Inspection on 01/05/06 for Langdale Court Care Home

This inspection was carried out on 1st 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 found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Langdale Court Care Home 27/04/09

Langdale Court Care Home 28/04/08

Langdale Court Care Home 03/05/07

Langdale Court Care Home 29/09/05

Langdale Court Care Home 27/01/05

Langdale Court Care Home 12/08/04

Langdale Court Care Home 31/03/04

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

CARE HOME ADULTS 18-65 Langdale Court Care Home 1 Colville Street Nottingham NG1 4HQ Lead Inspector Lee West Key Unannounced Inspection 1st May 2006 10:30 Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 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 Langdale Court Care Home DS0000002295.V292768.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 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. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Langdale Court Care Home Address 1 Colville Street Nottingham NG1 4HQ 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) 0115 947 2167 Mrs Cordelia Nwafor Ogbakaeko Mr Bernard Okenwa Ogbakaeko Mrs Cordelia Nwafor Ogbakaeko Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 Brief Description of the Service: Langdale Court, opened in 1987, is a converted Victorian style three-storey house with a small front and side garden, registered to provide personal care and accommodation for up to seven people with mental health needs. It is situated near the city centre and is close to shops, pubs. Post office and other amenities. There are five single bedrooms and one double bedroom; none with ensuite facilities. There is no lift to provide independent access and consequently the home is not suitable for wheelchair users, or, people with mobility difficulties. Car parking is street parking and a resident’s permit is required from the home. The service users are all male. The fees for this home range between £227.44 and £367.38, according to level of need. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Monday 1st May 2006, starting at 10.30am over a period of five hours. The provider and Manager Mrs. Cordelia Ogbakaeko was present and assisted throughout the inspection, and during the day, Chief Bernard Ogbakaeko, the co-provider was also present and assisted with some information. Their son was also working at the home during the inspection. Case tracking was the method used for this inspection, where Service users were spoken with about their experiences and expectations of living at the home, a tour of the home undertaken, and talking with members of staff to ensure that those living at the home have their needs met and their health and welfare maintained appropriately; together with analysis of all other available records. All the service users were in and around the home during the day and conversations with them all provided information into their views on the care they receive, but four service users’ records were case tracked All the judgements made in this report have been made using all this available evidence, including the visit to the service. Generally, the home provides an environment that the service users feel comfortable in. As the building is Victorian, there are areas of general maintenance that require attention. The stairs to the upper rooms are steep and the home is therefore not suitable for anyone with any mobility problems. What the service does well: The furnishings and décor of the home are generally adequate and a positive, supportive rapport between staff and service users was observed during the inspection. The service users said they are satisfied with the level of care that is available. They enjoy carrying out the routine chores around the home and enjoy being out and about in the local community if they want to. They also said that they enjoy their meals and are given choices. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Care plans require further improvement to include areas of service users’ aspirations and risk taking. This would provide a focus for service users and staff to investigate the individual’s aspirations and improve their quality of life within the home. Medication storage requires improvement and plastic carrier bags to be removed from the medicines cupboard. The unlabelled blister pack must be returned to the pharmacy and new, correctly labelled, pack obtained. All medication must be recorded and administrated from the Medicines Administration Records and not handwritten sheets. Medicines Administration Records (MAR sheets) must be kept together, with photographic identification of each service user on the front of each, with dividers between to separate each service user’s record. These measures would reduce the risk of any medication errors within the home, protecting the service user from potential harm. The complaints procedures should be followed to include complaint, action taken, timescales and outcomes. All to be recorded in accordance with the data protection recommendations. The service users would be protected by a robust complaints procedure. The toilet on the upper floor requires repair with new seat and cistern top, together with new door lock and the hole in the wall requires filling. The improvement to these facilities would reduce the risk of cross infections within this area. Staff supervision is required to be carried out regularly and formally recorded in the staff files. The service users would be protected by a competent workforce. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 7 The Manager to enrol on National Vocational Qualification Level 4 in care and management, or equivalent course to ensure appropriate skills and competence necessary for managing the care home. Staff training to be reviewed and updated. Some in house training to be replaced by external training to meet legislation requirements, especially moving and handling and first aid training. Staff training or retraining in the proper storage, administration and recording of medicines, by an appropriate external body, is needed to ensure the medication errors are addressed and to develop competent care staff. The results of the service user surveys to be collated and made available to service users and other interested parties, including the Commission for Social Care Inspections. This practice would provide opportunities for improvements in the standards of care provided for the service users within the home. 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. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 8 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 Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 9 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): 1,2,5, Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has an informative service user guide and statement of purpose. Individual assessments are identified within the service user records and each has a written statement of terms and conditions. EVIDENCE: All the service users have been resident for a considerable time, but records show there was assessment of needs carried out. Each file case tracked also contained a statement of terms and conditions. The home does have a printed statement of purpose and also service user guide which sets out the information needed to help prospective service users make the choice whether the service is appropriate. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 10 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): 6,7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are aware their needs are reflected in care plans. They do take part in aspects of life in the home and are encouraged to maintain an independent lifestyle. They also know that information about them is kept confidential. EVIDENCE: During the inspection, service users were observed carrying out their “chores” around the home, setting tables, “doing the bins”, letting other service users know when meals are ready, were amongst those seen. The service users and staff were observed to interact with a positive and supportive rapport. The service users said they are encouraged to go out and about and can “do my own thing”. Service users are able to access the local facilities and bus and tram service, which are close by. Their care plans reflect this area of support, but care plans inspected did not all reflect the changing needs and aspirations of the service users. There was no evidence within the cases tracked of supporting “risk taking” either. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 11 Service users also said that they knew that any information about them was kept private. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 12 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): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are able to take part in appropriate activities in the local community. The meals served appear nutritious and served at times that suit service users. EVIDENCE: Service users spoken with said they use the local pubs, shops and visits to family and friends help “keep me in touch with my friends.” The activities within the home did evidence development opportunities. Indeed some of the service users had certificates of attendance at some of the training sessions organised for the staff. Service users said they felt this “helped me feel valued”, but “there’s not that much to do in the home”. Activities observed during the inspection consisted of smoking and sitting watching television in the lounge, but service users spoken with all said this is the activity that they preferred. Food served during the inspection, was seen to be appetising and of portions which service users said “there’s enough to eat”. There was evidence seen Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 13 that service users are given choices of meals and this also was confirmed by talking with them. They also said that they can get up and have breakfast when they want, providing “its not too near lunchtime.” Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 14 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): 18,19,20,21, Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users receive support they prefer and their physical needs are met, including identification of their wishes around ageing and death. No service user administers their own medication and the home’s procedures for dealing with medicines requires improvement. EVIDENCE: The service users all said they were satisfied with the support they receive. “staff let me do things myself and don’t interfere too much.” Staff were observed during the inspection to be supportive and encouraging, service users were prompted to dress appropriately and to shave. Personal choice was observed when service users did not want to wear particular items of clothing, with staff explaining the consequences of not doing so, but leaving the choice to the service users. Individual wishes on ageing and death were identified within the service user files case tracked. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 15 No service users, due to complexity of their needs, administer or control their own medication. The home’s procedures for the administration of medication had some areas requiring improvement, evidenced during the inspection. One blister pack was unlabelled, although unused, this was suggested by staff to belong to a certain service user. This was not acceptable and the blister pack was removed during the inspection and the pharmacist replaced it with a new blister pack appropriately labelled on 2.5.06. The medication for service users is kept in carrier bags within the cabinet with the current week in the shelving part of the cabinet. This practice is not appropriate and more suitable storage in accordance with the Handling of Medicines regulations to be implemented to reduce the risks of errors in giving medication. Some of the medicines were being recorded on sheets produced by the home and not on the Medicines Administration Records supplied with the medicines. Although there were no errors observed in the administration of the medicines and no evidence of overstocking, or out of date medicines, this practice also could lead to medicines either being given twice or not at all, putting service users at risk. All medicines must be administered only from the Medicines Administration Records. Receipts in and medicines returned must also be recorded on these sheets to enable any audit of medicines to be carried out. Staff have received training in administration of medicines, but in view of the errors, retraining in this area, by an appropriate external body, is necessary. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users said they feel their views are listened to, but complaints are not being recorded. Staff have received training in safeguarding adults. EVIDENCE: Service users said they could “tell Cordelia anything and she will deal with it.” However, there are no complaints recorded in the complaints book and any issues brought up by the service users are not being recorded, but dealt with spontaneously. Staff interviewed during the inspection said they were aware of their role within the safeguarding adults procedures and staff records viewed contained certificates of attendance for this. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 17 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): 24,25,26,27,28,30 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service user and shared rooms are generally clean and hygienic and meet the needs of the service users. The toilet and bathroom facilities are sufficient to meet needs, but repairs are required. EVIDENCE: Generally, the home is adequately furnished, with service users rooms inspected to be appropriate for their needs. Service users said they were satisfied with their rooms and have their own things around them. Keys are provided for the rooms. The home was observed to be clean and hygienic. The lounge, a smoking area, shows the results of smokers, with some burns and discolouration of décor, but service users said they were “happy with the room.” A large Victorian building, the décor and furnishings require routine maintenance. The toilet on the upper floor has a damaged seat, damaged cistern top a large hole in the wall, and a broken door lock, which all require repair. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 18 The cooker, previously in need of repair, has been replaced with a smaller, new one, which is sufficient to cook meals for the 7 service users. The kitchen was observed to be clean and hygienic. The staircases to both upper storeys are steep, but have handrails on both sides. However, this home would not be appropriate for any service users with mobility problems. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 19 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): 31,32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staff have received training within their roles and responsibilities and the home’s recruitment practices protect and support service users. Staff are not at present formally supervised. EVIDENCE: The proprietor/manager, and one carer were on duty during the inspection. Staff records identified training received in the roles and responsibilities of the care worker, who is also training locally as a nurse in mental health. The service users said they are “satisfied that Cordelia and the staff know what they are doing.” Discussions with the care worker also reflected knowledge of the needs of the service users and what is needed to deal with these. Staff recruited are Criminal Records Bureau checked and references were seen within the staff files, together with certificates, evidence of all the training undertaken by the staff member. Staff records have no evidence of regular, formal, supervision taking place and staff on duty had not received any such appraisals, which could impact on the service users by a training need not being met, such as is evidenced with the issues around the medications storage, administration and recording, possibly dealing to service users being put at some risk. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 20 Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 21 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): 37,38,39,40,41,42,43 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has policies and procedures in place to safeguard service users rights and best interests. The manager does not hold a nationally recognised management qualification and some omissions in the management area show some management improvement needs. EVIDENCE: The service users spoken with said they are satisfied with the way the home is run, that their interests are safeguarded and that their needs are “catered for”. Since the last inspection, health and safety records have improved, with evidence of fire alarm testing and water temperatures records being completed. The service users said they complete a questionnaire “every so often” and these were seen within the service user files, but no evidence of audit of these Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 22 questionnaires was available. The manager said that she reads these, takes a note of what they say and deals with anything that is not in order. None of this is recorded, so quality monitoring is not being carried out, which could lead to service user’s views and opinions not being taken into account. The manager does not hold a required qualification in care and management at Level 4, although some in-house management training has been given by Chief Ogbakaeko, who holds a certificate in training. The manager is required to enrol on a National Vocational Qualification course at Level 4, or equivalent, to ensure management skills are up to date, to benefit the service users. Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 23 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 Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 2 3 3 3 2 Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 24 none Are there any outstanding requirements from the last inspection? Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 25 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 YA6 Regulation 15(1) Requirement Timescale for action 04/07/06 2 3 YA20 YA20 13(2) 13(2) 4 YA22 22(1-6) 5 6 YA24 YA36 23(2) 18(2) 7 YA39 24(1)b 8 YA43 10(3) Langdale Court Care Home Develop individual care plans to include how the home will meet the current, changing needs and aspirations of each service user To return unlabelled blister pack 02/05/06 to the pharmacist. THIS WAS CARRIED OUT IMMEDIATELY Carry out improvements to the 04/07/06 recording, handling, safekeeping, administration and disposal of medicines received into the care home to meet the Regulations within the Medicines Act, including training staff in this area, using the appropriately qualified provider Ensure any complaints are 04/07/06 recorded and include the stages and timescales for the process, and action (if any)taken. Toilet seat, cistern, damage to 06/06/06 wall, door lock of upper floor’s toilet to be repaired or replaced Ensure that staff are 04/07/06 appropriately supervised and this is formally recorded in the staff member’s file, to include personal development as well as skills and responsibilities. Publish results of service user 30/08/06 surveys, make available to service users and their representatives and use to aid the development of a quality tool to audit the care quality and improvements required. The Registered Manager to 06/09/06 undertake National Vocational DS0000002295.V292768.R01.S.doc Version 5.1 Page 26 Qualification at Level 4 in Management or Care, or equivalent. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 1 YA35 To organise training for staff by appropriately trained providers in areas of medication, first aid and moving and handling techniques and record in staff records, together with the in-house training provided by Chief Ogbakaeko Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Langdale Court Care Home DS0000002295.V292768.R01.S.doc Version 5.1 Page 28 - 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!