Inspection on 07/12/05 for Jerome House

This inspection was carried out on 7th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Jerome House 03/09/07

Jerome House 30/05/06

Jerome House 03/06/05

Jerome House 04/10/04

Jerome House 02/06/04

Jerome House 05/02/04

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

CARE HOME ADULTS 18-65 Jerome House 71 Randall Avenue Neasden London NW2 7SS Lead Inspector Julie Schofield Unannounced Inspection 7th December 2005 12:15 Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 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 Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Jerome House Address 71 Randall Avenue Neasden London NW2 7SS 020 8450 8544 020 8452 8544 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) Mrs Lucille Rabor Mrs Lucille Rabor Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd June 2005 Brief Description of the Service: Jerome House is situated within walking distance of the shops at Neasden. Randall Avenue is close to a bus route and there is access at one end of Randall Avenue to the North Circular Road. The nearest underground station is Neasden. It is a large semi-detached house with a small area at the front of the house and a garden at the rear of the property. The house has a driveway providing on site parking. There is also parking space available on the street outside the house. The home is registered for 4 adults with mental health problems and there are bedrooms on both the ground, first and second floor with bathing and toilet facilities on all floors. Communal space is situated on the ground floor and consists of an open plan lounge and dining area, which leads to a small, indoor smoking area. There is an office on the first floor. At the time of the inspection there were no vacancies. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in December 2005. It started at 12.15 pm and finished at 3.25 pm. The Inspector would like to thank the manager, staff and residents who took part in the inspection. During the inspection a partial site inspection, an examination of selected records and discussions with manager, staff and residents took place. What the service does well: What has improved since the last inspection? Since the last inspection the number of residents for which the home is registered has increased from 3 to 4. A loft conversion has provided an additional bedroom, shower room (including a toilet) and a storeroom on the second floor. The hall, stairs and landings have all been redecorated. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 6 The open plan lounge/dining area and the smoking area have all been refurbished as part of the programme of upgrading the accommodation and residents said that they were pleased with the improvements. 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. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Obtaining a copy of the assessment of the prospective resident from all the services supporting the person, ensures that the needs of the resident are identified and that the home is able to determine whether they can meet these. Using the pre-admission information and her own assessment the manager has judged that the home is able to meet the needs of the prospective resident. EVIDENCE: Since the last inspection 1 resident has been admitted to the home. In addition another resident has transferred from another Randall care home. The case file of the resident admitted to the home was examined. There were a number of documents making up the pre-admission information supplied by the placing authority. This included the discharge summary from the hospital, minutes of the CPA meeting, a risk assessment, a summary of needs and a care plan, a report from the O.T and a report from the psychiatrist. The manager had completed a personal profile and this was used in drawing up a care plan. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Evaluating and reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. Residents exercise their right to make decisions about their lives. Staff support residents to take responsible risks so that residents can enjoy an independent lifestyle. EVIDENCE: Two case files were examined. Each file contained a comprehensive care plan, which addressed personal, health and social care needs. Monthly evaluations of the care plans had been carried out and were up to date. There were also minutes of CPA review meetings and minutes of reviews convened by the home on file. These had been carried out on a regular basis. There was evidence on the case files that residents were actively involved in making decisions about their lives. Residents said that they managed their own money; although the manager said that the home would help a resident if they had problems or queries about their benefits, if they wished. They decided which activities they took part in, whether to vote in the elections and whether to attend appointments etc. If there are any restrictions in relation to the facilities in the home this is subject to a written agreement with the Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 10 resident, which their social worker is aware of and is in agreement with. Evidence of this process has been seen during previous inspections. Each of the case files contained risk assessments, which were tailored to the individual needs to the residents. Risk assessments had been drawn up for using the kitchen, being out of the home, aggressive behaviour and self-harm. The risk assessment included risk management strategies. An anger management course had been arranged for one of the residents but they had refused to take part. This was recorded on file. The resident said to the Inspector that when they had feelings of aggression they were able to talk to staff and named a particular member of staff who they felt comfortable speaking with. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The resident’s right of choice, privacy and freedom of movement are respected. Standards 12, 13, 15 and 17 were inspected during the previous inspection in June 2005. EVIDENCE: Residents said that they were involved in the daily routines in the home. During the inspection one of the residents was cooking a meal for themselves. Another resident said that they did there own washing although they found it difficult to do their ironing. Residents choose how to spend their days although they are encouraged to develop regular routines during the day e.g. getting up, washing and dressing and having breakfast in the morning so that their day has structure and purpose. It was noted that staff knock on the bedroom door and wait until they are invited to enter, if they wish to speak to a resident. Residents have a key to their bedroom door and to the front door, unless there is a risk assessment on their case file preventing this. Residents choose whether they wish to spend time on their own or enjoy the company of others, although social isolation is not encouraged if it is not in the best Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 12 interests of the resident. Evidence of this has been seen in notes of meetings with the psychiatrist. Residents decide when they wish to go out and have access to the communal areas in the home at any time. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Residents receive assistance with or prompting with personal care in a manner, which respects their dignity. Residents’ health care needs are met through access to health care services in the community. Residents are supported by staff to take their medication, at the times directed and in the doses prescribed by their GP, in order to promote their general health. EVIDENCE: Residents are able to attend to their own personal care needs although staff may need to prompt or to encourage them. A reminder that a male resident needed to ensure that the trouser zip had been closed was given discreetly. There are male and female residents and both male and female staff so that residents can be supported by a person of the same gender, if they wish. Residents purchase their own clothing etc and choose what to wear each day. Advice may be given if the clothing selected is not appropriate for the season. The staff team reflects the cultural and religious backgrounds of residents and residents acknowledged that staff knew about their needs. There was evidence on file that residents receive specialist support e.g. O.T services, as required. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 14 Two case files were examined. There was a record of appointments with the GP, psychiatrist, dentist, chiropodist and the optician. Residents had received a flu jab. An O.T. was supporting one resident and there was a record of the home visit. Residents had access to routine health care screening e.g. blood tests. One resident had been a day patient in a hospital for a minor operation. The manager said that an escort was provided for appointments, as required. The medication policy included the use of homely remedies. The storage of medication was inspected and was safe and secure. The home uses a system of dosette boxes, which are filled by the pharmacist. These were inspected and had medication had been appropriately removed from the boxes according to the day of the week and the time of day. Records of the administration of medication were up to date. Included in the file was a list of designated staff that were responsible for the administration to residents. The manager said that staff that administer medication have received medication training. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents are aware of their right to complain if the care that they receive is not satisfactory. An adult protection policy, familiarity with the interagency guidelines and protection of vulnerable adults training for staff contribute towards the safety of residents. EVIDENCE: The manager said that no complaints have been recorded since the last announced inspection and residents who took part in the inspection confirmed that they had not made a complaint. The residents said that they would speak to the manager if they wished to raise concerns or make a complaint. There is a complaints procedure in place. It is simple to understand and includes timescales for each stage of the process. There is a protection of vulnerable adults policy in place. The home has a copy of the local authority’s interagency guidelines. The manager said that staff have received protection of vulnerable adults training and the member of staff on duty during the inspection confirmed this. The manager said that no allegations or incidents of abuse have been recorded since the last announced inspection. Residents said that they enjoyed good relationships with other residents and with members of staff, who residents praised. Staff also receive training in the management of aggressive behaviour. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 Residents enjoy a comfortable and “homely” environment. Single bedrooms provide residents with privacy and residents are satisfied that the size of the room provides them with sufficient space in which to relax. The ratio of bathing and toilet facilities to residents is high and they are conveniently situated in the home. Residents enjoy comfortable communal areas in which they can relax, socialise or take part in activities. Residents enjoy a home, which is clean and tidy. EVIDENCE: A site inspection took place and the house was clean and tidy, safe and Well-maintained. The home was comfortably furnished and decorated. Levels of heating and lighting were suitable for the time of year. The outside of the house was smart and the property was in keeping with its neighbours. The home is within walking distance of shops with transport routes close by. Each resident has their own single bedroom and 3 of the 4 bedrooms were seen, including the new room on the second floor. The new room accommodates a resident who has transferred to Jerome House from another Randall care home. The resident who has moved into the new room praised Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 17 the décor, the furniture and the view from the window. Two other residents said that they were satisfied with their rooms. All residents appreciated the size of their room. The home is registered for 4 residents and on the ground floor there is a toilet and shower. On the first floor there is a bath and toilet and on the second floor there is a shower and toilet. The facilities are sufficient for the number of residents living in the home. There are facilities on each floor where there are residents’ bedrooms and there is a toilet in close proximity to the communal areas on the ground floor. The resident who moved into the new room on the second floor was particularly pleased with the shower and toilet next door to the bedroom and the fact that as there was only one bedroom on the second floor and as the 2 residents on the first floor had a bath and toilet on their level he would have the exclusive use of the shower and toilet. The communal areas on the ground floor have been redecorated and refurbished and the usable space has been increased by the removal of part of a wall. There is an open plan lounge/dining area and a separate small room for people to use who wish to smoke. Residents were pleased with the alterations and redecoration and refurbishment and thought that it was comfortable and “homely”. There was sufficient space for 4 residents in which to relax. During the site visit it was noted that the premises were clean and tidy and free from offensive odours. The laundry area is situated on the ground floor and residents are encouraged to do their own laundry. The home does not service incontinent laundry. Staff have received infection control training and certificates were seen on staff files. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 NVQ training enhances the quality of care provided to residents and the home needs to continue its commitment to supporting staff in their studies. The rota demonstrated that there were sufficient staff on duty to support the residents but the support given by the manager must be recorded. The home’s recruitment policy promotes and protects the safety and welfare of residents. The home lacks a training and development plan, with costings allocated to budget headings, for ensuring that training provided enables staff to meet the objectives contained in the Statement of Purpose and is tailored to meet the individual and changing needs of residents. EVIDENCE: A discussion took place with the manager regarding the progress of the home in meeting the recommended standard of 50 of carers achieving an NVQ level 2 qualification. Staff working in the home may also work shifts in other Randall care homes. Five staff are currently studying at level 2 or 3. One member of staff has completed level 2 and 3 staff have either a nursing qualification e.g. RMN or are studying nursing courses. A statutory requirement was identified during the previous inspection in June 2005 that all staff supporting residents need training in mental health issues. The timescale for action is the 31st December 2005, which has not yet expired. The manager and one of the carers have attended a 5-day mental health training course on Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 19 relapse prevention. Residents praised staff and one said that it was good that staff were around and that they were there to support residents. It was noted that there was a good rapport between residents and staff/managers and staff gave that advice in a respectful manner. A copy of the rota was provided for the inspection. Staffing levels were sufficient to meet the current needs of existing residents. Either 1 or 2 carers are on duty each shift during the day and at night there is 1 member of staff on duty. The rota includes details of post titles. As the manager is also the registered manager for another Randall care home, which is a minute’s walk away, the hours on duty are shared between the two care homes. However, the manager’s name was entered for only one shift and no hours for the shift were specified. Information about the management on call rota was available. Staff meetings are held on a monthly basis and details of the date of the next meeting are on display in the office. Two staff files were inspected. Both contained 2 satisfactory references, proof of ID (passport details), an enhanced CRB disclosure, job description and a contract. A statutory requirement was identified during previous inspections that the home needs to develop a training and development plan. This would ensure that the training provided enables staff to meet the objectives contained in the Statement of Purpose, that training is relevant to the client group and that it helps staff to meet the individual and changing needs of residents. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 43 Continuing development of knowledge and skills contributes towards an effective manager. There are systems in place for gathering feedback on the quality of the service provided by the home and this needs to be incorporated into an annual development plan. The home lacks a business plan to demonstrate the home’s financial viability and sound management. Standard 42 was inspected during the previous inspection in June 2005 EVIDENCE: The manager said that she has completed her NVQ level 4 studies and is waiting for her portfolio to be assessed by an external verifier. She already holds a nursing qualification and is an experienced manager of care homes for adults with mental health problems and care homes for adults with learning disabilities. It was noted that there were completed service user satisfaction survey forms on both of the residents’ case files that were inspected. The manager said that feedback from residents was also obtained during the residents’ meetings, 1 to Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 21 1 meetings with residents and by residents talking with managers. Feedback forms are also given to relatives, social workers, district nurses etc for quality assurance purposes. Staff are able to make comments about the service by speaking directly to a manager of the company, giving comments during a staff meeting or discussing matters during supervision. However, the home does not have a system of annual feedback questionnaires for members of staff to complete. The home needs to use the information received as a result of its quality assurance systems in the planning of its services and in formulating the home’s annual development plan and the manager said that they would bring all the information together to formulate a plan in April. It was recorded in the policies and procedures file that these had been reviewed in May 2005. A statutory requirement was identified during previous inspections that the home needs to develop a financial and business plan, with costings for each budget code. The company has made available a draft business plan, without costings. The manager said that they have purchased a computer software package to assist with drafting a complete plan. Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 3 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Jerome House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X 2 DS0000017485.V269527.R01.S.doc Version 5.0 Page 23 YES Are there any outstanding requirements from the last inspection? 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 2 3 4 Standard YA32 YA32 YA33 YA35 Regulation 18.1 18.1 17.2S4.7 18.1 Timescale for action That staff achieve an NVQ level 2 01/07/06 qualification. That staff receive training in 31/12/05 supporting residents with mental health problems. That the hours worked by the 01/02/06 manager in the home are recorded on the rota. That the home has a training and 01/04/06 development plan. (Previous timescales of 01 June 2004 and 01 November 2005 not met). That information obtained from 01/04/06 quality assurance systems is used to draw up a development plan for the home. That the home has a financial 01/04/06 and business plan, with costings for each budget code. (Previous timescales of 01 January 2005 and 01 November 2005 not met). Requirement 5 YA39 24.2 6 YA43 25.2 Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Jerome House DS0000017485.V269527.R01.S.doc Version 5.0 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!