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Inspection on 24/01/09 for Moorlands Rest Home

Also see our care home review for Moorlands Rest Home for more information

This inspection was carried out on 24th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Moorland`s is a small home with a warm and friendly atmosphere. It is clean and hygienic throughout and attractively decorated and furnished. Residents are encouraged to personalise their own rooms and these are decorated and furnished to a comfortable standard. The gardens are well stocked with mature shrubs front and back and residents say it is nice to sit outside in the warm weather. This is a well run home where management react quickly to the views, concerns and comments of the residents and their relatives. They always listen to residents and visitors opinions and are quick to respond to any requests and suggestions made. The staff team are kind, caring and well trained. They know the needs of residents well and are quick to respond when needed. Several residents commented that staff were `very friendly`, `always cheerful` and `polite and courteous`. The activity programme is varied and interesting and several of the current residents regularly take trips out to Reading town centre and other places of interest. Records are well kept and provide staff with the information they need to provide quality care to residents.

What has improved since the last inspection?

Since the last inspection and nutritional tool has been introduced which assess the nutritional status and dietary needs of residents. Medication practices are more robust. Medicines with a short shelf life are now dated when they have been opened. `Dorgards` have been fitted to bedroom doors in order to keep them open for the residents. These activate in the event of fire to close the door automatically. The application form for new staff has been amended to provide reference details. The roster now gives details of who is on call in an emergency.

What the care home could do better:

The home should consult with the Fire Authority about fire safety issues including the use of the boiler/WC room as a drying room. Fire drills should take place regularly and be recorded and door closures should be adjusted so that doors close firmly into there frame. Care plans should be regularly reviewed to reflect changes in residents health and welfare.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Moorlands Rest Home 987 Oxford Road Tilehurst Reading Berkshire RG31 6TN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Willis     Date: 2 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Moorlands Rest Home 987 Oxford Road Tilehurst Reading Berkshire RG31 6TN 01189427522 01189427522 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Sundith Ramdany,Mrs Koomari Nanda Ramdany care home 12 Number of places (if applicable): Under 65 Over 65 12 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 12 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Moorlands Rest Home is a care home providing personal care and accommodation for twelve older people with low to middle dependency needs. The home is located approximately two miles from Reading city centre and privately owned by Mr. and Mrs. S. Ramdany. Mrs K. Ramdany, who is a qualified Registered General Nurse and Registered Mental Nurse, manages the home. Service users are currently accommodated in two double and eight single bedrooms. Moorlands Rest Home is equipped with a four-passenger lift and bathing aids to assist the more dependent service users. The aim of the home is to provide a homely and comfortable Care Homes for Older People Page 4 of 28 Brief description of the care home atmosphere; a lifestyle that satisfies their social, cultural, religious and recreational interests and needs; promote and maintain service users? health; and to ensure the independence and individuality of the service users is respected. Fees range from 400 to 420 pounds per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on a Saturday morning and afternoon over the course of five hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the services manager, and any information that CSCI has received about the service since the last inspection that took place on the 23rd February 2007. Prior to the visit a questionnaire was sent to the manager along with survey and comment cards for residents and visiting professionals such as doctors and nurses. Any replies were used to help form judgments about the service. Consideration has been given to other information that has been provided to the Commission since the last inspection. Care Homes for Older People Page 6 of 28 The inspector toured the building, examined records and met all of the residents. The inspector also spent time talking informally to staff and observing how care was being delivered to the residents. From the evidence seen by the inspector and comments received, the inspector considers that this service has a good awareness and understanding of equality and diversity issues and would be able to provide positive outcomes for residents in the areas of race, ethnicity, age, gender, sexuality, disability and belief. The inspector gave feedback about her findings to the homes Manager at the end of inspection. There was one legal requirement made as a result of this inspection and one recommendation. The Commission has received no information concerning complaints about the service since the last inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 28 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are fully assessed prior to admission to ensure their needs can be met by the home. Evidence: The statement of purpose and service user guide are detailed and specific to the range of facilities and services provided by the home. Information is given in plain English and sufficient information is provided to enable a potential resident or purchaser of the service to make an informed decision as to whether the home can meet their needs. A full assessment of need will be carried out by the homes Manager prior to admission. Examination of the pre-admission assessment documentation for three residents evidenced that all necessary information about the residents health and personal care needs are sought prior to admission, along with information about the residents dietary needs, communication needs, mobility needs, history of falls, continence and Care Homes for Older People Page 11 of 28 Evidence: mental state. Information was gathered from a variety of sources, including the resident, their family, and other health and social care professionals. The information gathered was used to produce an initial care plan and to ensure that any aids or equipment needed by the residents were available on admission. Residents confirmed that they had been provided with information about the home prior to admission and had been given the opportunity to visit the home informally to meet staff and other residents. One resident said, I was impressed with the quality of the home particularly as it is small and intimate and Im happy living here. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information is in place to enable staff to effectively meet the health and personal care needs of residents. Residents are encouraged to participate in the care planning and review process from the outset. Residents are provided with quality care in a manner, which maintains their right to dignity, privacy, independence and choice. The system for the administration of medication is good with clear and comprehensive arrangements in place to ensure the safety of residents. Evidence: The files of three residents were examined in detail and case tracked from preadmission assessment to date. The written records were user friendly and satisfactorily documented. They provided staff with sufficient information to enable them to offer the appropriate level of care. They do however, require regular and formal review to ensure that they continue to effectively meet and reflect the changing needs of Care Homes for Older People Page 13 of 28 Evidence: residents. Observation of care practice concluded that residents were encouraged to remain as independent as possible by providing appropriate levels of support to maintain the residents privacy, dignity and independence. Sufficient time is provided to oversee self-care where necessary. Staff were observed to provide personal care in a discreet and sensitive manner and were heard to be polite and courteous to residents at all times. Staff routinely knocked and waited until they were invited in, before entering residents bedrooms. Residents are provided with access to other health and social care professionals for advice and support. General practitioners and community nurses are regular visitors to the home and provide advice to the staff on all aspects of care. One health care professional commented in response to a CSCI survey The home demonstrates real care for residents and they call for assistance appropriately. Residents confirmed that they regularly see their GP and are referred to hospital when necessary. Routine screening and preventative treatments are provided to all residents, as are chiropody, sight and hearing tests. From examination of the medication administration system and discussion with the homes Manager it is clear that the home follows best practice guidance when administering drugs. From examination of staff training records it is evident that a number of staff have been trained in the administration of medication. They are responsible for the administration of medicines at the home in the absence of the Manager. A monitored dosage system is in operation at the home and medication is delivered to the home on a monthly basis. Storage systems are effective and disposal systems are safe. The inspector spoke at length to four residents. All confirmed that they were happy with the quality of care provided by the home and felt that the staff were caring, kind and professional. Residents felt involved in the way their care was being delivered and felt confident that staff would listen to their wishes, preferences and concerns. A number of comments were received about the service from residents and visiting professionals. One resident said, this home is marvelous. I chose it because it was local to me and was small, I didnt fancy the larger ones. Another resident said, You cant fault them, the staff are very kind and obliging. A care professional said, Sometimes staff go beyond what is required to ensure the individuals needs and requests are met. Care Homes for Older People Page 14 of 28 Evidence: A relative said, the standard of care my mother receives is extremely high, which in my view goes above and beyond the call of duty. All of the residents are treated like family members and I would recommend it to anyone. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a range of activities that provide mental and physical stimulation. Food is good quality. Evidence: From discussion with the management, staff and residents it is clear that residents are offered the opportunity to participate in a range of activities suited to their needs. On the morning of inspection, residents were relaxing in the lounge or in their bedrooms watching television or reading the newspaper. A number of the residents were expecting visits from family and friends during the afternoon. Games, puzzles and quizzes are offered routinely and staff will offer one-to-one sessions to those people that dont like to take part in group activities. The home is situated ten minutes from Reading town centre and several residents regularly take a bus to the shops. Residents confirm that their visitors are made welcome at any time and are offered appropriate hospitality during their visits. A number of social events are held throughout the year which promotes community involvement and which provide Care Homes for Older People Page 16 of 28 Evidence: residents families with the opportunity to engage with the staff and residents on an informal and regular basis. Clergy and people from local churches are regular visitors to the home and offer the residents Communion and personal counseling and prayer. Residents say the food is good quality. The residents had a choice for lunch at the time of the inspection either Quiche or Cornish pasty with creamed potatoes and mixed vegetables followed by jelly and ice cream. There are always alternatives to the main course each day and special diets can be catered for including diabetic and vegetarian meals. Most residents choose to eat in the conservatory where tables are laid with table cloths and small vases of flowers. Others choose to eat in their rooms. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system. Residents feel their views are listened to and acted upon. Residents are protected from abuse and exploitation by well trained and competent staff that can demonstrate knowledge of the homes abuse of vulnerable adults and whistle-blowing policies. Evidence: The complaint policy in the home meets the requirement of Regulation and Standard. Residents are provided with information on how to make a complaint and the different stages in procedures. Examination of the complaint records indicated that there has only been one minor complaint made to the home in the past year. The details of the complaint were well documented and evidenced the investigation undertaken by the homes Manager and the outcome provided to the complainant. The CSCI has received no information about complaints about this service since the last inspection. Residents said that they felt confident that any concerns or complaints would be taken seriously by the home and efforts would be made to remedy any problems in timely fashion. Care Homes for Older People Page 18 of 28 Evidence: There was evidence in staff files and from discussion with management that they received training in adult protection as part of their formal induction into the home. Their learning is later consolidated when undertaking NVQ training in which it forms a core module. Residents confirmed that they felt safe and well cared for by kind, caring, knowledgeable staff. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards of furnishings and decor in this home are good and offer residents a comfortable and homely place to live. The home is clean and hygienic throughout. There is a need however to ensure that the building meets Fire Authority Regulations and is safe for residents. Evidence: Residents were complimentary about the quality of decor and furnishings in the home. They said the home is always odour free, kept clean, fresh and hygienic and is vacuumed and dusted daily. The communal areas are homely and well used by residents. Bedrooms were individually personalised and were bright and airy. Residents said that they were able to bring with them small items of furniture and pictures and ornaments to personalise their own rooms. All residents use the bathroom on the first floor it was clean and hygienic. The bath was equipped with a bath hoist to aid residents access and ease of use. Residents do not use the ground floor bathroom at the moment as it is entirely Care Homes for Older People Page 20 of 28 Evidence: unsuitable for residents use and is in a dilapidated condition. The laundry containing a washing machine is adjacent to the bathroom and is accessed via the bathroom door, as there is no external door to the corridor. This could compromise peoples privacy whilst bathing. The inspector was told by the Manager that there are outline plans to turn the existing bathroom into a wet room. The bath in situ is in a dilapidated condition and the walls are flaking and unattractive. There is a need to seriously consider the use of the area to allow better access to the laundry and more choice of bathing facilities for the residents. In consultation with the Fire Authority the practice of hanging wet washing in the boiler/WC room should be reviwed. There is a need to ensure that the current practice does not pose a risk to residents safety. Several bedroom doors and other doors in the home do not close properly into there frames. It will be a requirement of this report that any adjustment needed to closure devices is addressed without delay. There is a large mature garden to the front of the property. Access to the home is up two flights of steps making it inappropriate for residents with mobility difficulties to use this way into the home. There is however, a concrete ramp to the rear of the property, which provides access to wheelchair users. The gardens to the rear provide a comfortable area in which residents can relax in the fresh air. Residents said, It was the homely feel of Moorlands that made them choose to live here and the I knew the close proximity of shops and other amenities would be beneficial. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment policies and procedures at the home are robust and transparent and ensure the safety of residents. Evidence: Examination of three staff records and discussion with staff and management indicated that all necessary checks are undertaken on prospective staff to ensure the safety and protection of residents. Records were well kept and met the required standard. The staff files and training records evidenced that most of the current staff have either gained or are in the process of attaining NVQ qualifications at levels II & III. The current percentage of trained staff is 75 . Staff are trained and supported by Assessors and Verifiers at Newbury College. The Manager is keen to support staff to achieve professional qualifications in care and provides the necessary guidance to candidates. All staff are properly inducted and complete a period of shadowing senior staff to ensure that they are confident and competent to carry out tasks of the job. There was evidence in training records that staff had undertaken induction training to Sector Skills for Care specification. Care Homes for Older People Page 22 of 28 Evidence: The homes manager keeps copies of induction training, job descriptions, training records & certificates, supervision and appraisal records. These were examined to evidence compliance with good practice. Residents visitors to the home told the inspector that staff were always courteous, kind & caring and were always willing to help at any time and responsive and attentive to the residents. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a well managed home, where there is evidence that their health and safety is considered. The registered persons are qualified, competent and experienced to run the home for the benefit of the residents. Evidence: The Homes Manager - Nanda Ramdany is an experienced nurse RGN, RMN, who has also achieved the Registered Managers Award to further enhance her knowledge and skills. She works hands on in the home on a daily basis and is well liked by the residents. Several of the residents praised her competence and professionalism as manager of the home. A team of committed and caring staff support the Manager in her task. Staff are cheerful and well motivated and it is clear that the staff team is valued by the Care Homes for Older People Page 24 of 28 Evidence: residents. Residents confirm that there is always someone available to deal with their enquiries and that management are open and approachable. Discussion with residents confirmed that they are regularly consulted on issues that affect them they feel their views are taken into account. The residents say that when requests are made or concerns expressed the issues raised are followed up promptly by management. An examination of the homes quality assurance system evidenced that it seeks the views of residents and relatives on an annual basis. The results of the most recent survey in June 2008 evidenced a high level of satisfaction with services provided at the home. The annual survey is used by the home to measure its success in meeting its published aims and objectives. Examination of a sample of health and safety records indicated that in the main they were up to date and in good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals to maintain the home as safe and risk free environment for residents. There is a need however, for fire drills to be formalised as the current practice of sounding the alarms weekly as a test does not obviate the need for an evacuation walk through so that staff know what to do in a real fire emergency. ( See also environment section) Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 38 In consultation with the Fire Authority check that the use of the boiler room as a drying area for wet laundry is safe and does not pose a fire safety risk to residents. Ensure that fire drills are carried out at regular intervals. Check that fire doors close properly into there frames. To ensure that residents are kept free from risk of harm 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 There is a need to ensure that care plans are regularly updated at least once a month to ensure that they continue to reflect the needs of residents. Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 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!