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Inspection on 30/09/08 for Oakdene Care Home

Also see our care home review for Oakdene Care Home for more information

This inspection was carried out on 30th September 2008.

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

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.

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

The people living in the home lived in clean, well decorated, well maintained, safe and attractive accommodation. They were well cared for by a well managed, educated, committed and competent care team. Those people who were spoken with expressed satisfaction with the care and service provided by the home. All people were assessed before entering the home and there was a recreational and activity programme provided which provided stimulation. There was a thorough assessment and review of care with wherever possible the involvement of each person and or their relative/family. There was a comprehensive programme of education provided which ensured that staff knew how to care and support the people living in the home.

What has improved since the last inspection?

They have improved the way they present information in the service user`s guide as a result of discussions with the people who live in the home. They have involved the people living in the home in the recruitment process for new members of staff. They have introduced more easier to follow care plans which describe the individual needs of each person. They have provided new chairs, carpets and provided a large, bright purpose built conservatory which overlooks the garden area at the back of the home. They have increased the hours provided by the activities person to provide more time for social activities. They have increased the amount of training provided to meet the diverse needs of the people living in the home and develop the skills of the staff.

What the care home could do better:

There were once again no requirements or recommendations from this inspection. Where improvements were required, they were already being addressed by the manager or directors from the company. They carry out regular quality assurance monitoring audits and surveys. They continue to be proactive and keen to introduce new methods and approaches to care and suppport.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakdene Care Home 4 Eastgate Sleaford Lincs NG34 7DJ     The quality rating for this care home is:   three star excellent 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: Tobias Payne     Date: 3 0 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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: Oakdene Care Home 4 Eastgate Sleaford Lincs NG34 7DJ 01529415253 Telephone number: Fax number: Email address: Provider web address: oakdene@onetel.net Name of registered provider(s): Name of registered manager (if applicable) Helen Patricia Reilly Type of registration: Number of places registered: Oakdene (Sleaford) Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Oakdene Nursing Home is registered to provide nursing and personal care for up to 35 people who are over the age of 65 years. On the day of the inspection there were 28 people living in the home. The home is a two storey grade 2 listed building with a purpose built two storey extension within walking distance of the town of Sleaford. The home has an enclosed walled garden with trees, lawn and shrubs set within its own grounds. There is car parking available at the side of the home. Accommodation is provided on ground and first floor levels and the first floor is served by a shaft lift. The directors of the home visit regularly and work closely with the registered manager. Close by the home is a new development of 17 bungalows and flats, which are separate and not managed by the home. The fees at the inspection on the 13/10/2008 ranged from 335 to 447 pounds each week. Extras are for hairdressing which range from 6 to 23 pounds , chiropody 7 pounds , toiletries, personal newspapers and magazines. Care Homes for Older People Page 4 of 28 0 Over 65 35 Brief description of the care home 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: three star excellent 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: The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This key inspection was unannounced and started at 8.10 am. It was undertaken using a review of all the information available to us about Oakdene Care Home. It took place over 6 hours. We spoke with 8 residents, 6 staff and the manager. We also briefly spoke with the two directors of the company who were visiting during our visit. The Commission is trying to improve the way we engage with the people who use the service, so that, we can gain a real understanding of their views and experience of social care services. We are using a method of working where the Expert by Experience Care Homes for Older People Page 6 of 28 is an important part of the inspection team and helped the inspector to get a picture of what it is like to live in or use a social care service. The Expert by Experience spoke with 25 people on their own, contributed to the inspection process and provided a separate report. Comments and observations are reflected in this report. The main method of inspection was called case tracking. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. We also examined the annual quality assurance assessment (AQAA) that was sent to us by the manager before this key inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. It was very clear and detailed. Before making our visit we asked the people who live there to send us comments about the support they receive. We received comment cards from 7 of the people living in the home. All comments were positive. We also received positive comments from 3 staff. 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. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home receive clear and detailed information in many forms to suit their needs to enable them or their relatives/advocates to make an informed choice as to whether or not they wish to live in this home. Where a person is referred to the home they receive a comprehensive assessment to ensure that their needs can be met. Evidence: The home had a statement of purpose and service users guide. Each person had a detailed welcome pack placed in their bedrooms which gave information about the home and the town of Sleaford. Since the last inspection and as a result of discussions with the people living in the home the information has been made easier to read with photographs of the facilities. Information about the home could also be provided in large print, audiotape and Braille. It could also be translated into other languages. Care Homes for Older People Page 11 of 28 Evidence: There was a detailed admission procedure, which described the needs of the people coming into the home. All were assessed before entering the home and written confirmation was sent to them that the home was able to meet their needs. The home did not provide intermediate care. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and detailed care planning system in this home. This and the homes comprehensive internal audit system ensures that the health and welfare needs of people living in the home are fully met. People are encouraged to make decisions for themselves and be independent with the support and guidance of staff. Medication is safely given by nurses who know what they are doing and are safe in their practise. Evidence: Each person had a detailed care plan outlining their care and support. The care plan had been produced wherever possible with the involvement of the person, their family/advocate and other relevant people. The manager was in the process of introducing a more simple but individual method of recording care and support. The aim being to make care more person centred. The new care records included a photograph for identification purposes, admission details, medical history, mental capacity assessment, personal history with social life, hobbies and interests, continence, nutritional (using a nationally recognised malnutrition universal screening tool), dietary, oral health and risk assessments. These were all very clear and detailed. Care Homes for Older People Page 13 of 28 Evidence: As a result of these assesments a care plan based on risk, assessment and outcome for each care needs was produced. There was also a daily and night time care plan outlining what the person liked to do and how they wished to spend their day. Records were signed and dated. The manager acknowledged that they needed further development and had arranged for all staff to be trained on the new system. The company had detailed policies and procedures concerning accessing personal records, confidentiality and data protection. Staff also were trained to respect confidences. Choice and decision making was clearly shown in the care plans. The people were given choice concerning their interests activities and lifestyle. Staff received training to assist and support them. The care records were more detailed, person focussed and reviewed regularly. Where required, people living in the home were referred to GPs, Community Nurse, Community Psychiatric Nurse, Tissue Viability Nurse, Continence Nurse, Physiotherapist, Opticians, Dentist and Chiropodist. As part of its quality assurance a survey of Community Nurses and GPs were was carried out by the home in April and June 2008. Positive comments were in the main received. Specific comments were excellent caring environment, and very professional staff, very good manager and a team who work in partnership and Oakdene provides a good quality service. The home had Link Nurses who specialise in tissue viability, infection control and palliative care. They met up with other nurses and promoted up to date practice in consultation with the Lincolnshire Teaching Primary Healthcare NHS Trust. Nurses administered medication. There was a policy and procedure for medication and there had been a visit by a pharmacist in April 2008 with no concerns. The manager assessed each nurse before they were considered safe to administer medication. There was no person self medicating. The manager also carried out monthly internal audits of medication to monitor safe practice. The last was on the 17/9/2008. There were no concerns. People were satisfied with the way staff cared for them and had confidence in the staff. We saw staff quick to ask if the people were alright and did they need anything or like another drink. People commented everyone does their utmost to make things easy for me, there are a lot of people who need help but I rarely have to wait long though, they are busy but they have time to spend time and have a chat and the staff are like an extended family and they seem to know just what I want. Care Homes for Older People Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are varied, well managed, creative and provide daily stimulation and interest for people living in the home. Visitors are made to feel welcome and supported. People enjoy varied and nutritious meals. Evidence: On admission details of each persons interests were obtained. The home had a written programme of activities, which was displayed on the notice board in the dining room and in the entrance to the home. The home employed an Activities Co-ordinator. Since the last inspection the hours provided for activities had been increased. Activities are now provided four days a week between 9.30 am and 4.30 pm and one day a week between 9.30 am and 12.30 pm. She is a member of the National Association of Providers of Activities for Older people (NAPA). Activities included table games, craftwork, reminiscence, quizzes and music and movement. During the inspection a group activity was taking place with many people being involved and enjoying the activity. The home has a residents committee which meets every 3 months and a newsletter is sent to each person every 4 months. We were told that the activities were very popular and of a future outing to Sandringham. Care Homes for Older People Page 16 of 28 Evidence: North Kesteven District Council again awarded the home 4 stars (very good) in April 2008 following an Environmental Health Ofifcers inspection, in recognition of the catering service provided. Meals were served in the dining room with tables with clean table cloths. Staff were assisting those residents who needed assistance. Residents and relatives were complimentary about the food. The menu was displayed on the wall of the dining room. Comments were I find the food very enjoyable, I always look forward to meal times, they will go out of their way to provide an alternative if I do not like what is on the menu and they will heat up the food without hestitation if I have let it get cold. 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. People know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. They are protected from abuse by correct and safe recruitment procedures. Evidence: Each person received a copy of the complaints procedure in the welcome pack, which included the service users guide. The information was also on the notice board and in the statment of purpose. These also included our new Cambridge Regional office address and phone number. No complaints had been received by the home or the Commission since the last inspection. We had been made aware by the home of an incident of theft which was thoroughly investigated by Lincolnshire Police with full co-operation by the home. We have no concerns about the way the home handled this issue and were kept fully informed. None of the people living in the home or staff had any complaints about the home and felt they could discuss any concerns with staff or the management. Staff also knew what to do if they received a complaint from a person living in the home. Care Homes for Older People Page 18 of 28 Evidence: All staff were correctly recruited including a check by the criminal records bureau (CRB). During their induction each member of staff received information about abuse. Three staff were asked what constituted abuse and all knew their role and what abuse was. Staff also received regular refresher training to ensure their knowledge was up to date. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People continue to live in clean, well decorated, comfortable and safe accommodation. Any maintenance is promptly addressed. Evidence: Since the last inspection new carpets and chairs have been provided and a new purpose built large, bright conservatory had been built overlooking the attractive back gardens. There were 2 lounges and a combined lounge/dining room all of which overlooked the enclosed back garden. Records kept by the Commission shows that there was one single bedroom 38 (9.67 square metres) and one double bedroom 11 (15.91 square metres), which did not meet the national minimum standards. This information had been included in both the statement of purpose and service users guide. People we spoke with told us they were satisfied with the decoration and cleanliness of the home. They also spoke of how they liked their bedrooms. They were encouraged to bring into the home small items of furniture, television, pictures and personal items. Care Homes for Older People Page 20 of 28 Evidence: The home was clean and odour free throughout. Comments we recieved included, I am very comfortable, my clothes are looked after well, we have a good laundry. The home had a separate laundry with commercial washing equipment. There were a variety of electric hoists, pressure relieving equipment and special beds to meet the needs of the people living in the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a safely recruited, well-trained, supported staff team available who have the skills to meet the varying needs of the people living in the home. A wide range of inhouse training and National Vocational Qualification training is provided. Separate staff are provided for nursing/care, housekeeping, catering, laundry, maintenance and activities. Evidence: The home was adequately staffed with people who were experienced and competent to care for older people. People we spoke with did not express any worries about the level or availability of staff. During our inspection visit staff attended to the needs of the people promptly and in a calm and friendly manner. Comments we received included, they are busy but have time for a chat, we could do with more staff at times, the staff are always polite and kind and they meet my needs. The manager monitored the dependency and varying needs of the people. She had introduced shifts for a member of staff to work when the home was particularly busy. At the beginning of each shift there was 15 minute handover to pass information about the changing needs of the people in the home. Care Homes for Older People Page 22 of 28 Evidence: We examined the files for 2 new members of staff. Records were clear, detailed and showed that staff were safely recruited in accordance with the regulations. This included a check by the Criminal Records Bureau (CRB). Since the last inspection representatives of the people living in the home have been involved in part of the recruitment process. There continued to be a wide range of training provided. This included formal training in care to National Vocational Qualification standards (57 percent of the staff had achieved NVQ level 2 and a further 3 were working towards this). A number of staff had achieved NVQ level 3. Training since last inspection had covered, moving and handling, abuse prevention, fire protection, Diabetes, dementia care, first aid, infection control, catheter care, sensory deprivation awareness, medication, record keeping and the Mental Capacity Act 2005. A variety of distance learning training had covered palliative care, equality and diversity and health and safety. Comments from staff were, it is hard work but I enjoy working here, we work as a good team, we receive plenty of training and alot of support and guidance. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and staff benefit from the positive leadership of the management team. Management record systems show that peoples health, welfare, safety and choices are promoted. The management team ensures that the people living in the home have the opportunity to voice their views and opinions. The management uses feedback from questionnaires from a number of sources and quality assurance systems to make improvements. Evidence: The manager was a registered nurse with 32 years experience in nursing practice and management. She had been the manager of the home for many years. She also had a management qualification. There were detailed policies and procedures, which enabled staff to deliver care and support the people in the home. The company had a policy on equality and diversity. People told us that they saw the manager on most days and said she often popped in to talk with them. Care Homes for Older People Page 24 of 28 Evidence: Regular staff meetings were held. They told us that they felt valued and supported. Staff were seen to attend to the needs of the people in the home in a confident, knowledgeable, and sensitive manner. There was a relaxed atmosphere. We received comments from the people in the home which included, I am as happy as I can be. Every carer is cheerful and we have a laugh, we find at all times, the staff are always willing to make themselves available at listen and advise. The staff told us we have regular staff meetings and our manager will always find time and come out of hours to see us if there is anything we need to discuss, we have regular reports at the change of each shift, we have a dedicated team who try to meet all our service user’s needs, sometimes time is an issue in meeting all their needs. Peoples monies were well maintained with a page for each person with details of description, money in, money out, balance and signatures. Directors from the company made monthly unannounced monitoring visits. We examined these reports and found them clear and detailed. There had been no concerns. Records throughout our visit were available, up to date and well maintained. The company also had comprehensive quality assurance procedures. These included 25 completed surveys from the people living in the home in June 2008 which resulted in positive responses. They carry out monthly relative surveys and comments received by the home included all staff are friendly and any concerns I have are readilly dealt with. They also survey community nurses and general practitioners. In addtion the manager carried out internal audits of medication and care plans. Again, very clear records were being kept. There were also details on the notice board about the local advocacy service. The company had comprehensive health and safety policies, which also included detailed and up to date risk assessments. A health and safety audit by an ouside consultancy was carried out in July 2008 with a detailed report. A detailed fire risk assessment had also been carried out in January 2008. There were regular tests of the fire system as well as regular fire drills and monthly monitoring of hot water temperatures. There were also infection control policies and staff made use of alcohol hand rub bottles throughout the home to further prevent infection. 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 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 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 © (2008) 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!