Inspection on 02/08/06 for Rose Meadow

This inspection was carried out on 2nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Rose Meadow 03/07/07

Rose Meadow 23/02/06

Rose Meadow 25/07/05

Rose Meadow 11/03/05

Rose Meadow 05/10/04

Rose Meadow 02/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Rose Meadow Yarmouth Road North Walsham Norfolk NR28 9AU Lead Inspector Ann Catterick Unannounced Inspection 2nd August 2006 09:15 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 Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Meadow Address Yarmouth Road North Walsham Norfolk NR28 9AU 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) 01692 402345 01692 500157 Rose.meadow@norfolk.gov.uk Norfolk County Council-Community Care Mrs Elizabeth Ann Lockwood Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. From time to time the home may accommodate one service user over the age of 65 years who has dementia and is named in the Commission’s records. Total number not to exceed thirty (30). People who need wheelchairs to assist with independent mobility at the point of admission can only be accommodated in rooms numbered 34, 41, 66 and 68 23rd February 2006 2. Date of last inspection Brief Description of the Service: Rose Meadow is a care home providing personal care and accommodation for up to 30 older people. The cost of a placement as given to the CSCI in July 2006 is £368.72. This does not include hairdressing, chiropody, toiletries, newspapers or magazines. The home has 28 permanent placements and 2 respite care placements. There is a day centre attached to and managed by the care home and this offers up to 12 day care places on Wednesdays, Thursdays and Fridays. The home is owned by Norfolk County Council and is located on the outskirts of North Walsham, being quite close to shops, pubs and other local amenities. The home was purpose built and accommodates service users on two floors. Norfolk County Council has completed some refurbishment and redecoration but further work remains outstanding. All service users have their own bedroom but several of these are rather small. The communal areas are plentiful and offer a variety of seating areas including a smoking area, quiet room and large dining room. There is a shaft lift that offers access to the first floor. The lift is very small and does not comfortably accommodate a wheelchair. There is a large garden that service users benefit from in the summer months. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a Key inspection, unannounced. It took place on the 2nd of August and was over a period of 9hrs. During the inspection outcomes for all of the Key standards were inspected. Prior to the inspection a ‘pre-inspection questionnaire’ was completed by the manager. Two comment cards were received from relatives and one from the local health professionals. These all spoke positively about the service. The comment cards completed by service users were not sent to the CSCI but were at the home on the day of inspection. The inspector was able to speak with the manager, staff and service users. Policy and procedures, staff files and care plans were also inspected. Most comments from service users written feedback were positive. Two service users who were admitted at short notice did not have very much information about the home prior to admission. One service user made a comment that staff were often very busy and another made comment that they would “like to do more”. All other written feedback was positive about all aspects of their care. All of those service users spoken to on the day of inspection gave very positive feedback about the home. Some comments made were: “You can take all troubles to the staff and they are very helpful.” “Won’t find a better place, everything is good.” “Taken out on trips, couldn’t have anything better.” “Food couldn’t be better.” In conclusion the quality of care provided by staff and management is good. Staff numbers are not always adequate and this has an impact on the care provided. Service users are generally satisfied with the environment although there are some areas of the environment that are poor and institutionalised. What the service does well: Staff are offered appropriate training, induction, and supervision and this was reflected in the good standard of care provided. Service users are satisfied with the care they receive. Service users spoke very positively about the meals provided and the quality of the food was good with cooked meals being offered at bother lunch and tea. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 6 The manager is actively involved in measuring the quality of the service and has received feedback from service users, relatives and staff. This information has been made available to service users and their families. What has improved since the last inspection? What they could do better: 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. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 7 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 Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users needs are assessed prior to admission to ensure that the home can meet need. The home does not provide intermediate care. EVIDENCE: Prior to admission the home receives an assessment from the placing social worker. The manager would then go out and make her own assessment and this is then recorded. Evidence of this was seen on file. A pending file was seen and included an assessment from the social service worker, the GP and was awaiting a visit from the Manager. Good practice in this area. The home has two respite care beds but provides no intermediate care. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans are generally good with opportunity for development around social interaction. Service users could be more involved in their care plan. Medication is overall good but one area needs improving. Privacy and dignity are promoted by staff but the environment does not support this as the home has inadequate bathing and toilet facilities. EVIDENCE: Three care plans were looked at and these include details of service users health, social and personal needs. Care plans had nutritional charts, risk assessment, health and personal care plans and were reviewed on a regular basis There was little in the care plans about what occupation or social activities service users were able to get involved in within the home. A recommendation has been made in this area. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 10 Some aspects of care plans were case tracked and showed good practice. For example in a service user’s care plan it indicated that they had particular preferences and need and when checked these preferences were addressed. Those service users spoken to were positive about their care and believed that their needs were being met. One nutritional plan seen showed how the home identified a weight problem recorded intake and encouraged food with the outcome being that the service user gained weight. The review system was that staff crossed out information from the old review form and added new information in different colour pen on the same for. This was not always clear. A recommendation had been made in this area. The procedures around medication were inspected. Generally good practice was evidenced. MAR sheets were clear and accurate. There where no gaps in the MAR sheets. The fridge was of the correct temperature and staff checked this on a daily basis. Medication was stored safely. There were some medications audited that, initially, did not tally up. When this was further investigated by the manager it was found that the receipt of some medications had be entered with the incorrect date. The manager has said that this part of the process of receiving medication needs to be done with two staff to minimise the possibility of errors. A requirement has been made in this area. Staff were observed working with service users in a way that promoted dignity and respected privacy. One area where this is not possible is around bathing. At the time of the inspection only one bathroom was ‘fit for use’ for 27 service users. This meant that all of those service users upstairs had to be taken downstairs past other residents, visitors relatives etc to get to the one bathroom. Some communal toilets are in pairs and have a gap at the top that does not allow privacy or promoted dignity. A requirement has been made in this area. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in the outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are satisfied about the lifestyle they experience in the home although staff acknowledge that they do not always have opportunity to spend very much social time with service users. Relatives and friends are welcomed in the home. Meals times are relaxed and meals are of good quality and service users have choice. The liquidised meal seen on the day of inspection was poorly presented. EVIDENCE: Staff spoken to were aware of the importance of spending quality social and one to one time with service users. Activities were planned on a regular basis but much of staff time was taken up with task centred care and not person centred care. This was not because staff did not want to become involved but is due to limited staff being on duty. Service users had been out on trips in the mini bus and some spoke of games of bingo and manicures that took place in the home. All service users spoken to said that they were satisfied with their days and were happy with the care and interaction with staff. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 12 Visitors are made welcome. All service users spoken to were very positive about the choice and quality of meals. Food seen on the day was nutritious and well presented and the dining area is a bright and pleasant environment for service users to have their meals. There is a hot choice for both dinner and tea. A liquidized meal seen on the day of inspection had been liquidized together making it look unrecognisable and unappetising. A recommendation has been made in this area. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in this outcome area is good. This judgement has been used using available evidence including a visit to the service. Complaints policy and procedure were in place and used appropriately. Information about adult protection was in the policy folder but there were no specific basic guidelines for staff to follow. EVIDENCE: Six complaints had been received in the last 12 months and all had been dealt with appropriately and recording was detailed and thorough. The complaints procedure is within the Service User Guide and on display in the home. All of those service users spoken to said that if they had a complaint they would take this to the manager and felt quite confident and relaxed about this. The policy and procedure folder included the Norfolk Protection of Vulnerable Adults Policy. I asked the manager what procedures staff would use in her absence if an adult protection issue came up and there were no clear guidelines for staff. A recommendation has been made in this area. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24,and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There is no comprehensive maintenance and renewal plan for the environment and this means that service users continue to live in an inadequate environment. The community lounges are plentiful but some areas would benefit from redecorating. The dining area is large, welcoming and bright. The poor quality of toilet facilities and the lack of bathing facilities do not promote privacy and dignity. Many bedrooms are rather small but service users are satisfied with their bedrooms. Generally the home was clean, with no odour, however, the main bath and bathroom were unclean. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 15 EVIDENCE: There are still significant shortfalls in the environment. There is brief reference to the environment within the Annual Development Plan 2006/2007 but this does not address the main issues. Generally the communal areas of the home are plentiful and reasonably furnished. There is ample communal space and service users have choice of where to sit. Bedrooms are small but service users all spoke positively about their bedrooms. Not all bedrooms have a TV aerial socket. All bedroom doors are lockable but none of those service users spoken to chose to lock their doors. Keys were hung above doors and this is rather institutionalised. A recommendation has been made in this area. The home has 27 service users accommodated on the day of inspection and only one bathroom was in use. This bathroom was not clean and the bath needed a thorough clean with taps being covered in lime scale. There was a shower in a shoddy bathroom and one service user used the shower. The home has plans to refurbish bathrooms and this was initially planned for July but has been put back to September. A requirement has been made in this area. Communal toilets are old fashioned, do not promote privacy and dignity and have old worn out toilet seats and systems. These are also due for refurbishment but the date has been delayed. These facilities are inadequate. A requirement has been made in this area. The upstairs corridor is long all one colour and has no pictures or other items on the wall making it look very institutionalised. Many of those pictures and prints in the home are old and lost their colour and need replacing. In one bathroom the light cord had broke and had been replaced with a piece of string. A recommendation has been made in this area. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Recruitment practice is good and when appointed staff receive good training and supervision. Staff are competent and able to fulfil their role. The numbers of staff on duty at any one time is the absolute minimum and if staffing numbers were increased the quality in this outcome area would be good. EVIDENCE: The staff rota was seen. Three care staff are on duty for the am shift with a care coordinator. The care coordinator on the day of inspection was seen to give medication, answer the telephone, and become involved with visitors and visiting social workers. This meant they were able to give little time to offer any practicable support to the carers. When the registered manager was taken off the rota these hours were deducted from the care/ coordinator hours. The way the manager has dealt with this is to end some am shifts early. For example on the day of inspection one carer finished their shift at 12.30 and another at 1.30 leaving the home especially short of staff in the early afternoon. Three care staff are not able to meet all of the needs of service users and ensure their safety. For example a member of staff said that if she were walking around the garden with a resident and another member of staff was bathing a resident this would only leave one carer for the other twenty eight service users. Within the complaints book a service users had complained that she had missed a cooked breakfast, as staff had not been able to assist her up before Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 17 9am. When the manager asked staff why this had been they explained that because of the dependency levels of the service users they could not get all of those service users who chose to get up by 9am up as there was not enough staff to do this. Staff were aware of the importance of social time with service users but acknowledged that they did not have very much time to do this. It was suggested that the time when social interaction could take place was when bathing service users as you had one to one time with them without any interruptions. Three staff are on duty in the afternoon but once again there is a particular shortage on some occasions when one of the afternoon staff do not start duty until 4.30. A requirement has been made in this area. Staffing training is good. Nearly 42 of staff are trained to level NVQ level 2 or above. Twenty four staff hold a first aid certificate and all staff receive the mandatory training required as well as opportunity for further training. All service users spoke positively about staff and staff were seen to work with service users in a caring professional way. Two staff were interviewed by the inspector and showed themselves to be competent and caring both enjoying their work and having a sound knowledge in their field. Two staff files were seen and all matters regarding recruitment and selection were in order. Application forms, references and CRB records were seen and all were in good order. Good quality staff are appointed and they have the appropriate training and supervision. The quality outcome for this area is poor as there are not sufficient numbers of staff on duty at all times to meet the needs of service users. The quality of this outcome area would move to good if staff were employed in sufficient numbers. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by an experienced competent registered manager. God quality assurance systems are in place and these can be further developed. Service user’s finances are safeguarded by the homes procedures in this area. Overall the manager aims to ensure the health and safety of staff and service users. EVIDENCE: The manager for the home is experienced and qualified providing good management to the home. This was evidenced by her good quality assurance Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 19 system, feedback from staff and service users and observations of a well managed home on the day of inspection. The manager follows a quality assurance system including questionnaires to service users relatives and staff. Once the information is collated it is put in a readable form and is included in the Service User Guide and is available near the front entrance to the home. The manager could further develop this system by completing regular environmental audits. This would then highlight the shortfalls within the environment. The money that is looked after by the home was inspected and random auditing took place and all was found to be in order being recorded well with safe systems. All staff have appropriate training to ensure good health and safety practice. Incidents and accidents are reported and recorded appropriately. All staff receive induction and foundation training. Fire records were looked at and were in order. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 20 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 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 3 1 3 1 x 2 3 x 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 X 3 Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13.2 Requirement The registered provider must ensure that when medication is received and records made of this that they are accurate and correct. The registered provider must ensure that an improvement plan is produced that specifically relates to standard 19 and the outcomes for this area. The provider must ensure that adequate bathing and toilet facilities are available and that these are suitable, in sound order, comfortable and provide privacy. This is a repeat requirement, the previous timescale was 31/08/06. The provider must ensure that there are always enough care staff on duty to meet all of the needs of service users. This is a repeat requirement, the first timescale was 30/06/06. Timescale for action 01/09/06 2. OP19 24 (a) 01/10/06 3. OP21 23(2)d j 01/11/06 4. OP27 18(1)a 01/11/06 Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP23 OP7 OP7 OP15 OP18 OP19 OP24 Good Practice Recommendations The registered provider should have TV aerial sockets fitted in every service users room. It would be good practice to review the format of the review form to make easier to read and understand where amendments have taken place. It would be good practice to include more details of social interests within the care plan and identify how preferences and choices in this area are met. It would be good practice when providing a liquid diet to liquidise separate foods rather than the whole meal. It would be good practice to have clear guidelines for senior staff to have with regard processes and procedures about the protection of vulnerable adults. It would be good practice to make the long upstairs corridor more homely by having pictures or other attractions on the wall to make it more homely. It would be good practice to reconsider the practice of having keys to bedrooms on a hook above service users bedroom doors. Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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 Rose Meadow DS0000034927.V307581.R01.S.doc Version 5.2 Page 24 - 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!