Inspection on 04/05/06 for Kingfisher Nursing Home

This inspection was carried out on 4th May 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

Kingfisher Nursing Home 24/04/07

Kingfisher Nursing Home 07/12/05

Kingfisher Nursing Home 04/08/05

Kingfisher Nursing Home 08/06/05

Kingfisher Nursing Home 12/10/04

Kingfisher Nursing Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Kingfisher Nursing Home Emmanuel Lodge College Road Cheshunt Hertfordshire EN8 9NQ Lead Inspector Pat House Unannounced Inspection 4th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kingfisher Nursing Home DS0000019574.V293156.R02.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. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kingfisher Nursing Home Address Emmanuel Lodge College Road Cheshunt Hertfordshire EN8 9NQ 01992 627 939 01992 632708 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr P S Patel Mrs Anjani Patel Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate 22 older people in need of general nursing care. This home may accommodate 22 older people in need of convalescent care (aged above 55 years). 7th December 2005 Date of last inspection Brief Description of the Service: Kingfisher is a care home providing nursing and convalescent care for 22 older people. The home is privately owned and situated on the ground floor of Emmanuel Lodge, a two-storey complex, which provides supported housing for older people. Emmanuel Lodge is jointly owned by Broxbourne Borough Council and a Primary Care Trust. Kingfisher has eighteen single and two double bedrooms. None of the bedrooms have en-suite facilities. There is level access suitable for wheelchairs throughout the home and lounge and conservatory areas for the benefit of service users. The home has its own laundry but kitchen facilities are shared with Emmanuel Lodge. Service users have access to the gardens and patio belonging to Emmanuel Lodge and there are extensive areas for parking around the home. The building is situated in an area of parkland on the outskirts of Cheshunt, where there are shops, pubs and bus services. The A 10 trunk road, the M 25 motorway and rail links are nearby. Prospective service users are provided with information about the home, in the form of a Service User’s Guide, which is currently being reviewed. Residential fees for the home for 2006 range between £528 and £700 per week. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day with three inspectors. This inspection was a full or “key” inspection where all vital or “key” standards were checked. All parts of the home were visited and service users, staff and visitors were spoken with. The mid-day meal was served during the visit and a random selection of records were examined. The Manager was present during the inspection. A visit had been made to the home on 17th February, to check the progress being made in implementing requirements made at the previous full inspection. Although improvements had been made, two of the previous requirements were carried forward at that visit and two more requirements were made. The present Manager had been recently appointed after the last full inspection, and had already made improvements to the running of the home by the February visit. A recent Quality Assurance survey has also been carried out by the Manager and the results were seen during this inspection. It is commendable that, as described in this report, the home is now providing a very high standard of care in all areas, and that no requirements have been made as a result of this inspection. What the service does well: What has improved since the last inspection? Service users and relatives said the provision of food is now very good and there are now very few unpleasant odours in the home. Everyone in the home has benefited from the new appointments of a Laundry assistant and Activities co-ordinator. The system for laundering clothes is now more efficient and delicate clothing is specially dealt with. Activities are now provided every day and service users said they no longer felt bored in the home. Kingfisher Nursing Home DS0000019574.V293156.R02.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. Kingfisher Nursing Home DS0000019574.V293156.R02.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 Kingfisher Nursing Home DS0000019574.V293156.R02.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): 3,4 and 5. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Full assessments are completed for all prospective service users, who are also able to visit the home prior to entering. This, together with good levels of staff training and support, ensures that the home is suitable for and can meet the needs of the individuals who decide to enter the home. EVIDENCE: A service user who had been resident in the home for only two weeks said that she had spent time looking round Kingfisher before she took up a place and staff said that all prospective service users were welcome to make visits and spend time in the home. The records for this and other service users were tracked during the visit and all those seen had thorough assessment details recorded before they entered the home and full needs assessments completed once they had taken up a place. As at previous visits, the care plans examined were all well documented and contained the appropriate details necessary to enable staff to meet individual care needs. Staff confirmed that relevant training has been taking place and service users confirmed they were receiving appropriate, high standards of care. Kingfisher Nursing Home DS0000019574.V293156.R02.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): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. High standards of care planning ensure that individual needs are set out in detail so that staff can make sure that all these needs are met. A sound system for administering medication in the home helps to further protect service users and procedures in the home promote individual independence and privacy. EVIDENCE: Several care plans were tracked and these were meaningful and relevant to the individuals they described. The plans are also in a good format, which enables care staff to understand them and provide appropriate care and the plans are shared and signed by service users or families. Treatment from Health professionals is recorded and there are details of nutritional screening in appropriate cases. Service users confirmed that they regularly saw a chiropodist and had regular sight and hearing tests. Records showed that one resident, who had come from another care home and had been previously undernourished, had increased her body weight considerably and was maintaining her current weight. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 10 The son of another resident said that his mother had been virtually unable to walk until she entered the home, but could now move independently, using a zimmer frame. Those residents spoken with also said that staff always treated them with respect and promoted their privacy and independence. In one of the shared rooms, which had been recently decorated, the dividing curtain between the beds had been removed. However, the Manager is arranging for this to be replaced shortly, to ensure the privacy of service users using that room. The system for administering medication in the home was checked and was basically sound. One or two suggestions were made, and have been included as recommendations in this report. It was recommended that details of unused medication to be collected are recorded when being stored in the storeroom, to ensure amounts coincide with the final returns, and that totals of all PRN medication are carried forward on each record sheet. Staff were reminded that the back of the record sheets should be used for extra details and that all non-blistered medication should be dated on opening, as most was. Kingfisher Nursing Home DS0000019574.V293156.R02.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. New incentives and attitudes to the provision of activities in the home have provided more stimulation for the residents who now have a focus for each day. Service users and visitors are happy with the home’s arrangements for maintaining contact and the home’s procedures are aimed at maintaining service user independence where possible. Service users are happy with all aspects of the food provided and this enjoyment helps to ensure individual wellbeing. EVIDENCE: An activities co-ordinator has been appointed since the last inspection, and had been working in the home for the last two weeks. The co-ordinator is working from 10 am till 4 pm from Monday to Friday. A programme of planned daily activities was displayed on the notice board and showed events for every morning and afternoon. Skittles were played in the lounge during the inspection and service users spoken with said there was now much more to do during the day. Care staff and service users praised the new co-ordinator and staff in general were much more enthusiastic about providing stimulation for the residents in the home. The co-ordinator has started to compile a social plan for each resident, which includes his or her “likes and dislikes”. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 12 Records are being kept of who took part in each activity and whether they enjoyed the event. Several visitors were spoken with and they confirmed that they were made welcome in the home and could visit at any time. Results from the returned Quality questionnaires also showed that there was complete satisfaction with the facilities provided by the home for visitors to see their relative in private and that staff made visitors welcome at all times. Details of advocacy groups are available in the home and staff said that personal records could be accessed, subject to the Data Protection Act. Currently, all residents have families who handle their finances, however it was felt that some residents in the home would be able to hold their own personal allowances, and might enjoy being able to choose how this money was spent. The Manager may discuss this area with residents, perhaps at the time of a review. The main meal of the day was served during the visit and this looked very appetising and was clearly enjoyed by the residents. The menu, with the choices of food for the day was clearly displayed in the dining room and service users confirmed they chose the meals they wanted from a choice of two, the day before they were prepared. Staff were sitting beside some residents to assist with feeding and this was being done in a discreet and appropriate manner. A visit was made to the kitchen during the inspection and this area was extremely clean and clearly running efficiently. The cook and assistant were wearing protective clothing and food, fridge and freezer temperature checks were being recorded. There had been a recent, unannounced inspection from the Environmental Health Officer, which had confirmed the high standards in place. There were large amounts of food in store, with one large fridge full of fresh vegetables. The cook confirmed that she plans all the menus and that all the soups are home made. The cook does not hold her own budget for food but said that no limits have been imposed on the food ordered and she is able to order anything she needs. In the Quality survey, completed in February, 88 of returns said they were satisfied with the food, with 12 dissatisfied. The displayed summary of these results gives details of the changes made since the replies were received. Comments from service users and visitors, made during the inspection, said improvements have taken place and praised the food provided. Kingfisher Nursing Home DS0000019574.V293156.R02.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): 16,17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The policies, procedures and staff training in place help to ensure that service users in the home have their rights promoted and are protected from abuse. Families and residents in the home are confident that any concerns they might have will be appropriately dealt with and that there will be no adverse reaction to voicing these issues. EVIDENCE: A written complaints procedure is available, which is openly displayed in the home, together with a leaflet giving detailed guidance. Copies are also included in the Service User’s Guide, which is given to all service users and families. In the Quality surveys, however, 20 of those returned indicated that families were not aware of the procedure. The actions printed with the Quality summary show that, since February, The Manager has pointed out the complaints procedure to visitors and sent copies again to all families. Those residents spoken with during the inspection said they found all the staff approachable and would not hesitate to voice a concern if they had one. One visitor, spoken with during the inspection, also said she had confidence that the Manager would listen to any concerns and would act to resolve the situation, with no ill feeling about this. All residents in the home are registered to vote in elections. Written policies for Adult Protection are in place and action taken follows the Hertfordshire County Council guidelines for reporting concerns. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 14 There have been two recent staff training courses in Adult Protection in the home and all but one of the current staff, including ancillary staff, have completed this training. The remaining member of staff will be attending a course run at another home in the company. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 15 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users benefit from living in pleasant, well maintained surroundings, which is kept clean and hygienic, and promotes their good health. EVIDENCE: Many areas of the home have been recently upgraded, as described in previous inspection reports. All areas of the home were clean and well maintained during the visit and service users were enjoying the patio and grounds outside the building. The maintenance assistant was working in the home and was spoken with and is clearly an integral part of the day-to-day running of the home, and enthusiastic about its upkeep. It was unusual that several residents took the initiative in mentioning the work done by this member of staff, saying how efficient he was and how pleasant, and that he was always quick to solve individual problems as well as those of the building. Some over-bed tables were identified as being in poor repair, but the Manager had already ordered replacements for these. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 16 The Quality survey had highlighted the laundry as an area to be reviewed. (80 satisfied, 20 dissatisfied), and changes have now been made, including the appointment of a new laundry assistant. Service users and visitors spoken with commented that the laundry system in the home is much improved and now provides a really good service. There were no unpleasant odours apparent in any areas of the home and, again, one visitor said this aspect of the home had also improved. Kingfisher Nursing Home DS0000019574.V293156.R02.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are appropriately supported, and have their needs met by adequate numbers of well trained staff. The home’s recruitment procedures help to ensure that service users are in safe hands and protected from abuse. EVIDENCE: As already described, since the last inspection visit, an activities co-ordinator and a laundry assistant have been appointed to the staff team. This has resulted in the morning care staff compliment being reduced from five to four. Despite an initial concern about this reduction, service users and staff said that they did feel staff numbers were adequate at this moment. Care staff said that having laundry duties removed from them during the week, had enabled them to provide more appropriate care for the residents and that the new assistant also provides breakfast for service users. Currently, there are less service users needing two staff to assist with transfers, than at previous inspections, and fewer service users who need help with feeding. Should dependency levels again increase in the home, the Manager would need to reassess staffing numbers, especially at peak times. The group of homes in the company have a shared “bank” of care staff. These staff are used when regular staff are unable to work. Staff moral in the home is very high at the moment and the two new members of staff said how well supported they felt and how well staff worked “as a team”. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 18 There is always a registered nurse on duty in the home, apart from the Manager and care workers, and now 50 of care staff are trained to NVQ level 2. More staff will be completing NVQ training over the year. Since the last visit, a large amount of staff training has taken place, and two Adult Protection courses have been completed by staff. The new staff confirmed they had received good induction training and the Manager is currently introducing the new “Skills for Care” induction programme into the home. All mandatory training for staff is now either planned or completed, and ancillary staff confirmed they are included in staff training. The Maintenance assistant has just renewed his qualification as a Fire Marshall and provides regular fire safety courses and drills for staff and residents. The recruitment files for some of the newer staff were checked and evidence of all appropriate checks was seen. All staff had POVA or CRB clearance and two references in place before employment commenced, and certificates for completed training courses were seen. The Manager has produced a training overview and this clearly sets out when individual training updates are due. Kingfisher Nursing Home DS0000019574.V293156.R02.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): 31,32,33,34,35,36,37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users appreciate and benefit from living in a well run home, where the management is open, approachable and effective. Policies in place ensure that the views of service users are acted on and where financial procedures safeguard their interests. Health and safety is promoted through the good practice in place in the home. EVIDENCE: The Manager is currently applying for registration with the CSCI and completing NVQ 4 training. All staff and service users spoken with praised the new Manager and said how the running of the home had improved since her appointment. The Manager has made significant changes and said she has been supported by the owners in all in her work. There are regular staff meetings and residents meetings and all those spoken with felt their views were listened to. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 20 A policy for ensuring Quality Assurance is in place and the Manager sent out Quality surveys in February. These surveys went to service users, relatives and stakeholders, such as doctors and nurses. These replies were seen during the visit and a summary of the results, with what actions have been taken as a consequence, is on display in the home. The changes made in the home, as a result of all the consultation, are commendable, and are clearly appreciated by service users and families. When asked the question about “overall care provided” at the home, 100 of those who replied said they were satisfied. The only criticism of the process is that not enough of the praise, seen in the survey replies, was included in the summary, which is displayed. A certificate of appropriate insurance cover was seen during the visit, and all records were being stored properly. The home shares an administrator, with another home in the group, and this lady explained some of the financial procedures in place. There is a system in place for sending accounts to families and for items purchased on behalf of service users and this system was checked. All accounts seen were in order, and receipts for all purchases were in place. Staff said they now all have regular, formal supervision, and that there are regular fire drills. Servicing and maintenance was up to date and risk assessments in place where appropriate. Staff regularly notify the CSCI of all serious accidents and incidents. Kingfisher Nursing Home DS0000019574.V293156.R02.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 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Kingfisher Nursing Home DS0000019574.V293156.R02.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The Registered Provider should ensure that details of unused medication are recorded as they are stored for collection and that all totals of continuing “PRN” medication is carried forward on each record sheet. Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Kingfisher Nursing Home DS0000019574.V293156.R02.S.doc Version 5.1 Page 24 - 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. 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