Inspection on 06/03/06 for Jasmin Court Nursing Home

This inspection was carried out on 6th March 2006.

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

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

Other inspections for this house

Jasmin Court Nursing Home 25/06/07

Jasmin Court Nursing Home 27/06/06

Jasmin Court Nursing Home 08/06/05

Jasmin Court Nursing Home 26/01/05

Jasmin Court Nursing Home 25/08/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Jasmin Court Nursing Home 40 Roe Lane Pitsmoor Sheffield S3 9AG Lead Inspector Marina Warwicker Unannounced Inspection 6th March 2006 11:15 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 Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 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. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Jasmin Court Nursing Home Address 40 Roe Lane Pitsmoor Sheffield S3 9AG 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) 0114 278 1595 0114 278 7257 Sage Care Homes (Management) Ltd Mrs Philippa Jayne Williamson Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 of the 50 beds are registered for old age (OP) OR physical disability (PD) for people aged 50 years or over. 16th August 2005 Date of last inspection Brief Description of the Service: Jasmin Court is a purpose built nursing home situated within the community of Pitsmoor, Sheffield. It offers such amenities as local shops, public houses, schools and a church. The people from Pitsmoor have easy access to the city centre by public transport and car. Jasmin court nursing Home was first registered in January 1992. The staff at the home together with the NHS teaching hospital physiotherapy and occupational therapy staff work closely to provide rehabilitation- step down service- to service users who are transferred from the hospital prior to being discharged into the community. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out between 11.15am and 4.30pm on Monday 6th March 2006. The inspector spoke with service users, relatives and staff, toured the premise and checked the records. Since the manager was on holiday and the deputy was on days off the inspection was carried out with the help of the sister in charge. The sister was efficient and helpful throughout the day. The inspector would like to thank the sister for spending time and facilitating staff interviews and records checking. To complete the inspection and also to give feed back to the deputy manager a second visit occurred on 8th March between 5.15pm and 7.15pm. What the service does well: What has improved since the last inspection? All windows have been replaced and the window restrainers are in place. There was evidence of staff supervision. The staff receive formal training on adult protection procedures. There were adequate numbers of staff on duty, which reflected the dependency levels. A new activities co-ordinator has been appointed. Chairs were made available for the relatives to use when they visited. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 6 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. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 7 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 Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3&4 All service users have needs assessed before being admitted to the home. The service users are supplied with contracts or terms and conditions. The staff at the home are able to demonstrate that they are able to meet the needs of the service users. EVIDENCE: Four service users were consulted and three care plans and contracts were checked. The service users said that they were able to visit the home before admission and one said that she used the step down bed (i.e. rehabilitation) and then became a permanent resident. Three service users checked had contracts, which were signed, by both service user or their next of kin and the management at the home. Discussion took place between the deputy manager and the inspector regarding who should be responsible from the home for counter signing the contracts. A decision is expected on the manager’s return. All three service users had full needs assessment by the placing authority. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,910&11 The service users’ assessed needs are met by staff and the service users are able to access external health care services. EVIDENCE: Three service users’ care plans were checked and staff were interviewed. There was evidence of staff providing the care for the identified needs. There was documentation of assessments of the service users’ nutritional needs. There were risk assessments for those who were at risk of pressure sores, falls, incontinence and malnutrition. These had been checked each month and the nurses have made the necessary changes. The care staff said that the nurses informed them of changing care needs. However, the care staff were not in the habit of reading the service user plans for up dates. It was established during the staff interviews that each care staff was allocated a number of service users and the member of staff was referred to as the service user’s key worker. The staff had the opportunity to read the care plan and contribute to the daily records. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 10 The majority of the care staff knew the service users by their first name and not their surnames. Therefore, the service users do not get the opportunity to be referred to as Mr. X or Mrs. Y hence this can be perceived, as the service users were not given the choice of address preferred by them. Not all care staff were aware of the reason the service users were at the home and some felt it was the job of the nurses to know such information. There was written evidence that the service users had given permission for the nurses to administer medication. The sister explained that those service users who were able to self medicate were helped to do so. However, the three service users tracked by the inspector were unable to self medicate. The Inspector suggested that the nursing staff kept information with regards to medication in the care plans so that the care staff are able to access it easily. Three Medication Administration Sheets were checked and they were recorded correctly. The recent Pharmacy report too was satisfactory. The care staff need to be aware why the residents they are key workers to are on medication and the precise side effects they should be observing for during the shift. Since the care staff are the front line workers they need to have information, training and skills to be able to deliver a high quality of care under the supervision of the nurses. Two service users and two relatives said that the staff were very kind and would help them any time. Staff verbalised the way they maintain service users’ privacy and dignity and how they look after those who are in need of palliative care. There has not been any formal training on dealing with bereavement or palliative care. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 The service users are able to keep in contact with their family and friends. The staff encourage the service users to have control over their daily life. However the service users have not had any formal activities for some time. The cook organises four weekly menus and prepares food, which is appreciated by the service users. However, there was a lack of information available in the kitchen on specialist diets and the likes and dislikes of the service users. EVIDENCE: Three service users said that they were able to get up and retire to bed as they wished. The staff interviewed supported this. Service users said that they had missed not having activities and that they were aware of a person being recruited. The inspector met the new activities co-ordinator and discussed the expectation of his role and the comments from the service users. Not all staff that work in the kitchen assisting the cook had basic food hygiene training. Those who had attended training need refresher courses to keep them up to date. Discussion took place with the cook and the care staff regarding the service users’ likes and dislike of food and any special diets the service users were on for medical or cultural reasons. Since there were no formal Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 12 records of these, it was agreed following discussions with the cook and the deputy manager that on both floors (first floor and the top floor where service users have their rooms) the staff would maintain a list of service users’ names with information regarding food. A copy will be submitted to the kitchen staff and this will be kept up to date by a named staff from each floor. There were also discussions regarding meal times. At present the breakfast is served at 9am, lunch at 12miday and dinner (tea) at 4pm. This is unsatisfactory; although there are plenty of snacks and drinks available in between the main meals the service users need to be offered the three main meals at appropriate intervals during the day. The cook is to trial different meal times and obtain feed back from the service users. The meal times were discussed with the deputy manager on 8th March and he agreed to revise the time and trial it. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 The home has a complaints policy and the staff said that they had received training on protecting vulnerable adults and reporting abuse. EVIDENCE: The inspector checked the complaints the home had received and the manager kept the relevant paper work of each complaint. It was suggested to the deputy manager that a record is kept of all complaints made including details of investigation, the outcome and any action taken as a result of the complaint. The staff perception of training differed from person to person therefore the inspector sought clarification from the deputy manager on 8/03/06. The staff received both video training and external training. The manager showed evidence of the training and discussed how he assessed the staff competency and understanding of the topics. The inspector recommended that the staff receive documentary evidence of the assessments and this may help the care staff to remember the training they had received. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25&26 The location and layout of the home is suitable for its stated purpose. An on going programme of maintenance and renewal of fabric is underway. The service users’ rooms suit their needs and there are sufficient communal areas for the service users. The cleanliness of the home remains unsatisfactory. Some practices at the home jeopardise the safety of the service users. These were discussed with the deputy manager on the second day of inspection. EVIDENCE: There is a major maintenance programme in progress. Recently all windows have been replaced. Some relatives made positive remarks about the new windows. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 15 Five bedrooms out of forty seven were checked and the following observation was made. • • • • • • • • Window restrainers were in place in the rooms checked. Generally the rooms were in good repair. One bed looked as though it had been made, but did not have a bed sheet and the plastic cover on the mattress was torn. A bedside table was found to be dirty. Cushion covers were not always zipped up. Some chairs were not cleaned after use. A footplate belonging to a wheelchair was found in a bedroom. One room emitted urine odour. Some parts of the home including the stairways were not clean. The equipment used by care staff was dirty and was not cleaned after usage (e.g. hoists, bucket chair). The sister in charge witnessed the above. The practices at the home, referred to above as jeopardising the safety of the people occupying the home are: • • • • Allowing three bins full and overflowing with clinical waste. The overflowing of domestic waste is non-compliant with environmental health regulations. Storing of rubbish outside the kitchen outer door under the expeller fan is a fire risk. Keeping the back garden gate padlocked causes obstruction if there was to be a fire and service users needed to be evacuated from the conservatory area. The home continues to use one of the first floor bathrooms as a storage room. Extra chairs have been provided for the relatives to use when visiting service users. The staff expressed their concerns about the safety of the dining room chairs. They were worn and unsteady. During the tour of the premise the inspector noted that incontinence pads belonging to service users were kept on the back of the toilet where it was on display. The clinical waste bins in the toilets did not have lids and emitted urine smell. Discussions took place regarding the dignity and privacy of the service Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 16 users who have continence problems and how the home could improve on the storage of pads in each toilet used by the service users. The deputy manager informed the inspector that the home is to renew the sluicing disinfector. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Staffing numbers are sufficient for the present occupancy. Staff recruitment and staff training is to be checked on 8/03/06 when the deputy manager returns. The manager operates a recruitment procedure based on equal opportunity. There is a programme of induction and training. EVIDENCE: On the days of inspection the staff on duty were in satisfactory numbers. The service users said that there was plenty of staff around most days. The staff said that to maintain continuity of care if there was staff absenteeism they cover the gaps themselves. This was evident when checking the staff rotas. Four staff recruitment files were checked. The following gaps were noted: • • • One staff file did not have a recent photograph. Another staff file did not have medical declaration. Two files did not have full employment history including written explanation of any gaps in employment. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 18 Although all four staff files had evidence of satisfactory CRB clearance, one of the care staff on duty was without a recent CRB clearance. Discussion took place with the deputy manager to rectify this matter. Four staff training files were also checked. There was evidence of staff attending mandatory training such as moving & handling, health & safety, fire safety and protection of vulnerable adults from abuse. The staff viewed videos and had discussions with the deputy manager to consolidate the information. There needs to be a formal assessment of staff competency as mentioned before. Some staff have attended a two day rehabilitation training. There was positive feed back on the training. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,36,37&38 The management need to formalise the quality monitoring, which takes place at the home. The staff need regular supervision which requires to be documented and used during following supervisions. Although the registered manager may ensure that as far as is reasonably practicable the health, safety and wellbeing of service users and staff are protected, there is a lack of monitoring of practices at the home. EVIDENCE: The service users, relatives and staff said that they were not aware of the management seeking feedback about the service provided by the home. For example: • The views of the families, friends and the other professionals engaged at the home. DS0000047893.V276415.R01.S.doc Version 5.1 Page 20 Jasmin Court Nursing Home • • • The cook consulting with the service users and their families about the meals served at the home. Staff meetings with minutes and points for action. Service users meetings with minutes and feed back. The inspector was unable to obtain any results of such surveys carried out by the management in the last six months. Staff said that they did not receive formal supervision. However, they all said that the manager and her deputy when on duty regularly supervised them. This was checked on the second day of the inspection and the deputy manager produced evidence of staff supervision for three staff. It was noted that the staff were generally apathetic with regards to training and supervision and therefore their comments did not always reflect what happened at the home. Not all staff were able to verbalise what they had learnt about the home’s health and safety policy. The staff said that they had attended training on health & safety, moving and handling and fire safety. The evidence of training was checked on 08/03/06 and reported under staff training. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 2 2 2 3 2 3 2 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 3 3 2 Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP10 Regulation 12 Requirement All staff must use the terms of address preferred by the service users. The staff must receive formal training on palliative care and bereavement counselling by trained professional staff. All service users must be given opportunities for stimulation through leisure and social activities. Previous time scale 25/10/05 Each service user must be offered three full meals a day at appropriate intervals. The care staff and the kitchen staff must formally share information on special therapeutic diets and likes and dislikes of service users. All staff handling food must be trained in basic food hygiene. A record must be kept of all complaints made. The records must include details of investigation and any action taken as a result of the findings. DS0000047893.V276415.R01.S.doc Timescale for action 14/04/06 2 OP11 12,18 14/07/06 3 OP12 14 14/04/06 4 5 OP15 OP15 16 16 09/03/06 09/03/06 6 7 OP15 OP16 16 17, Schedule4 (11) 14/07/06 14/04/06 Jasmin Court Nursing Home Version 5.1 Page 23 8 OP19 16,23 9 OP19 16 10 OP20 16 11 OP21 23 Grounds of the home must be kept tidy and safe at all times. The arrangement must comply with the local fire safety and environmental health regulations. All parts of the home including the equipment used must be kept clean and free from offensive odour. The bins containing used pads in the toilets must be supplied with lids. The dining room furniture especially the chairs must be checked for their suitability for its purpose. The first floor bathroom must be used for its stated purpose. Previous timescale 31/03/05 Storage areas must be provided for aids, equipment and incontinence pads. Previous timescale 31/03/05 The doors to service users’ private accommodation must be fitted with locks suited to service users’ capacities and accessible to staff in emergencies. Previous timescale 31/03/05 The care home providing nursing must have a sluicing disinfector. 09/03/06 09/03/06 14/07/06 14/04/06 12 OP22 23 14/04/06 13 OP24 23 14/07/06 14 15 OP26 OP29 13,16 12,19 Schedule2 14/04/06 16 OP30 12,18 The registered person must operate a thorough recruitment procedure by ensuring staff are confirmed in post only after a 09/03/06 satisfactory CRB clearance and the information held on each staff comply with the care homes regulations. Staff induction training must be formalised. The training programme must take into 14/04/06 account national training organisation workforce training targets. DS0000047893.V276415.R01.S.doc Version 5.1 Page 24 Jasmin Court Nursing Home 17 OP33 24 18 OP38 13 The home must have an effective quality assurance and quality 14/07/06 monitoring system. It must be based on seeking the views of service users, staff and visitors. The information needs to be used to measure how the home meets its stated aims and objectives. The frequency of the disposal of clinical and domestic waste must 09/03/06 be increased. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP2 OP8 OP9 Good Practice Recommendations There should be dedicated staff who are able to counter sign the service users’ contracts. The care staff should be encouraged to read and contribute to the care plans. The care staff should understand the conditions of the service users, the reason why they are taking medication and any side effects. Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Jasmin Court Nursing Home DS0000047893.V276415.R01.S.doc Version 5.1 Page 26 - 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!