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Inspection on 13/11/08 for Redmount Nursing Home

Also see our care home review for Redmount Nursing Home for more information

This inspection was carried out on 13th November 2008.

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

Redmount Nursing Home provides a warm clean and odour free environment for people to enjoy. This year they have made a decking area outside for people to enjoy. One person living at the home said `` it`s a lovely home, so clean and nice to sit out in the summer.`` The care and support is well planned and the staff group are well trained and supported to provide care in a consistent way. Individuals personal and health care needs are well met. Relatives said ``I chose this home because it has a good reputation, overall we are very happy with the care.`` People who live at Remount said `` The staff are lovely, we are really well looked after, they will do anything for you, you only have to ask.``

What has improved since the last inspection?

An additional bathroom has been adapted to ensure that they have sufficient bathroom facilities for the number of people they care for. An activities coordinator has been employed and works five afternoons per week to provide a range of activities for people to keep them stimulated.

What the care home could do better:

Although plans of care give good information about individuals personal and health care needs, they should be developed further to include more detail about preferred routines and social needs. This will help to plan for individuals social interest. Where individuals are not fully supervised in the taking of their medications, a risk assessment needs to be in place to ensure that this is safe. As needed (PRN) medications should be clearly recorded in the individuals plan of care with clear instructions as to when PRN should be considered, and what steps should be taken before it is considered. Where there are radiators not covered, risk assessments must be completed and where significant risks are identified, solutions must be put in place to prevent the risk of burns from hot surfaces. The home should ensure that the recruitment practices are fully robust, this includes making sure references are always obtained prior to appointing a member of staff.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Redmount Nursing Home Your Health Ltd 21 Old Totnes Road Buckfastleigh Devon TQ11 0BY     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: Joanne Walsh     Date: 1 3 1 1 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 27 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 27 Information about the care home Name of care home: Address: Redmount Nursing Home 21 Old Totnes Road Your Health Ltd Buckfastleigh Devon TQ11 0BY 01364642403 01364643187 redmount@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Your Health Ltd care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Registered for maximum 10 DE (E) seervice users 65 years and over Registered for maximum 10 MD (E) service users 65 years and over Registered for maximum 10 OP Registered for maximum 35 PD (E) service users 65 years and over Up to 5 Service Users from age 55 may be accommodated in the Physical Disability category (PD) Date of last inspection Brief description of the care home Redmount Nursing Home is situated within 150 yards of the main street of the rural town of Buckfastleigh, which is on the edge of the Dartmoor National Park. It is also Care Homes for Older People Page 4 of 27 Over 65 10 10 10 35 0 0 0 5 Brief description of the care home just a short distance from the A38 and A384 junction at Buckfastleigh, the A38 leads to the cities of Plymouth and Exeter. The home is a large detached property that has been extended and adapted to provide care to physically disabled people who need both personal and nursing care. It is part of a group of homes that operate under the company name of Your Health Ltd. The accommodation is arranged on three floors that are served by two shaft lifts and two staircases. Individuals bedrooms, communal space and the kitchen area are contained on the ground and first and second floors. The office, a meeting room/staffroom and laundry are situated on the lower ground floor. There are several car parking spaces available at the front of the home. The small garden and patio areas are accessible to all including those in wheel chairs. There are 26 single rooms and 8 shared rooms, the majority of which have en-suite facilities. The home is registered to cater for 42 Service Users (aged 65 and over), 35 of which are registered for Service Users who require nursing care. The home has disabled toilets and bathrooms, and a variety of equipment including hoists and pressure relief aids that are available for Service Users who have been assessed as needing them. The home has a registered nurse on duty at all times. An experienced registered nurse and an experienced administrative manager, manage the home. The homes fees for residential care or for nursing care can be obtained from the home. In addition to this people pay for their choice of newspapers via invoice from the paper shop, hairdressing and for the services from the visiting beautician. Care Homes for Older People Page 5 of 27 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 key inspection took place during a week day in November and looked at all the key standards to ensure individuals living at the home receive good quality outcomes. We did this by talking to people who live at the home. We also spent time observing care and support being offered and by talking to visiting relatives. Their views and those of the people living at the home are included in the report and have helped to inform the judgments made. We also looked at some key documents, including plans of care assessments, risk assessments, medication records staff recruitment and training files. Prior to the inspection taking place to asked the home to provide information about Care Homes for Older People Page 6 of 27 how they maintain a safe environment, how they support, train and recruit staff and what policies and procedures that have to ensure the home is run safely. This information is contained in the Annual Quality Assurance Assessment (AQAA), which the home completed fully and well enabling us to gain an in sight into how they run. Some surveys were sent to staff and to people living at the home, unfortunately at the time of writing this report, these surveys have not been available. 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 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 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 9 of 27 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. Individuals needs are assessed prior to them moving in to ensure that the home can meet these needs. Evidence: The pre admission assessment information was looked at for the two newest people admitted to Remount. The registered manager said that where possible they will go out a visit the person either in their own home or hospital and talk to them, their carers and family members to help them complete an assessment of needs. They also ensure that where the person is funded by the local authority they obtain a copy of the care management assessment and care plan. This helps them to make a decision about whether they can provide a service for an individual. The assessment information we looked at on this occasion gave basic details of the individuals needs and what care and support they would need. They could be further Care Homes for Older People Page 10 of 27 Evidence: improved by including more detail about the individuals social history and needs. One persons assessment only stated in the social history that they had transfered from another home. It did not give any detail about what the person enjoyed doing past or present. Getting this social history information at the assessment stage will help the home to plan how they can meet the social needs of an individual. Care Homes for Older People Page 11 of 27 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. Individuals personal and health care needs are well met. Evidence: Eight people who live at Redmount were spoken to about their experiences of living at the home. Time was also spent observing care practices throughout different periods of the day and lunchtime was also observed. We also spoke to four visiting relatives. People spoken to gave overall positive responses about their experiences of living at the home. Comments included The caring is very good, we are well looked after, the staff are wonderful, I have just got my own room so am much happier now I dont have to share. Sometimes it is difficult with communication I dont always understand the overseas staff, but they are very kind and they work very hard. Relatives of individuals who live at Redmount also gave positive feedback about the care and support provided at the home. One relative said I couldnt wish for better, all the staff are very good, we are always made welcome and they do an excellent job Care Homes for Older People Page 12 of 27 Evidence: of keeping the place clean. Another relative said we chose this home because it has good reputation, there are only a few minor issues such as the hearing aid not being always put in properly, but overall the standard of care is good. We saw staff providing care and support throughout the day in a caring and respectful way. Hoisting equipment was seen being used for some people who were unable to mobilize without support. Staff appeared busy but still chatted to people sitting in the lounge areas. Plans of care looked at showed that care and support is well planned for personal and health care needs. The home complete assessments on mobility, nutritional screening where needed, assessments on skin care and vulnerability to developing pressures areas. Where such risks have been identified, plans include clear instructions about what staff need to do and what equipment needs to be in place to minimize risks. One person for example had a pressure relieving mattress and instructions were written for staff as to how to keep skin free from redness, such as regular turning and applying a barrier cream. Plans of care also show clearly when the GP has been called and what observations staff have made about individuals general well being via daily records. Relatives and individuals spoken to said that personal and health care needs were well met. One area plans of care could be further developed would be to include more detail about the individuals personal and preferred routines throughout the day. This would help to plan care and support in a more person centered way. Where possible more details and information should be included in the social history so that activities and social needs could also be better planned for. Plans of care should now also include details about whether the individual has mental capacity to make informed decisions in everyday life. The medication records, storage and how it is administered was all looked at as part of this inspection. Medications are kept secure and records in respect of receipt anf administering of medications all appeared well recorded. We did note that one individual was not observed by staff taking their medications and had in fact kept on tablet back, which they put into their bag. The person did inform the staff member, but the nurse administering medications was not aware of this. It was agreed for this individual, who does not have dementia and can make their own decisions about whether to comply with taking medications, a risk assessment needs to be in place. The home are also asked to ensure that where PRN (as needed) medications are Care Homes for Older People Page 13 of 27 Evidence: prescribed that this is included in the persons plan of care including agreed instructions as to if, why and how many PRN medications should be given. Care Homes for Older People Page 14 of 27 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. Individuals social needs are well met and improvements to menu choices will help to ensure a balanced diet is offered. Evidence: The routines of the home appear flexible to suit individuals needs and wishes. During this inspection one person told us they liked to get up early and staff supported them to do this and brought them a hot drink in the morning. Other people were seen to be having a later sleep in and the registered manager said that this was their choice. Individuals preferred routines for getting up and going to bed would be useful to include in their plans of care so that staff can provide this in a consistent way. Individuals spoken to said that activities are offered to them usually in the afternoons and had included games, exercises, bingo quizzes and trips out. Three people said they had enjoyed a trip out on the moor the day before and had had an ice cream. The registered manager said that the home are looking to purchase their own bus so that they can facilitate more trips out. Other activities offered within the home are hairdressing and visits from local clergy to provide services and communion. The home will contact any Church or religious group to see if they can arrange a visit if an Care Homes for Older People Page 15 of 27 Evidence: individual wishes this. People are able to have visitors anytime they please. The visitors book shows that there are a large number of visitors to people throughout the day. Relatives who were visiting during the day of the inspection were spoken to and confirmed that they were made welcome by the home and that staff were friendly and offered them refreshments. One area identified by the management of the home in their AQAA and through feedback to us, was to improve their menu choices. They are currently preparing new menus, which will run for a 3 to 4 week cycle and include two hot choices for lunch and more of a selection of teatime meals. Two relatives spoken to said that the one area they were not so impressed with was the food and choices offered. One person said that the meals appear repetitive, not much choice and portion size was small. They gave an example of the same cake being offered every day for afternoon tea. Another relative said that although the food was okay it was sometimes not well presented, and gave the example of food all being pureed together so it looked very unpleasant. This was passed to the registered manager who said that their policy was to puree each item of food individually so you can tell what is being served and said she would remind all staff about the importance of presentation. One person living at the home said I came for respite and the food was excellent so when I needed full time care I chose here but sadly the food is no longer very good. The lunchtime meal was eaten with some of the people who live at the home. The meal offered was fish pie, no alternative appeared available. It was well presented and very tasty. All the food was served hot and in an unhurried and relaxed manner. Only a handful of people choose to sit the dining room, which is small but bright and nicely furnished. The home would not have enough space in the dinning room if everyone decided to eat in there. Care Homes for Older People Page 16 of 27 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. Individuals views are listened to and acted upon. Evidence: The home has a stated complaints procedure that is included in the information given to all people who move into the home and to those who are considering a placement. Since the last inspection the home have dealt with three complaints within the timescale they say and in writing. We are satisfied that the home have evidenced that they take concerns and complaints seriously, that these and the actions taken to rectify any issues are documented. Relatives spoken to said that the management approach of the home was open and that they could make their concerns known and be confident that they would be dealt with. The home have policies and procedures in place for dealing with any suspicion of abuse and staff receive training in this area so that they are aware of abuse issues and what to do should they suspect abuse. Care Homes for Older People Page 17 of 27 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. The home is clean, homely and comfortable however, some improvements are needed to ensure that all parts of the home are safe. Evidence: During this inspection all of the communal areas and some of the individual bedrooms were looked at. Some radiators are not covered or have low surface temperature. Some of these were in areas that people could easily fall against, like near door ways and en suites. These must be risk assessed and where significant risks are identified solutions be put in place to ensure people are protected from the risk of burns from hot surfaces. The home is clean and homely and a programme of refurbishment is taking place with rooms being redecorated and new furniture being bought throughout the year. There is a shortage of space in the dining area, should more than 15 people wish to eat comfortably in there and some thought should be given to how in the longer term this might be improved upon. Individuals are encouraged to personalize their rooms. There are a number of rooms that are double, with screening provided to ensure privacy for personal care. Plans of care should include that individuals who do share have agreed or their representative Care Homes for Older People Page 18 of 27 Evidence: has agreed to this. One person told me she agreed to a shared room only until a single became available and that they now had their own room and were much happier about this. Policies and procedures are in place to ensure good practices are in place to help with infection control. Cleaning gel, soap and paper towels are available throughout the home and soiled laundry is dealt with appropriately. Staff were observed to wear aprons and gloves at appropriate times. Care Homes for Older People Page 19 of 27 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. Staff are reasonably well trained and supported to do their job effectively. Evidence: The staffing levels are sufficient for the number and needs of the current group of people living at the home. Usually there are seven carers and one nurse in the mornings, and one nurse and 6 carers during the afternoon and early evening. Throughout the night there is one nurse and two carers available. In addition to this the home employs two cleaners, a laundry assistant, cook and kitchen porter and a maintenance man. Records show that staff are offered regular training and support to do their job effectively. They have training in all areas of health and safety but would benefit from training in dementia care. The registered manager said that they put up flyers of other training available and staff have been on training in respect of use of a nutritional screening tool, the Liverpool pathway, a way of caring for terminally ill. Staff are also encouraged to complete their NVQ in care (NATIONAL VOCATIONAL QUALIFICATION), and have more than 50 with this. Staff recruitment files show that a reasonably robust recruitment process is in place, although one file did not have references. The home are reminded that they should not offer employment until two satisfactory references are obtained. The home should also Care Homes for Older People Page 20 of 27 Evidence: ensure they keep evidence that they have completed all checks completed in respect of POVA list. This ensures that only people who are suitable to work with vulnerable people are employed. The manager had done these checks but did not keep documented evidence of this as she had been advised by the umbrella company doing the checks not to keep it. Care Homes for Older People Page 21 of 27 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. The home is well run and in the best interests of the people who live there. Evidence: The registered manager is qualified and experienced to run the home. She and the home manager who has responsibility for all the administration and is also the Responsible Individual for the company, ensure that home is well run. The home has a number of ways in reviews the quality of care provided, they have recently completed surveys for people who live at the home specifically on food. This has resulted in the new menu being planned and the decision to offer more choice and variety of meals. The company also recently did a mystery shopper exercise, where they sent someone to each home as a prospective family looking for a home for their relative, then gave the homes feedback on the results as well as ways they need to improve on their customer care. This was done independently and gives the home some good ideas on how they can improve in this one area. Care Homes for Older People Page 22 of 27 Evidence: The home provided information in their AQAA prior to the inspection which provides us with details of all their policies and procedures in safe working practices and tells us when they last maintained equipment, fire safety, heating and lighting systems. Care Homes for Older People Page 23 of 27 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 24 of 27 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 13 All parts of the home must be free from hazards to safety, including risks from burns from hot surfaces Risk assessments must be carried out on all radiators not covered, where significant risks are identified, solutions must be found to minimize the risk of burns from hot surfaces. 15/01/2009 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 3 The home should ensure that social needs are assessed where possible so that they can plan for meeting social and recreations interests and needs. Risk assessments should be in place where it is agreed that an individual does not need to be fully supervised in taking their medications. PRN medications should be included as part of the persons plan of care including clear instructions as to when PRN should be considered. 2 9 3 9 Care Homes for Older People Page 25 of 27 4 15 The menu changes planned should be reviewed with people at the home on a regular basis to ensure that a good choice range and balanced diet is offered. The home should ensure that all references are in place before appointing a new member of staff. They should also ensure that evidence is kept for all checks completed on staff. 5 29 Care Homes for Older People Page 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!