Inspection on 05/02/07 for Sharon House

This inspection was carried out on 5th February 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sharon House 08/11/07

Sharon House 16/10/06

Sharon House 21/03/06

Sharon House 12/09/05

Sharon House 14/12/04

Sharon House 21/06/04

Similar services:

Cowden Road, 52 - 54

Norbury Crescent (30)

Chatsworth Care - Tudor Lodge

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

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

CARE HOME ADULTS 18-65 Sharon House 24 Sharon Road Enfield Middlesex EN3 5DQ Lead Inspector Karen Malcolm Key Unannounced Inspection 5th February 2007 10:30 Sharon House DS0000010653.V329919.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 Sharon House DS0000010653.V329919.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. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharon House Address 24 Sharon Road Enfield Middlesex EN3 5DQ 020 8804 5739 020 8804 5739 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) Mr Chandra Jootun Mr Chandra Jootun Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as either of the specified service users vacates the home. 16th October 2006 Date of last inspection Brief Description of the Service: Sharon House is situated on a quiet residential road in Enfield, a short walk from Brimsdown train station. Residents can reach Enfield Town by bus or train. The home is registered for five adults aged between 18 and 65 years who have a learning disability. There is also a condition allowing the home to continue to care for two people who are now over the age of sixty-five. The current residents are aged between 62 and 80 years. The home is owned and managed by Mr Chandra Jootun. The cost of placements was reported by the manager to be £570-680 per week. Following Inspecting for Better Lives, the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Sharon’s House’s second key inspection with the Commission. The duration of the inspection was approximately three hours. Present in the home were two support workers and four service users. One of the support workers assisted the inspector throughout the inspection, which was deemed open and positive. The registered manager was not available at the time of this inspection; therefore a number of requirements made at the last inspection pertaining to staffing were not inspected. Therefore these requirements have been restated in this report. The main reason for this inspection was check compliance from the previous inspection had been achieved. The inspector was able to speak independently to one of the service users and the remaining service users together. Feedback given was very positive about the home, the manager and the service provided. Service users shared their personal experiences and what activities they participated in, on a daily basis to the inspector. From feedback it was evident that service users are comfortable and happy in their surroundings. The inspection involved sampling two care plans, examining policies and procedures, completing a tour of the building and observed staff interaction with service users. The inspector would like to thank all the staff and service users for their time and co-operation during the inspection process. What the service does well: The people living at Sharon House say they like living there, they get on well with the staff and are looked after well. Staff stay at the home for a long time and so they are able to get to know the people living there very well. Staff and residents have a good relationship and the residents know who will be coming each day of the week. This helps them feel secure. Staff take residents on holiday every year which they enjoy. The house is kept clean and comfortable for the people living there. People are encouraged to keep in touch with their family and friends. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: This inspection has identified ten areas of improvement and three recommendations. Five of which have been restated from the previous inspection report, one of which was an ‘Immediate Requirement’, which related to Regulation 37 reports not being submitted. Prior to this inspection report being completed an action plan was submitted to the Commission addressing this requirement. Therefore the Commission is now satisfied with the information provided. While it is evident that the staff are experienced and competent, the home has failed to ensure that some of the service users needs are consistently not being monitored and up-dated appropriately. The five restated requirements made in this report relates to ‘Staffing’. These were: • All staff must have a Criminal Records Bureau (CRB) certificate on file • All staff is to undertake training in health and safety, fire safety, first aid and food hygiene and specialist training such as managing challenging behaviour • Staff must have a annual appraisal completed and regular supervision The other requirements relate to the registered person ensuring that on all service user contracts have the fee amount clearly documented on the contract in place. Fire safety assessment is to include a section on emergency procedures. All staff are to be aware of any changes regarding any specific service users in the home this is to be clearly documented or communicated. One specific service user risk assessment and cultural needs are to be more specifically documented on file. The three recommendations are deemed as good practice. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 8 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 Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 9 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): 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each service user has an individual written contract in place. However, the cost of the placement is not clearly documented, therefore service users are maybe unaware of what the cost, when they are to pay. EVIDENCE: No new service users have moved into the home since the last inspection therefore Standard 2 was not inspected at this inspection. Contracts were on file. However, these examined were not fully completed by the registered person. The information pertaining to fee amount for each service user was not recorded; therefore service users were unaware of how much they were the cost each week. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 10 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 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are consulted on decisions affecting their lives, but it is not possible to say whether their changing needs are reflected in their care plan nor those they are receiving the appropriate and consistent support with more complex needs. EVIDENCE: Since the last inspection one service user has died on 27th January 2007. However no notification has been submitted to the Commission prior to this inspection. At the last inspection it was required that the registered person must under Regulation 37 give notice to the Commission without delay of any occurrence relating to service users in the home. As a result of noncompliance with this requirement an Immediate Requirement was issued to the registered person. Prior to the completion of this report the registered person submitted a copy of a letter send to Sarah Mackenzie social worker on the 23rd January 2007. Notifying her that the specific service user had moved out of Sharon House to St Joseph Hospice on 23rd January 2007. Following this the Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 11 service user died. In discussion with the staff it was not evident that they were aware that this specific service user had been discharged from the home, they thought the specific service user was in hospital due to their illness. Following on from this requirement it is reminded that the registered person must ensure that all staff are aware of any changes pertaining to specific service users care needs, this is to be clearly communicated and recorded on individual’s files. On the day if the inspection the specific service user file was not in the home. At the previous inspection it was required that the registered person ensures that actions agreed at service users reviews are incorporated into care plans and the specific service user who has their cigarette use restricted has clear behavioural guidelines agreed. Prior to this inspection an action plan was submitted to the Commission and this included the specific service user’s guidelines and it also evident that actions agreed at reviews were incorporated into care plans. Another requirement was made regarding having clear guidelines when supporting an individual to eat sensibly. Included in the action plan submitted to the Commission a section related to this requirement was addressed. However, the specific service user, whom this requirement related to, has recently died. Risk assessments are undertaken by the home. However, one service user risk assessment pertaining to their behaviour stated that the individual was ‘stable’ and ‘restriction’ stated ‘needs more supervision when going out’. This was discussed with the staff member who explained what this meant for the individual. It was advised that more specific information must be recorded on the specific service user care plan, to ensure that each staff supporting the individual supports them appropriately. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 12 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): 11, 12, 13 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made adequate improvement on meeting individual service users needs with regards to social activities. Therefore service users social needs are appropriately and meaningful met. However, this could be further improved with regards to meeting individual cultural needs appropriately. EVIDENCE: The inspector was able to speak to one service user individually and rest as a group in the lounge. It was observed that service user were comfortable in their surrounding and asked the inspector a number of questions as to why they were there. Service users gave positive and open answers about the home, staff and manager. It was observed that service users had a choice of programmes they could watch, as the home provides Sky TV. Several of the service users were watching a comedy programme during the inspection. One service user asked to go out later that afternoon, and the staff on duty were arranging the time and place they wanted to go. It was advised that risk Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 13 assessment must be in place on how individual are support clearly when going out on an activity to ensure that all staff are consistent with their approach. On the care plan examined. It was evident that the only cultural need explored by the home related to spiritual needs - going to church. Recorded was the service user care plan stated this activity is declined. However, no other areas of the individual cultural needs had been explored. This was discussed with the member of staff. It was advised that the specific service user’s cultural needs must be explored further with individual, to ensure that their overall cultural needs is addressed appropriately. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 14 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. Since the last inspection improvements have been made with regards to ensuring service users healthcare needs are appropriately recorded and monitored. The medication procedures have also improved. EVIDENCE: At the previous inspection four requirements were made relating to Healthcare issues being clearly actioned • Health appointments for a specific service user to be clearly documented • Changes to medication by the GP or psychiatrist are recorded clearly • Guidelines are in place for the specific service user who is on PRN medication It was evident from this inspection that these requirements had been addressed and clearly documented. Discussion with one service user they told the inspector that they were worried about one specific service user, who had recently died. From the discussion it was evident that the service user had not been told of this. This was discussed Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 15 with one member of staff who informed the inspector that all service users had been informed. However, from the discussion, with the specific service user, this was not clearly understood. Therefore it is recommended that the registered person should find appropriate, sensitive ways of assisting service users with communication difficulties to clear understand the implications of death, it was further recommended that an advocate or social worker could undertake this. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Service users are confident that their complaints are listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: No complaints were recorded. Service users spoken to were happy in the home and spoke of activities they had undertaken. Staff informed the inspector that they have recently undertaken Protection of Vulnerable Adults (PoVA) training. The inspector was unable to check the records pertaining to PoVA training due to the manager not being available on the day. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 17 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): 24 & 30 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 well-maintained environment; bedrooms are spacious and meet individual needs. The home was found to be clean, pleasant and hygienic. EVIDENCE: The home is located in a quiet residential street but has easy access to buses and trains and has local shops within walking distance. The inspector looked at all the communal rooms, which consisted of kitchen, lounge, shower room and bathroom, laundry room and service users bedrooms. These are all clean, safe and tidy. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 18 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): Due to the manager not being available on the day of the inspection Standards under this outcome area were not inspected. EVIDENCE: Due to the manager not been available for the inspection, all the key standards or any requirement made at the last inspection were not inspected. Any requirements made at the previous inspection are restated in this report. Staff were asked whether or not they received regular supervision. Staff stated the manager undertakes that regular supervisison, however, evidence of this was not available at the time of the inspection due to the information addressed in the first paragraph. Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 19 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): 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are confident that the home is run well. Service users health and safety is regularly reviewed and monitored. However, if an emergency occurs there is no guidance in place for staff or service users to follow. Therefore service users cannot be sure that they are fully protected and safeguarded in the event an emergency occurring. EVIDENCE: At the previous inspection it was required that the registered person: • Undertakes a fire safety risk assessment • Staff are to undertake health and safety, fire safety, food hygiene and first aid training • Any information pertaining to Regulation 37 is to be submitted to the Commission without delay Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 20 Views of care managers/social workers were to be sought as part of the home overall consultation Staff informed and showed the inspector that the home’s fire risk assessment that was completed. This document was deemed good by the inspector. However, in further discussed, it was advised that an emergency plan must be included in the fire risk assessment. To ensure clear instruction and guidance are in place with regards to what action/s is/are to be take to find suitable accommodation for service users if any major incident occurs. Regulation 37 reporting has been addressed under ‘Individual needs and Choices’ in this report. Training was discussed with the two members of staff. From the discussion staff stated that they had recently undertaken basic first aid training and other training is being arranged. The inspector was unable to inspect staff personnel records due to the manager not been available at the time of the inspection. Therefore these requirements are restated in this report. • Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 21 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 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 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 X 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 1 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X 2 X x 2 X Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 22 Yes 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 YA35 Regulation 13(6) Requirement Timescale for action 30/04/07 2. YA34 19(1)-(5) 3. YA36 18(2) The registered person must ensure the staff have all been trained on how to positively support the service users who have challenging behaviours. This training must include how to diffuse a potentially aggressive situation. This requirement was not inspected at this inspection, as the registered manager was not available at the time. Therefore this requirement is restated in this report. The registered person must 30/04/07 supply written evidence that two outstanding CRB disclosures have been applied for to the CSCI. This requirement was not inspected at this inspection, as the registered manager was not available at the time. Therefore this requirement is restated in this report. The registered person must 30/04/07 ensure that all the staff have regular supervision, the content of which meets standard 36 of the National Minimum Standards DS0000010653.V329919.R01.S.doc Version 5.2 Sharon House Page 23 for care homes for adults. The registered person must ensure that all the staff have an annual appraisal. This requirement was not inspected at this inspection, as the registered manager was not available at the time. Therefore this requirement is restated in this report. The registered person must undertake a quality assurance exercise seeking the views of the service users, relatives and other care professionals and once the views have been received this must be collated into an action plan. This requirement was not inspected at this inspection, as the registered manager was not available at the time. Therefore this requirement is restated in this report. The registered person must amend the fire safety risk assessment to include a section relating to an emergency plan procedure. The registered person must ensure that all the staff have up to date health and safety training including fire safety, food hygiene and first aid. This requirement was not inspected at this inspection, as the registered manager was not available at the time. Therefore this requirement is restated in this report. The registered person must ensure that fee section on service users individual contracts are completed. The registered person must ensure that all staff are aware DS0000010653.V329919.R01.S.doc 4. YA39 24(1)-(3) 30/04/07 5. YA42 23(4) 30/04/07 6. YA42 18(1)(c) 30/04/07 7. YA5 5(1)(b) 30/04/07 8. YA7 17 30/04/07 Sharon House Version 5.2 Page 24 9. YA9 15(2)(b) 10. YA11 12(4)(b) of any changes pertaining to service users overall needs and this is clearly communicated and documented on the service user file. The registered person must 30/04/07 ensure that the specific service user, whose risk assessment was found to be very brief, is amended to ensure that the specific information pertaining to their overall care and support needs is clearly documented. The registered person must 30/04/07 consult with the specific service user or their representative on their behalf, regarding their overall cultural needs. 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. Refer to Standard YA7 YA21 Good Practice Recommendations It is good practice that the registered person has guidance in place on how communication with the team in disseminated to staff and how this is monitored. It is recommended that the registered person finds appropriate sensitive ways of helping service users with communication difficulties to understand the implications of death and bereavement. It is recommended that the registered person should seek advice and support for service users and support workers with regards to bereavement & loss. 3. YA21 Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Sharon House DS0000010653.V329919.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!