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Inspection on 21/06/07 for St Marys Nursing Home

Also see our care home review for St Marys Nursing Home for more information

This inspection was carried out on 21st June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

The Registered Providers had provided a statement of purpose and Residents Guide to the Home, and all new Residents applying to the Home would be appropriately assessed by the Manager before an admission was arranged. The Registered Provider/Manager and staff were found to be attentive and supportive of the Residents, and completed a very good level of administration to support this level of care. The Residents spoken to also said how helpful staff were to them, which was observed during this visit to the Home. Residents were found to be well protected by the Complaints procedure and the Safeguarding Adults procedure in the Home. The Home was found to be very well maintained throughout. Very good levels of care staffing were provided to meet the needs of all Residents. All of the administrative arrangements to ensure that the Home met the standards set by law were found to be in place.

What has improved since the last inspection?

At the time of the last inspection, in January 2006, only two Requirements were set for the Registered Providers and Manager to meet. The first was to replace a badly worn carpet, which had been done, and the second was to improve the quality of the recording of the administration of medication, which had again also been done.

What the care home could do better:

No Requirements have been set following this visit to the Home, however, a number of Recommendations were set. The statement of purpose and Residents Guide needed to be improved to ensure they contained information about the physical environmental Standards met by the Home. All the care plans of Residents must be maintained up to date, and the Manager should indicate in Residents files when she had reviewed them. All concerns and complaints must be appropriately recorded in the Complaints Record book. A policy should be provided stating that staff cannot not benefit in any way from Residents wills.

CARE HOMES FOR OLDER PEOPLE St Marys Nursing Home Ednaston Ashbourne Derby Derby Derbyshire DE6 3BA Lead Inspector Steve Smith Unannounced Inspection 21 June 2007 10:30 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 Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Marys Nursing Home Address Ednaston Ashbourne Derby Derby Derbyshire DE6 3BA 01335 360254 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) kathrynsmith@btconnect.com Institute of our Lady of Mercy Miss Kathryn Anne Smith Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (1) of places St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 35 places for OP, E & PD Date of last inspection 17th January 2006 Brief Description of the Service: St Mary’s is a 35-place care home with nursing. The Home is able to offer respite and short-term convalescence care, and is also suitably adapted to accommodate wheelchair users. The Home provides 24-hour personal care with nursing. Qualified nurses are on duty each shift, and additional management on-call arrangements are in operation outside office hours. Care staff are offered training to levels 2 and 3 National Vocational Qualification (NVQ). Additional in-house and mandatory staff training is provided. The Home offers 29 single en-suite bedrooms and 3 shared en-suite bedrooms. The Home also has a passenger lift between the ground and first floor. Residents have access to the large, attractive, well maintained grounds. The building is well maintained. Decoration and furnishings are of a very high standard throughout. The Residents also have access to a private chapel. The charges made for a room at St Mary’s Nursing Home range from £525.00 a week to £605.00 a week, dependent on the bedroom provided and the needs of the particular Resident. A copy of the Commission’s inspection report is available from within the Home. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in 7 hours. Discussion was held with three Residents, and the records of four Residents were ‘case tracked’. Discussion was also held with the Manager of the Home, and with one member of the care staff. A number of records were examined, and the bedrooms of the four Residents whose file were examined, and all public areas of the Home were looked at. The Commission’s pre-inspection questionnaire, sent to the Manager, was examined. The Commission’s Residents questionnaire was also sent to a selection of Residents, and 5 were returned at the time of this inspection. They all commented most favourably on the Home, some extremely so. What the service does well: What has improved since the last inspection? At the time of the last inspection, in January 2006, only two Requirements were set for the Registered Providers and Manager to meet. The first was to replace a badly worn carpet, which had been done, and the second was to improve the quality of the recording of the administration of medication, which had again also been done. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 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 Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1, 2, 3 & 6. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. All new Residents moving to the Home were appropriately assessed prior to their admission, so that they were reassured that their needs would be met. EVIDENCE: The Registered Providers had provided a detailed statement of purpose for the Home, together with a Resident’s Guide, which was available in each Residents bedroom. However, the statement of purpose did not contain details of the physical environment Standards met/not met by the Home, and nor were they summarised in the Residents Guide. However, the Guide was well completed, and included the opinions of Residents on what life was like in the Home. The Residents Guide also contained information on how contact could be made with the Commission, the local Social Services Dept and the local Health Authority. All of this information was also available to Residents on a cassette. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 9 The records of four Residents were examined during this inspection and a complete copy of the statement of terms and conditions of residency or a contract, if purchasing their care privately, was found in each file. When new Residents were admitted to the Home, the Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting each Resident, copies of which were seen. The Manager also assessed all Residents sponsored by Social Services Depts. If the Residents were self-funding from the outset, the Manager completed her own summary of needs, which were also seen during the inspection. Standard 6 does not apply to this Home. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 & 11. The quality in this outcome area was Excellent. This judgement was made using available evidence including a visit to this service. Residents’ health and personal care needs were being well met, as demonstrated within care plans, and medication was administered appropriately to meet Residents needs. EVIDENCE: To help assess Standard 7, the Resident’s Plan of Care, the records of four Residents were examined, for the purpose of case tracking. All of the basic information, concerning each Resident, was found to be in the files examined. That was, their name and date of birth, their preferred name, their next of kin, their GP, Care Manager and their date of entry to the Home. Records of the Manager’s initial assessment of each Resident were found in each file, together with well completed Individual Plans of care for each Resident. However, for one Resident the records were partially up St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 11 to date, while others were found to be two months out of date. Records of the risk assessment on each Resident were also available. The Manager had provided information within the files to say what additional needs Residents suffering with dementia might have had, and these were all reviewed at regular intervals. The files showed that very good records of events affecting each Resident were kept by the Home. The Manager also carried out formal reviews of Residents care needs at 3 monthly intervals, to which the Resident and their relatives were invited. All of the files were easy to read and good entries had been made by the care staff. The Manager said that she reviewed the records of each Resident at regular intervals, but she had not signed the records to indicate that this had taken place. The files were well organised, with different sections and confidential records were maintained when this was felt to be necessary. Staff were appropriately maintaining the records of Residents health needs. All medication and the method of distributing it to Residents was examined, and a good system was found to be in use. Discussion was held with Residents about life in the Home. They said that staff were very good at listening to their views on how they liked to be cared for and staff would carry out their wishes. They also said that their care needs were always met with dignity and respect. As a result, they felt very safe in the Home, and appeared to have a strong sense and appearance of well being – ‘Yes, staff want to know how I like things done, and they want to fit in with me in the main’. ‘I get first class care, all staff are good both day and night.’ Discussion was also held with Staff, and very positive ways were described of assisting Residents within the Home. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. The quality in this outcome area was Excellent. This judgement was made using available evidence including a visit to this service. Residents preferred lifestyles were respected by the Home, and Residents were given a wholesome and appealing diet in pleasant surroundings, that enhanced Residents well being. EVIDENCE: Residents were asked about the activities provided in the Home. They were each able to produce a list of activities for the coming month, which had been distributed by the Manager, and compiled by the Activities Coordinator. One Resident said ‘we have singers, films shows, talks, fashion shows, trips out, lots of events, its all down on the activities sheet.’ Residents said that they decided when they got up and went to bed – ‘I can go to bed and get up when I choose, I can have a sleep in the afternoon if I want.’ ‘I can go to bed and get up when I want, although I need assistance to do these things.’ Another Resident said ‘I have one bath a week, and I am happy with that, but I can have more if I need it.’ Relatives and friends of Residents were able to visit at any time, and could always be seen in private - ‘Yes, I always see my visitors in private.’ ‘They can St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 13 come at any time, and I can always see them in private, if I want.’ A member of staff said that visitors could call at any time of the day and confirmed that Residents could always see them in private. Residents were able to say that the Home provided good meals and that a choice was available at breakfast, dinnertime and teatime meals – Meals are good, I cannot fault them. A choice is available at every meal.’ ‘There is always a choice, some times so many I can find it hard to decide. Staff come around the day before to take your choice.’ Staff also confirmed this. The staff said that drinks and snacks were always provided between meals for Residents, which was witnessed during this visit to the Home, and that mealtimes were never rushed. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Complaints made to the Manager were addressed to meet Residents needs. The protection policies and procedures provided meant that Residents were well protected. EVIDENCE: Residents said that if they had a complaint to make they would tell the Manager but they had not had to do this to date. The Commission had not received any notice of complaint since the last visit to the Home, in January 2006. Since that date the Manager had recorded no concerns or complaints what so ever. A further check of the last time a concern or complaint was recorded dated back to 2005. However, good procedures were seen for both written and verbal complaints. The Registered Providers complaints procedure detailed that all complaints would be responded to by a Registered Provider, or the Manager, within at least 28 days. The Manager had a Safeguarding Adults procedure that included a ‘Whistle Blowing’ policy. The Manager also had a copy of the Public Interest Disclosure Act of 1998, and of the Dept of Health’s policy called ‘No Secrets’ available in the Home. The Manager confirmed that all allegations and incidents of abuse would be promptly followed up and that all actions taken would be recorded. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 15 However, this procedure had not been needed for a number of years. The policies and practices laid down by the Registered Providers ensured that all staff understood physical and verbal aggression by Residents. However, the Manager said that a policy had not been provided to prevent staff from benefiting from Residents wills, although a policy was in place to prevent staff from benefiting from gifts from Residents. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 & 26. The quality in this outcome area was Excellent. This judgement was made using available evidence including a visit to this service. The Home was very well maintained throughout, providing all Residents with a safe, comfortable environment in which to live. EVIDENCE: A tour was made of the public areas of the Home, and included the four bedrooms of the Residents whose care was reviewed at the time of this visit. The Home was attractively decorated throughout, and the lounges and dining room were most pleasant to sit in, and were provided with appropriate items for the Residents. An activities room was also seen that had the works of the Residents displayed upon the walls. The bedrooms seen provided very good space and provision for each Resident. All bedrooms were also provided with a toilet and shower. The Registered St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 17 Providers had provided appropriate furnishings in all locations seen during this visit. Toilets were easily available to all Residents, were clearly marked, and were provided with handrails where necessary. A call system was also available throughout the Home. All bedroom doors were provided with locks, which Residents could chose to use. All radiators were appropriately guarded, and could be controlled within each bedroom. The Home had appropriate sluicing facilities, and laundry was washed at appropriate temperatures. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. The quality in this outcome area was Excellent. This judgement was made using available evidence including a visit to this service. Care staffing was provided to meet the needs of Residents, and appropriate recruitment practices were always followed when recruiting new staff, so that Residents welfare was always safeguarded. EVIDENCE: A very good level of staffing was found to be provided in the Home to meet the needs of Residents. At the time of this inspection it was found that more than 50 of care staff held a qualification of at least NVQ level 2 in Care. The records of two new staff employed during the past 12 months were examined to see whether the Manager had obtained all relevant information about them, and it was found that all information had been obtained. The Manager said that new staff would be provided with induction and foundation training, which was confirmed by staff. She also said that all care staff were provided with at least three paid days training a year. A member of the care staff said that much more than three days was provided, often as many as 6 days paid training was provided. The records of some of this training was seen. All staff also had an individual training and development assessment and profile. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 & 38. The quality in this outcome area was Excellent. This judgement was made using available evidence including a visit to this service. Management arrangements at the Home were very clearly in place to ensure that Residents care was maintained at a positive standard. EVIDENCE: The Manager was appropriately qualified to manage the Home, having an NVQ level 4 qualification in Management and a Nursing qualification. The records of the monthly ‘inspections’ of the Home, carried out by a senior manager, were examined and found to be in good order. The Manager was able to show the annual development plan for the Home that reflected the aims and outcomes for Residents. She was also able to show the results of Residents surveys, and the results of relative surveys, both of which were posted on the Home’s notice board. She also said that the results of St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 20 Residents surveys were used by her when visiting potential new Residents to the Home. The Manager stated that the Home did not hold any savings money on behalf of Residents. Residents purchases and hairdressing etc were paid by the Home and relatives were then billed for these amounts. A staff member was asked about the supervision she received from the Manager or other senior staff in the Home. She said that this was done on approximately a 2 monthly basis, when her own needs and the needs of the Residents, for whom she was keyworker, were discussed. The Manager confirmed that supervision was provided by herself or senior staff, for all care staff working in the Home. The training required by the Regulations was examined. This showed that Moving and Handling training, Fire Safety training, First Aid training and Food Hygiene training and Infection Control training had been provided for all relevant staff, and this was later confirmed by the staff. From copies of the Home’s maintenance schedule, forwarded to the Commission prior to the inspection, it was found that all necessary maintenance and repairs were being appropriately addressed. All Residents had been risk assessed to determine their vulnerability and measures had been put in place to provide protection where necessary. The Registered Providers had complied with all necessary legislation, such as the Health and Safety at Work Act 1974, and the Manual Handling legislation of 1992. The Manager was able to show that she had provide risk assessments on the working conditions of staff; that is for care staff, catering staff and domestic staff. She had also provided a written statement of the policy, organisation and arrangements for maintaining those safe working practices. Finally, the Manager was able to show that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. With the assistance of the Fire Service, fire safety notices were also posted in relevant places around the Home. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 4 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 4 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 3 X 4 St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP1 No. 1. Good Practice Recommendations The statement of purpose should contain information on the physical environment Standards met/not met and be summarised in the Residents Guide. The individual plans of care for all Residents should kept up to date on all issues, and not allowed to have no entry made for at least two months. When the Manager has reviewed a Resident’s file, she could indicate that this has been done by signing the record with a red or green pen. 2. OP7 3. OP16 The Manager should ensure that concerns or complaints raised by Residents are recorded in the Complaints Record book. The Manager should provide a policy stating that staff DS0000002114.V329443.R01.S.doc Version 5.2 Page 23 4. OP18 St Marys Nursing Home cannot assist in the making of or benefit in anyway from Residents wills. St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT Commission for Social Care Inspection National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Marys Nursing Home DS0000002114.V329443.R01.S.doc Version 5.2 Page 25 - 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!