Inspection on 30/09/05 for Seahorses

This inspection was carried out on 30th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Seahorses 23/10/07

Seahorses 12/02/07

Seahorses 18/05/05

Seahorses 12/10/04

Seahorses 25/05/04

Seahorses 10/03/04

Seahorses 26/11/03

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

CARE HOMES FOR OLDER PEOPLE Seahorses 73 Draycott Road Chiseldon Swindon Wiltshire SN4 0LT Lead Inspector Bernard McDonald Unannounced 30 September 2005 th 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 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. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Seahorses Address 73 Draycott Road Chiseldon Swindon Wiltshire SN4 0LT 01793 740109 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Peter Coleman Mrs Shirley Cole Care Home 15 15 Category(ies) of DE(E) Dementia - over 65 registration, with number of places Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 15 service users with DE/E at any one time. Date of last inspection 18th May 2005 Brief Description of the Service: Seahorses is a private 15 bed home that provides care and accomodation for men and women aged over 65 years who have dementia. The home is situated on the outskirts of Swindon in the village of Chiseldon. Close by is Junction 15 of the M4.The accommodation is mainly on the ground floor with two bedrooms on the first floor. It consists of 2 shared rooms and 11 single rooms. The homeowner takes a keen and personal interest in the running of the home and resides on the premises most of the time. The homes manager has the day to management responsibility of the service. Support staff give the personal care and provide for the welfare needs of the service users. Their duties also include cooking, cleaning and administration as part of their job role. The home provides a garden with flat level access. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over seven hours. This was the second inspection of the home since the unannounced inspection completed in May 2005. The additional visit was due the home failing to notify the Commission of incidents that affect the welfare of service users. A requirement was made that the home must provide copies of all incidents required by Regulation 37 of the Care Homes Regulations 2001. The home met this requirement within the given timescale. The inspector met with all service users at the home and had opportunity to speak with them in private. However the inspector was unable to communicate effectively with all service users to obtain their views on the care they receive. The inspector did meet with the relatives of two service users who were visiting the home on the day of the inspection. The inspector viewed all communal living areas and the majority of service users bedrooms. In addition the care plans of four service users were examined. The inspector had opportunity to meet with four care staff in private and examine the recruitment records of two members of the care team. The registered owner and the manager were available to assist with the inspection. What the service does well: The admission of service users to the home is being well managed and sufficient information is obtained to ensure the needs of service users can be safely met. Care plans are developed from the initial assessment and records showed that one service users health had improved since moving to the home. The home has an enthusiastic staff team that are confident in their ability to meet the needs of service users. The inspector found service users that could communicate and express their views on the care they receive were happy living at the home. One service user said staff were “good” and another service user said “staff helped them” with their care. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 6 The inspector spoke with the relatives of two service users who said they were happy with the care provided to their relatives and that staff were “helpful” and they “respond quickly” to the needs of service users. What has improved since the last inspection? What they could do better: This inspection has identified seven requirements and four recommendations from the standards that were inspected. While the inspection found service users care plans covered areas of health and personal needs, they were lacking in substance on how staff should support service users whose needs may be challenging. Although behaviours were identified, the home has not provided sufficient information to enable staff to develop a consistent and safe approach for managing the challenges that can be presented by service users. This is further mirrored in the risk strategy adopted at home. Although the inspector found risks had been identified, the home had not developed a risk assessment that staff could follow to reduce the identified risk to service users. The home needs to improve the recruitment practices and ensure records that are required by regulation are available in the home. The home needs to ensure any gaps in employment history are fully explored to ensure a robust approach to safe recruitment practices. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 7 The inspector found that although activities were being provided at the home there was no evidence to demonstrate whether service users have participated, or whether the activities provided reflect service users interests and hobbies. While the inspector has noted the home has made a number of significant improvements to the standard of accommodation it is unfortunate that the first impression of the home is the odour at the front door and a stained carpet that would clearly benefit from being thoroughly cleaned or replaced. The manager is aware of the need to take action regarding this matter. The home needs to develop sufficient safe guards to ensure the health and welfare of service users are being protected. In particular hot water temperatures need to be monitored and window restrictor that are in place for the safety of service users must be immediately repaired when they are broken. 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. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4. The homes admission procedure ensures a full assessment of need is received prior to admission to ensure they are able to safely meet the needs of the service users being referred. EVIDENCE: One service user has been admitted since the last inspection. Examination of records demonstrated a comprehensive community care assessment prior to the admission of the service user to the home. The assessment identified a need for residential care. To ensure the home could fully meet the needs of the service user the manager visited the service user in hospital to complete the resident application / assessment. This ensures the home is aware of the needs of the service user and that they are able to meet their needs at the home. A care plan had been developed based on the initial assessment, which had been updated following the monthly review with the placing authority. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 10 It was noted in the review that the physical and mental health of the service user had improved since they had moved to the home. This would indicate that the home is currently meeting the needs of the service user. Discussion with care staff confirmed they had received training in dementia care and were confident of their abilities to meet the needs of service users at the home. The manager advised all service users are offered a months trial placement before a decision is made to make the move permanent. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 10, 11. Service users care plans set out how the home should meet their health and personal care needs but they do not provide sufficient information on interventions required by staff to meet the needs of service users whose needs are challenging. Risk assessment need to be further developed to ensure the safety of service users. Medication is being safely managed and service users dignity is respected. EVIDENCE: The inspector examined the care plans of four service users. The care plans were detailed and provided information on the needs, goals and interventions required of staff to meet their personal care needs. However where service users behaviours may become challenging or aggressive, the interventions required of staff were rather vague and did not give staff clear directions to ensure the safety of others living and working at the home. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 12 This was further evidenced during the inspection when two service users who have been aggressive towards each other were left alone in a situation that had already been documented could trigger an aggressive outbursts. This was discussed with the manager and registered provider and although some information was available in the care plan there was a need to take it one step further to ensure staff are clear on what may trigger the behaviour and what intervention is required. This should also be underpinned by risk assessments that are clear and follow the five principles to safe risk assessments. To ensure staff are fully aware of any risk associated with the care of service users, staff should demonstrate they have both read and understand and the risk assessments held in the home. As part of the service user care plan the home had completed a pro forma risk assessment chart that identifies where service users may be at risk. However the home had not completed a comprehensive risk assessment to demonstrate what steps have been taken to ensure the homes safely meets the needs of service users. The inspector met and spoke with the majority of service users at the home and the relatives of two service users. Where the inspector was able to communicate with the service users they were complimentary about the care provided at the home. One service user stated, “staff were nice”. This was also confirmed by the relatives of one service user who confirmed, “nothing was to much trouble for staff “and “they were always around”. Discussion with staff confirmed service users receive their mail unopened and where necessary are assisted to understand the contents. Staff were observed knocking on bedroom doors before entering and assisting service users with sensitivity and respect. Service users preferred form of address is recorded in the care plan. Examination of medication records demonstrated the home was accurately recording medication received at the home and administered to service users. The medication records contained detailed information on the side effects of medication. All medication is held secure. Service users care plans provide details on their wishes to be followed regarding death and dying. Discussion with staff confirmed the home is open 24 hours a day when service users are terminally ill. Families are able to stay at the home as long as they wish and sleeping facilities are available if necessary. The manager confirmed the home would support any service users to remain at the home as long as they could safely meet their needs. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15. The home is making an attempt to provide service users with opportunities to become involved in recreational and social activities but is failing to obtain their views as to whether these fully reflect their wishes and participation. The home is providing a healthy diet. EVIDENCE: Service users personal preferences are recorded in the care plan. This includes religious preferences and times for getting up and going to bed. Discussion with staff confirmed activities are provided at the home and that they try to encourage service users to take part. A weekly activities timetable is on display. Outside entertainment is also a regular feature at the home. While there was evidence to demonstrate activities are on offer at the home there was no evidence to demonstrate the activities reflected service users wishes, likes, interests or involvement in these activities. It is recommended these are obtained and recorded. The main meal of the day is provided at lunchtime. Discussion with one service user confirmed meals provided were “good”. Service users have a choice of where to eat their meal either in the dining room or at a small table in a comfortable chair in the lounge. The inspector observed staff assisting service Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 14 users with their meals in a discreet and sensitive manner that ensured service users were made aware of the meal they were eating. A requirement was made at the last inspection that the home must have sufficient stocks of food for the planned meal of the day. The inspector found the meal provided was reflected on the menu for the day and that there were ample food stocks at the home. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18. Procedures are in place to ensure service users are listened to and every effort has been made to ensure they are protected from abuse. EVIDENCE: The homes complaints procedure was on display at the entrance to the home and a copy is also included in the homes statement of purpose. The complaints procedure needs to be further expanded to include the timescale for responding to any complaint made. The outstanding complaint from the previous inspection has now been investigated and was not upheld. Discussion with staff demonstrated an awareness of what action they would take to report any concerns regarding the welfare of service users including contacting the CSCI. As part of the induction process staff are provided with a “recognition and prevention of abuse” pack. The pack includes categories and key indicators of abuse. The inspector was informed that all but one member of staff has completed abuse awareness training and copies of Wiltshire and Swindon “no secrets” guidance was available at the home. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26. The improvement to the furnishings and décor of the home has ensured service users live in a safe, comfortable and well maintained home. EVIDENCE: The manager confirmed the home has now completed the replacement of all the chairs in the communal lounge. In addition the dining room furniture has been replaced and two-service users bedrooms decorated. The manager confirmed there are plans to decorate the dining room over the coming month. The home is situated on two floors with service users accommodation divided on the two levels. The inspector viewed all communal living areas, bathrooms and the majority of service users bedrooms. The inspector found a good standard of accommodation was being provided. The inspector did note an unpleasant odour at the entrance to the home, which was brought to the attention of the manager. In addition the hallway carpet and corridor carpet would benefit from being replaced. It is unfortunate that these deficiencies were found at the entrance to the home as it gives a false Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 17 impression of the overall standard of accommodation being provided. No odour was found in any other part of the building. The laundry room is sited well away from food preparation areas. There is a commercial washer that meets disinfectant standards and has a sluice cycle. Discussion with staff confirmed training had been provided in infection control and that any soiled linen is brought into the laundry in sealed bags to reduce the risk of infection. The laundry floors and walls were readily cleanable to reduce the risk of infection. The family of one service user confirmed there relative’s laundry is always returned promptly and they always have clean clothes. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29. Staff are confident in their ability to meet the needs of service users. The home needs to fully demonstrate safe recruitment practices are being followed. EVIDENCE: On the day of the inspection there were three care staff on duty, and one domestic, which was reflected in the rota. Discussion with relatives confirmed staff were helpful and supportive and would respond quickly to service users needs. The rota demonstrated there were three care staff on duty till 2pm then two staff on duty for the remainder of the day including two waking night staff. In addition the owner takes an active interest in the running of the home. The manager is also available to provide extra support should this be required. Staff feel they are supported in their work and staff moral is good. The inspector examined two staff recruitment records. The inspector found that the records contained two written references, proof of identity, application form and terms and conditions of employment. However there was no evidence to show a satisfactory criminal records bureau check had been received at the home. The manager and owner advised they had been seen at previous inspections and then destroyed as instructed by the criminal records bureau. It is a requirement that evidence is held at the home to demonstrate this important check has been completed. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 19 One of the recruitment records did not have a full employment history and there was no reference to demonstrate this had been explored at interview. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 38, The manager has the necessary skills and qualifications to ensure the home is run in the best interest of service users. The home needs to be more robust in monitoring the health and safety of the building to ensure the safety of service users at all times. EVIDENCE: The manager confirmed the home was not holding any money on behalf of service users. Following a requirement made at the last inspection the Commission is now receiving notices of any incident affecting the welfare of service users. Discussion with the manager confirmed she has been manager at the home for over ten years. The manager has completed the registered managers award and a certificate to demonstrate successful completion was available for inspection. In addition the inspector was informed the manager has completed NVQ 4 in care and is an NVQ assessor and verifier. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 21 To monitor the quality of care provided the home has an independent quality audit completed every three months. The most recent report available at the home highlights the difficulties in obtaining the views of service users but noted staff are sensitive in their work with service users. The views of relatives are incorporated into the report. The manager confirmed copies of the report are forwarded to the Commission. The manager confirmed that any action identified from the quality audit is completed. The home was completing fire safety checks at the required intervals, the most recent fire drill being held in July. Staff training records demonstrated they had received training in manual handling first aid and infection control. The inspector noted a number of window restrictors had been broken on the first floor and could be a potential risk to service users. The manager confirmed these would be immediately repaired. The owner stated water temperatures are regulated close to 43c but the inspector found hot water in one service user room in excess of this temperature. It is recommended that the home keeps a regular check on water temperatures to ensure they do not exceed the recommended safety limit. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 x 3 x 3 x x 2 Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 23 No 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 7 Regulation 15(1) Requirement The registered person must ensure care plans clearly specifiy what action is required by staff to meet the needs of service users who may have challenging behaviours. The registered person must complete a comprehensive risk assessment where any risk to service users health and welfare has been identified and take action to reduce identified risks. The registered person must ensure the complaints procedure includes the timescale for responding to any complaint. The registered person must ensure the odour at the entrance to the home is eliminated. The registered person must demonstrate a satisfactory criminal records bureau check has been received for each member of staff. The registered person must ensure any gaps in employment history are explored and a record kept of the outcome The registered person must ensure water temperatures are regularly checked and a record Timescale for action 01/11/05 2. 7 13(4)(b) (c) 01/11/05 3. 16 22(4) 01/12/05 4. 5. 19 29 16(2)(k) 19(1)(a) (b)(i)(c) 01/12/05 01/10/05 6. 29 19(1)(a) (b)(i)(c) 13(4)(6) 01/10/05 7. 38 01/11/05 Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 24 kept to ensure hot water is distributed close to 43c. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 7 12 12 19 Good Practice Recommendations The registered person should ensure and demonstrate staff staff have read and fully understood the contents of risk assessments held at the home. The registered person should ensure service users hobbies and interests are recorded in the care plan. The registered person should record service users participation in activites held in the home. The registered person should replace or thoroughly clean the carpet at the entrance to the home and the connecting corridor to the lounge. Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Seahorses D51 D01 s3171 Seahorses v246053 300905 Stage4.doc Version 1.40 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!