Inspection on 06/05/08 for Ingleside

This inspection was carried out on 6th May 2008.

CSCI found this care home to be providing an Good 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

Ingleside 12/07/07

Ingleside 08/05/06

Ingleside 16/01/06

Ingleside 14/07/05

Ingleside 09/03/05

Ingleside 02/08/04

Ingleside 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ingleside 648 Dorchester Road Upwey Weymouth Dorset DT3 5LG Lead Inspector Gloria Ashwell Unannounced Inspection 6th May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ingleside DS0000026824.V362785.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. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ingleside Address 648 Dorchester Road Upwey Weymouth Dorset DT3 5LG 01305 812667 01305 813383 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) Mr Christopher James Webb Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two rooms may be used as doubles. Date of last inspection 12th July 2007 Brief Description of the Service: Ingleside Residential Care Home is a large semi-detached house set back from the main Dorchester to Weymouth road in the village of Upwey. The home is registered to accommodate 17 elderly people and has been owned and managed by Christopher Webb for over 20 years. In total there are fifteen bedrooms available in a combination of 13 single and 2 double rooms. Bedrooms are situated on the ground and first floor of the house. The first floor is accessed by chairlift on the main staircase or by a back staircase. Some bedrooms are at a slightly higher level and a chairlift is also fitted to this short flight of stairs. Communal facilities include two lounges, a separate dining room and a conservatory that overlooks the front garden. Laundering of clothing and household linen is carried out within the home at no additional cost to residents; items requiring dry cleaning are charged additionally because it is necessary to send them out of the home for this service. A hairdresser visits the home each week; there is an additional charge for this service. A public transport bus stop, for buses to the nearby town centre, is close to the home. Fees are charged weekly; the fee range quoted in the service user guide at the time of inspection was (per person) from £391 to £512. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 5 Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000. There have been no inspection visits to the home since the previous key inspection which took place during July 2007. This inspection was unannounced; the inspector arrived at 10.00 on 6 May 2008, toured the premises and spoke to residents, visitors, staff, observed staff interaction with residents and the carrying out of routine tasks and together with Mr Webb, the Registered Provider and the deputy manager discussed and examined documents regarding care provision and management of the home. The duration of the inspection was 4 hours. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. In advance of the inspection ‘Have Your Say’ questionnaires were issued to service users by the Commission via Ingleside; 10 completed forms were returned (2 from residents, 3 from residents relatives/representatives, 3 from staff of the home and 2 from health care professionals) and the information they contained has been used to inform the findings of this inspection, as has the content of the Annual Quality Assurance Assessment (AQAA) completed by the home and provided to the Commission during March 2008. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the service does well: People considering moving into Ingleside receive a full assessment and are provided with the opportunity to visit and spend time at the home in advance of admission. Visitors to the home are welcomed and offered refreshments during their visit. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 7 The home is comfortably furnished, attractively decorated and clean. Staff are patient, kind and conscientious and treat residents with respect. Residents are generally satisfied with Ingleside; comments included “I am well looked after all the time”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ingleside DS0000026824.V362785.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 Ingleside DS0000026824.V362785.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): 3 & 4 (The home does not provide intermediate care so St 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. EVIDENCE: The records of a recently admitted resident included details of pre-admission assessments carried out by the deputy manager when she visited the prospective resident at the previous address. In advance of making the decision to enter the home the closest relative of the prospective resident visited Ingleside to view the premises and meet residents and staff. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 10 Following pre-admission assessment of each prospective residents needs and circumstances the home writes to them confirming the agreement and ability to provide accommodation and care. A ‘Have Your Say’ questionnaire received in advance of the inspection from a resident stated “My daughter visited and also got all the information…visited myself to see it and met the staff who told me about it. I am well looked after all the time”. Ingleside DS0000026824.V362785.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the care they need but for some aspects of possible risk there has been insufficient assessment to ensure that all residents are protected from risks of harm and injury. Residents receive the medicines they have been prescribed. EVIDENCE: The care records of 4 people who live at the home were examined in detail and found to contain some risk assessments forming the basis for care plans and daily records describing the care of each person. It is recommended that for each resident, as a minimum, assessments for skin condition, nutritional status, moving and handling and risks of falling are recorded and routinely updated, with the findings used to inform the care planning process. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 12 It is also recommended that the home is able to provide evidence that individual residents or their representatives have been involved in the development and review of planned care provision. Notwithstanding these weaknesses in the care planning process, residents are satisfied with the standard of care received and from direct observation and discussion with staff and residents there was evidence that they are properly cared for and are treated with respect and have their privacy and dignity protected at all times. A ‘Have Your Say’ questionnaire received in advance of the inspection from the relative of a resident stated “I am always kept up to date and consulted about my Xs care… staff respect her wishes and dignity…she trusts them and has confidence in them …X receives the support and care that she needs, expects and what was agreed. This care is reviewed and adjusted on a day to day basis according to changing needs and circumstances.” Medicine handling is carried out by care staff and medication administration records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts. To maintain safe standards staff involved in medicine handling have received accredited training in this work. Residents wishing to do so can manage their own medicines; at present none have chosen to do so. However, to ensure that there is a process in place for future use, in the event of a resident wishing to self-medicate, the home is recommended to develop and implement an associated assessment process. Most medicines are stored in a locked metal safe in the kitchen and items requiring cold storage are kept in a lockable box in a separate (i.e. not also used for food) fridge in the kitchen. It is recommended that the temperature of all places in which medicines are stored is routinely monitored and recorded on a daily basis, to ensure safe temperatures are adhered to. Consideration should also be afforded to relocating medicine storage to a dedicated room, sufficiently large to enable staff to carry out all medicine handling processes including audit and associated record keeping; the home is recommended to follow the Royal Pharmaceutical Societys (RPSGB) latest guidance The handling of medicines in social care available at www.rpsgb.org.uk. At present the home does not have facilities for the storage or recording of Controlled Drug (CD) administration and Mr Webb said that to date no CDs have been used. However, to ensure that the home can meet the needs of persons who at a future date may be prescribed CDs it is recommended that suitable storage and recording facilities are obtained at the earliest opportunity. Ingleside DS0000026824.V362785.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): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are underway to provide residents with more opportunities to engage in social and recreational activities. Residents are encouraged and supported to pass the time according to individual preference. A choice of menu is provided and meals are nutritional and appetising. EVIDENCE: The home does not employ a dedicated Activities Organiser but does periodically arrange for visiting entertainers to lead music and song sessions. Care staff occasionally arrange games and other activities but Have Your Say comments received in advance of the inspection indicate there is room for improvement in these regards e.g. “It would be nice to have more entertainment in the afternoons e.g. games, music”, “…should employ someone to come into the home and have exercise time. We do have a musical entertainer once a month….and games on offer once a week but not always Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 14 wanted…a 4 hour slot is allocated for games and manicure and I feel this is not enough time allocated for both”. Mr Webb is aware of the potential for improved social and recreational activities and intends to soon make 6 additional hours per week available to a member of staff, who will then be able to plan and arrange activities. Residents said they spend their time as they want to and are given choices. Their rooms are personalised with their own possessions. They can access their personal records on request in accordance with the Data Protection Act 1998. Most residents appear satisfied with their lifestyles; one stated in the Have Your Say questionnaire “I like to sit quiet. I’m asked if I want to do things but don’t have to – which I don’t” and the relative of another wrote “I am always made welcome and given privacy and time to be with X…wholesome food; nothing too rich or fancy”. Lunch was served to residents during this inspection; most eat main meals in the dining room but can also be served to their bedrooms. Residents are offered a choice of meals and said the food is always plentiful and good. Ingleside DS0000026824.V362785.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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to complain and are confident their complaints are listened to. Service users are safeguarded against risks of abuse in its various forms. EVIDENCE: The home has a complaints policy and procedure; no complaints have been received since the previous inspection and there have been no allegations or investigations regarding the ‘safeguarding of vulnerable adults’. Have Your Say comments received in advance of the inspection indicate that residents are aware of the complaints processes; one stated “I have no complaints but I do know how to make a complaint and to whom”. Similarly, staff were aware of the correct procedure to be followed in the event of there being an allegation or suspicion that some form of abuse may be taking place although the homes written policy and procedure for the safeguarding of vulnerable adults provided incorrect instruction on the reporting and investigation of alleged or suspected abuse. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 16 Within two days of the inspection a suitably amended policy had been drawn up and implemented. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is properly equipped, comfortable, clean and suited to the needs of residents. EVIDENCE: Ingleside is a traditionally built house with bathrooms equipped for the use of persons requiring assistance and a hoist to assist residents with impaired mobility. On the day of inspection the home was clean, tidy and comfortable throughout; there were no unpleasant odours. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 18 Residents are encouraged to personalise their bedrooms; all rooms seen during this inspection were comfortable and well furnished. There are two lounges including one opening onto a conservatory overlooking the front garden. There is a separate dining room. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and maintenance of the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. The home promotes the achievement of nationally recognised care qualifications. EVIDENCE: Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. All staff spoken with during the inspection were enthusiastic about their work and felt that they provided a good standard of care to residents and are properly supported by the management and training provision. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 20 There is a stable workforce with very low turnover; no new staff have been employed since the previous inspection. The records of one staff member were examined and found to contain all essential information including written references, interview assessment, health details and evidence of identity. Criminal Records Bureau (CRB) disclosures are obtained for all staff in advance of employment. The home has developed and implemented an induction process for all new staff, designed to ensure their familiarity with all aspects of the home and a clear understanding of their responsibilities. During recent months all care staff have received training in ‘understanding dementia’ and routinely receive, and as necessary update, training in core subjects including fire safety, moving and handling and food hygiene. 11 of the care staff currently employed by the home hold a National Vocational Qualification (NVQ) in care; the standard of at least 50 of care staff holding this qualification is met. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 333, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is properly managed but more should be done to ensure it operates in the best interests of service users and protects them from risks of harm. EVIDENCE: Ingleside has been owned and managed by Christopher Webb for more than 20 years. Mr Webb is supported by a deputy manager who leads a team of care staff. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 22 Annual questionnaires are issued to residents and their relatives to monitor their satisfaction with the service; the home has recently issued the questionnaires for 2008 and is awaiting the return of completed ones. The home does not hold meetings for residents and/or their representatives and does not routinely invite them to the periodically held care planning review meetings. It is recommended that consideration be afforded to such meetings and that the quality assurance system be expanded to include a variety of inhouse audit processes, designed to ensure that safe and desirable standards are maintained in all aspects of the homes operation. The home has a selection of written policies and procedures to guide staff in their work; it is recommended that these be routinely reviewed to ensure they remain up to date and accurate. The home keeps records of accidents but there was insufficient evidence that all accidents to residents are thoroughly investigated with findings reflected in the care plan, to ensure that future risks are minimised. It is therefore recommended that a robust accident policy/procedure be developed and implemented, to include risk assessment and periodic audit to identify any particular trends e.g. time, place, person, activity, in order that action may be taken to minimise identified risks. The home manages the finances of most residents with regard to the safekeeping of monies for personal expenditure; a sample of documents were checked and found to tally with the balance records. During the inspection a sample of records regarding equipment servicing and maintenance were examined and found to be in good order; mechanical, electrical and gas powered devices are routinely checked for safety but there was no documentary evidence of the safety of the gas installation and it is recommended that this circumstance be rectified at the earliest opportunity. The home is again recommended to extend the fire safety assessment to include a detailed escape plan including specific reference to the currently accommodated residents. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 23 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 2 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 3 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 2 X 3 X X 2 Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP7 OP8 Good Practice Recommendations There should be evidence that individual residents or their representatives have been involved in the development and review of planned care provision. For each resident, as a minimum, assessments for skin condition, nutritional status, moving and handling and risks of falling should be recorded and routinely updated, with the findings used to inform the care planning process. The home should develop and implement an assessment process for residents wishing to self-medicate. The temperature of all places in which medicines are stored should routinely monitored and recorded on a daily basis, to ensure safe temperatures are adhered to. DS0000026824.V362785.R01.S.doc Version 5.2 Page 25 3. 4. OP9 OP9 Ingleside 5. 6. 7. 8. OP9 OP9 OP9 OP9 9. 10. OP38 OP38 11. 12. OP38 OP38 Medicine storage should be in a dedicated room. The home should follow the Royal Pharmaceutical Society’s (RPSGB) latest guidance “The handling of medicines in social care” available at www.rpsgb.org.uk. Suitable storage and recording facilities for Controlled Drugs should be provided. Consideration should be afforded to meetings for residents and their representatives, and the quality assurance system should be expanded to include a variety of inhouse audit processes. The written policies and procedures should be routinely reviewed to ensure they remain up to date and accurate. A robust accident policy/procedure should be developed and implemented, to include risk assessment and periodic audit to identify any particular trends e.g. time, place, person, activity, in order that action may be taken to minimise identified risks. There should be documentary evidence confirming the safety of the gas installation. The fire safety assessment should be expanded to include a detailed escape plan including specific reference to the currently accommodated residents. Ingleside DS0000026824.V362785.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Ingleside DS0000026824.V362785.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!