Inspection on 09/03/07 for Mill Green

This inspection was carried out on 9th March 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mill Green 06/09/06

Mill Green 15/09/05

Mill Green 04/05/05

Mill Green 21/07/04

Mill Green 13/04/04

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Thorndene

Insight - Eastchurch

Southfields

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

CARE HOME ADULTS 18-65 Mill Green Mill Green Mill Lane Felbridge East Grinstead West Sussex RH19 2PF Lead Inspector Lisa Johnson Unannounced Inspection 9th March 2007 09:10 Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 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 Mill Green DS0000013721.V330007.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 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. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill Green Address 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) Mill Green Mill Lane Felbridge East Grinstead West Sussex RH19 2PF 01342 326105 Ashcroft Care Services Ltd Post Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2006 Brief Description of the Service: Mill Green is a large detached house located in a quiet residential area in the village of Felbridge, East Grinstead. The home is registered to provide personal care for six younger adults with learning disabilities and is owned by Ashcroft Care Services Ltd, who own a number of care homes in the South East. The accommodation comprises of six single bedrooms, two sitting rooms, a kitchen/dining room, a utility room, toilets, and two bathrooms. The home has a large enclosed garden for the service users to enjoy, and ample parking in the front of the home. East Grinstead town centre is a short distance by car, and provides a good range of shopping and leisure facilities. The fees range from £1249. 66 per week to £1480.93 per week. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of a second key inspection. The visit was unannounced and took place over six hours commencing at nine fifteen am and finishing at three o’clock. The visit was carried out by Mrs. L Johnson Regulation Inspector Due to the communication difficulties experienced by the service users their direct views about their care could not be obtained. Therefore observations of interactions and service user responses through non verbal communication have been reflected in this report. A full tour of the premises took place. Staff training records, staff files and policies and procedures were sampled. The inspector spoke to three members of staff. The inspector would like to thank the staff and service users for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 6 Staff have received training in safeguarding adults from abuse. Staff personal files now contain all of the required information. The General Social Care Code of Conduct has been brought to the attention of staff and training has been provided in diversity and equal opportunities. A number of improvements have been made in the environment including the cleaning of carpets in bedrooms and the lounge carpet has been replaced. A new bed has been purchased for one individual. A walk in shower is now available and some bedrooms have been redecorated. Appropriate hygiene materials have been supplied in the toilets and bathrooms. A bedroom window sash and window restrictor has been replaced and attention has been given to three health and safety matters. The home has carried out a risk assessment in relation to the installation of radiator covers and this work is in process. A new manager has been appointed who is in the process of making an application to register with the Commission. The company is in the process of reviewing and updating policies and procedures. What they could do better: It was recommended that copies of pre- admission assessments be maintained with the service users records for viewing. Service users and/or their representatives should sign to agree their care plans to ensure they are fully involved and consulted A risk assessment for one individual must be reviewed and updated to ensure that their health and safety is protected. During this visit it was observed that some homely remedy medication and vitamins had been hand transcribed by staff on the medication administration record, which had not been dated and signed by the author. The member of staff in charge promptly attended to this matter during this visit. It was recommended that an assessment be completed to ensure the suitability of the environment to meet the needs of individuals with visual impairment and it was recommended that consideration is given to reviewing the space available in the dining area as part of the kitchen refurbishment. A recommendation was made that consideration should be given to providing visual awareness training to staff to support the needs of service users. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 7 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. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 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 Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are assessed prior to admission to the home. EVIDENCE: There have been no admissions to the home since the previous visit. The inspector was informed that the company’s head office receives initial referrals. An assessment is carried out with the manager having the opportunity to participate in this process. The pre- admission information for the last service user entering the home was examined. A community care assessment was available but there was no evidence available that would indicate that assessment had been completed by the organisation. The inspector was informed that this individual had moved into the home in as an emergency admission. The inspector was informed that a copy of the pre- admission assessment completed at the time was not available. It is recommended that copies that pre- admission assessments be maintained in the home for any future admissions to the home for viewing. Discussion took place with staff in respect of one individual’s suitability to live in the home due to the support this person requires and compatibility with the Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 10 other service users. The inspector has been informed that this matter is under review. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with an individual care plan, which records their individual needs and goals. Service users are supported to make decisions about their lives with assistance and are supported to take risks as part of an independent lifestyle although improvement is needed to ensure that risk plans are reviewed and updated. EVIDENCE: Two care plans were sampled during this visit. Each service user has a completed care plan based on assessment including star profiles. Plans included personal, health, emotional and social needs. It was observed that reviews take place six monthly and monthly. Care plans sampled could not be signed by service users to agree to their plan as a result of their needs and disability. A requirement was made that plans should be signed by service users relatives or representatives to ensure they are involved in the care planning process and that they agree to their plans. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 12 There is a key worker system in place and staff spoken with had a good knowledge and awareness of the service users needs. Two members of staff confirmed that they are involved in care plan reviews. The company is introducing person centred plans in the near future. It was observed that service users have individual skill building programmes in place, which included household skills including tea making. Each individual has a communication passport, which assists new staff in their understanding of each individual. Information provided in these documents included important people in the individual’s life, likes and dislikes strengths and needs, things staff can help with and personal care. The inspector was informed that these are to be reviewed to ensure that the information is up to date. One individual did not have a communication passport in place and it was advised that this would be beneficial to implement one for this individual to assist staff in meeting their needs. There were a range of risk assessments and management guidelines in place including support for service users who have epilepsy, tea making, challenging behaviour, and community awareness. One individual has sight impairment al the current risk assessment plan observed had not been updated for extended period of time. A requirement was made that this matter is addressed to ensure the health, welfare and safety of service users. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a range of appropriate activities and engage in a range of leisure activities. Service users are supported to take part in the local community and the rights and responsibilities of service users are respected. The home is able to demonstrate that service users are provided with a well-balanced and nutritious diet. EVIDENCE: During this visit a number of service users left the home to go out for a walk with one individual was attending day services. Service users had the opportunity meal out at lunchtime. Each individual has a structured activities programme in place and activities were based on individual needs and preferences including reflexology, cooking, attendance at college, trampoleing, music sessions a pub trips. The home has their own vehicle with service users having the opportunity to go out on day trips and some service users had been away on holidays. One individual likes church music and attends church every Sunday. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 14 A majority of service users maintain contact with their families who either visit their relatives at home or they visit the service. One Individual goes swimming with their relative and assisted by a member of staff. The inspector was informed members of the local church congregation had visited one individual. There was a calm and relaxed atmosphere and good relationships were observed between service users and staff who were talking and interacting. One individual was observed to come and find her key worker and was observed to be happy and smiling when she had located her. Staff were observed to carry out personal care in private. One individual’s preference to spend time on his own playing music was respected by staff. Staff spoken with described the support they give to service users encouraging them to make choices such as asking them about preferred activities, personal hygiene and choosing clothes. As service users were out having lunch at the time of this visit the meal was unable to be observed. Menus were in place and are arranged on a weekly basis. Meals are based on individual preferences and where alternative meals were provided these were recorded on the menu. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is able to demonstrate that that service users receive support in the way that they prefer. Service users physical and health needs are met and they are protected by the homes medication administration procedures. EVIDENCE: Two plans were sampled which indicated that service users have access to a range of health care specialists including for example a General Practitioner, chiropodist, dentist, optician and behaviour specialists. Primary health care checklists were in place for all service users, which were well maintained and accurately, recorded confirming when appointments have taken place. Weight and epilepsy recording charts were in place. One individual who is identified at risk of choking had guidelines in place, which had been completed in consultation with a speech therapist. Policies and procedures were in place for the administration of medicines. The inspector was informed that the company is presently updating the existing procedures A list was maintained for all staff that are trained and authorized to administer medication. All medications had been signed for following Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 16 administration. The cupboard was examined and found to be in good order. Records were in place for all medication received and disposed of. Medication is dispensed in blister packs and dispensed from Lloyd’s chemist. Staff receive training in the administration of rectal diazepam. Protocols were in place for “as required medication”. During this visit one individual was recorded as receiving vitamin tablets and a homely remedy on their medication administration sheet which had been handwritten by staff and it was observed that these items not been signed or dated by the author. This matter was brought to the attention of the deputy manager who promptly addressed this matter during this visit. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is able to demonstrate that the views of service users are listened to and acted upon. Service users are protected from abuse. EVIDENCE: The home has a complaints procedure, which was seen on display in the home. The procedure is also available in the homes service user guide and no complaints have been received since the previous visit. The up-to-date Surrey multi- agency safeguarding adult’s procedure was available and the company has their own safeguarding and whistle blowing procedures, which are currently in the process of being updated. The staff training records was sampled for three members of staff and it was observed that they have all received up to date training in safeguarding adults from abuse. Two members of staff spoken with were clear in their responses as to the action that they would take if they ever witnessed any abuse. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous visit a number of improvements have been made to the environment including some redecoration and refurbishment. The home is still awaiting installation for the new kitchen, which looks old and had some broken doors. The inspector was informed that this work is planned for the late spring. There is a spacious lounge and the dining area is provided in the kitchen. It was recommended that consideration should be given to the space provided in the dining area, as this area looked cramped. Since the previous visit a walk in shower has been installed which enables staff to assist service users who require support. Some areas in the house were identified that would benefit from redecoration and modernisation including window frames and bathrooms. The inspector was informed that there is planned programme in place. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 19 There is a large garden to the rear of the house, which was accessible and well maintained. Garden furniture and a trampoline were available for service users to enjoy in the summer. Portable ramps were observed to support service users to get in and out of the house. During a tour of the premises the home was observed to be clean and hygienic. Separate laundry facilities are provided and hand-washing equipment was available in the toilets and bathrooms. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent and qualified staff support service users. Service users are protected by the homes recruitment policy and practices. EVIDENCE: The staff duty rotas were examined which indicated that there is three staff on duty during the day with another person working from nine am until five pm. At night time one waking and one sleep in member of staff is provided. During discussion with the deputy manager it was clear that staff are supported to complete National Vocational Qualifications. Training records were sampled for three members of staff which confirmed that staff have received up to date mandatory training in safeguarding adults, moving and handling, food hygiene, first aid and health and safety A training schedule is maintained when staff are due to attend their next update. Records and certificates sampled verified that staff has attended training in autism, challenging behaviour and epilepsy, which supports the current needs of service users. One person has visual impairment and it was recommended that the company consider providing visual awareness training to staff in to ensure this individuals needs are met. The deputy manager stated that staff have Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 21 received in house training in equality and diversity. Induction training records were observed to be maintained in staff files. The recruitment files for Staff three members and it was observed that all of the required information was available including two written references and police checks. A copy of the General Social Care Code of conduct was observed in the home and staff spoken with confirmed that this document had been brought to their attention. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 22 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. 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. The service is able to demonstrate that service users benefit from a well run home. The health and safety of service users is protected and the home is run in their best interests. EVIDENCE: There have been a number of changes in the management of the home but a new manager has now been appointed who commenced in her post three months ago. The manager has experience of working with people learning disabilities and holds the Registered Managers Award. The manager is in the process of making an application to the Commission for Social Care Inspection for registration. Staff spoken with were positive about the changes in the home. Comments included, “The manager gets things done”; “ there is good team work”, the manager is supportive”. One member of staff stated that he Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 23 felt supported by the company in general. Staff spoken with stated that regular staff meetings take place. The Responsible Individual carries out monthly quality visits and copies of the reports were available for viewing and were observed to be detailed. The company has carried out consultation with service users and has updated feedback questionnaires to relatives and representatives. This information was recorded in the monthly quality visit report. The company’s quality assurance manager for has provided a report on the outcomes of the quality surveys, which has been made available to the Commission. A number of the company’s policies and procedures need updating and evidence has been provided to the inspector that this work is in process. The homes fire records were examined which indicated that regular alarm checks and fire evacuations take place. The home is currently completing an emergency contingency plan. Records were sampled for water temperature testing which were regularly checked and recorded. All substances hazardous to health were stored and locked away appropriately. Accident records and incidents records were sampled and were maintained appropriately. Maintenance certificates including water and gas were examined which indicated that regular servicing and maintenance of equipment takes place. Since the previous visit some action has been taken to install radiator covers but this has not been fully completed, however evidence was provided that a risk assessment has been completed in respect of this matter. Mill Green DS0000013721.V330007.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 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 36 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 14 15 16 17 3 X 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000013721.V330007.R01.S.doc Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mill Green X X 3 X X 3 X Version 5.2 Page 25 Score 3 3 3 X No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 2 Standard YA6 Regulation 15(1) Requirement Timescale for action 09/05/09 3 YA9 The registered persons must ensure that service users and/or their representatives agree and sign their individual care plans. 13(4)(b)(c) The registered person must ensure that individual risk plans are reviewed and updated to ensure the health, safety and welfare of service users. 09/04/07 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 2 3 Refer to Standard YA2 YA24 YA24 Good Practice Recommendations It is recommended that the home maintain copies of Preadmission assessments. The registered persons should consider the space provided for service users dining area as part of the kitchen refurbishment. It is recommended that the registered persons make arrangements for an assessment of the premises to ensure its suitability to meet the needs of service users with visual impairment. The registered persons should consider providing staff DS0000013721.V330007.R01.S.doc Version 5.2 Page 26 4 Mill Green YA32 training in visual impairment. Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Mill Green DS0000013721.V330007.R01.S.doc Version 5.2 Page 28 - 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!