CARE HOMES FOR OLDER PEOPLE
St Bridgets 14 East Avenue Talbot Woods Bournemouth Dorset BH3 7BY Lead Inspector
Debra Jones Unannounced 11 May 2005 10:00 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. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Bridgets Address 14 East Avenue Talbot Woods Bournemouth Dorset BH3 7BY 01202 291347 01202 291347 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 A L Howell Mrs Joanna Ethne Hills CRH (N) - care Home With Nursing 12 Category(ies) of OP - Old Age (12) registration, with number of places St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The home may accommodate a maximum of 2 persons in Room 23. Date of last inspection 6 December 2004 Brief Description of the Service: St Bridgets home accommodates 12 older people in need of nursing care in a large converted house. It is on a corner plot set back from the main road, in mature gardens with a small car park to the rear of the premises. The home is in the residential areas of Talbot Woods within easy reach of shops, bus routes and community facilities. The residents accommodaiton is arranged over the ground and first floor. A passenger lift is available between floors. Two of the bedrooms are single and 5 are double. None of the bedrooms have ensuite facilities but communal bathroom and toilet facilties are on the ground and first floor. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 3 hours and was one of the two anticipated inspections of the year. Recommendations and requirements made at the last inspection were followed up to see if the home had made any progress towards meeting them. Limited progress had been made and more requirements had to be made at this inspection. The Inspector looked around the building and a number of records were inspected. The Matron, 2 members of staff and 10 of the eleven (current number) residents were spoken to. What the service does well: What has improved since the last inspection?
Limited progress has been made in addressing requirements and recommendations made at the last inspection. The home has been inspected by the water board to see if they comply with the Water Supply (Water Fittings) Regulations 1999. An action plan to address the results of the inspection is not yet in place.
St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 6 What they could do better:
After someone from the home has carried out a pre admission assessment the home needs to confirm in writing that the home is able to meet the potential residents’ needs to give them the necessary reassurance that the home is right for them. It would be good if the home would consider refurbishing the upstairs bathroom which is currently not used by residents. It would also be good if the home got someone who had the right professional training to carry an assessment of the premises to confirm that it was suitable for the people living there. The home has an ongoing problem with an offensive odour in one room. This must be dealt with as it is unpleasant for residents, staff and visitors to the home. As there are a number of issues in respect of the premises that are being brought to the attention of the registered people, not for the first time, the owner is asked to prepare a plan as to how they are to be addressed. Criminal Record Bureau disclosures and POVA checks are to be completed for all staff employed at the home, and proof of the person’s identification obtained. This is to protect residents from unsuitable staff potentially working at the home. Documentation must also be in place to show that staff from abroad have the right to work at the home. It would be good if more care staff had an NVQ level 2 qualification in care. This would make care staff more knowledgeable about the job they do and potentially improve the quality of care delivered to residents at the home. The Department of Health gives a target of 50 of all care staff at the home to have this qualification by 2005 and the home is not on target to achieve this. Given that the number of requirements has gone up at this inspection and limited progress has been made to address requirements and recommendations made at previous inspections it would be good if the manager was given the time and support to address the shortfalls identified in this report. The home carries out surveys of residents views every year and also asks other people that visit the home what they think in order to improve services for the residents. It would be good if the home would pull all the responses together and write a report about what they have found. Sometimes registered people have to be involved in helping residents with their money. The law tells them what they can and cannot do and it is important that they follow the law to protect the interests of the resident. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 7 Staff are supervised on a daily basis but it would be good if staff had the opportunity to sit down with their manager 6 times a year to talk about their work and what training they need to do their jobs better and provide a better service to the residents. Records should be made of any supervision meetings. All staff are to be fire trained at regular and specific intervals to protect residents in the event of a fire breaking out in the home. A further measure of protection of residents is the regular check of fire equipment. The home carries out checks themselves, and records must be kept of this, and an external contractor carries out other checks every 3 months. The certificates issued by the contractor must be kept and be available for inspection. These certificates provide reassurance that the fire equipment has been checked and that any work that needed doing as a result of the check has been done. It would be good if when the home carried out fire evacuations that they noted what time of day the exercise took place and how long it took. 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. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 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 St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 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) 1,3,4 and 5. 6 is not applicable to this home. Information provided about the home and a good admissions procedure enables prospective residents to make informed decisions about admission to the home and ensures that only service users whose needs can be met by the home are offered places there. The home does not assure prospective residents in writing that their needs can be met. EVIDENCE: The Statement of Purpose and Service User Guide contain all the information required about the home and its facilities. Both are available in the home. A copy of the guide is usually given to a resident at the point when they decide to move to the home. Only one resident had moved to the home since the last inspection. They were unable to talk about their experience of moving into the home. Records showed that they had been living locally at the sister home of St Bridget’s (St Bridget’s residential care home), had needed more care and so had come to the nursing home on a respite basis. The respite period had worked very
St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 10 well and the decision to stay long term had been made. This decision included input from the residents’ GP and the manager of the other home. The paperwork from the residential home had transferred with the resident. This gave the nursing home the background they needed about the resident and of the care they had been given. An assessment was undertaken by the nursing home prior to the respite period beginning and a workable care plan was in place. Whilst the home clearly gathers all the information they need to decide if they can provide care for a prospective resident this assessed ability to care is not confirmed to the prospective resident in writing. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 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 and 10 There is a consistent and clear care planning system in place to make sure that staff have the information they need to meet residents needs. Residents are treated with respect and their right to privacy upheld. EVIDENCE: Comprehensive care plans and risk assessments of a high standard are in place. Plans are easy to read, to the point and informative. They clearly set out individual care needs and how they are to be met. Plans are clear about what residents can do for themselves and what staff are to assist them with. The plans are reviewed regularly and updated as needed. Daily notes support and evidence the delivery of care to residents. Most residents were not able to talk about the care they received but all but one said they were very happy ‘I certainly am (happy) there’s no two ways about that!’ Another talked of the home being ‘lovely’ and ‘wonderful’. The resident who was not happy was unable to say why, or what could be better. Staff were seen treating residents with respect. Where residents share rooms their privacy is not compromised as fitted curtains across rooms provide screening when needed.
St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 12 Two staff hoisting a resident before lunch did so in a professional yet friendly way, talking to the resident about what they were doing and chatting with them in a reassuring way throughout. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 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) 13 and 15 Residents’ lives are enriched by their visitors and they are encouraged to exercise control over their lives by staff at the home. The meals in this home are good offering both choice and variety. EVIDENCE: Plans are clear about what people like and don’t like to do. One resident, who spends most of the day in her room, talked of how she did not like to socialise and preferred her own company and that of her visitors. This was clearly respected. Staff often pop in for chats as well. The visitors book confirmed the number and range of visitors to the home. Nutrition assessments and plans are in place for residents as well as information about what people like to eat. Menus are based around the known likes and dislikes of the residents. The meal served on the day of inspection was a homemade turkey casserole with rice and vegetables followed by semolina. The resident not wanting this meal had been made an alternative. One resident said that ‘the food was good enough’.
St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 A system is in place to deal with any complaints that might be made by residents. The home ensures that residents retain their right to vote in elections. EVIDENCE: The home has a complaints policy / procedure that is included in the information given to residents. No complaints have been received by the home since the last inspection or by the Commission. No one had been interested in voting at the recent general election but all had been on the register and the staff had checked with each of them if they wanted to go to vote. One resident had shown an interest in the result of the election. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 15 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) 19,21,22,23,24,25 and 26 Adequate facilities are available to meet the number of the current residents. Residents enjoy living in a clean and pleasant smelling home with the exception of one shared bedroom where there is a problem with odour. No progress has been made to ensure that the home is suitable and safe for residents. EVIDENCE: The home is decorated in a homely character, although a little tired in part. Communal facilities are spacious for the number of people living at the home with a dining / lounge area and an additional large lounge being available. Residents’ bedrooms are adequately furnished and some had brought in personal possessions with them. There are a number of communal bathrooms and toilets, with appropriate aids and adaptations, available in the home for the number of residents living there. The bathroom on the first floor is not used and there have been discussions about its refurbishment. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 16 It was required at the last inspection that to prevent risks from scalding pre set valves, of a type unaffected by changed in water pressure and which have fail safe devices, be fitted to provide hot water close to 34 degrees centigrade. The temperature of the water in the baths is controlled but not the hand basins in residents’ bedrooms or the communal bathrooms. No changes had been made to the home since the last inspection and the matron was unaware of any plans. The offensive odour in one bedroom mentioned at previous inspections has still not been eradicated. Otherwise the home is clean and odour free. The laundry is appropriately sited. Suitable washing machines and sluices are in place. The home has not been assessed by a qualified person(s) including an occupational therapist. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 17 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, 28 and 29 Sufficient care staff are employed and deployed to ensure that the care needs of residents can be met. Limited progress has been made in the standard of vetting and recruitment with appropriate checks not being carried out potentially leaving residents at risk from unsuitable staff working at the home. EVIDENCE: Clear staffing rosters are in place that show who is on duty and when. A qualified nurse is on duty at all times. 2 health care assistants are on duty between 8am and 8pm and one health care assistant is on duty at night. The matron, who is also the registered manager of the home gets 6 hours a week of dedicated management time. Out of the 10 health care assistants employed at the home 2 are doing NVQ level 2, 1 is doing NVQ level 3 and 2 are interested in doing NVQ level 2 in care. Staff files are kept for staff and much of the information required in law is on file. Not all staff files showed that CRBs or POVA 1st checks had been applied for and not all contained proof of the person’s identification. The home employs some workers from abroad. Some files contained the right sort of information about people’s rights to work in the country and any restrictions on that work, but not all. The home was advised to get hold of a
St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 18 recent publication issued by the Home Office to inform them of the documents they need to see and copy before they employ foreign nationals. This guidance should also be reflected in the recruitment procedure. The procedure could also include the guidance offered by the previous inspector in respect of verifying written references, not accepting testimonials and being vigilant about the type of referees provided. Not all staff have been issued with contracts of employment. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 19 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) 31,33,35,36 and 38 The matron is capable of managing the home well but the number of shortfalls identified in this report indicate that not enough resources are going into the management of the home and if not addressed will potentially adversely affect the care and well being of the residents. Records do not demonstrate that residents would be safe in the event of a fire breaking out. EVIDENCE: The home is managed by Jo Hills who is an experienced nurse and manager. Ms Hill has a hands on approach to her job and this has a positive impact on the home in that she leads staff by example and residents know her well. The home has recently started to carry out their annual quality assurance survey. Once it is completed a report needs to be written based on the analysis of the results of the survey. This report can then be circulated to any interested parties.
St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 20 At the last inspection the owner was asked to review the procedure for handling residents’ monies as what he was doing did not comply with the restrictions imposed by the Care Home Regulations. This has not been done. Staff are supervised on a daily basis but the formal supervisions are not yet at the desired regularity. Staff meetings take place every 5-6 months. An up to date insurance certificate was on display along with the home’s registration certificate. Fire records were in place and internal checks are being carried out but records do not show that they are being carried out at the required regularity. An external company carries out quarterly checks, with the most recent being earlier this month. Although there was evidence of some of these visits not all certificates for the last 12 months were available, as they should have been, at the inspection. Fire training records for staff did not show that all staff, both day and night, had had fire training at the required intervals. The last fire evacuation took place in November 2004 and the next is due towards the end of May. It was suggested that the next evacuation involved night staff. Records of evacuations did not contain information about when the evacuation took place and how long it took. Accident records were well completed. Some were clearer than others about how staff came across accidents. Ideally all records would contain information such as e.g. ‘responded to call bells’; ‘responded to cry for help’ etc. Analysis of such records would provide the home with important information as to the effectiveness of the emergency systems in operation. An Environmental Health officer visited the home last year and revisited in December 2004 to confirm that all their recommendations had been addressed. The home has been inspected by the water board to see if they complied with the Water Supply (Water Fittings) Regulations 1999. An action plan to address the results of the inspection was not available. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 21 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 3 x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 2 2 3 x 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 2 x 2 x 2 2 x 2 St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 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 4 Regulation 14 Requirement The registered peson must confirm in writing to the resident that havng regard to the assessment the care home is suitable for the purpose of meeting their needs in respect of health and welfare. To prevent risks from scalding the temperature of water must be controlled in hand basins, that could be used by residents to about 43 degrees centigrade. (previous timescale of 31/3/05 not met) The home must be kept free from offensive odours. All staff records required by law must be held on file i.e. proof of identification, CRB disclosures and POVA and POVA 1st checks. Documentation for foreign nationals must be in place to demonstrate that they are allowed to work in the home. (previous timescale of 31/12/04 not met) All staff should be issued with contracts of employment. (previous timescale of 31/3/05 not met)
D55 S20497 St Bridgets V220444 110505 Stage 4.doc Timescale for action 1 July 2005 2. 25 13 1 September 2005 3. 4. 26 29 16 19 1 September 2005 1 July 2005 5. 29 19 1 July 2005 6. 29 19 1 September 2005
Page 23 St Bridgets Version 1.30 7. 35 20 8. 38 13 9. 10. 38 38 23 23 11. 38 23 Arrangements for receiving the benefits of residents must be reviewed to ensure that the registered person is complying with the restrictions for residents outlined in this regulation. (previous timescale of 31/1/05 not met). An action plan in respect of compliance with the Water Supply (Water Fittings) Regulations 1999) is to be produced and submitted to the Commission. Internal fire equipment checks must take place at the correct intervals and be recorded. Staff fire training must take place at the required intervals i.e. 3 months for night staff and 6 months for day staff and records be kept. External checks of fire equipment must take place every 3 months and the certificates issued by the contractor be available for inspection. 1 July 2005 1 July 2005 1 June 2005 1 June 2005 1 June 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 19 Good Practice Recommendations It is recommended that a plan and programme for achieving compliance with standards relating to the physical environment be produced, followed and records kept. It is recommended that consideration be given to the refurbishment of the upstairs bathroom to ensure the facilities in the home meet the needs of residents. It is recommended that an assessment of the premises be undertaken by qualified persons, including an occupational therapist.
D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 24 2. 3. 21 22 St Bridgets 4. 5. 6. 28 29 29 7. 8. 9. 10. 31 33 36 38 It is recommended that 50 of care staff achieve NVQ level 2 in care by the end of this year. It is recommended that recruitment procedures are updated in line with the Home Office guidance fo employers to prevent illegal working. It is recommended that recruitment procedures are reviewed in respect of verifying prospective staff references e.g. verifying written references, not accepting testimonials and being vigilant about the type of referees provided. It is recommended that the manager be given sufficient dedicated management time to be able to discharge her responsibilities fully. It is reccommended that results from quality assurance surveys be analysed and a report be compiled. It is recommended that care and qualified staff receive formal supervision 6 times a year. It is recommended that fire evacuation records be more detailed and include information about when the exercise took place and how long it took. St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole, Dorset BH17 0NF 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 St Bridgets D55 S20497 St Bridgets V220444 110505 Stage 4.doc Version 1.30 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!
