Inspection on 23/01/06 for Lindsay House Nursing Home

This inspection was carried out on 23rd January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindsay House Nursing Home 03/04/07

Lindsay House Nursing Home 28/07/05

Lindsay House Nursing Home 07/02/05

Lindsay House Nursing Home 13/05/04

Lindsay House Nursing Home 16/03/04

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

CARE HOME ADULTS 18-65 Lindsay House Nursing Home 110 - 116 Lindsay Avenue Abington Northampton Northants NN3 2JS Lead Inspector Mrs Linda Lilley Unannounced Inspection 23rd January 2006 10:00 Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lindsay House Nursing Home Address 110 - 116 Lindsay Avenue Abington Northampton Northants NN3 2JS 01604 406350 01604 409689 lindsayhouse@rethink.org 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) National Schizophrenia Fellowship Mr Martin Anthony Gale Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th July 2005 Brief Description of the Service: Lindsay House is a home situated in the residential area of Abington in Northampton. The home is close to the main local bus routes in to the town centre where community resources include shops, pubs, leisure centres and restaurants. The home is managed by Rethink, which is the operating name of the National Schizophrenia Fellowship and is registered to provide nursing care for fourteen adults with severe mental health problems. Purpose built, the accommodation for residents is provided across two floors. All bedrooms are single occupancy with en suite facilities; the home also has two sitting areas, two kitchens and two dining areas. The home has its own transport, which enables all the residents to access local facilities and a further range of activities. Rear and side gardens are accessible to the residents and there is a parking area to the front and rear of the home. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place in the morning and afternoon of January 23rd 2006. This visit followed a three hour period of review and preparation that included reviewing previous reports, reviewing information from other stakeholders, and documentation received in support of the process and preparing an inspection plan. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting two residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. Six residents and eight members of staff were spoken to during the inspection visit. A partial tour of the premises was also completed and a review of the documentation and records required to be kept in a care home was also undertaken. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. What the service does well: Residents spoken to are positive about the care they received, and staff were seen to treat the residents with dignity and respect, involving them in decisions, and addressing them in an appropriate manner. Many residents attend work placements and undertake appropriate leisure activities, and are encouraged to make appropriate choices, however these are not always documented. The staff have access to a wide range of education and training resources. A learning and development training needs analysis, which has resulted in a robust training plan 2005/06 has been carried out, to ensure staff have the skills and competencies to deliver effective care. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 6 There is a good recruitment strategy in place that ensures residents are protected and are cared for by competent staff. Newly appointed staff files seen contain appropriate information, and talking to staff identified they were undergoing a supported induction process. What has improved since the last inspection? What they could do better: Several fire doors to resident’s rooms were propped open with furniture, staff spoken to say this was to enable residents to have easy access to their rooms, as they kept losing their keys. Some residents spoken to did not remember having a key. The propping open of fire doors compromises safety in the event of a fire. This was raised in the previous inspection. The actions taken as a result of identified residents healthcare needs are not being documented to show that this care has been implemented or reviewed. For example one residents care plan indicated that “regular “blood pressure checks should be carried out, there was no evidence of what constituted “regular”, or a date for review, and the actual blood pressure recordings in the care plan file related to 2004. Recovery/Care plans and related documentation needs to demonstrate that resident’s holistic needs are being met. For example the current plans seen do not contain any indication of the leisure, work and social activities the resident is exposed to, or how these relate to the goals set with the resident. Ensure that the results of the organisations quality assurance monitoring e.g. residents or other stakeholders surveys, and the changes made as result of this are available in the home and shared with staff and residents, and are included in the Service User guide and the Statement of purpose, available in the home. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 7 Two residents files examined, did not contain completed contracts that indicated the terms and conditions within the home or which room they would occupy The policies and guidelines for directing care within the home are available from the company intranet and in paper format in the home, however some of the paper copies of the polices, held in the office file and accessed by staff are out of date, (some dated 2000), and the do not reflect the current national guidance. For example the confidentiality policy is dated 2000, and does not include any reference to the data Protection act. This has the potential to cause confusion for staff. 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. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2. 3.4.5. The home’s Statement of Purpose and Service User Guide provide useful information for prospective residents, enabling an informed decision about admission to the home. The process of assessment and admission criteria is good thus ensuring the home can meet the resident’s needs. The contracts for the residents are incomplete. EVIDENCE: The statement of purpose and service users guide was seen in the home. Two residents files examined provided evidence of multi agency assessment, and trial visits prior to them moving to the home. Three members of staff spoken to were able to describe the process of transition prior to the residents admission, indicating this was based on individual needs and may take up to 3 –4 months. They provided information regarding using other healthcare professionals, for example Occupational Therapists for advice, to ensure they could meet the residents needs. They also indicated the importance of ensuring the needs of the current residents were not overlooked. Two residents files examined, did not contain completed contracts (occupancy agreement) that indicated the terms and conditions within the home or which room they would occupy and they were not signed. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6.7.10. The care plans do support the residents physical needs, however the lack of information regarding the purpose of the work placements and leisure activities to enable them to meet their aims does not provide staff with sufficient information to meet the residents needs. Information regarding residents is handled appropriately. EVIDENCE: Care plans seen did provide staff with clear guidelines on what action to take to avoid triggers to situations and action to be taken if a situation arises, for example, aggressive behaviour. However the care plans focussed very much on the physical needs of the resident, and did not indicate the leisure or work activities they are involved in and how these relate to their individual aims and goals. Residents spoken to indicated they took part in many work and leisure activities. One residents plan seen, contained evidence of being discussed and agreed with them. Resident’s documentation is kept in a secure and confidential way. The staff provided the policy file containing the “confidentiality “ policy, (dated 2000) and were able to discuss the times when they would have to share information with their manager. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 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 the following standard(s): 11.12. 14.16. The home provides opportunities for residents to be involved in a range of work and leisure activities to enhance their daily lives. However the link between these activities and the resident’s recovery plan is not obvious. Limited progress has been made to ensure the residents rights to independence, choice and freedom does not put them at risk. EVIDENCE: The two residents care plans Recovery/Care plans and related documentation did not contain evidence that the resident’s holistic needs are being met. For example the current plans seen do not contain any indication of the leisure, work and social activities the resident is exposed to, or how these relate to the goals set with the resident. Many residents spoken to indicated they attend work placements and undertake appropriate leisure activities, and are encouraged to make appropriate choices Residents spoken to were positive about the care they received, and staff were seen to treat the residents with dignity and respect, involving them in decisions, and addressing them in an appropriate manner. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 12 Several fire doors to resident’s rooms were propped open with furniture, staff spoken to indicate this was to enable residents to have easy access to their rooms, as they kept losing their keys. Some residents spoken to did not remember having a key. Some staff spoken to could not indicate how they could maintain the fire regulations yet offer easy access to the rooms for this current group of residents. The staff and Manager are aware that the propping open of fire doors compromises safety in the event of a fire. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 21 The systems in place to support resident’s personal care are good. Healthcare referrals to appropriate practitioners take place, however the documentation available does not demonstrate the residents needs have always been met. Limited progress has been made to consult with residents regarding their wishes as a result of ageing, terminal illness or death. EVIDENCE: Residents spoken to were happy with the amount of choice they had regarding clothes hairstyles and the flexible routine within the home. Evidence was seen in two residents care plans of appropriate psychiatric care being reviewed. There is a designated key worker scheme in place. Evidence within the two residents care plans seen indicated they received appropriate referrals to healthcare practitioners such as dentist, optician, and chiropodist. The actions taken as a result of identified residents healthcare needs were not being documented to show that this care has been implemented or reviewed. For example one residents care plan indicated that “regular “blood pressure checks should be carried out, there was no evidence of what constituted “regular”, or a date for review, and the actual blood pressure recordings in the care plan file related to 2004. Later a clipboard containing charts relating to blood pressure recordings for this resident was found. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 14 One resident had a care plan identifying serious health concerns, however there was no indication of the resident’s wishes regarding terminal care or death. Another residents contract contained information regarding funeral arrangements only. The Deputy manger is in the process of revising the “dealing with the expected death of a resident “ guidelines for staff. The current guidelines do not refer the staff to the residents care plan or to any other individual information regarding the resident’s wishes. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. There is an effective system in place to protect the residents from abuse, and neglect. EVIDENCE: Staff could provide the Protection of Vulnerable Adults Policy and were able to describe the types of abuse referred to in the policy, (physical, sexual, financial, emotional, neglect and institutional abuse). There is a very good source of contact details for other agencies, e.g. police, social worker, CSCI. The “Rethink” recruitment and selection guidance clearly outlines the procedure and rationale for POVA checks for new employees and volunteers. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25.28. 30 The home is clean and hygienic. Whilst the resident’s bedrooms meet their needs the safety of the residents could be compromised in the event of a fire. The shared spaces provide a range of options for the residents and a homely place to live. EVIDENCE: A sample of resident’s bedrooms was viewed, including that belonging to the resident’s case tracked. The rooms appeared to be of an adequate size. All of the bedrooms were single, with ensuite facilities. They contained many personal items videos, stereo’s photographs, materials for hobbies. Many of the bedroom doors were propped open; this has been referred to in other sections of the report as the propping open of fire doors compromises safety in the event of a fire. The home was clean and special equipment for the prevention of infection was used appropriately. E.g., gloves, aprons, chemical hand wash, clinical waste, infected linen. The shared spaces, two lounges, dining rooms and a supervised kitchen (upstairs) were furnished well, residents said they could choose where they Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 17 wanted to go, and the downstairs lounge is the dedicated smoking area. The upstairs lounge is used as a quite room. The upstairs kitchen, planned to be used by residents, under supervision, to develop their cooking and household skills is not well used. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31. 32. 34.35. The home has good recruitment and vetting procedures to protect the residents, and robust strategies for training and development to ensure staff are competent to undertake their role. EVIDENCE: A review of two news members of staff files provided evidence of job application, interview checklist, enhanced police checks, references, photographs identity, job descriptions and contracts. A new member of staff outlined the induction process and showed the induction booklet in the process of completion. The home has a range of teaching materials including videos for staff to update their knowledge and question and answer sheets to test this. Permanent staffing levels have improved, this has enabled senior staff to start to develop services for the residents, both at a strategic and operational level and provide effective coaching and support to less experienced staff. The Deputy Manager has developed a training needs questionnaire for staff and organises a range of training opportunities for staff that are appropriate for the residents needs and link to the homes aims and objectives. , A recent example of a “diabetes update” session for staff also included a resident with the disease, to utilise their personal experience and update their knowledge. Many staff have undertaken NVQ in care level 3 and the Manager and two Deputy Managers have recently completed NVQ`level 4 in Management and Care. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37.39.40.42. 43 The home is generally well run, however the health and safety of residents and staff is compromised due to the propping open of fire doors. The Manager has clear development plans for the home that are communicated to the staff. The Manager is supported well by senior staff in the development of the staff and services provided. There is no evidence that resident’s views contribute to the development of the service. EVIDENCE: The health and safety of residents and staff is compromised due to the propping open of fire doors Permanent staffing levels have improved; this has enabled senior staff to be released to start to develop services for the residents, both at a strategic and operational level. Both deputy Managers have specific areas of responsibility to develop. Talking to residents they indicated they found the manager approachable, “he would sort things out” The policies available within the home are in two formats, electronic and hard copy, the hard copy file does not always match up with the polices on the intranet. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 20 Staff said the residents views are sought informally, the Regional Manager, now based in the home, talks to residents regularly and formulates reports. A formal “Rethink” quality assurance audit is to be conducted, including obtaining residents and other stakeholder’s views of the services. There was no evidence that residents or stakeholder’s views are collated into information that is made available in the home, or any evidence that they have any effect on the way the home is run. There is a business plan and financial plan in place for the service that has been reviewed annually. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 3 ENVIRONMENT Standard No Score 24 x 25 2 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x x 3 LIFESTYLES Standard No Score 11 2 12 3 13 x 14 2 15 x 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 x 2 3 3 2 2 x 2 3 Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 22 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 YA19 Regulation 12(1a&b) 13(1b) Requirement Timescale for action 01/03/06 2. YA24 13(4) 23(4a) 3 YA6 16(2m.n. The Registered Manager must ensure healthcare assessments evidence that resident’s health needs are being met. Previous time scale 01/09/05 not met. The Registered Manager must 01/03/06 take advice from the Fire Services and Rethink (the Company) on the propping open of fire doors. This must be addressed to meet fire regulations. Previous timescale 01/09/05 not met. The Registered Manager must 01/04/06 ensure Recovery/Care plans and related documentation demonstrates that resident’s holistic needs are being met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 23 1. 2 YA26 YA39 3. 4 5 YA5 YA40 YA21 The provision of door keys and the locking devices on bedroom doors should be reviewed to ensure residents are able to gain access to their bedrooms. Ensure that the results of the organisations quality assurance monitoring e.g. residents or other stakeholder’s surveys, and the changes made as result of this are available in the home and shared with staff and residents. Ensure that resident’s contracts for occupancy indicate the terms and conditions within the home and the room they occupy, and the resident signs these. The policies and guidelines for directing care within the home should be consistent. to reduce possibility of confusion by staff. Ensure that staff consults with residents regarding their wishes as a result of ageing, terminal illness or death and that this is clearly documented within their plan of care. Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Lindsay House Nursing Home DS0000012672.V277135.R01.S.doc Version 5.1 Page 25 - 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!