Inspection on 21/07/05 for Maesknoll

This inspection was carried out on 21st July 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

Maesknoll 01/12/08

Maesknoll 18/12/07

Maesknoll 30/07/07

Maesknoll 03/08/06

Maesknoll 14/01/06

Maesknoll 28/03/05

Maesknoll 05/10/04

Maesknoll 25/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Maesknoll 101 Bamfield Whitchurch Bristol BS14 0SA Lead Inspector Sandra Garrett Unannounced 21 July 2005 09:30 st 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. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Maesknoll Address 101 Bamfield Whitchurch Bristol BS14 0SA 0117 3772690 0117 3772691 maesknoll@bristol-city.gov.uk Bristol City Council 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) Frances Veronica Cole PC Care home 40 Category(ies) of OP Old age (40) registration, with number of places Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate one named service user aged 58 years of age. Home will revert when named person leaves. Date of last inspection 28-Mar-2005 Brief Description of the Service: Maesknoll is a care home registered with the Commission for Social Care Inspection to provide accommodation and personal care to forty residents aged 65 years and over. The home is owned by Bristol City Council Social Services & Health (SS&H) and situated in the residential area of Whitchurch. Maesknoll is arranged over two floors with lift access. There is a small patio and large areas of lawn surrounding the outside of the home. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection to follow up issues in respect of requirements made at the last visit. Nineteen residents and one relative were spoken to and a range of documents examined that included care plans, daily and key time records, complaints and health and safety records. What the service does well: What has improved since the last inspection? What they could do better: Medication and care records need further improvement. In particular staff must ensure that they sign in the correct columns of the medication administration record sheets and at the time of giving. Also medication subject to legal controls must be witnessed and signed for by a second staff member to ensure residents are fully protected from risk of error. Care plans must be put in place for all new residents, even those transferring from other local authority homes. Care plans must be updated when residents physical or emotional needs change, to ensure that assessed needs are able to be met at any time. Daily and healthcare records must be kept regularly in order to ensure residents’ needs are identified and met. Risk assessments in respect of pressure area care must be put in place where necessary to ensure residents are protected from harm. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 6 It was pleasing to note following the inspection that a review of residents’ food preferences was done. However this must now be built upon to ensure that residents get the food they like and want to have. Attention must be given to providing food that residents ask for in appropriate quantities and portion sizes. Records to be kept at the home subject to regulation, remains an unresolved issue. No staff member must start work before the necessary checks required under regulation have been made. Residents must be able to feel confident that they are protected from abuse or risk of abuse. Records of any issues or events adversely affecting residents must be sent to the Commission for Social Care Inspection to ensure their health and safety is protected. 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. Maesknoll D56_S35910_maesknoll_V234203_210705_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 Maesknoll D56_S35910_maesknoll_V234203_210705_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) 1,2 & 3 Residents may not get the correct information they need about the home or the fees payable. Residents and their families can be assured that the home can meet their needs following the trial period. EVIDENCE: The home’s Statement of Purpose had been subject to requirement at the last inspection. This had not been reviewed as required although the deputy manager said she had discussed this with the team manager. It is understood that the Statement of Purpose will be reviewed shortly for all local authority homes and the registered provider will carry out the review. Similarly contracts remain an unresolved issue and had not changed since the last inspection despite communication between the registered provider and the Commission. This matter will again be taken up with the provider. All contracts seen at this visit contained room numbers and residents had signed them. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 9 A requirement had been made at the last inspection in respect of ensuring reviews following admission are carried out and the home confirms that it can meet residents’ assessed needs. Copies of such reviews were seen together with confirmation that the residents’ needs are being met. One resident who had had their assessment period extended was now a permanent resident following a second review. The resident said that s/he now felt more settled at the home. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 10 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 showed limited improvement. Attention needs to be given to proactive management of mental health needs and updating when needs change. Healthcare records need improvement to ensure residents health needs are met. Attention needs to be given to ensuring medication records are recorded accurately to protect residents from risk of error. EVIDENCE: Several care plans and healthcare records were examined. Requirements made at the last inspection were followed up and some had been met. Residents’ preferred names were recorded. Care plans followed pre-admission care management assessments and evidence that residents’ expressed wishes in respect of personal care were now being honoured. It was further pleasing to note that the home had taken action to resolve a resident’s concern about change in medication following a consultant’s visit. However some care plans need further improvement in respect of updating following changes in residents health or assessed needs. One resident had transferred from another home and had developed health needs since coming to Maesknoll. No new care plan had been developed and no evidence that the plan s/he had been admitted with had been updated. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 11 The assistant manager asked for advice regarding a resident’s mental health needs. The resident’s care records were examined including correspondence from a psychiatrist. This advised a pro-active behaviour management plan should be put in place that hadn’t been done. Other mental health professionals had been supporting staff through training sessions but there was no clear evidence of consistent management of the resident’s needs following their advice. The existing care plan hadn’t been updated recently. No information about supporting the resident in respect of her/his mental health was recorded on the care plan. It was noted that the community psychiatric nurse who was supporting the home returned following inspection to give further training on managing behaviour that challenges. Some care records were poorly kept with gaps and mistakes. The assistant manager said that there had been problems with one particular resident’s records as the key worker had been off sick and there had been no replacement. Although clear information was seen in other records about prompt actions taken by staff in respect of health care needs, these weren’t evident in the care plans. Health care records were also patchy and factually incorrect e.g. one resident’s weight records showed an apparent large weight loss. However the assistant manager said this had been a mistake in the reading of the scales that had not been corrected. Whilst health appointments and visits from GP’s, district nurses and health care professionals were recorded some records failed to demonstrate this with any regularity e.g. one resident was due to have chiropody appointments every 8 weeks. The records showed only 5 appointments since May 2003. Further the resident had not seen an optician since 2002. It was noted that one resident had pressure areas that were being treated by the district nurse. This resident had been assessed as needing nursing care and had been admitted to hospital. It wasn’t clear from the records if s/he was still in hospital, had been transferred to another home or had returned to Maesknoll. Further no risk assessment in respect of the pressure areas was seen. A review of medication administration record sheets showed gaps of one whole day in recording. This led to misrecording on the following day. Some gaps were also noted in that day’s medication records that showed medications had not been signed for at the time of giving. The review also showed that Temazepam, a medication treated as a controlled drug, was not always witnessed by two staff members when given to residents, despite clear recording sheets available for this purpose. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 12 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 & 15 Residents are able to take advantage of a range of activities, entertainments and trips available to them. Food preferences continue to cause residents concern and further attention needs to be given to ensuring their food and meal preferences are honoured. EVIDENCE: Residents spoke about a forthcoming trip to Weston Super Mare that they were looking forward to. The assistant manager gave information about a fundraising event held at the home that the residents enjoyed. Funds are being raised in an effort to buy a mini-bus to take residents out on more trips. A new activities room complete with snooker table and dart board had been set up on the first floor although the assistant manager said it had not been used yet. Residents were involved in the activity of making cards and pictures at this visit. Several residents joined in although some said they didn’t want to take part in activities or entertainments. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 13 Residents were still ambivalent about meals at the home and whether there had been any improvements since requirements made at the last two inspections. Some residents felt little had changed and some said they thought the food was ‘lovely’. Some said they ‘mustn’t grumble’ about the food. The consensus of opinion however was that little had changed in respect of the teatime meal. The review of each resident’s food preferences had not been done as required and the deputy manager said this was because of shortage of management staff. However menus had been discussed at a residents meeting and had been amended. Those seen didn’t show the choices available at tea or supper-time. At a follow-up meeting the day after inspection, the tea-time experience was observed. This showed a range of sandwiches and fillings and seven different types of cake, some freshly made. Cooks spoken to clearly demonstrated a lot of knowledge of residents preferences although this knowledge wasn’t being used to meet residents needs. It was therefore pleasing to later receive a copy of an individual review of each resident’s preferences. Overall it’s clear that: - Too many choices of cake are being offered at tea time - Residents like a choice of simple hot dishes rather than lots of different sandwiches - Residents’ preferences and cooks’ knowledge of these are not used to best effect at tea and supper-time. - Residents are clear that they want ‘more’ or ‘better variety’ of sandwiches, hot meals and tinned fruit at tea and supper. A new requirement is therefore made to ensure that residents receive the food they want and in the quantities and portion sizes that they need. Further a good practice recommendation is made to ensure that fresh vegetables are made available daily following residents’ comments about disliking frozen ones. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 14 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) 16 Residents are clear about their rights to complain and management of complaints is satisfactory. EVIDENCE: Many of the residents spoken to said they had no complaints and were ‘very happy’ at the home. One resident said she had complained about noise that was promptly dealt with. Residents were clear about how to complain and who to speak to. Complaints information was seen in residents’ rooms. The complaints record was reviewed and no new complaints had been recorded since the last inspection. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 15 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) 19,22 & 26 Residents’ benefit from living in a spacious, accessible and homely environment. The premises are maintained to a high standard of cleanliness and meets residents’ individual and communal needs. Attention needs to be given to improving security for residents protection. EVIDENCE: The standard of décor and hygiene throughout the home is very high. One resident had been given a larger room and said he was able to choose the wallpaper before it was redecorated. Toilets and bathrooms were exceptionally clean and the home smelled fresh and clean. Residents said they were happy with their rooms and there were lots of individual touches that made each one unique. Residents were seen using all areas of the home. Two residents keep tropical fish in small aquariums in their rooms. One resident had a small fridge and staff had brought colourful fridge magnets back from their holidays for her. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 16 A new accessible parking space for disabled people was in the process of being marked out in the car park and new automated front doors have been put in place. Maesknoll has a large area of gardens to the front, side and rear of the home. It was noted that incidents involving vandalism and theft from the garden areas had occurred and the issue of security had been discussed at a recent staff meeting. A good practice recommendation is made to ensure security is addressed in order to protect residents’ security. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 17 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) 27,29 & 30 Staffing levels are appropriate to meet residents needs. Residents may not be protected from harm if appropriate staff records are not available in the home. Attention must be given to ensuring staff are properly trained to care for people with dementia. There was not enough evidence to confirm that residents are protected by a rigorous recruitment procedure. EVIDENCE: The home benefited from being fully staffed at this visit. Staffing shortages still present difficulties although staffing levels are monitored against residents’ dependency levels. One resident commented that ‘staff are very good but very, very short’ and went on to say that s/he didn’t like agency staff being used. Two residents raised issues about the length of waiting time when being helped back to their rooms after meals. Personnel records had been subject to requirement from the last two inspections. It was disappointing to note that this had not been met. Two staff records were examined that didn’t contain the records required under regulation. However proof of identity was seen and photographs of each member of staff are being taken for records. Criminal Record Bureau (CRB) checks for the new staff were seen although it was noted that these were obtained after the staff members started work instead of beforehand. The Commission for Social Care Inspection is taking up the issue of personnel records with the registered provider. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 18 Training records showed that several care staff had done the Effective Recording Skills course recently (see Standard 37). The ‘In-Reach’ team who support homes with mental health issues had visited to give sessions on managing behaviour that challenges and were due to return. All staff had done Protection of Vulnerable Adults training Only one staff member had previously done dementia care training in 2003. As the home has a number of residents with dementia a requirement is made to ensure staff are offered training in this subject. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 19 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) 32,33,37 & 38 Residents can now benefit from raised staff morale and communication and their quality of life effectively monitored. General report records show limited improvement. Attention must be given to the frequency of reporting and to ensure residents are not discriminated against in records kept about them. Reporting to the Commission incidents that adversely affect residents must be improved. EVIDENCE: The atmosphere at the home was calm and relaxed at this visit. Staff spoken to said they were much happier now and communication between management and staff had improved. From the recent staff meeting minutes it was noted that the team manager had met with staff and since then morale had begun to improve. This is commended. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 20 The registered provider had commissioned a new programme of quality assurance surveys and consultants had visited residents to do the surveys. The finished report showed that the results matched this inspection’s findings in several areas. Overall residents are highly satisfied with their environment though improvements could be made in other areas also highlighted in this report. Daily and key time records were examined. Key time in particular showed a marked improvement with several excellent records written from the residents’ perspective and detailing their enjoyment of life in the home. This is good practice. Daily records however still need improvement. Some records in respect of mental health issues were negatively written and could be interpreted as discriminatory. The deputy manager was advised to put in place a chart that demonstrated how one resident’s needs in respect of behaviour were being appropriately monitored and managed. This should also ensure that the resident’s needs met and to ensure daily records are written in a more holistic and positive way. Long gaps of up to five weeks were seen in general report records. Some gaps occurred after incidents happened to residents that should have been followed up in the records over the following day/days. A good practice recommendation is made to ensure that records are maintained at minimum intervals for each resident and follow incidents that may adversely affect them. From other records reviewed it was noted that some notices required under regulation were not being sent to the Commission. These were in respect of breaches of the home’s security and residents’ healthcare issues. Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 21 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 2 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 3 x x x 2 2 Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 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 OP7 Regulation 15(1)(2)( c) Requirement Changes to residents assessed needs in care plans must be documented when such changes happen and new care plans must be drawn up when a resident transfers from another home. Where needs in respect of mental health are identified clear information in respect of this must be recorded on care plans and a behaviour management chart put in place Where residents may be at risk because of their mental health a risk assessment must be put in place. Healthcare needs and appointments with healthcare professionals must be recorded appropriately. Risk assessments in respect of pressure areas must be put in place for any resident at risk from pressure sores Medication must be signed for in the correct place immediately after it is given. Temazepam must be witnessed and signed for by a second person when it is given Timescale for action 30 September 05 2. OP8 13(1)(b) 30 September 05 3. OP9 13(2) 21 July 05 Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 23 4. OP15 16(2)(i) 5. 6. OP30 OP38 18(2)(c)(i ) 13(4)(c) Residents food preferences must be honoured and appropriate quantities of food prepared to meet their preferences All care staff must be offered training in dementia awareness and care Notices of any incident adversely affecting residents, particularly in respect of health and safety issues, must be sent to the Commission for Social Care Inspection 30 December 05 31 December 05 30 September 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. Refer to Standard OP15 OP19 OP37 Good Practice Recommendations Fresh vegetables should be made available daily for residents main meal Attention should be given to drawing up a plan for making the external areas of the home more secure General report records should be written at a minimum weekly and follow up incidents that adversely affect residents Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG 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 Maesknoll D56_S35910_maesknoll_V234203_210705_Stage 4.doc Version 1.30 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!