Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 20/10/05 for St Michael`s Cheshire Nursing & Residential Home

Also see our care home review for St Michael`s Cheshire Nursing & Residential Home for more information

This inspection was carried out on 20th 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

The home benefits from strong management and a skilled staff team. Staff supervision is good and opportunities for staff training to meet individual training needs is provided for very well. The ethos of the home is of empowering residents to live a meaningful life of their choice. This is realised by involving residents in focus groups in the further development of service provision and encouraging residents to be critical of the service so that the home may continually be resident focused in order to further improve the conduct and care provision at the home.

What has improved since the last inspection?

What the care home could do better:

As a result of this inspection two recommendations are made. The first is that the home records clearly consent of consultation where a restraining aid is risk assessed for residents, such as bed rails or wheelchair/chair lap straps. This was not evident in two care plans inspected. The second recommendation following a discussion with nursing staff at the home is that the Leonard Cheshire Foundation devises clarity on its` policy of resuscitation in the home that meets the duty of care to residents. The current protocols expected of nurses are too woolly and leaves then in a vulnerable position should they intervene and attempt the emergency resuscitation of a resident at the home.

CARE HOME ADULTS 18-65 St Michael`s Cheshire Nursing & Residential Home Cheddar Road Axbridge Somerset BS26 2DW Lead Inspector Judith Roper Announced Inspection 20th and 21st October 2005 10:00 St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 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 Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.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 Adults 18-65. 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 Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Michael`s Cheshire Nursing & Residential Home Cheddar Road Axbridge Somerset BS26 2DW 01934 732358 01934 732809 Address 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) Leonard Cheshire Mrs Helen Bond Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, in the age range 18-60 years who require nursing care by reason of physical disablement Elderly persons of either sex, not less than 60 years, who require general nursing care Up to twelve places for personal care. Up to 30 places for `nursing care`. Registered for a total of 36 places in Categories OP and PD The home must, at all times, have an appropriately skilled clinical nurse on duty. 10.08.05 Date of last inspection Brief Description of the Service: The home is formed from the conversion of a former TB sanatorium, managed by the Anglican Sisterhood from 1878 until1968. The home now caters for Younger Adults with Physical Disabilities and is managed by The Leonard Cheshire Foundation. The home is set in large grounds on a sloping site that allows access to the grounds from each floor. Many of the original features of the house have been retained. The home is within walking distance of Axbridge Town where there are shops and other local facilities. Accommodation is on three floors, and there are two adjoining bungalows used as transitional homes for suitable residents. These bungalows are not registered for nursing or personal care. All bedrooms are single occupancy. The home has been well adapted for the younger service user. The home can accommodate self-propelled wheelchair users thereby fostering maximum independence. The grounds are accessible by wheelchair and there are tables and chairs for use on the patio in the warmer weather St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by one inspector and took place over two days for a total of 10 hours. 36 residents were at the home on the day of the inspection. There are currently no vacancies at the home. The inspectors were able to see and spend time interacting with the residents. Many staff on duty were able to give time to speak with the inspectors. The registered manager Mrs. Bond was available for comment during the inspection. The inspectors would like to thank Mrs. Bond and the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and friendly. Staff carried out their duties in a pleasant and professional manner. Prior to the inspection the CSCI received 28 comment cards from residents of the home and 6 comment cards from relatives/visitors. The general trends in the responses were discussed with Mrs. Bond during the inspection and generally the responses were positive. It is clear that residents at St. Michaels are given opportunities and support to express their views on the conduct of the service through structured and regular consultation by the Leonard Cheshire foundation as well as being able to approach staff and management at the home informally. This inspection focused on outcome statements for National Minimum Standards that were not inspected at the previous unannounced inspection of the home held in August 2005. Standards where a requirement or recommendation were made at the last inspection were also inspected. Records examined during the inspection were five care plans, a Regulation 26 visit recording on behalf of the provider carried out during the inspection on the 21st of October, fridge temperature records of the medication fridge, bath/shower hot water temperature records and medication administration records; other records will be examined at subsequent inspection visits. Prior to the inspection the home completed and forwarded to the CSCI on request a pre-inspection questionnaire and this included servicing details of equipment in the home, current menus, staffing rosters, staff training details, details and numbers of staff employed at the home, and the staff induction programme. During the inspection the inspector was also provided with the home’s revised Statement of Purpose of June 2005, the registered manager’s evidence of her Continuing Professional Development, minutes of recent resident led and resident focused liaison and strategy groups and a number of documents produced by the Leonard Cheshire Foundation that reviews the service provision for the residents who live at homes within the group and opportunities for residents to be involved in further development of service provision. One current resident has co-edited a book about St. Michaels Home explaining the history of the building. A copy of this book was also given to the inspector. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? 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 Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5. The home provides a range of information for prospective residents that are both informative and clearly presented. This gives potential residents useful information about the services at the home. Resident contracts now state the room to be occupied. This gives the resident security that they would not be moved from their contracted room arbitrarily by the home. EVIDENCE: The home reviewed and updated its Statement of Purpose in June 2005. The CSCI holds a copy of this current document. In addition to this document are a number of professionally presented brochures and information giving booklets about St. Michaels and the wider Leonard Cheshire organisation. Resident contracts have been amended following a recommendation made at the last inspection. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9, 10. Care plans are generally well maintained and reviewed at least three monthly. Wound care and pressure area care planning has improved significantly since the last inspection. Advocacy and self-advocacy is strongly supported and encouraged in the home. This adds to assertiveness and self-worth for residents. There is a range of advisory committees within the Leonard Cheshire for residents to sit on. This ensures that residents are part of the structured policy decision making within the Leonard Cheshire foundation. Risk taking is recognised as part of normal life for residents. A recommendation is made with obtaining consent for any resident’s use of a risk assessed restraining aid. Resident confidentiality is respected and maintained. The methods of maintaining confidentiality are explained to residents in the home’s Statement of Purpose and Service User’s Guide. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 10 EVIDENCE: A sample of four resident care plans were inspected. Residents spoken with were either not aware of their care plans or did not express a desire to be consulted in the writing of their individual plans of care. This seems to sit incongruously with the ethos of the home that is so resident voice focused. The inspector’s view of this was fed back to the manager. Residents do attend their placement reviews where their plan of care is discussed. Care plans were reviewed generally three monthly or more frequently if clinical need dictated this. The company care model for the Leonard Cheshire organisation promotes independence and choice for its residents. Advocacy and self-advocacy services are promoted and residents have a range of meetings in the home. Residents also form part of interview panels for new staff appointments. Residents are encouraged to retain management of their own personal finances. The home has a small shop that is run by residents in the mornings on a rota basis. Residents spoken with were aware of the organisation’s plans to locate to an alternative site. Risk assessments for individual activities and environmental risks at the home were present in individual care plans. The home is open for residents to move freely in and out of the building to access the grounds. The use of restraining aids such as bed rails or lap straps was risk assessed for individuals but no consent was recorded. This is recommended. Records were held in a manner to protect resident’s confidentiality. One resident expressed a concern to the inspector that some information in their bedroom of a personal nature was displayed in a non-discreet manner and asked the inspector if this information could be moved. The inspector spoke to the manager and this request was duly respected. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15. Residents and relatives gave feedback confirming that the home and wider organisation supports family and friendship links and that there is opportunity to choose to be part of social events or clubs locally. EVIDENCE: 6 comment cards were received from relatives prior to the inspection giving a positive assessment of the services at the home. 2 relatives were available for comment during the inspection said that the home consults promptly with them over their relative’s health needs. One comment card received stated. “I have total confidence in the quality of care offered.” The home employs a part-time psychiatric nurse who is also a trained psychosexual counsellor. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21. Medication is safely administered. Advice was given regarding some record keeping of cold medicines. Residents are supported to self-medicate where appropriate. The ageing process and progression of chronic illnesses is supported and managed sensitively for residents at the home. EVIDENCE: Medication management and medication record keeping was inspected briefly and a useful discussion was held on medication issues with the management and senior nursing team. Some advice was given to the home regarding the recording of cold stored medicines and labelling of medicines for resident day trips out. Medication Administration Records (MAR sheets) inspected were maintained in good order. Health care screening and community monitoring was recorded in care plans. The home plans to train a member of the nursing staff to provide an expertise in tissues viability for the home. Bereavement counselling for residents and palliative care training for staff was discussed with the management team. There has not been a death at the home for more than a year but the nursing and care team are aware of chronic and degenerative health needs of residents and the forward planning required with residents and families for the support needed in palliative and terminal stages of life. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. The home has a complaints procedure, which is appropriate and is adhered to. EVIDENCE: The home has received one complaint since the last inspection. The CSCI was notified of this complaint by the complainant. The home was asked to investigate the complaint. This investigation was carried out thoroughly and to the satisfaction of the complainant. The complaint was upheld and the home put in place immediately an action plan to try to prevent such a reason for this complaint arising again. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. The Leonard Cheshire organisation plans to move to a new purpose built facility away from the St. Michaels site in the future in order to meet National Minimum Standards. An alternative site is actively being sought. Residents are being kept informed of the organisation’s developments. In the meantime, St. Michaels has been adapted to meet resident needs as far as possible. Disabled access and disabled facilities are good. EVIDENCE: It is still planned that the Leonard Cheshire organisation will purchase a new site for the service currently offered at St. Michaels. Residents at St. Michaels are aware of the organisation’s plan. The St. Michaels site is large and of character. It has been adapted as far a possible to meet National Minimum Standards. The quality of internal décor varies but there is an on-going routine maintenance plan for redecoration. Wheelchair access around the home is good. All accommodation offered is in single rooms. Rooms are personalised reflecting the tastes of occupants. Toilets and bathrooms are lockable and have disabled facilities. Some bathrooms and shower rooms are functional rather than aesthetically pleasing. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 15 There is a range and good choice of shared space. This includes a servery area where residents can get a snack or drink between meals. Smokers have their own designated balcony lounge. The laundry facility is due to be relocated into the main home and feasibly studies have taken place for a suitable location. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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. The staff team is settled and there is a very good structured programme of staff training. There are sufficient numbers of staff rostered on duty to meet the current needs of residents. EVIDENCE: Roles and staff responsibilities are defined within the staffing structure at the home and are detailed in the Statement of Purpose. The home also uses Community Service Volunteers from across the world. These volunteers are not included in the duty staff rotas. There are minimal vacant staffing posts at the home. The existing staff team or agency workers cover required staff shifts. Copies of the current month staffing rotas were supplied to the inspector on request prior to the inspection for scrutiny. A team of administrative, management, physiotherapy, activity and ancillary staff supports direct care staff and nurses. The home employs a staff training development officer. Staff training records were maintained well with a good range of staff training in-house events scheduled throughout the year as well as staff accessing external training events. The staff induction programme is linked to the Skills Council guidance and is a full and useful induction programme that can be tailored to individual staff training needs. There are currently approximately 50 of employed care staff holding the NVQ level 2 in care award with many others studying to achieve this award at levels 2 and 3. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42, 43. The home is managed well with strong leadership and the Leonard Cheshire foundation’s ethos of empowerment for residents is actively pursued. The Disability Forum endorses policies and procedures at the home. Having current residents sitting on an internal policy panel adds weight to the professionalism of policies adopted by the organisation. A recommendation is made that the Leonard Cheshire foundations clarifies its resuscitation policy in a formal procedural document in order to support staff who may intervene in a life threatening situation by providing cardiopulmonary resuscitation (CPR) to a resident. Health and safety issues are monitored on a monthly basis with a report sent to the CSCI. This report included timescales given by the organisation for issues to be addressed by and is followed-up by the next months visit. The charity continues to invest into the environment of the home and the home is solvent. St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 18 EVIDENCE: A structured team manages the home and the registered manager holds a high level of qualification for this role. She keeps her continuing professional development up to date by attending relevant regular training sessions. The home has adopted all Leonard Cheshire policies and procedures and codes of practice. The Disability Forum endorses these. These documents are updated centrally. In discussion with management and nursing staff it was apparent that the organisation’s policy on resuscitation requires clarification in order to provide a clear guidance for staff trained to carry out cardiopulmonary resuscitation. Records are stored appropriately. Regulation 26 visit reports by the provider are copied to the CSCI on a monthly basis. The home has also notified the CSCI of reportable events between inspections via the Regulation 37 reporting process. Records of equipment servicing were provided to the CSCI in the preinspection questionnaire. This was discussed and followed up during the inspection and was in order. The kitchen was last inspected by the Environmental Health agency in September 2005. The report stated that. “There is a good standard of hygiene and record keeping.” St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.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 Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X 3 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 3 Standard No 37 38 39 40 41 42 43 Score 4 3 3 X 2 X 3 St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 20 No 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. 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. No. 1 Refer to Standard YA9 Good Practice Recommendations It is recommended that where a risk assessment for a resident indicates that a restraining aid be used (such as bed rails or lap straps), that this is discussed with the resident and their consent clearly recorded. If the resident is unable to consent a record of this being discussed with next-of-kin or the care manager should be recorded. This should be reviewed at least annually. It is recommended that the Leonard Cheshire Foundation devise a clear guidance policy document for clinical staff on the duty of care and resuscitation intervention at the home. 2 YA41 St Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Michael`s Cheshire Nursing & Residential Home DS0000003291.V249352.R01.S.doc Version 5.0 Page 22 - 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!