Inspection on 08/07/08 for Homelands Nursing Home

This inspection was carried out on 8th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Homelands Nursing Home 17/07/07

Homelands Nursing Home 25/04/06

Homelands Nursing Home 21/09/05

Homelands Nursing Home 07/06/05

Homelands Nursing Home 24/11/04

Homelands Nursing Home 12/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Homelands Nursing Home Horsham Road Cowfold West Sussex RH13 8AJ Lead Inspector Sarah MacLennan Unannounced Inspection 09:30 8th July 2008 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 Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homelands Nursing Home Address Horsham Road Cowfold West Sussex RH13 8AJ 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) 01403 864581 01403 865066 Medicrest Limited Care Home 43 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (17), Old age, not falling within any other of places category (26) Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A total of 43 Service Users may be acommodated in two units. Unit one, 17 service users in the category dementia (DE(E)) over the age of 65 years, of whom 6 service users in the category dementia (DE) age 60-65 years may be accommodate. Unit two, 26 service users in the category old age not falling within any other category (OP), of whom 6 service users in the category Physical Disability, age 60-65 years may be accommodated. Unit two may also accommodate up to six service users in the category Physical Disability Elderly PD(E), over the age of 65 years 17th July 2007 Date of last inspection Brief Description of the Service: Homelands is a care home, which is registered to provide nursing care. It has two separate buildings known as the Main House and the Coach House and is located in the village of Cowfold. The Main House accommodates up to 26 service users in the category old age not falling within any other category (OP). The Coach House accommodates up to 17 service users in the category dementia, over the age of 65 years (DE(E)). Private accommodation provided in each house includes single and double bedrooms, some of which also include en-suite facilities. Double rooms are being used as single occupancy as vacancies arise. Communal accommodation includes two lounges and a dining room in the Main House and a lounge/dining room in the Coach House. The registered provider is Medicrest Ltd who has appointed Mr S Alagaratnam as the Responsible Individual who is responsible for supervising the management of the care home. There is an acting manager in post who is responsible for the day to day running of the care home. The fees for this care home currently range from £535 to £650 per week. Homelands Nursing Home DS0000024155.V367516.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 service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care Inspection has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a ‘key’ inspection and was carried out by Sarah MacLennan, Regulation Inspector. The acting manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the acting manager and any information that CSCI has received about the service since the last inspection. A tour of the premises took place. On the day of this visit the inspector met with some people who use the service and some on-duty staff. Some of the people who use the service and some staff returned surveys. Some of the comments made to the inspector and made on the survey forms are quoted in this report. Observations of the interactions between staff and the people who use the service were also used to form the judgements reached in this report. The home completed an annual quality assurance assessment (AQAA) prior to the visit and care plans of people who use the service, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. We would like to thank the people who use the service and staff for their time, assistance and hospitality during this visit. What the service does well: The people who use the service were complimentary regarding the care that they received in the home. Comments included, ‘I’m very well looked after’. They are encouraged to be as independent as possible and to make their own choices, such interactions were observed. When asked if they received the support they required comments included ‘yes, they are very good’. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 6 All of the people who use the service who were surveyed and spoken to said that they were happy with the food provision within the home. Service users were observed to eat lunch during the inspection. The kitchen had recently been inspected by the Environmental Health Department, their report stated that ‘the procedures in place are effective and the kitchen is well run’. What has improved since the last inspection? What they could do better: Two of the files of the people who use the service did not have an adequate risk assessment or evidence of consent for the use of bed-rails or a lap belt. There was no evidence that the use of bed-rails or a lap belt was in the service users best interest and not being used as a form of restraint. A requirement has been made in this respect. The medication fridge temperatures in the coach house had not been checked or recorded since November 2007 as the thermometer had broken. The lifestyle offered in the home does not meet all the service users needs and preferences; the people who use the service need more activities and stimulation. Most areas of the home were seen to be clean and tidy; however the corner of the dining room in the main house was being used as a storage area for chairs, wheelchairs and walking frames. The inspector was informed that there was not a suitable area for equipment storage. The home does not provide a completely safe and well maintained environment for the people who live there. Several areas in need of maintenance were seen. These included torn wallpaper in the corridors of the coach house; some of the radiator covers were in a poor state of repair and hot water pipes were not covered. Discussion took place regarding the suitability of some of the beds; one bed was noted to be on wheels that did not have a locking facility. The staff spoken to did not feel that this presented the current service user with a risk; however no risk assessment had been completed. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 7 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. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 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 Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users had been assessed prior to admission to the home to ensure that the home can meet the service users identified needs. The home does not offer intermediate care. EVIDENCE: The inspector was advised that the acting manager or one of her deputy carries out a pre-admission assessment on all prospective people who will use the service. Five service user care plans were seen and contained a comprehensive preadmission assessment form. The form covered all elements of physical, mental, and social needs. In some of the files sampled the pre-admission assessment had not been completed; however there was some written Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 10 evidence that the service users had been assessed prior to admission. acting manager stated that she would address this shortfall. The All people who use the service and relatives surveyed and spoken to felt they had received enough information prior to moving to the home. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans, procedures and practices were in place to ensure the service users health care needs are met; however, there was no evidence that the use of bed-rails or a lap belt was in the service users best interest. EVIDENCE: The service user care plans and files were randomly sampled; five care plans and daily statements were looked at in detail. All the people who use the service had care plans, parts of which were detailed and comprehensive, with some risk assessments being completed. Two of the files sampled did not have an adequate risk assessment or evidence of consent for the use of bed-rails or a lap belt. There was no evidence that the use of bed-rails or a lap belt was in the service users best interest and not being used as a form of restraint. A requirement has been made in this respect. The daily statements evidenced that aspects of the care plans were followed and provided some details of the people who use the services’ 24hr day. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 12 The people who use the service surveyed and spoken with were complimentary regarding the care that they received in the home. Comments included, ‘I’m very well looked after’. The people who use the service were registered with a local GP and had access to other health care services including vascular nurse, tissue viability nurse, diabetic nurse, speech and language therapist, continence adviser and podiatrist. Mental Health referrals are via GP. The homes medication administration records were seen and found to be in order. The medication storage facilities in the main house were seen and found to be in order. The medication fridge temperatures in the coach house had not been checked or recorded since November 2007 as the thermometer had broken. Conversation with staff and the people who use the service evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. When asked if they received the support they required comments included ‘yes, they are very good’. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle offered in the home does not meet all the service users needs and preferences; the people who use the service need more activities and stimulation. EVIDENCE: During the visit the acting manger discussed how the home had recognised that they needed to improve their activity provision. An activities coordinator had been recently employed and was due to start the following week. This appointment is a positive step towards ensuring that activities provided will meet the preferences, expectations and needs of all the people who use the service. The home currently offers seasonal activities, including the planned summer garden party, a visiting library, music and television. The home has links with a local a Catholic and a Christian Fellowship church. Church services take place every Sunday. Due to the needs of the current service users, representatives of other denominations do not currently visit the home. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 14 All of the people who use the service who were surveyed and spoken to said that they were happy with the food provision within the home. Service users were observed to eat lunch during the inspection. The menu was on a four weekly rota and alternatives were available on request. No cultural diets are currently provided, but could be upon request. The kitchen had recently been inspected by the Environmental Health Department, their report stated that ‘the procedures in place are effective and the kitchen is well run’. Conversation with staff, relatives and service users evidenced that the people who use the service are encouraged to make their own choices, such interactions were observed. Staff were observed to treat the people who use the service with respect and care was provided in an unobtrusive and dignified manner. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a simple and accessible complaints procedure; the people who use the service felt safe. EVIDENCE: The home had a simple and accessible complaints procedure; a copy is given to all the people who use the service in the service users guide. Service users spoken to during the inspection were aware of who to speak to should they have any complaints and felt confident that they would be listened to. There had been no complaints since the acting manager had been in post. One complainant had contacted the Commission with information concerning the service. Safeguarding adults and whistle blowing policies and procedures were in place and readily available to staff. The home also had copies of the Sussex MultiAgency Policy and Procedures for Safeguarding Vulnerable Adults. Staff spoken to were aware of these policies and procedures and their whistle blowing responsibilities. Staff had received training in the protection of vulnerable adults. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not provide a completely safe and well maintained environment for the people who live there. EVIDENCE: The inspector toured areas of the home. The people who use the service were able to access all areas of the home and grounds. The décor was domestic in nature and free from offensive odours. Most areas of the home were seen to be clean and tidy; however the corner of the dining room in the main house was being used as a storage area for chairs, wheelchairs and walking frames. The inspector was informed that there was not a suitable area for equipment storage. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 17 Several areas in need of maintenance were seen. These included torn wallpaper in the corridors of the coach house; some of the radiator covers were in a poor state of repair and hot water pipes were not covered. Discussion took place regarding the suitability of some of the beds; one bed was noted to be on wheels that did not have a locking facility. The staff spoken to did not feel that this presented the current service user with a risk; however no risk assessment had been completed. The inspector was informed that the home is undergoing an extensive refurbishment that will ultimately include an extension and the addition of further beds. The acting manager stated that the home was in consultation with an architect regarding this. Some of the areas of the home had already been refurbished, including several bedrooms and a bathroom. New furniture and specialist nursing beds had been purchased for the refurbished rooms. A new platform lift had been fitted in the main house. Staff spoken to stated that the new lift greatly enhanced their ability to provide care to the people using the service. The home annual quality assurance assessment (AQAA) completed by the acting manager prior to the visit stated that: ‘Raised toilet seats are to be replaced on the recommendation of the OT. The ramps are to be changed at the front door at OTs recommendation. Storage space is to be found for aids and equipment. A new bathroom and two new shower rooms are planned for the Main House. The bath is to be one that raises and lowers with a ceiling hoist. Extra grab rails are to be installed where directed by the OT.’ A requirement has been made that the Commission is provided with comprehensive details of the planned refurbishments including timescales for actions required, to ensure that the building is suitable to meet the needs of the people who use the service. The inspector was informed that upstairs windows were restricted and thermostatic valves were fitted to taps and checked regularly. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing arrangements in place on the day of the inspection were sufficient to meet the needs of the people who use the service. The home had adequate ancillary staff on duty at the time of the inspection. EVIDENCE: Discussion with the acting manager, staff and the people who use the service demonstrated that the staffing numbers and skill mix were appropriate to meet the assessed needs of the people living in the home. The duty rota demonstrated that the home maintains staffing number of six carers in the morning, four during the afternoon and evening and two at night. A trained nurse is on duty in each unit at all times. Four staff files were seen during the visit and found to contain most of the required information and documents specified in paragraphs 1 – 9 of Schedule 2 of The Care Homes Regulations 2001 (as amended by The Care Standards Act 2000(Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004). All the required documentation was present in the staff files for staff members that had been recruited by the acting manager; however there was no evidence that the Personal Identification Numbers (PIN) of the trained nurses had been checked. The acting manager stated that she would address this shortfall within the next few days. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 19 The staff training records were randomly sampled, they evidenced that staff had received mandatory training in infection control, manual handling, fire safety, protection of vulnerable adults and first aid. Staff training had been planned for service user specific topics, including dementia care. Service users and relatives spoken with were complementary about the staff at the home. Comments included All interactions observed between the staff and service users were caring and respectful. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service benefit from the management approach at the home, which provided an open, positive and inclusive atmosphere. The acting manager demonstrated a good knowledge and awareness of the needs of the people who use the service. EVIDENCE: The acting manager has been in post for seven months and has not yet submitted an application to the commission to become registered manager. She is currently undertaking the registered managers award (RMA) and stated that she was unaware that she could submit her application prior to its’ completion. The acting manager was advised to consult the commissions website for up to date information on registering as a manager. The people Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 21 who use the service were seen to interact readily with her and an open and inclusive atmosphere was evident within the home. All staff and people who use the service appeared happy, contented and relaxed with the inspection process. The atmosphere within the home during the inspection was lively and cheerful. The acting manager stated that various quality audit systems were in place to ensure the staff, service users and their relatives had a forum for airing their views. These included staff meetings, residents, friends and relatives meetings and staff supervisions. The minutes of these meetings were randomly sampled and there was evidence that action was taken following comments made. The people who use the service who were spoken to felt that their views were usually listened to and taken seriously. The home does not currently conduct audits of the processes within the home; however the acting manager was working towards this. Procedures were in place to safeguard the financial interests of the people who use the service. No staff members were appointees for service users. The acting manager is aware of the need to maintain a safe environment for service users and staff. Required policies, procedures and safety checks were in place; samples of which were seen. Staff were observed to be following appropriate health and safety practices as they went about their work. Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 13 (4)(7) Requirement Timescale for action 08/09/08 2 OP19 13 (4) 23(2) (b)(d)(l) 24A (1) The registered person must ensure that the use of bed-rails or a lap belt is following an appropriate risk assessment and with service users consent to ensure that their use is in the service users best interest and not as a form of restraint. The registered person must 08/09/08 provide the Commission with comprehensive details of the planned refurbishments including timescales for actions required, to ensure that the building is suitable to meet the needs of the people who use the service. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Homelands Nursing Home DS0000024155.V367516.R01.S.doc Version 5.2 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!