Inspection on 25/03/09 for Isard House

This inspection was carried out on 25th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Isard House 20/04/08

Isard House 25/04/07

Isard House 19/04/06

Isard House 11/12/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Isard House Glebe House Drive Hayes Bromley Kent BR2 7BW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rosemary Blenkinsopp     Date: 3 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Isard House Glebe House Drive Hayes Bromley Kent BR2 7BW 02084626577 02084620952 isard.manager@shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Shaw Healthcare Ltd care home 45 Number of places (if applicable): Under 65 Over 65 0 45 dementia old age, not falling within any other category Additional conditions: 45 0 The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 45) Dementia - Code DE (maximum number of places: 45) Date of last inspection Brief description of the care home Isard House is a large two-storey building built around two secure quadrangles. The home is set at the end of a cul-de-sac with open fields bordering onto the rear and side of the homes grounds. Isard House is situated within walking distance of public transport links and local shops. Since April 2005 Shaw Healthcare have been responsible for the management and provision of this service. Referrals are made through the Local Authority Social Care Homes for Older People Page 4 of 30 Brief description of the care home Services Department. The home does have two bedrooms available for private purchasers. This home provides care and accommodation for 45 older persons who may or may not have dementia. In the last year Shaw Healthcare have reduced the number of double bedrooms to one and the remainder are all single rooms. Residents accommodation is mainly on the ground floor. There are grab and hand rails in corridor areas, stairs, toilets and bathroom. Specialised bathing and toilet equipment and lifting aids are available for residents use. There are various lounges and sitting areas available. Fees range from £458.17 to £624.00. The fees for Local Authority placement and those purchasing care privately are different as are the fees for those with Dementia. Items such as toiletries, hairdressing, and private chiropody are paid from individuals personal monies and not included in the fees. The home provides information on the service through a Statement of Purpose, which can be supplemented on request with a copy of the latest inspection report. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection conducted over a one and a half day period. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CQC. Six comment cards were provided and returned during the inspection, two from residents four from relatives. The majority contained favourable comments. During the visit we met with several relatives, residents and observed staff interaction and engagement with residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated Care Homes for Older People Page 6 of 30 into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the Manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admissions procedures provide residents or their families,with the information they require, prior to any decision regarding placement being made, to establish whether the service is right for them. Staff have information to ensure they can meet individual residents needs and on which to base an initial care plan. Evidence: There were 43 residents on site and one bed was vacant. No residents had pressure sores, one resident had MRSA . There was evidence that residents had been assessed prior admission. There is a standard pre admission form, which is a tick box format with space for additional comments. Some of these assessments, completed by one staff member, had very comprehensive information recorded. In addition Social Services assessments had been obtained and in some files,and correspondence from members of the multi Care Homes for Older People Page 11 of 30 Evidence: disciplinary team and hospital letters. One file had good assessment information obtained through Shaws pre-assessment documentation. The Social Services assessment had not been received, although with the information they had about the resident, staff could set up an initial care plan. One resident who had been admitted a month earlier, was without a photograph or description in place. In the event that this resident should wander there would be little information to provide to the police. Some of the initial assessment had been completed other sections had not, including the manual handling plan. The service agreement had also not been completed. This was pointed out to the manager and on the second visit it was completed. The manager said that many residents did not take up the opportunity to make preparatory visits to the service as they were too frail however many family members did. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care needs are met by staff in the home supported by members of the multi disciplinary team. Care plans are in place, although these in some cases provide limited information for staff to deliver the care and omissions in information could adversely affect the residents health. Medications were safely managed which provides protection to residents. Evidence: At the time of the site visit we were advised that there were two residents who were displaying challenging behaviour and one with an infection which needed special precautions. These care plans were included for inspection. Care plans and supporting risk assessments are set out on standard Shaw Healthcare formats. Care plans are being reviewed and the documentation should if fully completed, comprehensively reflect the health care needs of residents. Care Homes for Older People Page 13 of 30 Evidence: The care plan of the resident with the infection was inspected, although it had no care plan to indicate that an infection was present, and this led to confusion amongst staff as to what precautions needed to be in place . The nutritional assessment tool identified a high risk, in addition the residents weight had dropped almost five kilos in the first month of 2009, yet the care plan headed nutrition, did not reference any further special precautions which may have to be put in place to prevent further decline and weight loss. One care plan, that of a resident who had been in the home since December 2008, had only one problem identified although his assessment information detailed several problems, some of which care plans would need to be in place for. Care plans mainly reflected physical health needs and were limited on social and physiological care. Some reviews were in place. It was, in some care plans, difficult to assess what input residents have had in developing their care plan. There were records relating to visits made by members of the multidisciplinary team and the GP. One comment card that of a relative indicated she was advised of any incidents promptly and kept updated with changes. Another commented that staff are usually very good and caring. Comments from Care Mangers was that the service had of late improved. Staff had a good knowledge of the residents and what care they needed. Staff who were interviewed by us had a working knowledge of Dementia and how it presents, which is the category for this service, hence it is important staff are knowledgeable on the topic. The bedroom of the resident who required special infection control precautions to be in place was inspected, it had gloves hibiscrub but was without a yellow bag - this was said to be in the process of being changed. Staff were unclear of this residents status in respect of infection control precautions, and as with the care plan, this was causing confusion. Such information needs to be clearly communicated to all staff to ensure the correct course of action is taken and that residents health is protected. Included in the care plans was a list of the medication each resident was taking and this identifies possible side effects, this is a useful tool for staff. The medication records and storage were inspected. Documentation including medication administration records were maintained in a tidy manner. Photographs of the residents were in place and their allergies record. Records were retained for those medications Care Homes for Older People Page 14 of 30 Evidence: coming into the home and those being disposed of. Signatures of the all staff who were trained to administer medication were on file. Reasons for omitting medications were recorded on the reverse of the medication chart. Records were well completed. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities and engagement provides residents with stimulation, physically and mentally. Choices are provided which means residents are enabled to input into their day. This promotes residents independence and enhances individuals well being. Evidence: Relatives were seen to come and go throughout the day. Several of the relatives with whom we met visited the home frequently and had a good impression of the service. One comment made by a relative was, he is well looked after . Three relatives who were in visiting one resident were happy with the care their relative received, felt welcomed by staff and said the home offered a good service. Comment cards indicated that activities were arranged, one stating the entertainment is very good. Another commented that ---is allowed to do more or less as she wants. The lunch was nicely presented and tables laid in preparation for the meal. The lunch was colourful and appetising with good portion sizes observed. Staff assisted residents in an unhurried manner. Juice was offered, serviettes and condiments were used. Care Homes for Older People Page 16 of 30 Evidence: Residents were offered choices or enabled to do so. The level of engagement between residents and staff varied from unit to unit and throughout the day. Over the lunch period there was a lot of residents chatting to one another and more staff interaction and engagement. Activities were taking place during parts of the day, yet on another unit residents sat with their eyes closed in front of the TV. However there was evidence of increased and varied activities with more signs of well being than on previous inspections. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive complaints information is provided to residents, relatives and visitors, which provides opportunities to raise issues. Staff demonstrated insufficient knowledge of adult protection procedures, which would not afford sufficient protection to residents. The Manager operates an open door policy whereby any resident, relative or visitor may speak to her confidentially. Evidence: Shaw Healthcare have a comprehensive procedures for dealing with complaints. This procedure was on display and incorporated into several documents such as the Statement of Purpose. The complaints information sets out the time frames for initial and final responses. The CSCI has received no concerns regarding this service. Comment cards received, indicated that they were aware of how to complain and whom to refer them to. Shaw healthcare have standard forms for recording complaints. Head office monitor all Care Homes for Older People Page 18 of 30 Evidence: complaint to establish if there are any emerging themes. Of the five staff interviewed three were unaware of what whistle blowing was or what action to take should they need to. In relation to abuse, the level of knowledge varied, although again several staff were unaware of the external avenues to report such incidents. This was referred to the acting manager for action. She confirmed that training on abuse was carried out with staff and included during induction however this needs to be further actioned so staff have a comprehensive understanding of the topics. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with an adequate standard of accommodation. Sufficient equipment in relation to mobility aids and pressure relieving mattresses are provided to meet residents needs. Evidence: A tour of the premises was undertaken. The accommodation at Isard is all on one level which includes three separate units. Each unit has private bedrooms and communal accommodation. The main kitchen and laundry are all on the ground floor, as are the main offices. Bedrooms were generally clean and tidy and personalised with pictures, ornaments and other personal items. Some were extremely well kept and great efforts had been made to fill them with personal effects. Some areas had improved with new carpets and redecoration. New orientation signs were in place to aid residents to find toilets and bathrooms. A couple of the bathrooms were in need of redecoration and refurbishment, namely bathroom 2 and bathroom 4 . Cracked tiles, broken window blinds and stained carpets all gave a very tired, untidy appearance. Care Homes for Older People Page 20 of 30 Evidence: The external gardens were tidy. Parking to the front of the building benefits visitors and there are local buses and a train station close by. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided in sufficient numbers with an appropriate skill mix to meet the residents needs. Ancillary and administration staff work to support the care staff. Robust recruitment procedures afford protection to residents living in the home. Staff are provided with training and induction to enable them to undertake the work they perform. Evidence: At the time of the site visit there were two team leaders on site with seven support workers one of whom was an agency. In addition there was one administrator, domestics catering staff and a handy person. Staff spoke with us throughout the day. The staff selected for interviewing included new staff. They confirmed that they had been subject to recruitment procedures including an interview and CRB clearance. they had received a four day induction which had include the statutory topics including fire, manual handling health and safety and a session on dementia. It is important that staff are provided with induction and on going training on dementia as this is the type of resident who lives in the home, and residents require staff who are trained and competent in the condition. Care Homes for Older People Page 22 of 30 Evidence: The staff felt that there was sufficient staff although this was usually achieved with agency workers, most of whom were said to be good. Training was said to be available and encouraged. Sessions that staff had attended included Dementia care, diabetes, medication and foot care. The agency staff said she had worked in the home on a few occasions and had received 40 minutes induction which included a tour of the premises fire exits and a brief outline of routines. She had received training on the mandatory topics through her agency. Prior to working in Isard house, the manager had confirmed with the supplying agency, that she had proof of satisfactory recruitment and sufficient training. Personal files were sampled to check that records relating to recruitment were in place. Recruitment procedures are undertaken through head office. A pro forma form is retained in the personnel file to confirm items such as POVA /CRB clearance and references have been obtained prior to commencement of employment. Health questionnaires were available and completed. The pro forma document in several of those sampled had the information recorded, although it was not signed off. Without a signature in place it would not be possible to establish and validate that the information recorded was accurate. This needs to be addressed. Once appointed employees are issued with job descriptions, terms and conditions and contracts. Some supervision records were on file. Copies of the company induction forms were in the files. Probationary periods are in operation for all employees of Shaw Healthcare. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has had several management changes which in itself can be unsettling and does not provide consistency. Health and safety issues are addressed by regular servicing although the absence of a named person to address internal health and safety has lead to gaps in checks. The homes quality assurance systems are limited and do not fully include the views of all those who are involved in the service. Evidence: At the time of the inspection the home was being managed by Jackie Catley who was acting up into the role. The previous manager had left October 2008 to manage another service. The manager from Sheila Stead another Shaw Healthcare facility, which is due to be closed, is ear marked to take over at Issard. The home has had a number of management changes and this can be unsettling and may lead staff to Care Homes for Older People Page 24 of 30 Evidence: feeling demoralised. Shaw Healthcare has systems in place to address health and safety including regular servicing, policies and procedures and on going staff training. There was on site a current fire risk assessment and fire policy for the premises. On viewing the health and safety documentation there were some gaps. In particular the records relating to weekly fire alarm tests and checking of emergency lighting which had not been done since the handyman left October 2008. Not only is this of concern in respect of health and safety issues but it also reflects poorly on the auditing and quality assurance conducted within Shaw Healthcare. The company has a health and safety department with staff employed, in addition Regional Mangers all visit the home and oversee the service provision, yet these issues had not been identified until we visited. Records of fire drills conducted were in place for 2008, one in 2009 and one following the first day of inspection,when the absence of recent drills was raised. It is essential that all staff have sufficient training to take appropriate action when an emergency occurs including fire situations. Certificates were in place for the servicing of the fire equipment, nurse call bells,the annual gas test and portable electrical appliances. In relation to quality assurance again there were gaps and omissions in areas. The Regulation 26 reports, which arise out of the visits, and must be conducted monthly unannounced, had many gaps evident, and none of the recent reports could be located only those for 2007. Shaws own quality department had visited the home March 2008 where three areas were identified for improvement although it was unclear if a follow up visit had occurred. A relatives questionnaire had been distributed January 09 and responses received, although the summary report had not been completed. Minutes of a relatives meeting 2009 were available although very few prior to this. Relatives did say that they felt they could talk to staff and the manager at any time. Shaw have various audit tools some of which had been completed some had not been addressed for some time. An annual quality assessment of the home must be conducted which involves all those involved with the service. Care Homes for Older People Page 25 of 30 Evidence: Residents money was securely stored with supporting records for expenditure and receipts for purchases. A monthly audit of the finances is carried out by the manager and random checks by Shaw personnel. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must fully 30/09/2009 reflective all of the residents needs including physical, mental and social aspects. Staff need to have accurate and enough information provided in order that they can address the care. 2 18 13 Staff must be fully aware of how to action abuse and follow whistle blowing procedures. In order that staff can protect residents by taking the correct action in a timely manner. 30/09/2009 3 19 23 All parts of the home must be well maintained and in a good state of repair. To ensure that residents have safe, suitable and comfortable accommodation to live in. 30/09/2009 Care Homes for Older People Page 28 of 30 4 33 24 Quality assurance measures 30/09/2009 must be in place and include an annual review of the service . To enable all those involved with the service an opportunity to input into it. 5 38 23 Fire drills must be conducted 08/05/2009 regularly. To maintain staffs knowledge and ensure they are safe should a fire break out . Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!