff on duty should any concerns be raised. Discussions with the dedicated Training Manager for the Hillcroft group whilst at the Hillcroft (Carnforth) home confirmed that adult abuse awareness is covered both in the home’s own induction as well as in other training. There is also an ongoing training programme for all staff. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25.8 and 26 Residents live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. The water temperature is too low and may not ensure the comfort of residents. EVIDENCE: The home was toured and both the Manor and The Croft were found to be clean, tidy and providing a warm and very homely environment for the residents. A slight odour was noticed in the main lounge on the Manor - the registered manager confirmed that arrangements to have the carpet professionally cleaned were already in place. It is requested that confirmation be sent to the Commission once the cleaning has taken place. There is a secure garden which is accessible by residents, although this is generally with staff support. From the previous inspections the following is noted : Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 15 There is a dedicated housekeeper and maintenance section to ensure any requirements made by the fire department and environmental health are addressed promptly. There are no CCTV cameras in use in the home. There is a separate laundry for washing which is separate to the cooking and other areas of the home. It has previously been confirmed that all the requirements for the washing of foul laundry and disinfection standards are met. There are policies and procedures in place for the control of infection, as well as procedures should a serious outbreak occur. Discussions with staff during this inspection confirmed there is a good understanding of infection control. No hot water came through the taps on the sinks and bathrooms tested, despite running the water for a number of minutes. The registered manager advised that this has been an issue but staff are aware to run the taps. However, given the fact that no hot water came through even though the taps were run for some time the registered manager was asked to address this promptly. Screens have been provided in double rooms but, during this inspection, the registered manager was advised that one room did not have a screen in place. Although a screen may be available in the corridor it would be better placed (after risk assessing) in the room so that it is available for staff to use when they are in the room. Room 48 was noted to be not closing properly and the registered manager was advised that rooms should be checked to ensure they close properly in case a fire occurs. A visiting relative was spoken with who confirmed they were very happy with the home’s environment and were particularly happy that they were able to bring in treasured and familiar possessions for their relative. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Standards 28 and 30 were assessed and met at a previous inspection. The level and calibre of staff is very good. Residents are cared for by staff who are qualified, competent and dedicated. Staff are properly vetted before taking up employment meaning that only people who are suitable work with vulnerable people do so. EVIDENCE: Staffing rotas were seen and evidenced that the staffing levels are maintained to an appropriate level. Discussions with staff on duty and with one visiting relatives confirmed that they feel there is always sufficient staff on duty. Three comment cards received from relatives indicated that they felt there was sufficient staff on duty. One comment card include “the staff are very helpful and thoughtful”. On both The Manor and The Croft there is a qualified nurse on duty at all times, along with care staff. The Company has appointed a dedicated full-time ‘Care Supervisor’ on duty whose role is to organise the staffing levels at all the four Hillcroft homes, dealing with sickness and holidays and ensuring there is sufficient staff on duty. More recently, the Hillcroft group has employed 8 experienced people who are a dedicated holiday/sickness bank of staff used within the four homes Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 17 to cover as required. These people are required to be experienced to a higher level of competence, for example, auxiliary nurses or trained National Vocational Qualification Level III as a minimum. In addition, there is a dedicated Clinical Supervisor who organises and provides training to staff. To ensure staff get to know about changes to care needs, all staff now have a paid quarter-hour handover period. This provides an opportunity for qualified and care staff to get together to discuss any changes or specific instructions which have come about since their last shift. The General Manager for the four homes has introduced a ‘Staff Bulletin’ for all the staff and includes information on Company news; training available; welcome for new staff; congratulations on training completed; and any other pertinent information. Only one new member of care staff has been recruited since the last inspection and, from examining their personnel file, all the required checks have been carried out prior to appointment. Criminal Record Bureau disclosure forms have been obtained for all current staff and these were seen during this inspection. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 Standards 31 and 38 were assessed at a previous inspection and found to be met. The financial arrangements in place ensure that residents’ finances are safeguarded. Systems are in place to ensure the service is monitored and developed to the benefit of the residents. Residents and their relatives feel listened to. EVIDENCE: From previous inspections it is noted that, because of the needs of the residents at the home, formal residents meetings are not an option. However, the home has very close links with relatives and has its own support group. The support group is made up of both current relatives and relatives of people Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 19 no longer at the home and provides both a support, information and social function. The group meets on a 6 monthly basis, with input from both one of the Directors, the General Manager and the manager of the home. There is a financial cost to these meetings which is met wholly by the company. The registered manager confirmed that these support meetings continue to take place and the most recent one held at Christmas 2005 was well attended and enjoyed by those who were there. Discussions with a visiting relative during this inspection confirmed that they were very happy indeed with the care provided by the staff at the home; that they were made welcome at any time and they were kept informed of important matters affecting their relatives’ care. Comment cards received from relatives also confirmed that they are made to feel welcome at any time, are kept informed of important matters and are able to visit in private. Concerns raised by one relative were discussed with the registered manager who will look into the issue raised. Advice was provided that a Regulation 37 notification should have been sent to the Commission for this incident. Two residents who were able to do so also confirmed that they feel listened to and were able to talk to staff who took any concerns seriously and were happy with the care provided. Other residents were observed and were seen to be relaxed and comfortable in their environment. Overall financial administration takes place at the Company’s Carnforth home where it was confirmed all four homes in the Hillcroft group follow the same financial procedures. Through talking with the Company’s administrator it was confirmed that there are exacting and significant financial procedures in place to ensure the resident’s financial interests at all the four homes are protected. Examination of a financial file for one resident at Hillcroft (Caton Green) (whilst at the main administration office in Carnforth) evidenced that each resident has their own financial file into which copies of invoices, payments, contracts, etc., are kept. Residents can choose to have their own account into which money is paid. The home will make payments on behalf of individual residents and at the end of each month an invoice is raised and either presented to relatives or paid from this individual account. The Administrator confirmed that any large expenditures have to be authorised and receipts, etc., are sent out to relatives for their information. Minor expenditures on behalf of residents have to be receipted and presented to the finance department. Computer records are maintained of charges and payments and the Administrator also confirmed these are backed-up on a daily basis. A selection of accounts were examined and the information presented was seen to be exact. The Administrator also stated that for some residents monitoring of payments into accounts and appropriate action takes place as needed. The Administrator is the named person who will act as an appointee, if required. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 20 The General Manager has also confirmed that the existing quality assurance systems remain in place which include external and internal auditing, the use of ‘non-compliance forms’ which are used to identify issues so that appropriate action can be taken. Feedback is also sought from residents, relatives and external healthcare professionals. The registered provider also visits and tours the home on a weekly basis and, in addition to this, monthly reports are sent to the Commission by the General Manager. Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X x Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 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 2 Standard OP25 OP38 Regulation 23(2)(j) Requirement Timescale for action 31/03/06 28/02/06 The lack/delay of hot water in residents’ rooms and communal bathrooms must be addressed 23(4)(c)(ii Doors to residents rooms must i) close to ensure safety should a fire occur – noted room 48 was not closing properly 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 Refer to Standard OP18 OP10 OP9 Good Practice Recommendations Abuse awareness training should be provided to those staff who have not undertaken this training and refresher training to longer-serving employees Screens to ensure privacy should be in residents rooms and thereby available for staff to use at all times The issue over medication not being given at the prescribed times should be looked into by the registered manager and the outcome reported back to the Commission The registered manager was provided with advice over notifications which should be made to the Commission DS0000006141.V259827.R01.S.doc Version 5.0 Page 23 4 OP18 Hillcroft (Caton Green) Nursing Home which include events which may affect the wellbeing or safety of residents Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Hillcroft (Caton Green) Nursing Home DS0000006141.V259827.R01.S.doc Version 5.0 Page 25 - 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!