Inspection on 13/06/05 for Lindisfarne Residential Home

This inspection was carried out on 13th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lindisfarne Residential Home 04/08/08

Lindisfarne Residential Home 19/09/07

Lindisfarne Residential Home 05/10/06

Lindisfarne Residential Home 10/11/05

Lindisfarne Residential Home 24/11/04

Lindisfarne Residential Home 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Lindisfarne Nursing & Residential Home Durham Road Birtley Chester le Street DH3 1LU Lead Inspector Sharon McDowell Unannounced Monday, 13 June 2005 :09:30 th 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 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. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lindisfarne Nursing & Residential Home Address Durham Road, Birtley, Chester le Street DH3 1LU 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) 0191 492 0738 0191 492 1373 Gainford Care Homes Ltd Care home 60 Category(ies) of 60 x DE(E) registration, with number of places Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24th November 2004 Brief Description of the Service: Lindisfarne Care Home is a 60-bed purpose built home registered to accommodate people over the age of sixty-five years with dementia who require personal care. The Home does not provide nursing care. There is a separate day care unit with up to 10 day-care places for service users who have dementia. A choice of lounges is available on all floors and there is a dining room on each floor. Access between the floors is controlled by a coded keypad. A passenger lift services all three floors. All rooms are single occupancy with en-suite facilities, and service users are encouraged to personalise them as they wish. The home is situated in the centre of Birtley, with local shops and amenities close by, and the location also offers views of the local countryside. Transport links are good and ample car parking is available to the front and rear of the building. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs S McDowell, Lead inspector and Mrs E Allnutt, 2nd inspector, conducted this unannounced inspection, which took seven hours to complete. As part of the inspection a tour of the building was conducted. Several documents were reviewed including, resident care plans, medication and staff training records, accident reports and the fire log book. A total of eight residents, two visitors and four staff were spoken with to seek their views about their care and the services provided at the home. What the service does well: What has improved since the last inspection? What they could do better: Whilst the Home is very pleasantly decorated it is not adapted to the needs of people with dementia. Specialist advice regarding adaptations to the Home to help people maintain independence is needed. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 6 Residents care plans are not adequately completed to ensure the needs of the residents are fully met. There is still a focus on health and problem areas rather than personal and social care issues, which again could be improved by seeking advice from specialist dementia, care groups. 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. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 Pre-admission documentation is not completed in enough detail to ensure residents will have their needs fully met. Currently staff knowledge about the needs of people with dementia is limited therefore residents and their representatives cannot be assured that their needs will be fully met. EVIDENCE: Pre admission assessment documentation was not fully completed and limited care manager information was available therefore the residents needs have not been fully assessed before coming to live at the Home. The manager confirmed that the Home does not send a letter to prospective residents to confirm the Home can meet their assessed needs to assist them to make a decision whether to chose this home to live in. Staff have started a distance learning dementia care awareness course to increase their knowledge and skills in how to work with people with dementia. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 &9 Care plans do not reflect the assessed needs of the residents accommodated. Therefore individual health and particularly personal and social care needs might not be identified and fully met. Some progress has been made in the safe storage and administration of medicines. However some practices do not ensure medication is managed to fully protect residents from harm. EVIDENCE: Care plans do not contain all relevant information, for example, moving and handling, nutrition and risk assessments. One resident had a fall prior to coming to live at the Home yet there was no falls risk assessment available. There is no information about how the resident’s dementia affects their life, which is important to inform staff how to work with the person and to plan their personal and social care. As this was a former care home with nursing the care plans remain focused on health needs with personal and social care needs poorly identified, if at all. For Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 10 example, one resident spoke a lot about their time in the armed forces but nothing was documented in the ‘war years’ section of their social history. Individual care plans do not have enough detail to help staff to carry out the care described, for example, an entry for ‘hygiene’ describes the objective for the resident ‘to maintain current level of independence’ and the action required by staff as ‘assist and supervise, assist when necessary’. It does not specify what level of help and supervision is required to be given. Therefore it is open to interpretation, which might mean the resident does not get the right level of help. There is evidence that health care professionals are involved with the care of the residents when needed. Doctors and District nurses visit the Home and during the inspection a chiropodist was seeing several residents. He explained how the residents are referred to him and the routine of visits. During his visit several residents were being brought in to the room and waited in the same area as the person having their feet done. It was suggested it would be more dignified if residents could be seen in private, either in their own rooms or with residents waiting outside the room being used. The residents being seen made comments like ‘I float on air after having my feet done’. One visitor expressed concern that physiotherapy exercises were not being carried out for their relative. On review of the residents care plan there was reference to exercises being recommended by the physiotherapist. However there was no information to guide staff. Some practices in dealing with medication are not acceptable. Staff measure Oromorph solution in a jug to judge if the right amount is there as specified in the Controlled drug register. This increases the risk of contamination and errors from potential spillages. Staff are secondary dispensing medication from the package supplied by the pharmacist to give to a relative who takes their relative who is a resident home. This could lead to errors, as the medication is not in its original packaging. There is no list of staff signatures for those staff responsible for administering medication. Regular medication is administered correctly and signed as given by the staff member responsible for medication administration. At the last inspection the Registered Provider had allowed a nurse from another care home to conduct a medication audit, which resulted in many issues being identified. Unfortunately this information is not available for the new manager therefore he is unaware of the issues raised. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 Significant improvement has been made in the provision of activities, which means residents have a choice of social events both in and outside the Home. However, individual preferences and specialist interests are not always documented to ensure individual needs are fully catered for. Visitors are positively welcomed to the Home therefore residents are enabled to maintain contact with their friends and family. EVIDENCE: The Home has now appointed an activity person responsible for the organisation of social and recreational events. She works Monday to Friday, 08:00 to 17:00hrs. The day centre organiser also helps with activities from 17:00 to 20:00hrs on three nights of the week. The Home has it’s own minibus and since the appointment of the manager, day trips are organised two days a week to local areas, such as, the Winter Gardens in Sunderland and local beaches. An activity programme was displayed for the week, which included a picnic outing and a trip to Washington Galleries. Residents confirmed the trips occur. Information is written in activity records and photographs are displayed around the Home of outings. Sometimes the activity programme is not followed due to residents changing their minds about what they would like to do. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 12 The day centre organiser said she sometimes takes residents in to the day centre if there are not many people attending day care and during the evenings she is working to use this area for baking sessions and to have a quiet area. Care plans do not reflect the individual residents interests or have completed social profiles, which, if completed would help guide activities in the Home. Visitors come and go freely to the Home and residents look forward to their visits. One visitor stated they were happy with the standard of care at the Home and comments like ‘staff are good’, ‘they are the tops’ were made. As visitors entered the Home the manager was seen to be cheerful and welcoming, which encouraged visitors to come to his office to speak with him. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff are not fully aware of procedures for alerting abuse to the Protection of Vulnerable Adults coordinator therefore delays might occur for procedures to protect residents to be implemented. EVIDENCE: Staff training records indicate staff have attended training in Protection of Vulnerable Adults. However, some staff were able to answer who they would report suspected abuse to in the Home but were unsure of the local procedures for alerting abuse to the Adult Duty Team. This is particularly relevant for them to be sure what to do when the manager is not on duty. Currently the manager has given permission for staff to contact him anytime when he is not on duty, offering a twenty-four hour support service to his staff. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The Home offers a high standard of comfortable and safe accommodation. However there is little adaptation for people with dementia therefore limiting their ability to remain independent in the Home. EVIDENCE: The Home generally offers a clean, comfortable and spacious environment for residents to live in. Some signs of wear and tear are evident and some areas require action, as follows: - There are no mirrors in the bathrooms - Cracked window to basement back door - First floor toilet out of order - Marks on wall where meals are served from hot trolley - First floor kitchenette needs cleaning, microwave splashed with food, cups stained and walls marked, particularly around sink area. The Home has few adaptations for people with dementia. An attempt has been made to put picture signs on toilet and bathroom doors. However these are hard to make out, as they are not clear pictures. There is a lot of research available and support organisations, which was discussed with the manager, Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 15 who can give advice about environmental design. This is important to help people with dementia to keep independent living skills. The Home has a rear garden area, which is paved and has some planted areas. It is not currently developed as a sensory garden or with any special adaptation for people with dementia or physical disabilities. This potentially could provide a safe outdoor space for residents to enjoy. Some discussion took place about areas of the Home currently underused, for example, the basement lounge/dining area and the day centre (evenings and weekends). Both these areas offer a very pleasant environment. The lounge looks onto the garden area and the day centre is well equipped and situated in a quiet area of the Home. It was suggested these areas could be utilised for activities or just somewhere pleasant to sit and enjoy peace and quiet. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staff are employed in sufficient numbers to adequately meet the needs of the residents. Staff are enthusiastic about attending training. Therefore residents and relatives can be assured the staff will develop appropriate skills to meet their needs. EVIDENCE: Staffing levels are appropriate to meet the needs of the residents accommodated. There is a mixture of experienced and less experienced staff on duty therefore newly employed staff have support. The manager confirmed he has not had to use agency staff since he came to work at the Home, which means a consistent staff group cares for the residents. Staff confirmed they have attended a variety of training including, fire safety, moving and handling, dementia care awareness. A training matrix is maintained by the manger to demonstrate staff training attendance however this does not have dates of attendance, which would enable the manager to have a quick reference guide to the training needs of his staff. Staff have not been updated in infection control, food hygiene, health and safety or care planning, which would help them in their daily work with the residents. All staff spoken with were enthusiastic about the training opportunities and the chance to develop skills and knowledge to enable them to work in safe and better ways with the residents. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 38 The appointment of the manager has improved the general mood in the Home and staff morale has improved. Therefore resident’s benefit from living in a pleasant atmosphere with staff that works positively to improve their lives. The administration of some health and safety matters do not follow recommended practice. This puts affects residents privacy and puts their safety at risk in the event of a fire. EVIDENCE: All staff spoken with stated morale in the Home is high, particularly since the appointment of the current manager. They felt his approach was open, honest and positive, which as one staff member said ‘makes it a pleasure to come to work now’ another stated ‘we feel cared for’ and others stated ‘there have been lots of changes and all for the better’. This contributes to the effectiveness of the team and promotes a positive atmosphere in the Home. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 18 The accident logbook is completed for all accidents however it does not comply with the Data Protection Act as the body of the report contained personal details of the residents involved. These parts of the book are meant to be detached from the report and stored in a secure place, for example, the resident’s personal records. Fire safety checks of alarms and fire fighting equipment are carried out and logged in the fire book therefore equipment is known to work in the event of a fire. However staff training records do not identify that staff have attended the appropriate number of fire safety training sessions, which means they might not be up to date with what action they should take in the event of a fire. Domestic staff were seen to follow good practice in relation to health and safety, for example, making sure leads from electrical equipment did not cause a tripping hazard, wearing protective gloves and the trolley with cleaning material was supervised at all times. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x 3 2 Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement The Home’s Statement of Purpose and Service Users Guide should contain all required information as detailed in the body of this report. (Previous timescale of 30/4/05 not met) The terms and conditions document must detail the number of the room to be occupied and review statement regarding control of service users cigarettes and alcohol.(Previous timescale of 30/4/05 not met) Preadmission documentation must be completed in sufficient detail to enable decision to be made about the appropriateness of the admission and consequently a care plan to be formulated from the information. Service user care plans must provide current details of assessed health, personal and social care needs and restrictions made on service users freedom. (Previous timescale of 31/3/05 not met). Safe handling of medicines must be in accordance with legislation and good practice guidelines. All Timescale for action 30/9/05 2. OP2 5 30/9/05 3. OP3 31/8/05 4. OP7 12,13 & 15 31/8/05 5. OP9 13/6/05 Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 21 6. 7. Op18 OP19 8. OP19 9. OP27 10. OP38 11. OP38 issues raised in the body of this report must be addressed. All staff must be made aware of how to contact the Protection of Vulnerable Adult Coordinator. The manager and the Registered Provider must consult with specialist advisors regarding environmental design for people with dementia. All matters raised in the body of this report regarding repairs and improvements to the building must be addressed. All staff must attend statutory training in matters of health and safety as detailed in the body of this report. Fire training records must be updated to demonstrate that all staff attend the required number of fire training sessions. The accident report book must comply with the Data Protection Act. 13/6/05 30/9/05 30/9/05 30/9/05 31/8/05 13/6/05 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. 5. Refer to Standard OP19 OP19 OP21 OP21 OP22 Good Practice Recommendations Consideration should be given to making better use of the ground floor lounge and day centre when it is not used by day service people. The garden area should be landscaped to meet the needs of people accommodated at the Home. Consideration should be given to the design of sink taps particularly for service users with dementia to reduce the risk of accidental flooding Toilet roll holders should be replaced with a user-friendly type. A loop system should be installed for the benefit of service users who have hearing difficulties. B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 22 Lindisfarne Nursing & Residential Home 6. OP33 The quality assurance system should be further developed as an overall linked audit document. Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Baltic House Port of Tyne South Shields NE34 9PT 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 Lindisfarne Nursing & Residential Home B52-B02 S37820 Lindisfarne (Birtley) V219725 13 Jun 05 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!