Inspection on 15/04/08 for Hirst Villas, 6

This inspection was carried out on 15th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hirst Villas, 6 30/07/07

Hirst Villas, 6 18/09/06

Hirst Villas, 6 31/10/05

Hirst Villas, 6 25/04/05

Hirst Villas, 6 06/12/04

Hirst Villas, 6 09/06/04

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 Hirst Villas, 6 6 Hirst Villas Bedlington Northumberland NE22 5QQ Lead Inspector Jim Lamb Key Unannounced Inspection 15th April 2008 09:30 Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hirst Villas, 6 Address 6 Hirst Villas Bedlington Northumberland NE22 5QQ 01670 - 531799 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) ntawnt.hirst@nhs.net Northumberland, Tyne & Wear NHS Trust Vacant. Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th July 2007 Brief Description of the Service: Hirst Villa is a small residential care home providing personal care and accommodation for three female service users with learning disabilities. The home is located in a residential area of Bedlington. There is good access to all local amenities and transport links. The home provides very comfortable and spacious facilities for the service users. All bedrooms are single and highly personalised to each individuals taste. The homes front and rear gardens are landscaped and easily accessible. Fees for the home range from £949.17 to £1024.74. Information about the service and previous inspection reports is available in the home. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is 1 star. This means that the people who use the service experience adequate quality outcome. How the inspection was carried out. Before the visit: We looked at: • Information we have received since the last visit. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 15.4.08. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well: Admissions to the home are rare, however they will always ensure that they carefully assess future people wishing to come and live in the home, to make sure that their needs can be met. They will then draw up detailed plans of how staff will help them to meet their needs. This means that staff have the information they needed to support each person and keep them safe. The arrangements for supporting service users to make decisions about their daily lives and preferences are good. Each person was supported to take Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 6 appropriate risks as part of the home’s plans to promote as much independence as possible. Suitable arrangements are in place for people to take part in appropriate activities in line with their needs and preferences. The arrangements for supporting service users to maintain contact with their friends and family are very good. The relationships between staff and the people who live there are very good and personal support is provided in a way that promotes and protects their privacy and dignity. The meals provide by the home were good and provided a varied, nutritious diet. Suitable arrangements are in place for handling complaints and for protecting service users from abuse. Service users feel they can share any worries with the staff and feel that their views are listened to. The arrangements for keeping the home clean and tidy are very good. The standard of the accommodation, décor and furniture and fittings is excellent and provides a clean and comfortable place to live in. There is a stable and competent staff team who have been given a good training programme that includes training that covers the specific conditions of the people who live there. The manager is new and suitably qualified and experienced. The staff demonstrated a commitment to provide good quality care and support for the people living at the home. This is important in ensuring that the home is well run. The health and safety of the people who live in the home is taken seriously, and the proper checks and tests of safety equipment take place. One service user said, “I can see my friends whenever I like, and I sometime go out for a meal with them on my own. I also have lots of friends at college, and I also see my family often”. What has improved since the last inspection? The home has been without a registered manager for almost two years. The staff team have worked hard during this period to maintain high standards of care. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 7 The manager is new and suitably qualified and experienced. This will give the staff the support they need to continue to provide good quality care and support for the people living at the home. 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. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 8 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 Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are properly assessed and are provided with enough information about the service to enable them to make a choice about where they want to live. EVIDENCE: Details of the extra charges and what these are for, are in the contract given to service users and are agreed prior to their admission. The homes Statement of Purpose and the Service Users Guide both contained the full range of information required. This information is available in a pictorial format, and this helps service users to understand its content. Two service users’ files were checked and each included a full needs assessment. They contained a range of appropriate information. The service users are involved in drawing up both these initial assessments and the home’s subsequent service user plans. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 10 Two care plans were checked and two staff interviewed, which confirmed that a range of specialist services was provided to service users. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The care planning system is not clear enough to ensure that staff have the full information they need to inform them of the assessed needs of the service users. All are supported to make decisions about their lives, and take risks to promote their independence. EVIDENCE: All service users have a range of support care plans, but some parts have not been reviewed and evaluated to ensure their holistic needs are identified. Other assessed formats used include, the nutritional needs of individuals, the OK health check document, and the Braden assessment scale. Again these have not been reviewed and updated. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 12 Each person has a plan of care that is not as thorough as it should be. Care plans are looked at closely in regularly monthly reviews, but they are not updated as necessary. Service user’s information is held in several different files. Records were not easily accessible because they were not well organised. Staff said that they are always given up to date information about the service users and their needs, but not having clear leadership for so long has been difficult at times. Staff on duty showed that they had very good knowledge of each service users individual needs. The service user present said that they all make decisions about what they do each day, and that they can do (with staff assistance) what they want to do during the day, evenings and at weekends. People living in the home have a wide range of opportunities for choice. These include meals and cooking, activities, trips out, and what to wear. Holidays are negotiated individually with each person, and they can choose where to go, when, and who with. Interactions observed between staff and the people who live in the home are based on mutual respect and affection. The home’s policy is to accept that risk is part of the normal experience of daily living. Some of the service users risk assessments have not been reviewed or evaluated for almost two years. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users are offered a very good quality lifestyle, which includes social contact, activities and choice. EVIDENCE: Each service user receives individual staff support to develop and maintain their self-care and daily living skills. Each person has an individual timetable of activities, tailored to their likes and interests. They are supported to take part in a range of activities in a variety of settings. Outings and activities are planned. There are meals out, visits to cafes, shops, pubs, and trips to a local theatres, etc. All the people who live in the home have involvement with their families. The degree of contact is decided by the wishes of each individual, and it can be in Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 14 person or by phone. Some choose to visit their family members outside the home; others, to be visited at home. Staff were seen to respect and safeguard people’s right to privacy. Service users confirmed that staff respected their privacy. The people living in the home have unrestricted access to all areas of the home other than each other’s bedrooms. Those that are able help with household tasks such as, clearing up after the lunch meal, cleaning the kitchen and helping to prepare meals. Throughout the inspection staff were observed talking to and engaging appropriately with the service users. The daily routines in the home were seen to support the independence of the people who live in the home, rather than restrict them. Negotiation and consultation appeared to be the normal methods of communication. Any disputes between service users are resolved in a similar manner. Each person has her own bedroom door key, and bathrooms and toilets are lockable (staff can over-ride these in an emergency). They receive their mail unopened. They are addressed by their preferred name. People living in the home are fully consulted as to the weekly menu, and have a genuine input. Staff provide guidance with regard to nutrition, and healthy eating is promoted. People’s food likes and dislikes are known and are recorded, but staff will also actively try to extend the options available. If, however, an individual does not want the planned meal, then alternatives are offered. A cooked breakfast is available on request. Fresh fruit is available at all times. All staff have received basic food hygiene training. Each individual service users religious beliefs are acknowledged and respected. Two service users attend a weekly church service. All have informed staff of their wishes/feelings about growing old, illness, and their wishes following death. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The promotion of health care is taken seriously, and service users have their personal needs well met in the way that they prefer. EVIDENCE: People using the service are given sensitive personal support by the staff, who promotes each individual’s independence, dignity, privacy and choice. Each person has an individual assessment of his or her personal health needs, and has a care plan in place to meet those needs. Plans are person-centred, sensitive and thoughtful. They stress the strengths of the individual, and are positive in terms of seeking to develop the skills and abilities of the person. Some of these records need to be updated and evaluated to ensure they reflect each individuals current health needs. Privacy is given a high priority, and one service user said, “I have my own room where I can go if I want to be by myself”. She confirmed that staff always ask her permission before entering her room. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 16 Each person has his or her own ‘Personal Health Information’ file. This contains professional health assessments, correspondence, and records of contacts with health professionals. It demonstrated that all aspects of a person’s physical and mental health are taken seriously. Medicines are ordered weekly, and these are delivered in blister packs. This is said to be working well, and to minimise any risk of a medication error. The Medication Administration Records were checked. These were completed to a good standard, with no gaps, and the codes used properly. Medicines are safely stored. All staff have had training on how to use the blister pack medication system. They have also had external ‘Safe Handling of Medicines’ training. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good user-friendly complaints and protection system, which means that service users are safe, and their views are listened to and acted on. EVIDENCE: The home has a clear complaints procedure. It is also available in a pictorial format to help the people living there understand the system. No formal complaints have been received by the home during the last twelve months. The home has a policy on the protection of its service users from abuse, and a copy of the local authorities procedures. The staff team are aware of these procedures and have easy access to them. All staff have had Adult Safeguarding/Protection of Vulnerable Adults training. One service user confirmed that the staff always treat them well, and that they listen to and act on what they say. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a very comfortable, clean, safe and pleasant environment for those living there. EVIDENCE: The home is clean, tidy and homely in appearance. The premises are accessible to all of the service users. The Home is situated close to local amenities and public transport. The furniture and fittings are of a good standard, with comfortable furnishings. Maintenance and redecoration is carried out at regular intervals. Cleaning materials and other potentially hazardous substances are safely stored. Policies and procedures are in place relating to the Control of Hazardous Substances and Infection Control and other Health and Safety matters. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 19 Staff receive regular Health and Safety training including Food Hygiene. Staff demonstrated an awareness of infection control procedures. Some service users assist with the daily chores, such as: hoovering, laundry, emptying of bins, loading and unloading the dishwasher, and doing the weekly food shopping. All service users bedrooms are very spacious. Each has a double bed and attractive furnishings, and all are very highly personalised. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good match of well-qualified staff, who are appropriately recruited and offer consistency of care within the home. EVIDENCE: Staff levels on the day of the inspection met the agreed level. The required numbers of staff were on duty: 2 staff between 8am and 5pm with 1 staff between 5pm and 8am. All staff were over 18 years of age and those left in charge were at least 21. The training needs of the staff are identified in supervision and appraisal sessions. Supervision sessions have not taken place during the period when there was no manager in post. The homes training programme meets the National Training Organisation requirements for the first six months. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 21 Staff receive at least three days paid training each year. The Trust has a rigorous staff recruitement and selection process to ensure that all appropriate checks and references are in place prior to employment. The service has a good staff training and development programme in place. All statutory training was up to date and 99 of the staff team has completed NVQ level 2/3. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 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. 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 new manager is not yet registered, however she is supported by the organisation in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities, and service users best interests being promoted. EVIDENCE: The manager has several years experience in senior management prior to her recent appointment to the home. She has the appropriate qualifications, experience and skills necessary to manage the service. She will need to complete CSCI application to become the registered manager of the service. Staff spoken to were clear about their responsibilities. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 23 Service users are told when inspections take place and they are shown (easy read) inspection reports. Copies of reports are available for relatives and others to see. A quality assurance system has been used previously to monitor the quality of the service provided. This involves gaining feedback from service users, relatives and professionals involved with the home. However, due to t there not being a manager for some considerable time, the system has lapsed. There are no equality and diversity issues that raise any concerns. The Trust has devised equality and diversity policies and procedures, and these are promoted throughout the service. The records inspected were found to be appropriately completed. These included the fire log book, accident records, personal allowance records and Health and Safety manual. There is a health and safety policy and a range of associated procedures. Staff receive training in safe working practices. There are appropriate maintenance contracts in place for the home. Water storage tanks, gas and electrics are checked annually. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 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 3 2 3 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 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 4 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 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 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 YA39 Regulation 24 Requirement The homes quality assurance system must be brought up to date and an annual development plan drawn up. All service user care plans and health records must be updated to ensure that their personal and health care needs are fully identified and met. Outstanding since June 2007. Timescale for action 01/08/08 2. YA6 15 01/08/08 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. Refer to Standard YA37 YA36 Good Practice Recommendations The manager must complete and submit an application to CSCI to become the approved registered manager. Staff must receive the support and supervision they need to carry out their jobs. Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Hirst Villas, 6 DS0000000568.V362249.R01.S.doc Version 5.2 Page 27 - 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!