Inspection on 06/08/07 for Magnolia Court

This inspection was carried out on 6th August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Magnolia Court 17/03/09

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Magnolia Court 181 Granville Road London NW2 2LH Lead Inspector James Pitts Key Unannounced Inspection 10:40 6th August 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Magnolia Court Address 181 Granville Road London NW2 2LH 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) 020 8731 9881 020 8381 4182 magnolia@barchester.net Barchester Healthcare Homes Ltd Ms Melinda Jane Payton Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Magnolia Court provides nursing and care services for up to 54 older people. Barchester Healthcare Homes LTD, a private care sector provider, owns the home. The home accepts for admission people who require nursing care support from either local authorities or people who fund their own care privately. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the course of one day. The acting care manager was present during this inspection and she; along with various members of the staff team and home administrator all provided assistance during this visit. No surveys were received from service users, relatives or other stakeholders prior to this visit. However four service users and a number of relatives did give their view about the home during the inspection. These comments did not indicate that there are any concerns about the standard of care at the home and indeed positive remarks were made about the improvements to the service over recent months and relaxed interactions were observed. A number of records were also examined, including care plans, assessments, management records and those that relate to medication handling and administration. A tour of the building also took place and some service users gave permission for their own rooms to be seen, which is much appreciated. What the service does well: What has improved since the last inspection? The service user plans set out in detail how all aspects of the health, personal and social care needs of the people who live here are to be met. The people who use this service now have access to a comprehensive and varied programme of recreational activities, inside and outside of the home, that also takes account of the particular needs of people with physical disabilities, sensory impairments and dementia. The hoe is also doing everything possible to make the premises as accessible as possible for people with physical disabilities, and has made improvements where needed. The staff team have all now attended adult protection training. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 6 The monthly reviews of the service contain action plans and timescales for putting things right to demonstrate that these service reviews are effective and review and improvement of the management structure in the home has occurred. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 1, 2, 3, 4, 5 & 6 were assessed at this inspection. The people who use this service can be assured that the home provides enough information for potential service users and their relatives to make an informed decision about moving in to the home. The home effectively assesses and reviews people who come to live here in order to ensure that this is the most appropriate place to meet their care and support needs. EVIDENCE: The home’s stated procedures for introducing and assessing people who are referred for admission to the home is as follows: Prospective service users are invited for lunch and to join in activities prior to making the decision whether this is to be their home of choice. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 9 Services users are provided with a contract of terms and conditions and statement of purpose. Service users are fully assessed prior to admission, which ensures that they are appropriate for the home and for the needs of prospective service users for which the home is registered. In addition to this a four week trial period is offered. The procedures that are outlined above were seen to be applied from a sample of service user referral and assessment records that were examined during this inspection. Comprehensive information is offered to everyone who makes an enquiry about the service that is offered by the home. Written information is provided, the statement of purpose and service user guide is made available, as too is the most recent report about the home that is produced by the Commission. Respite care is offered although this does not occur frequently at present. At the time of this inspection there was no one in residence for respite care. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 7, 8, 9 & 10 were assessed at this inspection. The people who use this service can feel confident that their personal care needs and physical and emotional health needs are properly documented by the home. They can also be confident that their health care needs will continue to be attended to and that will receive the support, nursing care and treatment that they require. EVIDENCE: It was reported at the previous key standards inspection that care plans did not indicate the degree of involvement that either service users or their relatives had in deciding what the care plan should contain. Since that inspection, and as was noted at the intervening random inspection, a new care planning system has been introduced. This revised care planning format gives Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 11 a far greater degree of detail about service users’ preferences and needs. The sample of care plans that were examined at random during this visit show that the home demonstrates that the support provided by staff is more responsive to the wishes and needs of the people who live here and their families. Comments that were made by service users and relatives indicate that there is a consensus of opinion that the home listens to them and responds appropriately. It should also be noted that interactions that were observed between staff, service users, their relatives and other visitors showed how mindful staff are to responding quickly and efficiently to questions that are asked or needs that need to be addressed. People are admitted to the home primarily because they have a need for nursing care. In some instances there are also additional needs that result from Alzheimer’s or other conditions of dementia. This was noted on most of the sample of care planning records that were seen, although it should be noted that in each case the primary care need was in relation to physical frailty / medical conditions that require nursing care. The home is able to demonstrate, through individual healthcare records, that service users are in regular contact with General Practitioners and other health care specialists whenever they need to be. A local GP also visits the home weekly, and can be called upon at other times when necessary. The home also keeps some records of service users healthcare appointments. Since concerns were raised at the previous key standards inspection Barchester’s clinical development nurses have continued to have increased input at the home. This has resulted in service user’s health care needs being more effectively addressed and there are improved healthcare practices throughout the home. Following an outbreak of sickness in the home at Christmas 2006 infection control procedures were reviewed and failings were identified. As a result of this staff had updated training in infection control and this area continues to receive close monitoring. The home has also improved protocols for pressure sore management, continence promotion, chiropody and other healthcare needs. These areas are assessed and monitored using Barchester’s own organisational protocols and the experience / training of nurses working at the home or from community based specialist healthcare professionals where required. Medicines are ordered monthly so that there is not too much kept at the home at any one time. Only qualified nurses on duty are permitted to administer medication and it is noted that the administration records are not showing any gaps in recording. The home has an agreement from each service user’s respective GP about what types of “Homely” remedies may be used. A local pharmacist visits regularly to assess medication storage and handling and provides a report on the findings. Additionally medication protocols are Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 12 assessed every week internally by the home in order to identify if any issues are coming to light. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 14 & 15 were assessed at this inspection. The people who use this service can be confident that the home has, and continues, to improve upon the opportunity to engage in activities and social events. The home also continues to actively encourage and support each person who lives here to keep and maintain contact with family and friends. EVIDENCE: Conversations with a variety of staff on duty show that there is an increasing awareness within the staff team about diversity and equalities issues. The managing organisation has provided training material that seeks to improve awareness of care professional about acknowledging and respecting the dignity of people who represent a range of racial, cultural and religious backgrounds. It would, however, be timely for staff to have group training opportunities so that they can explore together their awareness and knowledge of diversity matters, and seek to share their experiences and methods for applying these principles in their day to day work. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 14 The people who live here now a more comprehensive and varied programme of recreational activities, inside and outside of the home, that also takes account of the particular needs of people with dementia, physical disabilities and sensory impairments. The appointment of 2 part-time activity organisers has clearly helped the home to achieve the necessary focus in developing an activities programme and offering these opportunities to those who wish to take them up. Visitors continue to be very welcome to the come to the home, which was confirmed by the comments that were made during this visit by some of the service users and relatives of those who live here. These comments also indicate that the staff team of the home are very clearly committed to respecting the privacy and dignity of service users, which is acknowledged with marked praise from both service users and their relatives. Meetings with supper have also been held with relatives & service user to invite them to serve on the resident and relative committee. The menu’s, comments from people who live here and observation of a mealtime showed that service users are provided with a wholesome diet. It was also commented upon that the people who live here have the opportunity to influence what is on the menu. The home’s chef makes a specific point of discussing menu requirements with people when they move into the home as well as keeping in regular contact to seek views and preferences. The nutritional intake and well being of everyone who uses this service is also regularly monitored and adjustments are made to individual menu requirements whenever this is necessary. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 16 & 18 were assessed at this inspection. The people who use this service can feel confident that if they were ever to have any concerns about the home that these would be properly addressed. They can also feel safe in the knowledge that the staff of the home do all that they can to ensure that service users are protected from abuse or neglect. EVIDENCE: The record of complaints was available to see during this visit. The home has recorded two complaints since the last inspection, one of which was also referred to the Commission for information purposes. Neither of these complaints indicated that there were concerns about the overall operation of the home as each were about very specific circumstances. The home also keeps a record of positive comments and compliments, of which three have been received in writing more recently. Two of these make specific reference to the number of positive changes that have occurred at the home in recent months. The service users who spoke during this visit said that they have no complaints about how they are cared for and neither had any relatives who also made comment. The home has a proper complaint procedure. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 16 The home’s protection from abuse policy is clear and includes the need to refer any allegations of abuse to the local authority care management team. No complaints of abuse have been made to the Commission and the service users made none during this visit. All staff have now received training about protecting vulnerable adults from abuse as was previously required. The home also has a whistle blowing policy. Additionally the home now aims to introduce care aware advocacy to all potential service users and relatives. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 19, 20, 21, 22, 23, 24, 25 & 26 were assessed at this inspection. The people who use this service can feel confident that they live in a comfortable, clean and well maintained home that has all of the necessary facilities to meet their needs. EVIDENCE: As a result of a previous inspection the home were required to review whether it is doing everything possible to make the home as accessible as possible for people with physical disabilities. This has now occurred and bedrooms are individually configured to allow proper access depending on the individual needs of each person who lives here. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 18 The home has a range of toilet and bathing facilities, as well as each bedroom in any case having an en – suite lavatory. Hoists, and other equipment that is required to assist in the care of everyone who lives here are al;so provided in more than adequate numbers. A refurbishment programme has been undertaken for 8 bedrooms, reception area and ground floor lounge. Each time someone leaves the home the bedroom that they were using is redecorated and recarpetted. The home also has a cyclical two yearly refurbishment programme for each bedroom, which includes renewing furniture wherever necessary. The rooms of some of the people who live here were seen, with their permission, and each is personalised to the extent that the indivdual wishes. The communal areas of the home are well maintained, comfortable and provide a pleasant environment for all who live here. The home has a dedicated ancillarey team who keep the home very clean and free of unpleasant odours. As this is a home that provides nursing care there are strict protocols in place to ensure that the prevention of cross contamination and infection control are well managed. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 27, 28, 29 & 30 were assessed at this inspection. The people who use this service can feel confident that the home continues to make sure that the staff are safe people to work here and that there are enough staff who are properly trained and qualified to support them. EVIDENCE: The home provides 2 qualified nurses and 3 or 4 carers to each of the two care floors on both of the waking day shifts. At night there is one qualified nurse and two carers for each floor. Since the previous key standards inspection the home has lessened the use of temporary agency staff and increasingly uses the organisations own care bank staff. This often means that staff who already work here sometimes do additional shifts to provide cover where required. This helps to improve consistency of care although the home is mindful that staff should not work excessive additional hours. The home has dedicated staff to undertake domestic, catering and maintenance tasks, which means that nursing, and care staff are able to focus all of their working time on direct support for the people who live here. The home has previously been seen to carry out checks to make sure that the people who work here are safe people to work with the service users. These Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 20 checks include things like asking the police if a new member of staff has ever been found guilty of a crime, and asking people who used to employ them if their work was good and if they are the right sort of person to work with the service users and to support them. The home keeps records that say what training courses staff have done, and when they did them. Over half of the care staff team have obtained the NVQ level two qualification and the home continue to go further by offering all of the staff the opportunity to obtain this qualification. An appraisal and development programme has recently been introduced which should do much to assist the home to identify skill levels and training requirements for each of the people who work here. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 31, 33, 35, 36 & 38 were assessed at this inspection. The people who use this service can feel increasingly confident that they are living in a home that is well managed and that their necessary health and safety is properly considered. EVIDENCE: Since January 2007 the registered manager had been on long-term sick leave and has subsequently left their employment with the home. An acting manager, who is also a senior manager within Barchester Healthcare, took over day to day management responsibility for the home. It was acknowledged that this person identified a significant number of areas in which the home had Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 22 to raise its standards in order to ensure that a good quality of care was consistently provided. At the time of the random inspection at the end of February this year it was noted that a number of improvements had been made, but much remained to be done. It is positively noted that since then there has been continued improvement and the standard of care is assessed at this time as achieving national minimum standards. The changes that have occurred in recent months attracted a number of positive comments from service users, relatives and staff at the home. There is clearly a growing opinion that much has been done to engage the people who use the service, and others, in making changes and seeking their views. The managing organisation has improved internal monitoring and this has lead to a planned and co-ordinated improvement programme. The home’s accounting and financial procedures safeguard the interests of the people who live here. The home’s policy is that no nominee responsibility is taken on behalf of any service user in respect of their personal finances. If staff ever do need to provide practical assistance this is properly documented and staff are expected at all times to adhere to Barchester’s protocols in this regard. It has been reported at both the previous key standards and random inspection that all staff must have at least 6 supervision meetings each year to guide and improve their practice. Improvements have been noted and these are continuing. The acting manager of the home accepts that this has yet to achieve the necessary minimum standard but is committed to ensuring that this will be achieved fully given more time. The previous requirement that was made in this regard will appear again in this report although the Commission is confident that this should be resolved, in light of the improvements that have been made thus far. The following health and safety checks have been carried out within the last year: Fire Alarm System: 30/05/07 Fire Extinguishers: March ‘07 Emergency lighting: 06/06/07 Gas Safety Check: 16/10/06 Electrical Installation: Valid until March 2008 Legionellosis: 12/07/07 Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 23 The home’s own maintenance person achieved the recognised qualification to undertake portable electrical appliance testing in March 2007. The home is good at making sure that the people who live and work here are kept safe from fire and other hazards. Fire alarm bells are tested weekly and regular fire drills also take place. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 25 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 OP36 Regulation 18(2) Requirement The registered persons must ensure that all staff working in the home have formal supervision at least six times a year. Requirement restated. Timescale for action 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations It would be timely for the home to expand upon the learning opportunities that have been provided to staff about diversity and equality. Staff discussion groups would he a helpful and useful addition to improving and underpinning the learning that is already taking place. Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Magnolia Court DS0000069404.V341448.R01.S.doc Version 5.2 Page 27 - 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. 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