Inspection on 12/03/07 for Russett House

This inspection was carried out on 12th March 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Russett House 07/03/05

Russett House 03/12/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Russett House 52B Southway Drive Yeovil Somerset BA21 3ED Lead Inspector Lesley Jones Unannounced Inspection 12th February 2007 09:30 Russett House DS0000030884.V334722.R01.S.doc Version 5.2 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 Russett House DS0000030884.V334722.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 Adults 18-65. 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. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russett House Address 52B Southway Drive Yeovil Somerset BA21 3ED 01935 426969 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) njrickwood@somerset.gov.uk Somerset County Council (LD Services) Janet Ferguson Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To provide a service to people whom, in addition to their learning disability, have an associated physical disability. To provide a service for people with PMLD (profound multiple learning disabilities). 7th December 2005 (The Maples) Date of last inspection Brief Description of the Service: Russett House provides residential care and support to up to ten service users with profound, multiple, learning disabilities. It is a Local Authority home. Ms Janet Ferguson is the registered manager of Russett House. At the time of this inspection the manager Mrs Sandra Harvey, residents and staff from The Maples in Castle Cary occupied Russett House. This is a temporary arrangement whilst The Maples is enlarged and upgraded. The Maples moved into Russett House in October 2006, it is anticipated that they will return to The Maples in Castle Cary In June 2007. Both managers are working together to run the home. There are currently eleven service users. These consist of the original seven residents from The Maples. Two residents who will become permanent residents at Russett house, and two residents who currently use Russett House alternatively for respite care while their suitability to become permanent residents is assessed. Major building work has taken place at Russett House to upgrade the building and combine two previously registered homes on the same site (Hardy House and Elliot House) as one. Accommodation consists of ten single bedrooms, five with overhead tracking, and five with en suite facilities( not all rooms have en suite facilities) two lounges, two assisted baths, two wet rooms, a laundry , a staff/visitors room and a kitchen. Outside there is a garden to the back of the house and a patio. There is a car park with a gate leading to the facilities of the main street. A one bedroom self-contained flat is attached to Russett House. This is to provide supported accommodation to someone with a learning disability but with good independence skills. The flat was not occupied at the time of this Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 5 inspection and is not part of the home’s registration. The person who moves in will receive support from a domiciliary care agency. Two staff provide waking night cover and may be called on to provide support in other homes in the network in an emergency . Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 12th February 2007 over a period of six hours. To carry out this inspection, I had discussions with the manager, and staff on duty. I looked at a selection of records, inspected the premises, and looked at the management of medication. As it is not possible to directly seek the views of the residents, I spent time with them in the lounge and observed their interaction with each other, the environment and with staff. All these things helped me form a view of their quality of life. Not all the standards were inspected on this occasion, but there was sufficient evidence to confirm that the majority of the National Minimum standards had been met and that the quality of care provided was good. Service users appeared content, well dressed and cared for, and appropriately occupied. Staff interaction with service users was thoughtful, kind and patient, and demonstrated that they knew them very well. The inspector would like to thank the Registered Manager and staff group for their help and cooperation during this inspection. What the service does well: The home benefits from a qualified, experienced and enthusiastic manager and a stable and skilled staff team. Russett House offers a high quality service for people with profound learning disabilities. It provides a homely, yet professional environment. Staff know residents well and are fond of them. All are treated with dignity and respect and as individuals. Good links are maintained with relatives. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Areas in need of attention are as follows:No evidence was available to demonstrate that the two respite clients were being assessed regarding their suitability as permanent residents in the home. To meet both the National Minimum Standards and the Regulations, this must be addressed. A storage facility for controlled drugs must be provided. It is recommended that current practice for recording the management of complaints and concerns be reviewed to reflect in greater detail, action taken by managers. This should include a written response to complainants. The use of a multi disciplinary consent from is recommended when any form of restraint with residents is used (for example cot sides). This form should include the views of social workers and parents or carers, and be subject to regular review. Current practice of male staff routinely providing personal care for female residents should be reviewed in keeping with best practice. The manager must ensure that there is always a female member of staff on waking night duty. Please contact the provider for advice of actions taken in response to this Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 8 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. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. 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. Good systems are in place to ensure that thorough assessments take place before any offer of a place is made. EVIDENCE: The Maples (at Castle Cary) was full and no service users have been admitted since the last inspection. The service user most recently admitted had undergone a full assessment. Introductory visits had taken place and staff from both homes, had worked together, to ensure that The Maples could meet the needs of the new person. Relevant specialist professional input was also involved in the process to advise on the necessary equipment, and care routines and requirements. There was evidence to show that the two residents who will remain permanently at Russett house had been assessed. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 11 No evidence was available to demonstrate that the two respite clients were being assessed regarding their suitability as permanent residents in the home. To meet both the National Minimum Standards and the Regulations, this must be addressed. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a comprehensive care and support plan, that is based on the assessed needs of each person and the community care plan. There is good evidence to show that residents are involved in making decisions about their daily life to the extent of their abilities. Risk assessments are completed and regularly reviewed to ensure that residents are able to live as independent a life as possible. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care and support plans are discussed at team meetings and updated accordingly. The service user’s social worker is involved in reviewing the plan at annual intervals, with the involvement of all relevant others encouraged. A sample of care plans inspected evidenced reviews, input and signatures from social workers. Staff aim to involve service users in their plan, at the level that the service users can understand, using the communication techniques best understood by the service user. The input of relatives or advocates is encouraged. Because of profound disabilities, service users cannot manage their own finances but are assisted to participate to the level that they can. Service user’s cash and record of transactions are kept in a lockable tin within the lockable space in each of the service user’s room. Some residents are taken shopping for their own clothes, to do their banking, paying bills and for purchasing small items of shopping for the home. The service users’ financial records undergo a periodic audit by the Local Authority Performance Review Team. All service users have risk assessments and risk management strategies. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager seeks opportunities for service users that are appropriate, beneficial, that service users enjoy and that are in agreement with their care and support plans. Presence in the community is supported through using local facilities for walks, shopping, banking, visiting local pubs and cafes in Yeovil and other neighbouring towns. Menus show a good range of well-balanced dishes. Alternative options are available, and snacks and drinks are readily available. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 15 EVIDENCE: A record of individual activities planned for each resident shows a range of imaginative options provided and staff records evidenced a great deal of enthusiasm in providing good quality experiences for service users. Staff keep a “my days” chart for each person that shows the activity options available each day, those that each service user had chosen to participate in residents daily care, and notes and messages. Family links and friendships are welcomed and nurtured One service regularly spends the weekend with his family. Less than half of the service users had involved relatives. They all have a social worker. Service users have opportunities to meet neighbours and local people. Three main meals follow a rotating menu. Menus are not set in stone and will vary as appropriate. The actual meal served is recorded in the daily diary. Beverages and snacks are available in between main meals, and there is great sensitivity in ensuring that all have enough to eat and drink. The breakfast meal is varied and includes, continental style and various cooked options on some of the days. The main cooked meal of the day is usually the evening meal. Meals are adapted to service users needs and activities. Meals are also taken at pubs, cafes or restaurants when out. There is a pleasant dining room where service users eat, as well as seating in the kitchen. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users dress and are groomed according to age, personal style, peer fashions, and preference. The record show that great care is taken of residents emotional and physical needs. The management of medication in the home is good. EVIDENCE: Residents look well dressed and groomed. It was evident that staff take great care to ensure that all are treated as individuals. There are sixteen care staff in the home, the majority of whom are women. Male staff care for male service users as much as possible. Current practice of male staff routinely providing personal care for female residents should be reviewed in keeping with best practice. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 17 The manager must ensure that there is always a female member of staff on waking night duty. Service users have mobility and sensory aids, according to their individual needs. The accidents and incidents record was inspected and found to be in good order. Care records evidenced monitoring posture and weight. Service users position was changed at agreed intervals, changing from wheelchair to lying flat on mattress and during activities such as swimming. Equipment such as ripple mattress, pressure relief cushions and orthopaedic shoes are provided, with professional involvement, to optimise posture and for the prevention of pressure sores. Service users’ accessed annual health checks and their consultants met specialist health needs. Medication is stored in each service user’s bedroom in the lockable drawer provided. The home has not yet obtained a lockable space suitable for controlled drugs. This must be addressed. Controlled drugs are used very occasionally (for example before any medical procedure such as taking a blood sample is carried out) and are only stored overnight at most in the home. The MAR sheets and returns documentation were found in good order. The pharmacist does not visit Russett House and it is a recommendation of this report that this is implemented. All staff are involved with medication. Staff follow County and in house procedures and the home’s medication’s policy. Staff have received training from Boots the chemist on the management and administration of medication. The manager formally reviews staff competency on a yearly basis and informally through observation. Staff continue to perform clinical procedures occasionally, as required for such problems as epilepsy and constipation. Training to update their skills in ongoing. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users views are listened to and acted on . Service users are protected from abuse. EVIDENCE: There is a local authority complaints procedure, which is also available in total communication. A record is kept of complaints. It is recommended that current practice for recording the management of complaints and concerns is reviewed to reflect in greater detail, action taken in response to issues raised. This should include a written response to complainants. There is a whistle blowing procedure and staff have access to the ‘raising concerns leaflet’. A County finance officer carries out monthly financial checks. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 19 The home follows the Local Authority policy for the protection of vulnerable adults. All staff are subject to enhanced police and POVA(protection of vulnerable adults) checks. Specialist training is provided to staff as evidenced by the training record and by the staff during the inspection. New Staff have participated in central induction, statutory training, physical intervention and minibus driving training. They also receive good training of the theory and practice of whistle blowing and issues of protection of vulnerable people. The management of service users’ money and finances is audited. The network manager also audits the systems and operations in the home. The service users’ social worker, and other professionals from the multidisciplinary team are consulted and involved. Service users have lockable space in their bedrooms. Personal care and private consultations take place in private. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. 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. Service users live in a homely, comfortable and safe environment. The home is clean and hygienic. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home is well maintained and even though most residents are at Russett House temporarily, the staff have supported them to personalise their private space very nicely. The home is well decorated and has furniture and furnishings of a good quality. Staff make every effort to make the environment as domestic as they can. Homely touches have been included in WCs and the bathrooms, which have specialist equipment. Plans are in hand to improve the permanent home for seven of the residents at The Maples to take into account the requirements of the Care Standards. The home’s kitchen is in good order. The home was clean throughout. Bathrooms, WCs, the laundry room and kitchen were clean. There was liquid soap, paper towels and lidded bins. There were arrangements for the appropriate disposal and removal of clinical waste. There is ongoing training on infection control, which most staff have attended. There is a rolling programme of statutory training. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained, work together cohesively as a team and have supportive and approachable managers. EVIDENCE: Staff receive induction and foundation training during the probation period. The speech and language therapist teaches specialist communication skills to staff as required. Staff have sessions with the physiotherapist. Profound, multiple, learning disability, Intensive interaction and eating and feeding training had been accessed by most of the staff- according to the training record seen. Statutory health and safety training was documented in the training chart, i.e. first aid , Appointed Persons and safe Manual Handling training. Staff have now attended training in infection control. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 23 Staff files checked showed that appropriate checks had been carried out and correct procedures followed. Staff spoken to were very positive about their work. They confirmed that their managers were approachable and supportive, and that staff worked well as team. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a safe and well managed environment. EVIDENCE: Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 25 Care and support records, and staff, evidenced a commitment to communicate with service users to find out their preferences. Total communication formats were used to involve service users. Staff have frequent contact with the service users’ social worker and with involved relatives to inform them, discuss issues and receive feedback. The network manager audits the home when visiting and measures performance against set objectives for the home and the service. The fire logbook evidenced weekly safety checks. All staff had received fire instruction. The home’s minibus is on a maintenance contract as are all hoists and mobile equipment. Hot water outlets had fail-safe valves. Water temperatures were recorded at monthly intervals. An accident and incident record was maintained. Pat testing had been carried out at the required intervals. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 2 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 2 x 3 x 3 x x 3 x Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 27 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 YA3 Regulation 14(1) Requirement The registered person shall not provide accommodation to a service user at the care home unless the needs of the service user have been assessed. In this respect, no evidence was available to demonstrate that the two respite clients were being assessed regarding their suitability as permanent residents in the home. To meet both the National Minimum Standards and the Regulations, this must be addressed. Timescale for action 01/06/07 2 YA20 13(2) The registered person shall make 01/06/07 arrangements for the recording, handling, safe administration and disposal of medicines in the care home. In this respect, the home has not yet obtained a lockable space suitable for controlled drugs. This must be addressed. Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 28 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 YA18 Refer to Standard Good Practice Recommendations Current practice of male staff routinely providing personal care for female residents should be reviewed in keeping with best practice. The manager must ensure that there is always a female member of staff on waking night duty. 2 YA20 The pharmacist does not visit Russett House and it is a recommendation of this report that this is implemented. It is recommended that current practice for recording the management of complaints and concerns be reviewed to reflect in greater detail, action taken in response to issues raised. This should include a written response to complainants. 3 YA22 Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Registration Team Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Russett House DS0000030884.V334722.R01.S.doc Version 5.2 Page 30 - 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!