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Inspection on 26/09/08 for Rosset Holt Home

Also see our care home review for Rosset Holt Home for more information

This inspection was carried out on 26th September 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 3 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

Residents say they are well looked after by staff who are kind and caring. Residents physical and mental health needs are well met with access to health professionals. Residents like living in a house that has plenty of communal space, lovely gardens, where they have rooms they can personalise and which they know will be kept clean. Residents who move into the home to follow Christian principles value being able to do so. There is an open and friendly atmosphere with good interaction between residents, staff and visitors. Residents know there are people who they can talk to about any concerns, who will listen and who will take action to improve the situation.

What has improved since the last inspection?

There is an ongoing programme of redecoration and refurbishment. A new assisted bath is being installed. Staff training needs have been assessed.

What the care home could do better:

Staffing levels must be reviewed to ensure they are appropriate to the needs of the residents at all times. Risk assessments must be more comprehensive in scope and content to help safeguard residents. Some residents would like more organised activities available for them to participate in, should they so wish. Freestanding toilet frames must be made secure to better protect residents from falling. The driveway surface should be made good so as to be safer for people to use. The staff rosters should show a designated person in charge at times when the Manager and Deputy Manager are not present to give clearer lines of accountability. The staff application forms need to be updated to comply with current employment legislation and facilitate the recording of a full employment history as required by Regulations.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosset Holt Home Pembury Road Tunbridge Wells Kent TN2 3RB     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: Gary Bartlett     Date: 2 6 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Rosset Holt Home Pembury Road Tunbridge Wells Kent TN2 3RB 01892526077 01892526077 marilynl@keychange.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Marilyn Rose Luck Type of registration: Number of places registered: Keychange Charity care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home According to its website www.keychange.org.uk Keychange Charity (formerly known as Christian Alliance) operates in two distinct areas of social need: providing homes for frail older people and supported accommodation for young and vulnerable homeless people. The website states that all its centres are run on Christian principles. The business has some 9 residential homes in England. Rosset Holt has bedroom accommodation on ground and first floors. Residents have the benefit of a passenger lift. Bedrooms are single occupancy but accommodation could be provided for people who wish to share a bedroom. Some rooms have en-suite facilities. Weekly fees are from #430-#450. Additional charges are made for hairdressing, chiropody, newspapers, personal telephone charges and personal spending. 0 Over 65 18 Care Homes for Older People Page 4 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 unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Rosset Holt from 9.00 a.m. until 3.30 pm. Judgements about quality of life and choices were taken from direct observation and by discussion with the residents, staff, a community nurse and visitors. Some records and parts of the building and grounds were inspected. Prior to the inspection, the Commission received completed surveys from some residents and staff. These indicate satisfaction with the service. The Manager had completed an Annual Quality Assurance Assessment, from which information was used to inform the inspection process. Care Homes for Older People Page 5 of 27 The Deputy Manager and staff gave assistance throughout the inspection. Feedback was given to the Manager on 29th September 2008 as she had not been at the home at the time of inspection. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as service users. People living at Rosset Holt prefer to be referred to as residents. Accordingly this shall be done in the text of this report. The Inspector would like to thank everyone involved for their contribution to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Staffing levels must be reviewed to ensure they are appropriate to the needs of the residents at all times. Risk assessments must be more comprehensive in scope and content to help safeguard residents. Some residents would like more organised activities available for them to participate in, should they so wish. Freestanding toilet frames must be made secure to better protect residents from falling. The driveway surface should be made good so as to be safer for people to use. The staff rosters should show a designated person in charge at times when the Manager and Deputy Manager are not present to give clearer lines of accountability. The staff application forms need to be updated to comply with current employment legislation and facilitate the recording of a full employment history as required by Regulations. Care Homes for Older People Page 7 of 27 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. Residents can be confident that they are appropriately placed due to good pre admission assessments and benefit from being able to visit the home prior to admission. Evidence: The Assistant Manager described how a pre-admission assessment is made of each prospective resident to ensure the home can meet his or her needs. If practical, a member of the senior team visits the prospective resident in their home or hospital to ensure the necessary information is current and accurate. Records show that prospective residents, their families, advocates, and relevant health care professionals are involved in the assessment process. Specialist advice is sought from external sources where required. Residents say they or their families had been able to visit Rosset Holt before moving Care Homes for Older People Page 10 of 27 Evidence: in. A resident’s friend who was visiting confirmed this and said staff are very helpful in assisting new residents to settle in. Rosset Holt does not provide intermediate care. 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. Residents’ care and health needs are well met in a dignified and appropriate manner. An improvement to care plan records would better evidence how they are met. Evidence: The judgment for this outcome group has taken into account the quality of life for all the residents. The judgement also includes assessment of the level of knowledge and understanding displayed by staff when providing both personal and health care. Comments made by residents, observation during the day of the site visit and as recorded in the previous inspection report indicates the standard of care provided is good. Residents say that staff are fully aware of their needs, particularly their keyworkers with whom they feel they have a ‘special’ relationship. Staff are aware of far more information than is recorded in care plans. A lot of information is shared at handover. The Standex care plans are adequate and are accessible to staff. Some detail of individual needs is given including personal preferences. Staff record daily summaries Care Homes for Older People Page 12 of 27 Evidence: of care which are generally detailed and informative. Care plans are not always updated to show changes in residents health as promptly as they should be. The care plans contain some risk assessments. The Manager is aware they are limited in scope and content. For example, whether a resident’s medication makes it safe for them to drink alcohol. The care plan of a resident who had recently become dependant on the use of a lifting hoist does not contain any risk assessments in respect of this. Staff spoken with generally have a good understanding of getting a balance between perceived risks and promoting independence. There have been improvements to the risk assessments, but as with the care plans, some further work is required for them to more fully encompass activities undertaken by residents. Overall, residents consider they have their health needs well met. References were made to visits by the chiropodist, community nurses and of good relationships with local general practitioners. Entitlement to NHS services are upheld and advice given when private funds might be needed. The Manager, Assistant Manager and senior carers are responsible for medication. The Manager and Assistant Manager have recently undertaken advanced training in medication and this is being arranged for senior carers. Standards of storage of medicines is good. When medicines arrive from the pharmacist, they must be stored securely without delay to safeguard residents. The Deputy Manager undertook to address this without delay, which negated the need to issue an Immediate Requirement Notice. The Deputy Manager also agreed to see that that hand written entries on the Medication Record Administration Record (MAR) sheets are double signed to help ensure accuracy. Medicines were seen to be given in accordance with good practice guidelines. Residents feel that staff are kind and gentle, this was confirmed by observation and discussion with visitors. Staff are considerate of the age and dignity of residents and treat them with courtesy. The home aims to care for people until the last stage of life. Christian support is offered where the resident wishes. Last wishes are identified and recorded in a compassionate way. Relatives and friends can be with the resident if the resident so desires. Care Homes for Older People Page 13 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. The relaxed and enjoyable lifestyles that residents lead would be enhanced if there were more organised activities available for them to participate in should they so choose. Evidence: Many residents lead active and reflective lives. They have access to newspapers, books and other media. Bible studies and prayer meetings take place regularly which residents may choose to attend. Occasional outings are arranged which residents enjoy. A notice board in the entrance hall includes details of forthcoming activities. It is clear from discussions with residents that some would like there to be more organised activities available for them to participate in. The home does not employ an activities co ordinator, a volunteer attends one afternoon each week and staff give assistance when they have the time. Family and friends feel welcome and know they can visit at any reasonable time. During the inspection a number of visitors were seen in the home and the visitors book records regular visits by families, friends and others. The design of the Rosset Holt provides seating areas within the communal areas where residents can entertain their Care Homes for Older People Page 14 of 27 Evidence: visitors, in addition to the privacy of their own room. Residents are encouraged to personalise their rooms with their own possessions if they wish. Most residents have brought items of furniture and plenty of personal effects with them. As rooms are differently shaped and sized this leads to very individual environments. Residents said they like the food and think it is well cooked and well presented. There is a planned menu which routinely offers two choices of main meal for lunch. One of the alternatives is a salad, which residents say they enjoy. The meals are generous in portions and look appetising. Mealtimes are relaxed, staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Hot and cold drinks are available through out the day. Care Homes for Older People Page 15 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. Residents and their relatives know their complaints are listened to and acted on. There are systems to protect residents from abuse. Evidence: The complaints procedure is readily available to residents and their relatives. They say they feel confident they are listened to and any necessary action is taken. One resident said that if she has a worry it is always quickly resolved. The home keeps a record is of all complaints received by them, the result of the investigation and how the complaint has been resolved. The Commission has not received any complaints about the home since the last inspection. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with have a sound understanding of adult protection procedures. The Manager stated any allegation of abuse would be referred to the concerned agencies without delay. There have not been any safeguarding alerts in since the last inspection. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a homely, clean and comfortable environment in which to live. Evidence: Rosset Holt is a large detached house, located near the centre of Tunbridge Wells. The home has large private grounds which can be used by residents. The home is commendably clean and free from offensive odours. The driveway surface is worn and should be resurfaced so as to be safer for people to use. Residents’ bedrooms are bright and airy, warm and comfortable. The design of the house allows for a variety of shapes and sizes of rooms giving the possibility of two being used for shared occupancy on request, such as for married couples. Bedrooms are generally personalised and have plenty of space to display personal possessions, store clothing, sit and relax and have a comfortable bed. Comfortable communal areas are provided for residents. There is a large lounge with plenty of seating and a dining room. There is a designated hairdressing room. Staff have their own good sized staff room. Residents can gain access to the upper floors by passenger lift. A staff call system is available with calls being answered promptly at the time of the inspection. One Care Homes for Older People Page 17 of 27 Evidence: resident is dependant on two staff using a lifting hoist to mobilise. The Manager agreed to arrange for an Occupational Therapist to visit the home and assess whether the correct type of hoist and slings are being used. An assisted bath is currently being installed. Residents say the toilet facilities are adequate. A support frame around a toilet is not secured, posing a potential hazard for residents. The Manager undertook to have this secured as soon as possible. Residents are protected from the risks of burns or scalds by radiator covers and thermostatically controlled hot water outlets. There is a designated laundry that is suitably equipped with systems in place to reduce the risks of cross infection. The sluicing facilities are also clean and well maintained. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are in the care of people who are hardworking and enthusiastic. Residents care needs have changed and staffing levels must be reviewed to take account of this. Evidence: Resident’s and their relatives speak highly of the staff and of the care given. People applying to work at the home have to complete an application form, attend an interview, provide references and satisfactory POVA and CRB checks. The files of the most recently recruited staff show that appropriate checks are made prior to them commencing duties. The Manager was advised that the staff application form should be updated to comply with current employment legislation and facilitate the recording of a full employment history as required by Regulations. New staff are required to undertake an induction programme. There was some discussion that the progress of staff in completing the induction needs to be more closely monitored so the Manager can be sure that new staff have learnt the homes policies and procedures. The Manager said a training analysis of each staff member has been recently Care Homes for Older People Page 19 of 27 Evidence: undertaken by Skills for Care. She is now arranging training courses based on the analysis and is in the process of updating a training matrix to give a management overview of courses attended and those booked. From discussion with residents, it is clear some of them think the home needs more staff at times. Residents say they sometimes have to wait for assistance and staff do not have as much time as they used to. The staff roster shows there are generally three staff on duty during waking hours but only two staff on Sunday evenings from 4.00 pm until 8.00 pm. This may not be sufficient as residents have become more physically frail and require increased help. Consideration must also be given to dealing with emergencies. Accordingly, it is a requirement that the staffing numbers must be reviewed to ensure they are adequate to meet the needs of the residents and maintain their safety at all times. It is recommended the staff rosters show a designated person in charge at times when the Manager and Deputy Manager are not present to give lines of accountability. The staff roster should also include the hours being worked by the Manager and the Deputy Manager rather than these being recorded separately in the home diary. Care Homes for Older People Page 20 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 run in the best interests of residents and there is an open and friendly atmosphere. Evidence: The Manager has been working at Rosset Holt for a number of years and has obtained the Registered Managers Award. She is well supported by a Deputy Manager who demonstrates a good understanding of the needs of the residents and a commitment to high quality service. The atmosphere is relaxed and friendly and staff and residents find the Manager approachable. The home has some quality assurance processes including resident and relative surveys. The Manager said it is intended to include health care professionals and Care Managers in future surveys. Residents meetings are held every six months. Care Homes for Older People Page 21 of 27 Evidence: The Manager described how there has not been regular staff supervision in the last few months, but this is now being implemented. This is necessary to ensure that the objectives of the home are being met. Residents manage their own financial affairs or have assistance from their family or representative. Additional charges are carefully recorded and residents are provided with detailed records of all additional payments requested from them. The standard of cleanliness in the kitchen and surrounding area is good. Food items are not always being dated when opened as required by food hygiene regulations. The Deputy Manager said this would be done with immediate effect. There are records of fire systems checks and fire drills and training. Staff spoken with have a good understanding of emergency procedures. The Manager said First Aid training is organised for staff who need updating. The Manager stated that records of maintenance and safety checks are in order. These were not inspected on this occasion. Care Homes for Older People Page 22 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 23 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 7 13 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Risk assessments must be more comprehensive and recorded in response to incidents and changes in residents welfare. Comprehensive risk assessments must be in place by the given timescale, if not sooner, and maintained thereafter. 26/12/2008 2 22 13 The registered person shall 14/11/2008 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Freestanding support frames around toilets must be Care Homes for Older People Page 24 of 27 secured. To be completed by the given timescale, if not sooner and maintained thereafter. 3 27 18 The registered person shall, 14/11/2008 having regard to the size of the care home, the statement of purpose and numbers and needs of service users (a)ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate to the health and welfare of service users. A review of staff levels must be undertaken to ensure they are appropriate to the needs of the service users at the home at all times. The result of this review and its methodology must be received by CSCI by the given timescale if not sooner. 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 12 It is recommended more organised activities are made available to residents to participate in, should they wish to do so. It is recommended the driveway surface is made good so as to be safer for people to use. It is recommended the staff rosters show a designated person in charge at times when the Manager and Deputy Manager are not present. 2 3 19 27 Care Homes for Older People Page 25 of 27 4 29 It is strongly recommended the staff application form is updated to comply with current employment legislation and facilitate the recording of a full employment history as required by Regulations. 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!