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Inspection on 10/10/05 for St Mary`s House Residential Home

Also see our care home review for St Mary`s House Residential Home for more information

This inspection was carried out on 10th October 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents liked the staff, saying they were "very friendly" and approachable. Time spent with residents and visiting relatives, identified that they felt the home was well run, and they had no concerns over the standard of care received. One resident said "as far as I am concerned everything is okay" and that the entertainment "sometimes was very good". Residents said that they enjoyed the food, and the flexibility of being able to have breakfast in bed. Staff worked well as a team and felt supported by the management.

What has improved since the last inspection?

The home has continued upgrading the environment, redecorating bedrooms, and replacing worn furniture. The home had undertaken a survey, to find out what relatives thought of the level of care residents received. This information will then be used, to identify any areas that the home feels they are doing well in, or they need to improve in.

What the care home could do better:

To ensure the safety of residents, the home needs to update their Fire Practice to stop fire, and fire resisting doors being held open with doorstops. Although care plans held a good level of information about residents, staff was not always being given clear guidelines, on how much help a resident needed. The home was asked to look at how they were trying to maintain a vulnerable resident`s safety, to see what methods could be used, to alert staff that someone was going into the resident`s bedroom.

CARE HOMES FOR OLDER PEOPLE St Mary`s House Residential Home Earsham Street Bungay Suffolk NR35 1AQ Lead Inspector Jill Clarke Unannounced Inspection 10th October 2005 12.00h X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Mary`s House Residential Home Address Earsham Street Bungay Suffolk NR35 1AQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01986 892444 01986 895708 Mr Christopher Albert Farrer Mrs W Farrer Mrs W Farrer Care Home 28 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (19), Old age, not falling within any other of places category (9) St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 The home may accommodate up to one person, aged 60 and over, who require care and accommodate by reason of dementia. 4th March 2005 Date of last inspection Brief Description of the Service: St.Mary’s House Residential Home is registered to provide care for 28 older people. Of these, up to 19 places are for older people with dementia, and 1 place for a person aged between 60 to 65 years of age. The home is situated in the market town of Bungay, close to shops, Post Office, public houses, Hotel, Library, Doctors surgery, Dentist, Optician, and restaurants. A bus service links it to the main towns, including Norwich and Lowestoft. St Mary’s House is a large adapted Georgian property. Residents’ bedrooms, toilets and bathrooms are located across all 3 floors. Communal rooms lounges/dinning rooms are on ground level, and have doors leading out to the patio and mature gardens. Residents can move around the home by using the passenger lift, platform lift, stair lift, stairs or ramp. A ramp is located to the rear of the home, to enable disabled, or wheelchair users access. There are 7 car-parking bays at the rear of the home. There is also off-street parking, and Pay & Display car park within walking distance. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out over 5 ¾ hours on a Monday in October. Time was spent in private with 3 residents, to hear their views, on what it was like living at St. Mary’s House. General feedback was also given during conversations with residents throughout the inspection. Time was also spent with 2 relatives and 8 members of staff, which included the Owners, Senior Carers and Care Assistants. Records viewed included care plans, pre-admission paperwork, and quality assurance survey. A tour was made of the communal accommodation and sample of 9 bedrooms, to check the condition of the décor, furniture and cleanliness. People living at the home were asked if they liked to be referred to as service users or residents, a resident said that “residents sounds much nicer”. This report respects their wishes. What the service does well: What has improved since the last inspection? The home has continued upgrading the environment, redecorating bedrooms, and replacing worn furniture. The home had undertaken a survey, to find out what relatives thought of the level of care residents received. This information will then be used, to identify any areas that the home feels they are doing well in, or they need to improve in. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 6 What they could do better: 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 Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 8 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 the following standard(s): 2, 3, and 4. People wishing to move into the home, can expect their needs to be fully assessed. This ensures that the home only admits residents within their registration category, whose care needs they can meet. EVIDENCE: Time spent with a relative confirmed that the manager from the home came and visited their next-of-kin before their admission. Staff said this was normal practice, to enable them to meet the prospective resident, and undertake their own assessment to ensure they could provide the level of care the person was looking for. Completed pre-admission assessments were held on file. Other pre-admission paperwork held on files included Social Workers assessments, and hospital transfer letters. The relative spoken to, confirmed that they had received information on fees. They said the resident “seemed very happy here”, and the home was able to provide the level of care/ support they required. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 9 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 the following standard(s): 7, 8, and 10. People living at the home can expect to receive a good level of care by staff that will respect their privacy. EVIDENCE: During the inspection the care of 3 residents was ‘tracked’. This included talking to the residents (or their representative) to hear their views on the level of care provided and, looking at their care records (care plans). Time was also spent with staff, to assess their knowledge of the resident’s care needs. Time spent with the residents and, where applicable relatives, showed that the staff gave them the level of support they wanted. They described staff as “very friendly”, “caring”, and always ensure “the door is closed when we dress”. In shared bedrooms there were moveable room dividers, which staff confirmed they used when undertaking residents personal care. Staff was seen to knock on bedroom doors before entering, and including residents in conversations. Care plans held completed residents ‘Initial Assessment Evaluation ‘ sheets, which gave staff guidance on residents physical, emotional and social needs. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 10 This led to discussions with staff over written instructions used such as ‘required part help’, and what this meant. Staff were able to give clear information on what was meant by ‘part’, for example, the resident could wash their top half, but required assistance when washing the lower part of their body. Although staff were aware, it was fed back to the owners, that new staff would not have the same level of knowledge on the residents needs. New or Agency staff would be more reliant on the written information. This was especially as many of the residents had dementia, and may not be able to fully communicate their needs. Risk assessments had been undertaken on the resident’s mobility, and risk of falling or tripping over. Where staff had identified that the use of bedsides, would reduce the risk of a resident falling out of bed, permission had been sought from the resident, or if applicable their family to use bedsides. Staff wrote daily records on the residents, and monthly summaries, which detailed any changes in the residents, physical, mental health and level of care given. It was noted that 1 of the residents care whose was tracked, had a small appetite, and was underweight. The care plan did not show if staff was regularly monitoring the persons weight. Discussions with the owner identified that further records were kept in the office. These records gave information on the residents weight, and visits by health professionals. Although the residents weight had been monitored, it had not been undertaken regularly. This led to discussions that the home is introducing the Malnutrition Universal Screening Tool (MUST) nutritional monitoring forms, which will be completed for all residents. The Owner said they had also attended a ‘Alzheimer’s Food for thought course’. Following the course the owner had untaken an analysis of the home’s menu, looking at the nutritional content of the food. This will also support the home in ensuring that resident’s individual nutritional requirements are being met. The home had carried out a quality assurance survey during August. Relatives were asked if they felt that the overall care residents received was ‘Very good’, ‘Good’, ‘Average’ or ‘poor’. From the completed sheet (26 sent out – 19 returned), 10 had said ‘very good’, 5 ‘good’, and 4 had been left blank. Where people had left the question blank – if was felt this could be an oversight, as other questions asked over care had been given positive feedback. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 11 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 the following standard(s): 14 and 15. People using the service can expect to be served varied, nutritional meals, and be supported to join in with different activities. However, the home needs to look at how they can give extra support to mentally alert residents, to stop them becoming isolated. EVIDENCE: Information in care plans included the residents ‘Life story’, which relatives, residents (if able) and staff had completed. It covered the resident’s early and working life, as well as information on their family – both living and deceased. Staff said this was useful, as they could use the information as discussion topics with residents, and it gave them insight into their lives. They felt this was especially important, to support residents with dementia, as they could often remember events. During the unannounced inspection, an entertainer arrived and played music in the lounges. One resident with a lovely voice, sang along. Residents said they enjoyed the music, although 1 preferred to sit away from the main entertainment, as they “liked peace and quiet”. Residents said that they have regular musical entertainment. The owners said they had also arranged for a small travelling show, to bring their latest St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 12 production twice a year. During the summer, residents had visited Oulton Broards, which included a Fish and Chip lunch. Residents said that they can also take part in Art, and ‘music therapy’ sessions. Time spent talking with 1 resident, who was sitting on their own, identified that they felt lonely at times. They praised the staff that would come and talk, but felt, due to other residents differing levels of confusion, they had no one they could sit and talk to. With the resident’s permission, this was fed back to the owners. This led to discussions about using volunteers or a ‘befriender’ who could have regular contact with the resident. They said they would look into the situation, to see if there were any local organisations. Information written in care plans showed that staff had asked residents (or if unable to answer - their representative) about their likes and dislikes, and how they liked to spend their day. One resident, asked if they felt staff respected their privacy?, replied “yes”. They then went on to give an example saying that staff always ensured the “bedroom door was closed” when they “were dressing in the morning”. Where resident’s movement might be restricted for their safety, such as using bedsides, care plans showed that permission had been obtained. This was either from the resident, or the person (relative, friend) acting on their behalf. Lunch served during the inspection included Chicken in Mushroom and Leek sauce, with Broccoli and potatoes. This was followed by Jam Tart and Custard. After lunch, time was spent with residents sitting in the first lounge, to hear their views on the standard of food. They felt the standard was good, saying staff “always come and ask what you want”. Another resident felt the “best bit”, was being “served breakfast in their bedroom”. During the afternoon, staff brought round a selection of cakes and hot drinks, which residents said happened every day. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 13 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 the following standard(s): 16 and 18. People living at the home can expect any concerns they have to be listened to, and acted on appropriately. Where concerns are raised over a resident’s vulnerability, the home should fully consult, and record any action taken to ensure their safety is maintained. EVIDENCE: It was identified at the last inspection, that not all the visitors to the home were aware where the homes complaint procedure was displayed. It was recommended that a copy of the home’s complaint procedure should be included in the visitor’s book. A look at the visitors book showed that a copy of the complaint procedure had been attached to the inside cover. Time spent with a relative confirmed that they would (if they needed to), raise any concerns direct with the owners or staff. Residents also confirmed if they were unhappy they would tell a member of staff. During the inspection, a member of staff was seen to unlock a bedroom door and take a tray of food in. On entering the bedroom, a member of staff was seen assisting a resident, who was lying in bed, and unable to feed them self. Concerns were raised with staff over why the resident was locked in their bedroom. Staff said that the resident who was unable to communicate, had been disturbed by another resident walking in, and out, of the bedroom. The resident’s family were concerned over the resident’s vulnerability, and had requested the bedroom door to be locked. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 14 There was no signed paperwork found in the care plan, from the relatives requesting this. The owners felt they were acted in the best interest of the resident. As the resident was unable to call out or move, they did not feel the resident was being restricted. The home was asked to look at other methods of controlling access to the bedroom, such as using a pressure pad, which would alert staff that someone was entering the bedroom. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 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 the following standard(s): 19, 23, 24 and 26. People using the service can expect to live in a clean, ‘homely’ environment, which meets their needs. EVIDENCE: Time spent talking to a resident in their bedroom, confirmed that they felt the bedroom met their needs, and they could easily get around. Asked if their bedroom was kept clean and tidy? They replied “oh yes”. Bedrooms viewed, had been personalised by the residents, with their memorabilia and possessions. This included soft toys, photographs, pictures and ornaments. Locks had been fitted to chest of drawers in the bedrooms looked at. The owners said they had nearly completed the work, to ensure all residents had a lockable storage space. The walk around the home, showed the work undertaken by the owners as part of their on-going maintenance and refurbishment programme. This included replacing worn bedroom furniture, decorating bedrooms, new fire door, bedding. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 16 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. Residents can expect the home to have enough staff on duty, to be able to meet their care needs. EVIDENCE: Time spent talking to staff and reviewing rotas, showed that the staffing levels are 1 senior carer and 3 carers in the afternoon. Another 2 carers then increase this at tea-time, when residents need more support. During discussions with residents and relatives, no concerns were raised over the staffing levels. The homes own quality assurance survey had asked relatives about the staffing levels. The majority (13 out of 19) had stated that the staffing levels were ‘very good’, with the remainder falling within ‘Good’ or ‘average’. A relative had written ‘the most important thing is good level of staffing and quality of staff – keep those good and everything else will follow’. The owners said that they go out personally to recruit overseas staff (who are qualified Nurses in their own country), to ensure that they have good written and verbal skills in English. Time spent with an overseas Carer, showed that they had a good understanding of the English language, and had no problems communicating with the residents. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 17 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 38. People using the service can expect to find an approachable management and staff team, who are committed to providing a good level of service. To ensure the safety of residents, the home must update their Fire Policies and staff practices. EVIDENCE: Information gained from the home’s annual quality assurance survey is used by the owners to improve on any areas, that relatives may feel are not up to standard. The owners said that they had not fully analysed the results from the August 2005 survey, but once completed, the results will be made available to the residents, relatives, visitors and staff. Feedback given by the home, and action taken to put right any shortfalls, has been evidenced at previous inspections. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 18 Whilst visiting residents in their bedrooms, it was noted that some of resident’s doors were held back with wooden wedges. The fire doors located between some of the upstairs bedrooms, and to the laundry room, were also held back. This was brought to the attention of the owners, who took immediate steps to remove all the door wedges. A local contractor was also contacted to come and look at the Fire doors, and discuss fitting automatic closing devices. This would enable the doors to be held safety open, but would close automatically if the fire alarms were set off. The owners have started, but not completed their Fire Risk assessment. Records showed that work required following the Fire Safety Officer’s visit in December 2004, had been completed. This included fitting a new fire door to the sluice room. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 19 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X 3 3 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X X X 2 St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 20 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 OP38 Regulation 23 (4) 13 (4) Requirement To ensure the safety of people living/working at the home, Fire and resident bedroom doors must not be ‘wedged’ open. Where a resident has requested that their bedroom door is kept open, an automatic closing device must be fitted, which meets fire safety requirements. Residents must not be locked in their bedroom. Where concerns are raised over residents safety, other methods of monitoring access to the bedroom must be identified and put into action. Timescale for action 10/10/05 2 OP18OP38 23 (4) 13 (4) 17/10/05 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 OP7 Good Practice Recommendations To be more informative to new staff, terms such as ‘part help’, ‘prompting’ should be followed by more detailed information, to ensure cares know what level of DS0000024499.V257217.R02.S.doc Version 5.0 Page 21 St Mary`s House Residential Home 2 OP18 3 OP12OP13 help/assistance they should be giving. Where relatives have asked the home to override the homes policy, such as locking the resident’s bedroom, whilst they are in it, must be fully recorded. The home prior to accepting any such arrangement should ensure that all other avenues, such as the use of door alarms have been tried. The home should then consult the resident’s social worker (if applicable), and CSCI (regulation 37) before any action is taken. To support residents(if they wish) who are mentally alert, the home should look at ways they can ensure regular social contact with external agencies, such as ‘volunteers’ or ‘befriender’. St Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Mary`s House Residential Home DS0000024499.V257217.R02.S.doc Version 5.0 Page 23 - 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!