Inspection on 13/11/08 for St Martins

This inspection was carried out on 13th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Martins 24/11/06

St Martins 26/01/06

St Martins 05/10/05

St Martins 09/02/05

St Martins 18/08/04

St Martins 24/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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 older people Name: Address: St Martins Queen Street Gillingham Dorset SP8 4DZ     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: John Clarke     Date: 1 3 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 Older People 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 Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 Older People Page 3 of 27 Information about the care home Name of care home: Address: St Martins Queen Street Gillingham Dorset SP8 4DZ 01747823221 01747826224 stmartins@care-south.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Claire Frances Brownless Type of registration: Number of places registered: Care South care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 32 in the category OP (Old Age) including up to 6 in the categories DE(E) and/or MD(E). Date of last inspection Brief description of the care home St Martins is located near to the centre of Gillingham. The home is operated and managed by Care South, which is a `not for profit? organisation operating a number of homes and care services across Dorset. Registration of the home is for accommodation of up to 32 older people over the age of 65 years, and up to six places can be used to provide a specialist service to older people with dementia or other mental health needs. Although the building is relatively old, it is well maintained and provides a range of comfortable accommodation for service users. There are five shared Care Homes for Older People Page 4 of 27 Over 65 6 6 32 0 0 0 Brief description of the care home bedrooms and prospective residents are made aware if the vacancy on offer is a shared place. There is level access throughout the home and a passenger lift provides access to the first floor. Fees range from 462 pounds to 570 pounds and for single occupancy of double room 650 pounds. This information was given on the 13th November 2008. Readers of this report may find it helpful if they have any queries about fees to contact the Office of Fair Trading www.oft.gov.uk. Care Homes for Older People Page 5 of 27 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home as part of our inspection. We looked at a number of records and documents including pre-admission assessments, care plans, staff recruitment and training,medication records and arrangements for the managing of medication in the home. We also looked at records regarding staffing in the home and those relating to health and safety. There was also an opportunity to talk with individuals who live in the home about the quality of the service they receive. We spoke with a number of staff about working in the home and their views about the service they provide at St.Martins. As part of this inspection the manager provided an Annual Quality Assurance Assessment which gave information about the service provided, improvements and actions they have taken regarding the service. We also received a number of Have Care Homes for Older People Page 6 of 27 Your say questionnaires from individuals who live in the home, staff and health professionals. This information has been used to help us make a judgment about the quality of the service. What the care home does well: What has improved since the last inspection? What they could do better: We identified from this inspection a number of area which must be addressed. Firstly that of all staff undertaking Safeguarding training and secondly first aid training. From records of night staff it was evident that a number had not undertaken this training. The manager must make sure there are sufficient staff on duty at all times that have first aid. This is particularly crucial during the nighttime period when there are limited number of staff on duty. Care Homes for Older People Page 8 of 27 We also have concerns regarding the maintaining of the necessary staffing levels recognising that there is no direct evidence of individuals needs not being met. However there were a number of comments received from individuals and staff which has led us to have these concerns. We established that the home has no system in place to satisfactory measure staffing needs against the dependency and care needs of individuals who live in the home. 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 Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The home undertakes pre-admission assessments so that they can make an informed decision about the capacity of the home to meet the health and social care needs of the individual. Evidence: We looked at a pre-admission assessment for an individual who had been admitted to the home in the past year. There was good information about the personal circumstances of the individual, their health and social care needs. Also included was medical and physical needs. A copy of the local authority assessment is obtained where individuals have had this assessment. We spoke to an individual about their admission they said they had been able to visit the home before they moved into the home and had also been asked about what help I needed. They said they had been given enough information about the home including a copy of the Service Users Guide. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. The home has an excellant care planning system in place which is person focused and provides staff with detailed and up to date information about the care individuals require. The arrangements for the management of medication and providing of health care helps in making sure the health and welfare of individuals who live in the home is protected. The policies and practice of the home makes sure that the dignity and the rights of individuals are upheld. Evidence: A new care plan system has been put in place since the last inspection and we looked at care plans for 4 individuals. They were well written with through and detailed information about the individual including Personal Profile written in 1st person indicated the involvement of the individual. Life history and My Nearest and Dearest. They provided clear tasks associated with the care of the individuals (skin care tasks to maintain integrity, observations) including Communication, Mental Health, Nutrition, Mobility and Activities of Daily Living. Reviews had been held regularly. Risk assessments completed for falls and other areas of risk.In one instance where Care Homes for Older People Page 13 of 27 Evidence: individual was at risk of leaving the building. Importantly actions to reduce the risk had been identified i.e. checks of whereabouts of individual and recording of clothing being worn. Waterlow and Nutritional assessments had been completed as had moving and handling profiles.These had been reviewed monthly. Where bed rails were in use there was consent from the individual and assessment evidencing the need for their use. Arrangements for the administering and storage of medication were looked at including MARS administering records for period of 4 weeks. These had been completed accurately with no gaps and good practice around receipt of medications and any changes. Controlled drugs recorded in CD register with two signatures as required and daily check of stock. Care Plans are completed for use of As Required medication and recorded on MARS records.. Risk assessments are completed where individuals choose to manage and self administer their medication. Where medication required being stored in fridge this was in place with daily checks of temperature. Returns recorded and signed for by pharmacist or their representative. Individuals who live in the home have full access to community health services including community nurses one of whom commented in their response to questionnaire as to what the home does well: provides individual and personal care well, staff know the residents well and able to meet their needs to an individual standard. Chiropody, dental and optician service are provided as needed. A doctor commented that what the home does well is always contacts the surgery immediately with any concerns. Individuals who live in the home and who responded to our Have Your Say questionnaire said that they Always 2 Usually 7 Receive the medical support you need?. One individual said they had been able to keep their usual doctor. Another said the home always gets doctor for me if I am not well. A relative said the home had acted quickly in getting a doctor. We spoke with individuals who live in the home as to whether they felt the staff treated them with respect and if their dignity was always respected. Individuals said staff always treated them as we would want to be treated. One individual who had help with washing and dressing said it never feels strange someone helping me they (staff) are all very good. When receiving visitors or doctor individuals said they can go their room. Staff were observed supporting and assisting individuals in a sensitive and appropriate manner. Care Homes for Older People Page 14 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. The home is making a good effort to provide activities so that the social needs of individuals who live in the home are met with the opportunity to maintain their links with family and friends. The meals provided in the home are varied and offer choice so that the nutritional needs of individuals are met. Evidence: The home has now recruited an activities organiser for 15 hours week and this is an area identified in the homes AQAA that they hope to improve with this appointment.. One staff member in their questionnaire response said now we have an appointed activities co-coordinator we hope the residents will get more activities during the day. So far it is working well. There was a noticeboard with picture of activities that had taken place and planned events. In talking with individuals who live in the home they commented we play games, staff take me out though would like more trips out. This individual enjoyed the Wedensday night club where they have bingo and quizzes. Other activities organised included games, exercise and cards. There is a monthly religious service. Outing had been arranged for the summer months and outside entertainers come into the home. A xmas bazaar was being planned. When asked whether staff have time to sit and have a chat one individual said they were usually Care Homes for Older People Page 15 of 27 Evidence: busy and another said staff very good, very busy dont get time to talk though another said staff do sit and chat. Those who responded to the questionnaire said they always 1 usually 3 and sometimes5 to Are there activities arranged by the home that you can take part in? Individuals we spoke with said they felt they were able to excercise choice in their daily routines one said what they liked about the home was the lack of rules another its up to me what I do. We spoke to one individual who needed assistance in getting up and going to bed and they said they felt its my choice I get up when I want staff will always come back if I say dont want to get up or go to bed then. Individuals we spoke with said they felt the home was always welcoming and friendly to their visitors. They said that they felt able to see their relatives and Friends at any time really. A relative we spoke with said they also found the home welcoming and always keep me informed no problem about visiting always nice welcome. We asked individuals who live in the home about the meals provided and all were very positive always good food very good, nice choice of food plenty of nice food Menus were looked at and showed a good range and variety of meals being provided in the home. Respondants to the questionaire said they always 5 usually 4 like the meals in the home. The inspector joined some individuals for lunch the meal was well presented and there was an unhurried and relaxed atmosphere with staff available to give assistance where this was needed and did so in a sensitive and discreet manner. The home had conducted a menu questionaire to which 23 individuals had replied. Nineteen had said there was enough variety in the menu offered and 16 said if they did not like the two choices were offered an alternative. There were a small number of negative comments about the snacks and as a result more variety is now available including fresh fruit and home made cakes. Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 home has procedures in place where individuals who live in the home can voice their concerns or make a complaint. There are Safeguarding polices and procedures in place and the manager has demonstrated good practice in responding to Safeguarding concerns. However not all staff have received Safeguarding training to make sure that all are aware and fully informed about Adult Protection and thereby fully protect the health and welfare of individuals who live in the home. Evidence: There had been one complaint made to the home since the last inspection. This was regarding the use of hearing aid for an individual. The home had responded appropriately within the timescales set out in the home procedure and met with the complainant. As a result new procedures and checks had been put in place. We spoke with a number of individuals about what they would do if they were unhappy about the service they received. All spoke of speaking to the manager Claire or telling staff. They importantly felt something would be done. Individuals said they were aware that the home had a complaints procedure and all respondents to the questionnaire said they also knew how to make a complaint. The home has Safeguarding policies and procedures in place and has the local authority guidance available. During the past year there have been two incidences around Safeguarding and the manager acted professionally following procedures. One Care Homes for Older People Page 17 of 27 Evidence: of these was regarding safe handling, the manager acted as required and has put in place new instructions regarding moving and handling practice in the home. We also spoke with a group of staff about their knowledge of Adult Protection they were able to demonstrate a good understanding of what may constitute abuse in a care home setting: not giving choice, incorrect moving and handling (drag lift) and talking over somebody. All of the staff were clear about what action they would take if an individual who lives in the home reported a concern relating to abuse. Staff records for 3 individuals showed that only one had completed Safeguarding Training. Care Homes for Older People Page 18 of 27 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, 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. 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 home provides a safe and hygienic environment for those that live and work in the home. Evidence: In looking around the home it was evident that there is a good standard of maintenance and decoration. In the past year there has been extensive decoration of bedrooms, dining room and lounge. New decking area has been installed to the rear of the home which provides provides level access to the garden. Individuals we spoke with all spoke of the home as being always clean and tidy. All respondents to the questionnaire said that the home is always fresh and clean. An Infection Control audit was undertaken in August 2008 and achieved 97 satisfaction. During our visit staff were observed following infection control procedures as necessary through the use of protective clothing and there are hand washing facilities available where needed. Staff training records indicated staff had undertaken Infection Control training. Care Homes for Older People Page 19 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements are generally satisfactory and there is a good effort to maintain staffing at the necessary level. However there is no audit of individual needs against staffing level so that staffing levels are as required to make sure the needs of individuals who live in the home are fully met. The recruitment and selection of staff makes sure as far as possible that the health and welfare of individuals who live in the home is protected. The training of staff helps in ensuring that they act in a competent manner however there are gaps in training which must be addressed so that the welfare of individuals is protected. Evidence: On the day of our visit there were 5 care staff on duty am in addition to activities organiser. Staffing rotas showed that generally there are 4 care staff on duty am, 3 pm with waking night staff. When speaking with individuals who live in the home they commented on the staff availability: if we want help they will help us usually busy good...anything I ask they will do it very good, very busy dont get time to talk. Respondents to the Have Your say questionnaire said Always 1 Usually 8 to Are the staff available when you need them? with one individual commenting sometimes staff times are limited get called away. To the question Do you receive the care and support you need? respondents said Always 2 Usually 6 Sometimes 1. Staff who responded to questionnaire said Always 1 Usually 5 and Never 1 to Are there Care Homes for Older People Page 20 of 27 Evidence: enough staff to meet the individual needs of all the people who use the service?. Two staff also commented If staff are off sick or on annual leave their hours are not always covered which leaves remaining staff to do their own work and cover for those not there When staff sick it is not always covered by agency and I feel the residents are the ones who suffer... but this has improved greatly with our new manager. Records showed that from 44 occasions staff on annual leave or sick 12 had not been covered. Staff we spoke with on the day of our visit said one of the improvements would be to sometimes have one more staff on duty so that they could spend more time with residents. However one member of staff said one of the things they did well was that of having more staff and have more time to spend with residents. Staffing recruitment records showed that the necessary checks had taken place namely full application with employment history, two references, POVA 1st checks undertaken before employment commenced and Enhanced Criminal Record Bureau check. The inspector was however not able to verify certificate in that these are retained at the company head office. Training records for 3 staff members showed that they had undertaken mandatory training i.e. moving and handling, health and safety, food hygiene. However only one had undertaken Safeguarding training which is also considered mandatory. Senior staff had undertaken medication training. In addition staff undertake infection control, dementia awareness training. We also looked at night staff training in relation to first aid only 3 of 6 had completed this training. Care Homes for Older People Page 21 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 manager of the home provides an open environment where individuals who live in the home can express their views about the quality of the service they receive. The practices of the home help in making sure the health and welfare of those that live and work in the home is protected. Evidence: The manager has been in post for 18 months. We spoke with a number of individuals about her approach they said that she is someone we can always go to if I have a problem I speak to Claire. Staff described her as approachable has open door policy. One staff member said that very improved morale because of change of management and that the whole atmosphere is better, we are more supported and its relaxed. Residents meeting are held regularly and the last meeting discussed activities and outing being organised, the visiting optician service now available. Also discussed was Care Homes for Older People Page 22 of 27 Evidence: the Dining Experience questionnaire and changes that had been made as a result including the placing of menus on dining tables and providing of water jugs in lounges and individuals bedrooms in the evenings. Staff we spoke with confirmed that regular staff meetings are held to discuss practice issues and routines in the home. Health and Safety records confirmed that fire checks take place as required with weekly fire alarm test and monthly emergency lighting test. The fire system was last serviced in July 08. A fire risk assessment was completed in May 08. Staff had undertaken Fire Safety Awareness training and fire drills. Other records evidenced servicing of equipment such as hoists and lift. It was noted that there remains uncovered radiators in the home however risk assessments had been completed to identify whether they needed to be covered or remain uncovered these are generally in corridors and lounge. Care Homes for Older People Page 23 of 27 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 Older People Page 24 of 27 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 1 27 18 The registered manager to 01/03/2009 make sure that having regard to the size of the care home and the number and needs of individuals who live in the home that there are at all times suitably qualified, competent and experienced persons at the care home in such numbers as are appropriate for the health and welfare of all those who live in the home. This is in response to concerns as to the maintaining of staffing level and comments received from individuals and staff. Further comments about this requirement have been made in the What they could do better section of this report. 2 30 18 The manager to make sure that persons employed to work at the care home receive training appropriate 01/03/2009 Care Homes for Older People Page 25 of 27 to the work they are to perform. This refers to the need to make sure there are the necessary staff on duty at all times who have received first aid training. This also refers to the need to make sure all staff have undertaken Safeguarding training. 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 Older People Page 26 of 27 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 © (2009) 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 Older People Page 27 of 27 - 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!