Inspection on 25/08/05 for Leahurst

This inspection was carried out on 25th August 2005.

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

The inspector 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

Leahurst 18/11/09

Leahurst 09/09/09

Leahurst 15/08/07

Leahurst 06/02/07

Leahurst 01/01/06

Leahurst 12/01/05

Leahurst 07/09/04

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

CARE HOME ADULTS 18-65 Leahurst Coronation Drive Widnes Cheshire WA8 8AZ Lead Inspector Anthony Cliffe Announced 25th August 2005 9:00 am 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 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 Stationary 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. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Leahurst Address Coronation Drive Widnes Cheshire WA8 8AZ 0151 495 1919 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hilton Residential Homes Limited Mr Michael Moran Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (26) of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (26) Physical Disability (1) Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The total number of Service Users must not exceed 26 2 26 of the Service Users may be MD 3 26 of the Service Users may be MD(E) 4 1 of the MD Service Users may also be PD Date of last inspection 12 January 2005 Brief Description of the Service: Leahurst care home provides personal care for 26 adults with enduring mental health problmes. The home has two double bedrooms but uses these for single occupancy. There are two buildings, the main building with an upstrairs three bedroom flat and the lodge a three bedroom detached property. The flat and the lodge have their own kitchen, bathroom and living areas. The home is close to local shops and a mile away from Widnes town centre. It is on alocal bus route and served by two railway stations. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Leahurst was rearranged with the registered person at the Request of the Commission for Social Care Inspection (CSCI). It took place over a period of eight hours. The inspector agreed the format of the inspection with the manager. The inspection was carried out using a process of cross referencing the documentation of identified residents following discussion with them and following the delivery of care and support to them. A tour of the building, including all communal areas, the kitchens and a number of bedrooms, was completed. Residents and staff contributed their experience of living, visiting and working in the home What the service does well: What has improved since the last inspection? The manager has achieved the registered managers award Fire equipment had been replaced as required by Cheshire Fire Services. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 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. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed, as there have been no admissions to the home since January 2005. EVIDENCE: Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 and 10 Residents make decisions and are consulted about their needs and lifestyles taking account of individual risks, which are recorded in their care plans. These need to be reviewed more regularly to reflect residents’ mental health needs and inform professionals involved in their care. Information about residents is treated with confidence and records of residents are kept securely. EVIDENCE: The records of residents were examined. It was evident from records and discussions with residents and staff that residents are able to choose their own lifestyle and staff support them to plan their lifestyle. Some of the residents are on the enhanced Care Programme Approach and are difficult to engage with. Some of the residents refuse to engage with the local mental health services. The records of one resident detailed a number of missed appointments with his psychiatrist in January, March and July 2005. An internal review of the resident’s care plans and risk assessment was last completed in January 2005 with the resident present. The resident agreed in his care plans to keep his personal bedroom clean and tidy and attend to his own laundry. The resident’s risk assessment, which was reviewed in January 2005, was also discussed and he agreed with the risks identified by his key worker. The resident’s nutritional intake was discussed. He said he liked the meals but did not eat much at the home and did not want to cook for himself. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 10 The resident also said he did not want to join in activities. The resident discussed his mental health needs and in particular experiencing auditory hallucinations. He agreed that when these bothered him he could talk to staff but he was not troubled at the time. Other professionals do not necessarily attend the internal reviews at the home and where the home is part of the Care Programme Approach care plan would be a useful source of information for informing professionals of the resident’s mental health needs. Another resident talked about her mental health needs. She said she had lived at the home for seven years and ‘I have never settled anywhere for so long. I go out when I want to and have a friend who I visit all the time. I go into the hairdressers or into town, there are some cafes I like to visit with my friend’. The resident talked about her mental health and said ‘I can talk to my key worker she is great. My CPN and key worker talk to one another, so if I have a problem they both know about it and if I don’t get to see my CPN then I can talk to my key worker about it. I keep my own tablets, I have a cassette every week and I keep them locked away safely in my draw. I have a key to this. I sign the records to show I’m taking my tablets. I have been looking after my own tablets for some time now. I have my own bedroom key so everything is locked away safely’. I have a weekly programme of activities, which includes my cooking days and cleaning days. I don’t have to do anything I don’t want to, staff ask me and I can refuse’. There was a care plan in place to meet the resident’s needs and a risk assessment regarding self-administration of medicines. The manager and care staff asked residents if they were participating in their individual programmes and some declined to help with domestic chores. A resident said that ‘I wash and iron my clothes every week and Gill is going to help me iron today. I clean and tidy my room every week but it’s not that tidy. It’s my bedroom, my taste’.’ I don’t have to stick to my programme it depends upon how I feel’. Residents were offered the opportunity to talk in confidence without staff being present. Residents were also left to talk in private. The senior care staff approached a resident and requested a confidential talk. The resident later said ‘David has arranged for me to attend the dentist we chatted about this before in my bedroom.’ See recommendations 1 and 2. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 14,16 and 17. Residents have opportunities to develop and peruse their own lifestyles and interests. Resident’s rights and responsibilities and choices are recognised and respected. Residents are offered a healthy choice in their diet. EVIDENCE: Residents talked about their lifestyles and leisure interests. A resident showed how he had personalised his bedroom with his own artwork. He said ‘its my own bedroom it looks untidy but I have tidied it up. I live with two other residents, we get on well together. I borrow money of them to buy cigarettes. I pay them back though. They don’t mind my artwork and have let me put some up in the living room. My mum is visiting me later’. Another resident said ‘I enjoy going out for walks and visit my mum every day. I also go to the centre for gardening and the computer’. Another resident talked about his hobbies ‘I enjoy collecting military objects, reading and smoking. I use to go to the MIND centre but sometimes it’s a bit rough and I feel threatened. I get visits from my nephew who lives in Warrington, we go to the pub for lunch and do some shopping’. The senior care staff on duty confirmed that one of the residents is supported through a local authority project to access a gardening Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 12 and computer course via the MIND organisation and has a support worker to help him. Another resident said she was delighted when ‘the residents had a surprise birthday party for me’. Another resident talked about her voluntary work with the SCOPE organisation and adult literacy classes. ‘I’m a Christian and enjoy helping people. I work at the SCOPE shop in town two days a week. I put the clothes on hangers and put them out. I help clean up and go on messages. I attend college one day a week. I am doing a certificate in English literature. I am enjoying this and Mike and all the staff are supporting me in this’. The manager and care staff asked residents if they were participating in their individual programmes and some declined to help with domestic chores. A resident said that ‘I wash and iron my clothes every week and Gill is going to help me iron today. I clean and tidy my room every week but it’s not that tidy. It’s my bedroom, my taste’.’ I don’t have to stick to my programme it depends upon how I feel’. A resident had a double bedroom now used for single occupancy. She said ‘It’s large and spacious and I have a sitting area. It’s my responsibility to keep my bedroom clean’. Another resident said ‘ I like it here, there are no rules, they are not strict. I couldn’t tolerate that it’s not the right way to live. I enjoy it here because I can choose what I do. When I lived in the other home she was strict. Here staff don’t shout at you. I can have a friendship and it’s my choice. I keep in touch with my sister. I can say I feel settled it’s my home’. The chef does not have responsibility for the food budget. The chef completes a weekly food order and the registered person purchases fresh fruit and vegetables twice a week. There are separate kitchen facilities in the main building, lodge and first floor flat. The kitchen in the main building is for residents to make their own drinks and meals or can eat in the dining room. In the lodge and first floor flat residents can cook their own meals and make snacks. Residents in the lodge are supplied with bread, milk, cereals and sandwich fillings for their own use or they can eat in the main building. Breakfast is a choice of cereals, toast and porridge. Lunch was a choice of three options. Some residents cook meals for themselves independently or as part of their care plan. A resident chooses to purchase food items and have these cooked. The menu is a four-week rolling menu, which the chef changes to suit residents’ requests. Periodically the chef asks residents to revise the menu and meals can be added or taken of the menu at the residents request. The chef is not part of residents’ meetings and does not have the opportunity to discuss meal preferences with them. Some residents said they occasionally preferred a snack meal a resident said ‘I like to go out and buy a pot noodle’. Meal arrangements are flexible and residents can eat their meals at the time of their choosing within a given time. Residents approached the chef and asked for their meal to be prepared when they were ready to eat. One resident who is difficult to engage with either eats meals at the home or purchases food from the bakery if he does not want the choice offered on the menu. The Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 13 manager confirmed that if a resident wanted to purchase an alternative meal then they would be reimbursed for this as part of the fees for their care, but would not reimburse residents if they went and purchased additional food items for themselves. In discussion two residents said they had recently been out for a pub lunch with staff and this was paid for them. They said they did this regularly See recommendation3. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 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 standard(s) 19 and 20. Residents receive support to maintain their health and welfare. Residents are supported to manage their own medicines within a safe system of medicine administration. EVIDENCE: Residents are supported to maintain their health and welfare. A resident confirmed that staff had reminded her about the need to attend the dentist and had made an appointment for her. Another resident spoke about how she is supported emotionally to maintain good mental health. ‘I have to attend reviews and Mike came to the last one. My last CPA was in March and the next in December. It says I am taking my own medication. I can talk to my key worker about the tensions in my head and my CPN encourages this. I get support from staff when I feel frustrated and angry, when things in my head don’t feel right. I like to talk to Gill or my CPN they are both gentle people’. The resident’s care plan incorporates the Care Programme Approach review and identifies a contingency plan should the resident’s mental health deteriorate. This describes the signs staff should be aware of that indicates a relapse in her mental health and what strategies staff can use to diffuse her anger and aggression. Staff can access the crisis intervention services. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 15 The home uses the NOMAD monitored dosage system. The pharmacist delivers medicines weekly. Medication supplied by the local mental health services is sent in original packages. Receipts of medicines were recorded on the medicine administration sheet. No errors were noted on these. The home has a controlled drugs policy, procedure, recording and storage facilities, but does not keep any at present. Staff training records confirmed that staff had received training on the use of the NOMAD system. A resident described how she manager her own medicines. ‘I keep my own tablets, I have a cassette every week and I keep them locked away safely in my draw. I have a key to this. I sign the records to show I’m taking my tablets. I have been looking after my own tablets for some time now. I have my own bedroom key so everything is locked away safely. Staff and my CPN monitor me to make sure I am taking them’. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 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 standard(s) 23. Residents are protected from abuse, neglect and self-harm by an informed staff group. EVIDENCE: An incident was discussed with the manager that the home had notified the Commission of under Regulation 37. The registered person reported an incident witnessed by an off duty staff member to the police which concerned a resident. No further action was taken. The incident was also reported to the local authority under the adult protection procedures and the resident interviewed by staff from the local authority social services department. No further action was taken. Staff has monitored the resident and no further incidents occurred. The manager had arranged to attend the local authority ‘train the trainer’ course on the local authority adult protection policy and procedure. He had written confirmation of attendance on the course. All staff had training using the homes own training video on 19th August. To demonstrate their understanding of adult abuse staff have to complete a work sheet, which is kept as evidence of training. Staff confirmed they had been given the local authority information leaflets on the adult protection procedure. Once the manager has completed training on this he confirmed he would cascade the training down to staff. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 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 standard(s) 24 and 30 Residents live in a comfortable and safe environment, which is clean and hygienic. EVIDENCE: A tour of the main building, first floor flat and lodge was undertaken. A number of residents’ bedrooms were seen. The kitchen areas of the lodge and first floor flat are old but serviceable. These areas were clean. The kitchen in the main building used by resident is well maintained. The carpet area outside of this is stained with tea and coffee, where residents transport drinks to the smoking lounge. The smoking lounge carpet has been recently replaced but has several areas on burns from cigarettes. The registered person was present and stated his intention to replace the floor coverings in these areas with non-slip tiles, which cold be kept clean and were fire proof. The home was clean and hygienic. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 34. A competent and appropriately trained staff team cares for residents. The recruitment procedures ensure residents are protected. EVIDENCE: The manager works from 08.30 to 1700 Monday to Friday. From 0800 to 20.00 there is a senior care and two support workers. From 20.00 to 08.00 two support workers are on duty. The care staff team are supported by a catering manager assistant cooks and domestic staff. Staff interviewed said they enjoyed working at the home. A staff member who was leaving to further her career said ‘ I have a number of regrets about leaving, the manager and staff team are very good. Mike is very supportive, you can approach him for advice and support. If you feel under pressure you can say so. I will miss working here it’s a very good place to work’. Staff had received training on the NOMAD medication system, moving and handling, food hygiene and infection control. Eight of the eleven staff working at the home have an NVQ 2 qualification. Recruitment procedures for staff were examined. Protection of Vulnerable Adult and Criminal Records Bureau checks were completed prior to staff commencing employment. Applications for employment contained a chronology of the applicant’s previous employment details. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39. Residents’ views are listened to but their contribution to the development of and the health and safety of the home could be improved. EVIDENCE: A residents’ meeting was held on 26th July 2005. The matters covered in this were that residents made positive comments about a recent holiday. Issues were discussed about the standards of food and provision of activities and if residents wished to participate or not. The safety of the home was discussed with residents requested not to smoke in their bedrooms and to respond to fire alarms. The previous residents’ meeting was in 2004. Concerns about the health and welfare of residents in the home needs to be discussed regularly. The registered person confirmed that fire equipment had been replaced as required by Cheshire Fire Services. See recommendations 3 and 4. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 x 3 x 3 2 Standard No 31 32 33 34 35 36 Score x 3 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Leahurst Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 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. 2. 3. 4. Refer to Standard YA6 YA6 YA17 YA39 Good Practice Recommendations Residents care plans should be reviewed more regularly to reflect their current mental health needs. The outcomes and information from internal reviews should be shared with other mental health professionals when residents do not engage with mental health services. The catering manager should be included in residents meetings to get feedback on the standard of catering. Residents meetings should be held more regularly to encourage residents to contribute to the running of the home and highlight concerns about their welfare and safety. Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Leahurst F51 F01 S5193 Leahurst V233276 250805 Stage 4.doc Version 1.30 Page 23 - 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!