Inspection on 04/11/08 for St Marks House

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Excellent service.

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

St Marks House 15/11/06

St Marks House 30/11/05

St Marks House 07/02/05

St Marks House 20/07/04

St Marks House 31/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Marks House Brook Street Lye Stourbridge West Midlands DY9 8SE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Lancashire     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: St Marks House Brook Street Lye Stourbridge West Midlands DY9 8SE 01384896654 F/P01384896654 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Kathleen Rhooms Type of registration: Number of places registered: Chadd Housing Association care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The Registered Provider may provide personal care and accommodation for service users of both sexes whose primary needs on admission to the home are within the following categories: Mental Disorder, excluding learning disbility or dementia (MD16) and old age not falling within any other category. (OP 9) The maximum number of service users who may be accommodated is 16 Date of last inspection Brief description of the care home St Marks House is a purpose built home. It is in Lye, in an area which is partly residential and partly light industry. There are local amenities nearby and the Home is within walking distance of several good bus services to nearby towns. The frontage of the Home has ample car-parking facilities; to the rear there are well-maintained and Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 9 16 0 Brief description of the care home accessible gardens, with mature trees, shrubs, flowerbeds, patio areas and a gazebo. The interior appears bright and airy, with domestic fixtures and fittings. The Home provides 16 single en suite bedrooms for people over 50 years of age, who have been diagnosed with mental health needs. There are four bathing/ showering facilities. There are a number of seating areas around the Home including a well-used conservatory extension, a quiet room and designated smoking lounge. The Home has a stable staff team. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We carried out this inspection in order to check that the home had met the requirements of the last report. We also measured the performance of the home against the key National Minimum Standards. We arrived at this home on a weekday morning without telling anyone that we would be visiting that day.We toured the building and some of the people living there invited us to see their rooms. We talked to people who live in the home, to staff and the manager. We ate a meal with staff and people at the home. We looked at information provided to us by the manager before the inspection and we examined a sample of records about the people in the home, the staff, health and safety and quality monitoring. We checked that the money held by the home on behalf of three people was correct and we looked at the records of the administration of medication. Care Homes for Adults (18-65 years) Page 6 of 28 We used our findings to write this report. What the care home does well: What has improved since the last inspection? What they could do better: The manager continually identifies areas for further development and improvement and has identified the following for action in the coming year. Care Homes for Adults (18-65 years) Page 8 of 28 Ongoing training for all staff, making sure that all new staff receive training in equality and deversity. Making sure that one assistant manager completes NVQ level 4 and assistant managers undertake advanced fire training. Additional training for the head cook and assistant cooks in healthy eating and diabetes in mental health and to gain more understanding in communicating the need for healthy eating to people with mental health difficulties. Developing the format for obtaining peoples views so that it is more understandable for all people. Updating the Statement of Purpose which is given to people in the home. Enabling staff to visit people who are considering moving into the home before they move in. Replacing furniture in individual rooms. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the necessary information to make an informed choice about moving into this home. Their needs are assessed and and people know that the home will be able to meet these. People have the opportunity to visit the home before moving in. Evidence: We saw good, clear information for people considering coming to this home and their representatives. The Statement of Purpose is displayed in the entrance hall and people are also provided with service user guides. The manager said that staff also explain these documents to people and discuss their rights and expectations of the home. People are also given a copy of the staff key worker handbook so that they have a clear understanding of the staff roles. There are clear criteria for admission to this home. We sampled files and saw that before anyone is admitted, the home has a copy of the care management assessment and a care plan. The manager or assistant manager also carries out an assessment of the persons needs and consideration of whether or not the home can meet these. The Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: manager told us that she will only accept a person when she is sure that the home will be able to cater for their needs and preferences. There are regular assessments as peoples needs and behaviour change. People are aware that assessments are carried out and they are involved in these. We saw records of pre-admission visits which people had made to the home. The manager allocates a member of staff to help the person to understand the way the home is run and the services and facilities which are available to them. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are involved in preparing and reviewing their own care plans, so they can be sure that they reflect their own goals and needs. They are supported and encouraged to make decisions about their lives and are consulted about the running of the home. People are supported to take risks as part of an independent lifestyle. Evidence: All people have a care plan and these include details of how each person prefers to be supported. We saw that these are reviewed and updated on a monthly basis. People are involved in discussion with their key worker about how their plan should be updated so the plans reflect their goals and preferred lifestyle. An assistant manager showed us how this process works and a person in the home told us that she makes decisions about what she does. There is a detailed risk assessment system which covers the possible risks for each Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: person. As peoples health or behaviour changes, these are updated to reflect the new level of risk. Peoples behaviour is now recorded in daily sheets and these provide evidence for the assessments. Staff try to enable people to live as independently as possible and examples of this include making drinks, going out alone and administering their own medication. Where staff are aware that people are making choices which may be detrimental to their health or safety, they try to encourage people to change their behaviour, but they also respect their choices and try to make them as safe as possible. For example, people who choose to smoke are provided with a safe location to use and staff supervise them. Where people are at risk from naked flames, staff look after their lighters. There are meetings of people who live in the home and they are used to make decisions about how the home is run. The minutes of recent meetings show that people are consulted about a range of aspects of the home such as activities, outings and routines. There are also questionnaires which the manager uses to gain peoples views. There is regular discussion on an individual basis and at the meal tables so that everyone is encouraged to express their opinion. One example of a change which was brought about after people requested it is the change in mealtimes so that the main meal is now in the middle of the day. After this was requested by people in the home, the new arrangements were put in place for a trial period. People were asked again if they were happy with the change. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to maintain relationships with people in the community and to participate in a range of activities inside and out of the home. Their rights are respected. People have choice of nutritious food which meets their needs and preferences and is served in pleasant surroundings. Evidence: We saw most of the people who live in this home on the day of the inspection. The notice board had details of various activities and a visiting worker was doing activities with people in the living room. People told us about a range of outings and visits which they had enjoyed, including trips to concerts and the seaside. Staff said that they encourage people to spend time in the room where activities are taking place so that they can watch, even if they do not wish to participate. Staff organise quizzes and board games and help people to make craft items, which they sell at Christmas and Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Summer events. These are fund raising activities and there are letters on the noticeboard thanking people from the charities to which they have donated a proportion of the proceeds. We also saw the regular newsletter which keeps people in the home and their visitors informed about what is happening and what is planned. People are given the opportunity to follow their chosen religion and to express their beliefs. There are also themed cultural events. The records showed that people make use of facilities in the local community services. Some go out regularly. Several people said that they were looking forward to staff helping them to do their Christmas shopping. We saw the visiting policy on display and people told us that they are welcome to invite friends and relatives to their rooms or quiet areas of the home. Each person has details of advocacy services and staff are aware of the contacts which each person wants to maintain. Meals are taken in the dining room and staff sit at the tables and chat to people. There is conversation between tables and the meals are very social occasions. We saw that the menus provide good choice and on the day of the inspection we saw staff changing someones meal because they had decided not to have what they has originally chosen. The meals cater for the cultural and medical needs and preferences of the people in the home and the cooks know what each person prefers to eat. They take pride in producing good quality food and have received five stars and a gold award from the environmental services. The cook told us that she is now working towards a platinum award. The food eaten by us was well presented and appetising. Snacks, fruit and drinks are available throughout the day in the dining/conservatory area and people may make their own drinks. Everyone who talked to us said that they enjoyed the food. There has been a recent change to eating the main meal of the day at lunch time because people preferred this arrangement and it seems to work well. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with personal support in a way which meets their needs and preferences, so that their physical and emotional health needs are met. They are protected by the homes practices in relation to the storage and administration of medication and supported to administer their own medication where possible. Evidence: The care plans include details of the personal support which each person needs and the ways in which they prefer to be assisted. Staff demonstrated awareness of the particular needs of various people and showed sensitivity towards peoples individual preferences, whilst being aware that people sometimes need to be encouraged to undertake tasks for themselves. Everyone is registered with a GP. Most are registered at one surgery, but people do have choice and the records show that some have changed their doctor. We saw good records of appointments attended with a variety of health professionals. A record sheet is taken to appointments and professionals have provided brief details of the treatment or advice provided at the time. This means that staff are aware of the health needs of Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: the people in the home and the ways in which they can support them to remain healthy. Where people have failed to attend appointments, the staff have recorded the reason and rearranged the appointment so that it has not been missed. Staff showed that they are aware that people may not feel like attending on one day, but may be more motivated at another time. Staff escort people to appointments so that they can support them to get appropriate treatment. Staff have access to training in various aspects of health care. They do not carry out any invasive medical procedures. All necessary injections are administered by visiting nurses. There are comprehensive medication policies and the assistant managers are all trained to administer medication. The home has changed the medication system so that it is now obtained from a large supplier in a monitored dosage system. Several people are encouraged and supported to administer their own medication and there is a good system for making sure that they do so with appropriate monitoring and risk assessment. This includes periodic random checks. The pharmacist inspects the medication at regular intervals. The last report by the pharmacist was in September 2008 and no problems were noted. We saw that the records of doses given were up to date with no gaps. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well protected by the homes practices. They are provided with good information about how to complain and their views are listened to and acted upon. Evidence: We saw that the complaints system is displayed in the reception areas ans is also in the service user guide and key worker handbook which is given to all people when they move in. People who live in the home told us that they would make a complaint if they needed to, but said that the staff would always be there to put things right. There is a record of complaints received but there have been none since the last inspection. The manager is considering starting a record of informal complaints so that the home can demonstrate how many small requests for change are responded to. There are policies and procedures for protecting people at the home and the staff are trained in recognising symptoms of abuse. There is a good system for reporting such incidents although there have been none. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people in this home live in a comfortable and homely, safe environment which is well maintained and meets their needs. Evidence: This home is purpose built on two floors, with communal areas and 16 en-suite bedrooms. We toured the premises and found that all areas are maintained to high standards. Some people showed us their rooms and they were well furnished, with many personal items. People told us that they had chosen their colour schemes and liked their rooms. In addition to the two lounges and dining room, there is a landing area with seats and books. Staff told us that the hairdresser uses this space. One bathroom sink has been converted so that it can be used by the hairdresser and is more comfortable for the people who live in the home. The kitchen and laundry areas are clean and well organised. There are good arrangements for infection control in the building. These include the supply of disposable gloves and aprons. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The manager told us that several communal areas and bedrooms have been decorated since the last inspection and she confirmed that all repairs are attended to quickly, with urgent ones being done the same or following day. The garden has a wide, accessible path which leads through the area and to a gazebo. There are raised beds so that people can participate in gardening. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people in this home are supported by adequate numbers of well trained staff. They are protected by the homes practices in relation to recruitment of staff. Evidence: We looked at a sample of staff files and found that they are recruited through a standard process which ensures that references are taken up and the necessary checks are made through the Criminal Records Bureau. The files were well organised and contained the necessary evidence of good practice in this area. The rotas show that there are adequate numbers of staff on duty at all times and staff confirmed that they are able to carry out their duties and provide a good level of personal support to people in the home, including accompanying them to appointments and activities when needed. All staff undergo structured induction training and this is followed by NVQ training which is competed within 2 years. There are 5 members of the team with NVQ level 3 and 2 with level 4. In addition, staff receive training in a variety of areas such as mental health and challenging behaviour and they receive refresher training in the basic areas such as manual handling and first aid. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: When we watched staff working and spoke to them we noticed that they were enthusiastic about their roles and felt that they had gained important knowledge from their training. They work well as a team and the low turnover of staff means that the people in the home benefit from staff who know them well. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people in this home benefit from good and competent management so that their views are taken into account. Their health, safety and welfare is promoted by the homes practices. Evidence: The manager has been registered since the last inspection. She is very well qualified for the role and has NVQ level 4 and the Registered Managers Award. When we spoke to her she demonstrated a very detailed level of knowledge about the people in the home, the staff and the systems for management. Staff had confidence in her leadership and all were keen to maintain and develop the standard of care provided so that they could provide the people in the home with the best possible care. Staff were aware of their own roles and responsibilities. The manager spends time with the people who live in the home and eats meals with them. They were relaxed in her company. We also saw good communication between her and the staff. The home has recently obtained a new quality assurance system which is based on Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: checks being made against the National Minimum Standards. There are questionnaires for people who live in the home, their visitors and visiting professional workers. The manager demonstrated how the results of the questionnaires are used to identify areas for further development in the homes development plans. She provided an example of change which had been brought about as a result of responses. There are also monthly unannounced checks made committee members who provide the manager with reports on their findings. These measures all help to make sure that the home continues to be run in the best interests of the people who live there. The manager provided us with the dates of recent safety checks and servicing of equipment. We sampled these and found that there are good arrangements to make sure that the home is safe for people who use the building. We also saw risk assessments and accident records, including the measures which had been taken to minimise the risks to people in the home. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!