Inspection on 12/09/08 for Perth Green House

This inspection was carried out on 12th September 2008.

CSCI found this care home to be providing an Good 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.

Other inspections for this house

Perth Green House 24/09/07

Perth Green House 01/11/06

Perth Green House 08/02/06

Perth Green House 11/08/05

Perth Green House 29/09/04

Perth Green House 05/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Perth Green House Inverness Road Jarrow Tyne and Wear NE32 4JX Lead Inspector Anne Brown Key Unannounced Inspection 12th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Perth Green House Address Inverness Road Jarrow Tyne and Wear NE32 4JX 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) 0191 4893007 0191 489 2782 moiraworkman@southtyneside.gov.uk South Tyneside MBC Moira Workman Care Home 30 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Old age, not falling within any of places other category (30), Physical disability (5), Sensory impairment (2) Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 30 Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 2 Physical disability - Code PD, maximum number of places: 5 2. Sensory impairment - Code SI, maximum number of places: 2 The maximum number of service users who can be accommodated is: 30 24th September 2007 Date of last inspection Brief Description of the Service: Perth Green House is registered as a care home for older people and is operated by the Local Authority. It provides intermediate care services only, including rehabilitation, interim and healthcare, in partnership with the Health Authority and Primary Care Trust. There are no long-stay residential places at Perth Green. There are 30 places, of which 15 are for rehabilitation and the remaining 15 provide healthcare and interim care, (2 of which may be used for emergency placements.) The building is situated in a housing estate and is close to local amenities. All accommodation for people using the service is on the ground floor and there is level access into and around the building. The home provides single rooms to all service users. One bedroom has an en-suite facility. The radial layout of the corridors allows for separate self-contained units, each providing bedrooms, lounge, and bathroom, and all leading to a central large dining area. On the second floor there are a number of offices for social and health care staff, with a separate entrance. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 5 There are no charges for those people assessed for the rehabilitation service, which can last up to 6 weeks. There is no charge for the interim or the healthcare service for up to 6 weeks. The charge after this period is between £94.45 - £408.79 per week (depending upon Attendance Allowance benefits). Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out. Before the visit: We looked at: • • • • • Information we have received since the last inspection on 24th September 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The provider’s view of how well they care for people. The views of people who use the service and their relatives. The visit. • An unannounced visit was made on 12th September 2008. During the visit we: • • • • • • Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records that must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last inspection. We told the manager what we found. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 7 What the service does well: The home is well maintained, safe and comfortable providing the people using the service with a pleasant place to stay. There are appropriate aids and adaptations provided throughout the home to help maintain people’s independence. There are nurses, physiotherapists and occupational therapists based in the building so people using the service can have immediate access to them. This means that any changes in their health care needs can be quickly addressed. Opportunities for training are good which enables staff to learn new skills to support the residents in all aspects of their lives. The manager and the staff team are committed to treating people as individuals and ensuring they can make personal choices. They enjoy their work and make every effort to ensure the home is pleasant and comfortable. People using the service said that they could continue their preferred daily routines. They confirmed that their privacy and dignity was respected by the staff. There is a good complaints procedure and when a complaint is made the manager makes sure that this it is investigated quickly. The majority of staff have an NVQ 2 or 3 qualification in care. Staff recruitment procedures are good and these ensure that only suitable people are employed to work in the home. Comments from people using the service included:“As a person who didn’t want to come to Perth Green I was pleasantly surprised to see how well run, and orderly everything is run. It is like a five star hotel. Staff very pleasant and helpful. Food first class and well presented. Very clean”. “I was amazed at the meals and looked forward each day to meal times. I will miss the meals when I go home”. “I am expecting to go home in two weeks or less and I know I am going to miss everything about Perth Green”. “The care and support has been 100 ”. “Everything satisfactory”. “I’m as happy as can be”. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: The manager should introduce a system to ensure people who are referred to the service are given information about it prior to their admission. The medication administration record should include the dates for each day of the week and not the ‘week commencing’. Staff must receive refresher training every three years on safeguarding adults. It is considered good practice to renew Criminal Record Bureau checks every three years to help to protect the people using the service from abuse. A suitable quality assurance system must be introduced to help ensure standards are met and improved. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 9 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. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6. Quality in this outcome area is adequate. People using the service are provided with information to help them decide if the service can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Perth Green House offers three different types of care. The rehabilitation service is for older people who are recovering from illness, either from hospital or from home, who no longer need medical care but need support to regain daily living skills so that they can return home. This service may take up to six weeks. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 12 The healthcare service aims to prevent admission to hospital and to get people back into their own homes. The interim service aims to support people whilst awaiting necessary adaptations to their own home, or to provide a safe environment whilst awaiting admission to long-term care. A service user guide has been produced which provides good information to the people using the service. However two people said they had not been given this information prior to using the service. The manager said new leaflets are soon to be produced which include photographs of the home and will be given to all prospective service users. Initial assessments are carried out prior to admission. When people are admitted to the home a further assessment is carried out by the care staff, health care staff and the doctor over a 48 hour period. People using the rehabilitation service are helped to reach their full potential. They are involved with a care manager to agree services they need to support them in their own home. They are also supported by a physiotherapist and occupational therapist. People are involved in daily living tasks and domestic activities. Two training kitchens are provided for this purpose. Other mobility aids are available. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. People are well supported by staff, and care plans show the amount of care and support that is provided. There are good arrangements in place to ensure that the health needs of the people living in the home are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An excellent aspect of the service is the on site nurses, occupational and physiotherapist as well as a GP who visits twice each week. There are regular meetings held with different health care professionals who closely monitor people’s progress towards achieving their therapy goals. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 14 There are rapid response nurses, falls lead nurses, and an overnight nursing team on site at the home for advice or referral. The home also has good links with the continence advisor, speech and language therapists, stroke unit, falls co-ordinator, geriatrician and community psychiatric nurse. People using the service said that they felt their health care needs were met at Perth Green House. A medication risk assessment tool is completed when people are admitted to the home. This is used to find out about the support each person needs with their medicines. Some people using the service said that they looked after their own medicines and lockable facilities have been provided. When people are admitted to Perth Green the staff record details of their medication including name, strength of dose and time to be administered on a medication administration record (MAR). For those people unable to look after their own medication, senior staff administer this. A random sample of medication records and the system for storage and handling medication was looked at and found to be appropriate. However the medication administration record should include the dates for each day of the week and not the ‘week commencing’. The manager said all staff who dealt with medications had received training and this was confirmed by the staff on duty. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. A range of activities and events are provided in the home for the people using the service to enjoy and they are able to make personal choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service are able to spend their days as they choose. Some people chose to spend time on their own in their bedrooms whilst others were in the communal lounges. Comments included “I can get up and go to bed when I like and have a bath or shower when I like”. Activities take place in the main dining room and the smaller lounges on the units. These include bingo, film nights, scrabble, cards, games, etc. A small Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 16 bar is located in the main lounge where drinks are served on social evenings. Some people said they preferred not to join in the activities. Others said they liked to socialise but sometimes not many people joined in the activities provided. One person said they might join the social evening and have a glass of their favourite lager. A range of books are provided and the library service visits and can provide talking books if requested. An activities book is maintained and staff record who joins in certain activities and encourage people to do so to help ensure they do not become socially isolated. Menus are displayed in the home and are available in large print. Meals are served in the main dining room and tables were appropriately laid. Special diets are catered for and alternatives are always available. After people have been assessed by the occupational therapist they may have to prepare their own meals as part of their rehabilitation programme. Comments included:“Too much food”. “Wonderful baking, I want to take the cook home”. “Standard of cuisine is excellent”. “I was amazed at the meals and look forward each day to mealtimes. I will miss the meals when I go home shortly”. “Excellent meals and very well served”. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. A complaints procedure is in place and people living in the home are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, a copy of which is available to each bedroom. It is provided in easy to read print, and is available in Braille and on cassette for people who have a visual disability. It is also displayed around the home. Records are kept of any complaints received, details of the investigation and the outcome. The outcomes are used to improve the service. The people who were spoken to and the information contained in the surveys returned indicated that people knew how to make a complaint. One survey stated “a complaint, if any, is acted on at once”. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 18 Staff had received training on safeguarding adults and were aware of the different forms of abuse. The staff on duty knew the procedure to follow if they suspected any bad practice was taking place. Some staff had received training on safeguarding adults three years ago and this had not been updated. This could mean they may not be aware of any procedures which have been updated. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23 and 26. Quality in this outcome area is adequate. The accommodation is generally warm, clean and hygienic and provides people with a pleasant place to stay. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Perth Green House was built in the 1970s as a residential care home. It has a five separate units with a large central dining room. Rooms in one corridor and all of those on the first floor accommodation are used wholly for offices for the many social and health professionals that are based in the building. The Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 20 accommodation for people using the service is on ground floor level only, so it is accessible for people with mobility needs. Since the last inspection two baths have been replaced with ones that are more suitable to meet the needs of the people using the service. The worktop in the sluice room was damaged which could cause the spread of infections. The screws on the toilet door handle in the Cedars wing were loose which could cause people to injure their fingers. The lounges and bedrooms were warm and comfortable providing people with a pleasant environment to live in. All areas of the home were clean and free from offensive odours. A phone booth is provided for people using the service which means they can make telephone calls in private. Comments from people using the service included:“It’s like a five star hotel”. “Every room is turned out every morning. Windows opened to fresh air”. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. The staff working for in the are appropriately recruited, selected, trained and supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the manager, five care staff, five domestic assistants, cook, laundress and administration assistant were on duty. The manager confirmed that five care staff were on duty from 7 am until 10.30 pm each day. At present there are two vacant posts for 32 hour care assistants. These hours are being covered by staff working in the home, staff working in other services within the Local Authority and agency staff. Thirteen members of staff have achieved a National Vocational Qualification (NVQ) Level 2 and five have achieved Level 3. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 22 A policy and procedure supporting the recruitment and selection of staff is in place. A random sample of staff files was examined and these confirmed that Criminal Records Bureau (CRB) checks and two written references are received prior to staff being employed in the home. This helps to protect people using the service. However CRB checks are not renewed after three years, which is considered to be good practice. Job descriptions and contracts of employment have been issued to all staff members. A programme is in place to make sure staff receive up to date mandatory health and safety training. Specialist training has been provided to meet the individual needs of the people using the service. This included continence promotion, Stoma care, peg feeds, diabetes, pressure sores, nutrition and equality and diversity. The staff on duty felt they received appropriate training to carry out their jobs effectively. Comments from people using the service included: “Staff could not be more helpful if they were hand picked”. “Staff are very supportive”. “I have been here for going on five weeks and the staff are first class. The staff are really dedicated to their job, wonderful people”. “There is someone there no matter what time you need them day or night”. “They show interest in everything you say or ask for”. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. The home is run in the best interests of the people living in the home and there are systems are in place to ensure their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is experienced in managing care homes and holds appropriate qualifications. She is committed to ensuring the home is run in the best interests of the people staying there. She promotes an ethos amongst staff of involving the people living in the home in decision-making. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 24 Service user focus groups and staff meetings are held on a regular basis and the minutes of these were available for inspection. The staff and the people using the service confirmed that the manager is supportive and very approachable. Each person using the service handles their own finances and the manager does not held any money on their behalf. Comprehensive health and safety policies and procedures were in place. Health and safety checks are carried out on a regular basis. The manager confirmed that the fire risk assessment had been approved by the fire officer. The fire evacuation procedure includes details of each person using the service, their room number, ability and assistance they would require. All accidents are recorded and monitored by the manager. The manager has recently attended a training course to assist her to develop the quality assurance and monitoring system in the home. When this is fully introduced it will help ensure standards continue to be met and improved. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement A system must be introduced to ensure all people using the service are given a copy of the Service Users Guide prior to admission. Senior staff who administer medication must ensure that a date is entered on the record for each day of the week instead of the date the week began. Staff must be provided with refresher training for Safeguarding Adults to help protect people from abuse. The maintenance issues discussed in the report must be addressed. Timescale for action 31/10/08 2. OP9 13(2) 31/10/08 3. OP18 13(6) 31/12/08 4. OP19 23(2)(b) 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 27 No. 1. Refer to Standard OP33 Good Practice Recommendations The manager should ensure an effective quality monitoring system continues to be developed to ensure standards continue to be met and improved. Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Perth Green House DS0000037978.V371490.R02.S.doc Version 5.2 Page 29 - 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!