Inspection on 18/09/07 for Rosemount

This inspection was carried out on 18th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosemount 17/03/08

Rosemount 03/08/06

Rosemount 19/01/06

Rosemount 01/07/05

Rosemount 19/11/04

Rosemount 20/05/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Rosemount Sunningdale West Monkseaton Whitley Bay Tyne & Wear NE25 9YF Lead Inspector Suzanne McKean Key Unannounced Inspection 09:30 18 September 2007 th 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 Rosemount DS0000028819.V338131.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. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosemount Address Sunningdale West Monkseaton Whitley Bay Tyne & Wear NE25 9YF 0191 251 0856 0191 2510866 rosemount@fshc.co.uk 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) Cotswold Spa Retirement Hotels Limited (wholly owned subsidiary of Four Seasons Healthcare Ltd) Mrs Sylvia Huntingdon Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (1) of places Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2006 Brief Description of the Service: Rosemount is a purpose built care home of traditional brick build design on one level, there is a car park to the front of the building. This allows level access to the home. It is situated in the residential area of West Monkseaton, Whitley Bay. The home is easily accessed by metro, bus and car. All accommodation is provided in single, en-suite bedrooms and there are a selection of communal facilities, including lounges, dining rooms and a conservatory. There are no shared rooms. The home charges fees between £356 and £505 depending upon the needs and requirements of the individual residents. The home provide information about the service through the service user guide and a copy of the last inspection report from Commission for Social Care Inspection is available in the entrance to the home. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit on 3rd August 2006. • How the service dealt with any complaints & 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 & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 11th September 2007 and a further visit was made on 19th September 2007. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the manager what we found. What the service does well: What has improved since the last inspection? There is a new manager now in the home who is aware of the problems the home has and is taking active steps to make improvements. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Rosemount DS0000028819.V338131.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 Rosemount DS0000028819.V338131.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process is comprehensive and ensures that people’s needs are clearly identified before decisions are made about admission to the home. The home does not offer intermediate care. EVIDENCE: Each care plans contains a comprehensive pre-admission assessments which is based on the activities of daily life but include an overview of the individuals social and health history. Either the Manager or the senior staff carries this out. The records were well documented and detailed enough to form the basis of the care planning. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 9 The care plans also contained a care management assessment, which is carried out by the social worker who uses it to look at what the individual person needs and how they can be met. It is given to the home on admission or before admission. It is from these documents that an individual care plan is developed. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 10 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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care is not planned in an effective or meaningful way. This prevents staff from providing good care. EVIDENCE: All residents have an individual plan of care, based on the admission assessment, which is then added to during the placement. The care plans looked at contained a large amount of information regarding the care of the resident. The section entitled “Support and Care to be provided” did not contain the information necessary to inform staff of how to provide the care. It contained questions about the residents needs, for example suggesting the need to find out the resident’s food preferences, this should be found out and included in this section. There are risk assessments available for the nutrition, wound care, moving and assisting, and continence promotion. Not all of the Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 11 care plans were being regularly reviewed and updated to ensure that they contain up to date and accurate information. The care plans showed that the residents have access to all NHS services and facilities. There was a good range of pressure relieving mattresses in use for the prevention of pressure sores. During the visit the air mattress of a resident was faulty and deflated, a relative and resident said that this was not uncommon and that there had been problems in the past with the speed at which it was dealt with. This mattress was working at the next inspection. There have been problems with the basic care for example residents teeth not being cleaned, glasses put on or hearing aids, a relative said that they felt this had improved since the new manager has arrived. Visiting professionals were concerned about the homes compliance with the advice they had given around the specific care of the residents. The care plans of these residents did not contain the necessary advice or why it had not been followed. They did not feel satisfied with the care being provided. The manager is aware of the issues and is working with the staff to address the problems. The systems for managing medicines in the home were found to be appropriate. The staff record the medicines being ordered, the prescriptions are then checked on receipt from the General Practitioners and are then sent to the Chemist for dispensing. The medicines are then again checked against the records when received into the home so that any errors can be picked up. The home has a contract with a Pharmacist, which included giving advice as necessary. No residents are currently managing their own medication. Recent problems with administration of medication have are being dealt with by the manager however this is a similar situation as was found at the last inspection and suggests that there are ongoing problems with the staff complying with safe medicine procedures. A number of the medication administration records (MAR) sheets had signature gaps and the records did not contain photographs of the resident for safe administration. The manager has planned a programme of auditing the medication systems, which needs to be undertaken to identify the action that needs to be taken. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 12 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities are adequate but need to be developed further to make sure that enough opportunities are available for the residents, particularly when the are more physically frail. The individual residents are well supported to keep in contact with their family and friends and the local community. The food is good for most of the residents but not all are fully supported to make choices when they have specialist dietary needs. EVIDENCE: The residents described the ways they are encouraged to take control of their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. Staff confirmed that they assist residents to make choices about how they spend their day. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 13 Some organised activities are available and staff said that residents are able to choose whether or not they are involved. The home employs an activities coordinator who has a weekly programme of activities offering differing opportunities. This is not sufficiently developed to offer individualised activities for the residents in line with their social assessment. Also due to the dependency level of some of the residents a number of the activities offered need to be less active and provided on a more one to one basis. The records of the activities provided are not detailed, and it is necessary that this be developed further to show the full extent going on in the home. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives are given information within the residents’ guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. During the visit the main course being served was lasagne and chips, there was no alternative to the chips so some residents had only the lasagne. This was tasted and was well cooked. The residents said the enjoyed this and cleared their plates. An example of resident’s comments was one who said, “this is lovely” and “ the food is always nice”. However relative feedback was mixed and there was concern that the specialist diets such at the “soft” choice lacked variety. One resident said that she was dissatisfied with the food and that it could be a bit “hit and miss” The cook has been in post as head cook for a year and it was made a requirement at the last inspection that she be given training for the role, which she is very keen to do. This has now been organised and is due to commence soon. It is necessary for the Head Cook to be given catering training which to ensure she has the skills and competencies to perform her role fully. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good complaints and protection of vulnerable adults policy in place, which is well managed and give s the residents the opportunity to have their concerns dealt with and their safety maintained. EVIDENCE: The complaints procedure is available in the service users guide and a copy is available at the front entrance and is displayed in the home. The records of the complaints were examined. The complaints received since the last inspection have been recorded and the records of these are in place. A number of concerns have been raised during the relative/resident meeting, which the manger has agreed to address as part of her improvement plans. This is recorded in the notes from the meetings. The records of these were detailed including the response to the complainants and any action for improvement taken in response to the issues raised. Residents who were interviewed during the visit understood how to make a complaint, and could identify the way this would be dealt with. Three relatives who were visiting the home were aware of the complaints procedure and had raised concerns with a previous manager. They said that they felt that the new Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 15 manager was aware of the issues and were satisfied for her to be given time to address them. Staff are given protection of vulnerable adults training both as part of the inhouse training package and from outside organisations. The home has written guidance in place regarding the protection of vulnerable adults through detailed policies and procedures. These are included in the induction training and ongoing in-house training. Staff confirmed that they knew about the guidance and could identify the action they would take if they were made aware of or had any concerns regarding this issue. There is an ongoing safeguarding adults investigation. The manager is working with the process. As it has not yet been completed the records of this will be examined once available. The manager has already taken appropriate action to address the some of the issues that have been identified. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 16 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, 20, 24, & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The decoration, carpeting and furnishings in the home are poor although the programme of work being done to address this is making improvements. The staff are aware of the principles to reduce the risk of cross infection and have the equipment they need to do this. EVIDENCE: The home was generally clean and odour free, however this is compromised by the need for an extensive redecoration programme. The manager has commenced the redecoration programme and has identified a number of the communal areas that are in need of re-carpeting, redecoration and replacement of the furniture. On the second visit the lighting in the main Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 17 corridor had been replaced and this was a significant improvement this is planned throughout the home. Bedrooms are personalised and are decorated in line with the wishes and choices of the resident but need to be redecorated and re-carpeted. Four bedrooms were in the process of being redecorated and the manager had arranged for the fitted furniture to be removed. This will allow the room to be set out in the most appropriate way for giving care particularly for those residents who need nursing care and may need specialist equipment. Bathroom areas were tidy and clean. They are in need of redecoration and are on the schedule to be done, some of them have already been completed. There is liquid soap and disposable paper in the on-suites and appropriate waste bins have been purchased so staff are able to dispose of them without leaving the room. Appropriately coloured aprons were available to allow staff to follow control of infection policies, and staff were seen to be using them correctly. Red dissolvable laundry bags are available and staff were therefore not handling soiled linen prior to it being washed. Feedback from the relatives suggested that the bedroom areas are not always deep cleaned to the necessary standard. Although this was not evident on the visits it is recommended that the Manager undertake an audit of the bedroom cleaning to ensure that it is not a problem. The kitchen area was clean and tidy, and there is a cleaning schedule in place to demonstrate the way in which this is being achieved. Changes are being made to this area to make it more practical workspace. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and systems around recruitment, selection and training of staff are adequate to meet the range of needs of the people using the service. The home has a sufficient number of staff employed. EVIDENCE: Staff recruitment and selection records were complete including two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. The interviews are recorded formally in the staff record giving the Manager a record of the full process. The staffing rota’s showed that sufficient numbers of staff are scheduled to work however sickness can result in periods when there are insufficient numbers for some of the time. Four relatives said that they were concerned that there are not enough staff on duty and that there were times when the nurse call buzzers were not being answered within a reasonable time scale. The manager confirmed that she has ensured that the staff are up to date with moving and handling, first aid, and fire training. They also are offered a Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 19 number of other training opportunities including pressure area care; continence training and catheter care training. The staff are encouraged to undertake National Vocational Qualifications (NVQ 2) once they have had their induction training. The records show that the training programme is up to date except for the updates of the fire training, which is usually, provided six monthly for day staff and three monthly for night staff. One of the returned relative questionnaires suggested that there were insufficient staff. The staffing rota does not support this, however it may be the result of individual perceptions of the required staffing levels or the way the staff are delegated. It may also relate to the dependency of the current residents in the home and it is therefore recommended that the Manager undertake an audit into the dependency levels and the impact on staffing requirements. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 20 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent management problems are being dealt with by the new manager who is making improvements, including improving the health and safety practices and staff training. EVIDENCE: The records of the arrangements to ensure that persons working at the care home receive suitable training in fire prevention and by means of fire drills and training in the procedures to be followed in the case of fire were examined and were adequate. However the training for all staff are not up to date. There is Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 21 a system in place to review health and safety in the home involving the staff, for which records are available. During the tour of the premises it was noted that there were no obvious risks and the Manager confirmed that she undertakes daily tours herself to ensure that it remains so. Records were examined of the staff meetings, which take place regularly, and the contents of these suggest that there is a broad spectrum of relevant issues discussed. The Manager also facilitates meetings with the relatives and residents as appropriate, which she is using to consult the residents, relatives and other interested parties to review the service provided. A number of relatives have said that they feel that the new manager is taking time to consult with them and keep them informed of the improvements she has planned and introduced. The personal records kept in the home for residents who are receiving assistance to manage their finances were examined and are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. There is a small float available for the staff to access on behalf of the residents. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 X X X 1 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement Each resident must have an up to date care plan containing sufficient information for the staff on the care to be provided. The home must promote and make proper provision for the health and welfare of the residents. A full audit of the medication must be undertaken and an action plan to address the problems found. The residents must have more opportunities to be involved in varied and individualised social activities, which must be recorded in detail. Outstanding from 01/12/06 All residents must receive an adequate diet according to their choices and needs. The cook must be provided with training to give her the skills and competencies to fully fulfil her DS0000028819.V338131.R01.S.doc Timescale for action 01/12/07 2. OP8 12 (1) 01/12/07 3. OP9 13 (2) 01/12/07 4. OP12 16 (2) (m) (n) 01/12/07 5. OP15 16 01/12/07 6. OP15 18 01/03/08 Rosemount Version 5.2 Page 24 role. Outstanding from 01/03/07 7. OP19 23 (2) The home must undertake a programme of redecoration, recarpeting and re-placement of furniture in the communal areas and bathrooms. The home must undertake a programme of redecoration, recarpeting and replacement of furniture in the bedrooms. The Manager must review the numbers to ensure there are sufficient staff with the skill mix for the numbers and dependency levels of the residents. The home must ensure that the staff working in the home have the skills and experience necessary for the work they do. The home must submit an application to register a manager with Commission for Social Care Inspection. 01/03/08 8. OP24 23 (2) 01/03/08 9. OP27 19 01/12/07 10. OP30 19 01/12/07 11. OP31 8 01/01/08 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. Refer to Standard OP26 Good Practice Recommendations It is recommended the Manager introduce an audit of the bedroom cleaning to ensure the standard is not being allowed to fall. Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Rosemount DS0000028819.V338131.R01.S.doc Version 5.2 Page 26 - 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!