Inspection on 11/04/08 for Langdale House Care Home

This inspection was carried out on 11th April 2008.

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

Langdale House Care Home 18/04/07

Langdale House Care Home 19/04/06

Langdale House Care Home 12/10/05

Langdale House Care Home 24/06/05

Langdale House Care Home 09/02/05

Langdale House Care Home 08/11/04

Langdale House Care Home 24/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Langdale House Care Home Grove Avenue Nottingham NG7 4BP Lead Inspector Lee West Unannounced Inspection 11th April 2008 11:30 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 Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 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. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langdale House Care Home Address Grove Avenue Nottingham NG7 4BP 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 978 3822 F/P 0115 978 3822 Mrs Cordelia Nwafor Ogbakaeko Mr Bernard Okenwa Ogbakaeko Mr Bernard Okenwa Ogbakaeko Care Home 12 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (12) Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total number of residents accommodated, 1 may be within the registration category MD(E) 18th April 2007 Date of last inspection Brief Description of the Service: Langdale House Care Home is an adapted detached house on a private road, situated close to the shops and other amenities in Hyson Green and near to the tram route to Nottingham city centre, Bulwell and Hucknall. The accommodation is on two floors. Three bedrooms are on the ground floor with one shared bathroom. The remaining bedrooms and a shower room are on the first floor and there is a lift to these rooms. There is a small garden to the rear of the home, with a courtyard frontage. Car parking is limited to the courtyard and to the front of the building, on a narrow, private road. The home is not fully accessible for full-time wheelchair users, but a portable ramp is available on request, to provide access to the main entrance, which has four steps. Although registered for people of both sexes, the current occupants are all male. The current scale of charges is £323.36 per week, which does not include the cost of haircuts, trips or new clothing. The Service User guide sets out the range of facilities provided, people’s rights and the complaints procedures. This is available on request, but also on display in the foyer of the home, together with the current Certificate of Registration and a copy of the last Inspection Report. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and aspects of service provision that need further development. This inspection was unannounced and involved one inspector. The main method of inspection used is “case tracking”, which involves selecting three residents and looking at the quality of the care they receive by speaking with them, observation, reading their records, and asking staff about their needs. Documents, including care plans, medication administration records, complaints records and quality reviews were inspected, together with staff files and training records, to help form an opinion about the health, safety and welfare of people at the home. Information supplied to the commission by the manager, on the Annual Quality Assessment, with information received by the Commission about the home, since the last inspection, were also considered, and helped the decision of which areas to focus on. The quality rating for this service is 1 star. This means people who use this service experience adequate quality outcomes. What the service does well: The home is warm, clean and hygienic, with people who use the service commenting, “I am happy with my room, I have everything around me that I need.” People who use the service said they are very settled, “this is a homely place and staff treat me well,” one stated. Another stated that “food is basic, but very good. Its just the sort of food I like.” Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 6 The rapport between people who use the service and staff was respectful and positive, with laughter and jokes shared, helping everyone, “feel at home”, as one person said. What has improved since the last inspection? What they could do better: Pre-admission assessment and Care Plans require attention to be paid to people’s individual diversity and equality needs, not just religion and dietary needs. Personal and medical histories would help meet their care needs more in line with their individuality and would help the carers be able to identify any changes in mental or medical conditions, or reactions to medication, as well as to support them in a way they would prefer, improving the outcome for people using this service. An activities programme, to include visits and activities outside the home must be organised, to provide opportunities for individuals to be involved within the community, in a way that enhances their individual diversity, mental and physical abilities and choices. One person said, “I like it here but I can’t get out much on my own now and I sometimes feel very hemmed in. I would love to go out to the seaside, or to a pub in the country.” To help staff, who said they were not sure about mental capacity, support people with differing mental capacity, they should undertake training in this, which would enhance the well-being of people using the service as well as the competence of the carers. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 8 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 Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Basic information is available to help people decide if the service would meet their needs, but pre-admission assessments do not address all the areas of diversity, or individual histories to ensure care is carried out to their individual preference. EVIDENCE: Pre-admission assessments for the people case tracked, did not take into consideration their individual needs, concerns and anxieties. They had information about religion and dietary needs, but nothing about individual, specific cultural or diversity requirements. People had been given the opportunity to visit the home before being admitted, and one person spoken with confirmed this had happened and that, “everyone was cheerful and kind to me and that helped me to make my decision to come to this home.” Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 10 The service user guide had been updated and included clear information about the service’s policy on alcohol within the home, which had previously been misleading. The service user guide, statement of purpose, certificate of registration and certificate of insurance were all displayed clearly in the foyer of the home, to help people who were seeking information about the facilities and suitability of the home and staff to meet their needs. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care needs for people using the service were identified, but scattered around in various locations, leading to lack of clarity in the individual’s care plan and possibly leading to compromised care needs being met in a way they would wish. EVIDENCE: Each care plan case tracked had a sheet identified as “Assessment care needs/Staff support”, which, on admission, spelt out what care support was needed, but this was not transferred onto the care plan, which didn’t have any information about personal histories, medical histories or personal preferences and wishes in other areas, such as preferred daily routines, or particular mental health issues that required support to help carers provide suitable care. There was evidence seen of reviews of the care plans, but there were no clear actions identified. An example of this was one of the people had had an injury Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 12 which was identified within the care plan, but there were no actions set out on how to assist this person. There was also no indication, in any care plan, of how carers should assist people who had mental health issues, nor any indication of possible side effects from any medication being taken, to help them maintain a positive outcome with their mental health, as well as physical assistance. When spoken with about the care they carry out for people using the service, although they did not have a clear understanding of the mental health issues, they were able to describe how they recognise changes in their manner or mood and how they tried to deal with this to improve the mood. Risk assessments were in place for those people case tracked and these included risks of pressure problems and possible falls, identifying interventions to help reduce any risks. Medication was stored appropriately and the Medication Administration Records were completed accurately. The medicines were administered in accordance with the home’s procedures and everyone had their medication at the proper time. People using the home were spoken with and they said they were happy with the care provided and that carers treated them with dignity and respect and helped them whenever necessary. One said, “I’m looked after ok, and I can do as I please.” Another said, “I like to be left alone and do my own thing, and they respect that.” Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Daily activities within the home remain limited, with little indication of supporting personal interests and activities, but interaction between staff and people using the service was positive. Food was basic, but varied and nutritious and provided at the time people wanted it. EVIDENCE: People spoken with told me about the Christmas activities and how much they enjoyed them. There had been a party, with relatives and local people invited. One said, “we chose the music, Motown and Country and Western, and there was a great choice of food.” Another said he had spent Christmas with his family. None of the care plans had any indication of people’s personal history, interests, hobbies or cultural needs, to help meet their personal diversity. There was, though, a programme of activities set out in a chart on the wall in the dining area, and there were drawings on the walls, games available and one person was watching a classic film on the television, accompanied by one Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 14 of the carers. However, everyone spoken with said they could still do with some interesting activities, particularly something outside the home, like a holiday, or trips somewhere. One said, “I like it here but I can’t get out much on my own now and I sometimes feel very hemmed in. I would love to go out to the seaside, or to a pub in the country.” Everyone spoken with said they enjoyed the food, one person said, “I love the food, its not fancy or spicy and there’s enough of it.” The meal served at lunchtime was a meat pie, with potatoes and a choice of vegetables. It looked well cooked and nutritious and there were other choices available for those who did not want the pie. Bernard had responded to a request by people using the service for the option of a full cooked breakfast every morning and those spoken with said they enjoyed, “the chance to choose a good fry up, or not.” Staff spoken with said they found it difficult to motivate the people into activities, but they enjoyed conversation and watching television. Although there were no visitors at the time of this inspection, people using the service confirmed their relatives were made welcome at any time and they were always offered something to drink if they wanted it. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are treated fairly and know how to complain and any concerns are taken seriously. EVIDENCE: There was a letter in a file case tracked where a relative had made a complaint and the manager dealt with this swiftly and the relative was satisfied with the result. Letters and responses were seen of this. Carers spoken with were aware of their role and evidence was seen in the staff files of training in safeguarding adults. Each person also had their own copy of the complaints policy, given to them on admission and records of complaints and concerns were seen. There had recently been a safeguarding issue recorded, but to date there has been no outcome, although care planning documentation was seen and the family were aware of the issues. People using the service said they felt safe with the carers and one said, “they look out for me and if I have a complaint I can always speak to Bernard.” Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a safe, homely environment, with personalised bedrooms. EVIDENCE: The home was clean and hygienic and there had been a number of improvements made to communal and private areas, and plans for continued improvements and refurbishment were also seen. Three bedrooms had been redecorated and also had new carpets down. Routine maintenance and repairs had been carried out, with records of maintenance completed. The floor in the dining area had been replaced, also the dining chairs and the lighting had been improved in all areas, which made the communal areas, particularly the dining area, much brighter. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 17 There had also been improvements to the garden and there were flowers in bloom in flower beds around the house. People using the service said they liked the new dining area, one commented, “I can see what I’m eating now.” Rooms seen all had clean linen and toilets and bathroom were clean and hygienic. The kitchen area was also clean, when visited after lunch had been served. People said they had their own possessions around them in their bedrooms and they felt there had been an improvement in the home generally. All the people using the service spoken with said they were comfortable in their own rooms. Cleaning and cooking was carried out by named carers each shift. Those spoken with said the improvements had made it easier to keep everywhere clean and hygienic. One person using the service said, “the girls keep this place nice and tidy and I’m comfortable here.” Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are clear about their role and people using the service are generally satisfied with the care they receive, but carers have limited knowledge of mental health or mental capacity issues, which could have a detrimental effect on people using the service. EVIDENCE: Information sent to the Commission by the manager, on the Annual Quality Assessment stated new staff patterns had been introduced, which meant more staff on duty at peak times. The duty rota was checked and there were two carers working, with the manager in the home on split shifts (working with a few hours off midafternoon). During the afternoon there were also 2 carers working with the manager present to meet the needs of the people using the service. Staff spoken with said they were satisfied there was sufficient staff to meet their needs, and also to carry out the cleaning and cooking duties. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 19 One stated, “we only have a couple of people who need assistance, the majority are mostly independent, which means one of us gets on with the cooking or cleaning.” One person using the service said, “staff are always around if I need help and in the afternoons we sometimes play games, but I prefer to go to my room after dinner and watch television.” Staff records all contained evidence of Criminal Records Bureau checks and two references in place in accordance with safe recruiting practices. The staff files contained evidence of training in Food hygiene, moving and handling, management of violence and aggression and First Aid, but there was no training specifically to deal with mental health issues, dementia, or the mental capacity act. Staff spoken with confirmed they had undergone National Vocational Qualification Level 2, but during discussions about how the people using their service and the Mental Capacity Act, they did not know about this and how it affected people they were caring for, but they were able to describe how they would deal with particular behaviour patterns of people who use the service, in a way which supported their mental health needs. People using the service said they were comfortable with the carers, who, one said, “seem to know what they are doing.” Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The manager has an open and transparent management style, and is developing quality assurance to enable people using the service to have an input into the daily organisation of the home. EVIDENCE: In the Annual Quality Assessment, the manager with over 20 years management experience in a care setting and a qualification in Management and Care, described the home’s annual development plan, to identify what would be achievable within the next twelve months. This was reinforced during discussions with the manager, when he described the plans underway to refurbish a double room and market it as a single one, when completed. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 21 People using the service had completed questionnaires, which were audited to help plan for improvements to the service. Those spoken with said they felt they would be listened to, and one stated about the changes made to breakfasts after a resident and manager meeting. “We can talk to Bernard,” said one of the people using the service. Finances were dealt with by the people using the service and their families, and not by the home, and people said this helped them to feel independent, because they could spend their money on whatever they wanted. Staff spoken with said they had regular supervision and appraisal and their training needs were discussed during the sessions. Records were seen of this in the staff files case tracked. The Annual Quality Assurance identified the dates of health and safety checks and dates of servicing of equipment, which were reinforced by records kept at the home. The home’s policies and procedures had been updated in June 2007, and evidence of this was provided with the updated Service User Guide and statement of purpose. Service User surveys returned showed people using the service were satisfied with the home and how it was run, “I am comfortable here and Bernard is always helpful.” Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 22 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 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement Timescale for action 01/09/08 2. OP7 15(1) Pre-admission assessment of people’s individual care, diversity and equality needs must be carried out to ensure the care home can meet the needs of the person in a way which supports their individuality and where possible independence. 01/09/08 Care Plans must address all people’s individual diversity and equality needs. Personal and medical histories are required to help meet their care needs more in line with their individuality and help the carers be able to identify any changes in mental or medical conditions, or reactions to medication, as well as to support them in a way they would prefer, improving the outcome for people using this service. An activities programme, to include visits and activities outside the home must be organised, to provide opportunities for individuals to be involved within the community, in a way which DS0000002296.V362309.R01.S.doc 3. OP12 16(2)n 01/09/08 Langdale House Care Home Version 5.2 Page 24 enhances their individual diversity, mental and physical abilities and choices. 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 OP30 Good Practice Recommendations To support and enhance the mental capacity of people using the service, carers should undertake training in the Mental Capacity Act, how it affects their role and the people who use the service. Langdale House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 House Care Home DS0000002296.V362309.R01.S.doc Version 5.2 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!