Inspection on 05/09/07 for Stanley House

This inspection was carried out on 5th September 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stanley House 02/10/06

Stanley House 12/12/05

Stanley House 25/08/05

Stanley House 13/10/04

Stanley House 21/07/04

Stanley House 11/11/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stanley House 155 Duffield Road Derby DE22 1AH Lead Inspector Jo Wright Key Unannounced Inspection 5th September 2007 08:45 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 Stanley House DS0000002110.V342497.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. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanley House Address 155 Duffield Road Derby DE22 1AH 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) 01332 364734 01332 344481 office@willover.co.uk Willover Limited Mrs Susan Mary Buckby Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd October 2006 Brief Description of the Service: Stanley House is a 42-bedded Care Home providing nursing care and is situated in a residential area of Derby. It is close to a range of shops and local amenities. The property was originally a private dwelling that has been converted and considerably extended. Residents bedrooms are located over three floors, which can be accessed via a passenger shaft lift or by a staircase. The Home provides limited en-suite facilities. There are a variety of communal areas made available for use at all times. The garden areas are landscaped and accessible to residents. The Home provides 24-hour staff care, three meals per day, with drinks and snacks provided at regular intervals throughout the day. Personal laundry is attended to and a range of leisure activities is provided by an Activities Coordinator throughout each week. The charges made for a room at Stanley House range from £475.00 to £525.00 a week, dependent on the size of room, the facilities provided, and whether the room is a double or single room. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the key inspection for this service. During this visit, time was spent speaking with residents, relatives and staff, and observing the daily routine within the home. The records for four residents were looked at in depth, as well as records relating to the general running of the home. Communal areas, bathrooms and a small number of bedrooms were viewed. Information received prior to the inspection was used to inform areas to look at during the site visit. 8 completed resident surveys were returned and the information within the surveys has been incorporated into the relevant sections of the report. What the service does well: What has improved since the last inspection? Bathing facilities are being upgraded to provide residents with a choice of facilities that meets their needs. Following the recent quality assurance survey, a choice of meals has been introduced at dinner time. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 6 Improvements have been made to recruitment practices, although some additional information still needs to be obtained. 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. Stanley House DS0000002110.V342497.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 Stanley House DS0000002110.V342497.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): Standards1, 2 and 3 (Standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient Needs Assessment information ensures that the needs of the people using the service are identified and met. EVIDENCE: People living at Stanley House were provided with a copy of the Statement of Purpose, Service Users Guide and National Minimum Standards in their bedrooms. All of the completed surveys indicated that everyone had received enough information about the home before they moved in so they could decide if it was the right place for them. Comments on the surveys included that ‘home recommended by an acquaintance’ and ‘chose what felt to be a caring and secure environment. Information supplied by the provider prior to this site visit and the documentation seen supported that people do not come to live at Stanley Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 9 House unless a member of staff had visited them, and assessed that the home was able to meet the person’s personal and health care needs. Additional information about the person’s needs was also obtained from care management, if the person’s care was funded in this way. The care of four residents was case tracked during this visit and their files were looked at in depth. Documentation completed following admission was detailed and provided sufficient information about individuals’ abilities and areas where they required support to enable staff to identify and plan how to meet their personal and health care needs. Assessments had been rewritten if a person’s needs had changed considerably or they had lived in the home for a number of years. The written contract and terms and conditions of residence were available for people living at Stanley House. People confirmed in the surveys that they had received a contract. Stanley House DS0000002110.V342497.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concise care planning and risk assessments ensure that residents’ needs are being met in the way that they choose. Medication procedures ensure that residents receive their mediation as prescribed so their health needs are met. EVIDENCE: Comments in the surveys and discussion with residents supported that generally they were satisfied with the care and support they received. Comments included ‘staff are very supportive, relative well cared for, never seen distressed on visiting’, ‘generally satisfied with my care, but small details are often ignored’, ‘on the whole happy in the home’, ‘could not be cared for better’, ‘well cared for and content’ and ‘settled well into home, carers are lovely, all very caring’. Care planning documentation was detailed and provided staff with sufficient information to meet the individual needs of residents. Detailed plans of care Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 11 were in place in each of the files looked at. The plans of care were based on assessment of need, and care plans been rewritten and updated as the residents needs changed. There was evidence to support that residents and families had been involved in planning and reviewing the care delivered, and that discussions had taken place about any possible limitations of choice, freedom and decision making. Good use had also been made of risk assessments and the information used in the development of the care plans, and the choice of equipment. Discussion with residents, families and staff, the records and information supplied by the provider prior to this site visit supported that residents health care needs were monitored and health care professionals involved as required. Qualified staff are responsible for the administration of medication. Systems were in place for ordering supplies and disposal of unwanted medication. The records and supplies of medication supported that residents received their medication as prescribed. Medication required cold storage was stored appropriately and the temperature of storage checked and within the safe range. Information supplied by the provider prior to this site visit indicated that the service has changed the community pharmacist, in order to obtain a service that meets the needs of residents. Qualified staff are also supported by the pharmacist from the local GP surgery, who visits regularly to reassess residents medication. Since the last inspection, any alteration or an additional medication recorded on the medication record is signed by two staff, dated and the name of the doctor authorising the change recorded. Stanley House DS0000002110.V342497.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ wellbeing was enhanced by the range and frequency of social and recreational activities provided. EVIDENCE: Information supplied by the provider prior to this site visit stated that a full time motivator was in post, and organised both group activities and one to one sessions. This was supported by comments from residents and staff, observation during the visit and the records. Several residents commented that they choose not to join in with the activities. Recent activities have included trips to Carsington Water and Chatsworth House, as well as reminiscence, games, and social evenings. Comments made in the surveys included ‘arrange activities which aim to include all residents regardless of their specific difficulties, this is very positive and essential to be inclusive of the community’ and ‘we have a very patient motivator, but she can only organise a few of us at a time, so we take our turn. Occasionally have entertainment organised for all of us to listen to, very enjoyable’. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 13 Comments from residents, staff and observation supported that the routine within the home was flexible. People were able to use all areas of the home as they wished, and remain in rooms if they wished. Visitors commented that they were able to visit at any time, and this was observed throughout the visit. It was observed that visitors were made welcome and offered refreshments. Residents were encouraged to continue to manage their own affairs, with support if required. Residents and relatives are encouraged to bring in personal belongings and furniture and this was observed during this visit. Information about advocacy services was readily available. Information supplied by the provider prior to this site visit stated residents and relatives have access to their records and may disagree with any information recorded. There was evidence to support that the care provided had been discussed with residents and relatives. As a result of the recent quality assurance survey, a written choice of meal has been introduced at dinnertime. Weekly menus were available on each dining table. Residents commented that they enjoyed the meals provided, and this was supported by comments made in the surveys, such as ‘meals generally good and served nicely’, ‘meals are very tasty’, ‘always likes the food and it appears to be good quality’ and ‘choice of course to choose from’. Staff commented that this change had been positive, and residents looked forwarded to being asked what choice they would like from the menu, and less food was now wasted. Staff were observed supporting residents as required with their meals and drinks. Stanley House DS0000002110.V342497.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concise complaints procedures ensure that residents and their families feel that they were listened to and their concerns acted upon. The lack of safeguarding adults training for some staff may result in residents not being protected from harm. EVIDENCE: Systems were in place for addressing complaints. Residents receive their own copy of the complaints procedure within their Service User Guide. Residents and relatives spoken with were aware of how to raise any concerns and felt able to do so, and this was supported by comments in the surveys. Comments in the surveys also confirmed that staff listened and acted on what residents said to them. Information supplied by the provider prior to this site visit indicated that two complaints had been received internally and both had been addressed within the required timescale. The records relating to these complaints were seen and were satisfactory. Information supplied by the provider prior to this site visit indicated that safeguarding adults procedures were in place. Staff spoken with were aware of where to find this procedure and how to report any incidents. No referrals have been made through safeguarding procedures during the previous 12 months. Information supplied by the provider indicated that not all staff had Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 15 received training on safeguarding procedures, and some staff had attended this training over 3 years ago. Stanley House DS0000002110.V342497.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and safe environment that meets their needs. EVIDENCE: The building was well maintained and decorated, although there were areas where the paintwork was badly scratched. The surveys confirmed that residents thought that the home was usually clean and fresh, and included comments such as ‘always impressed with the cleanliness, there are fresh flowers’, ‘bedroom is clean, but paintwork and entrance hall could be cleaner and needs decorating’ and ‘always clean’. Observation supported that residents were encouraged to personalise their rooms with their own belongings and furniture. There was evidence of ongoing investment in the building. The provider reported that all bedrooms are redecorated and the furniture and carpet reviewed and replaced as required, as they become vacant. A Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 17 refurbishment plan was in place, and work progressing well, as some items have now been achieved. Information supplied by the provider prior to this site visit indicated that there are plans to refurbish communal areas during the next 12 months. The provider has recognised the need to upgrade bathroom facilities in order to meet the needs of residents, and had consulted staff on their preferred options. One of the bathrooms was being upgraded at the time of this site visit. Two smaller rooms had been knocked into one larger room and the ‘medic type baths removed. A large domestic style bath with access on three sides and a wheel in shower were being installed instead. Residents were observed making good use of all areas of the home, including their bedrooms. There are a number of lounge areas in which residents may sit, and each of these was well decorated and furnished. The dining areas were well present, with sufficient space for residents. There has also been recent investment in laundry equipment, with new washing machines and tumble driers installed. Efforts have also been made to improve the ventilation in this area. Systems were in place for the laundering and return of personal clothing. Information supplied by the provider prior to this site visit indicated that a policy for preventing infection and managing infection control. However, only three members of staff have attended training on the prevention and management of infection. Stanley House DS0000002110.V342497.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a staff team with the necessary skills, knowledge and experience to fully meet their needs. EVIDENCE: Information supplied by the provider prior to the site visit indicated that staffing levels were sufficient to meet the assessed needs of the residents. Discussions with staff supported that they felt they had sufficient time to provide care for residents. The surveys generally supported that staff were available when residents needed them. One person commented that staff visited their relative at least hourly whilst they were in their room, as this resident was unable to call for assistance, and another commented that ‘many of the staff had been post for several years’, which they felt was a positive sign. However, one person also commented that ‘staff sickness often means they work short handed and are very busy’. Information supplied by the provider prior to the site visit indicated that staff continue to receive training towards National Vocational Qualifications (NVQs) and the target of 50 NVQ trained care staff has been achieved. Staff confirmed that they were offered this training. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 19 Residents living at Stanley House are supported by a relatively stable staff team, as staff turnover is low. Recruitment procedures have improved since the last inspection. Four staff files were reviewed as part of this site visit. Preemployment information had been obtained and was on file. However, full employment histories were not recorded on all of the application forms. Information supplied by the provider prior to the site visit stated that newly appointed care staff complete the common induction standards, with support from a qualified member of staff who acts as a mentor. The member of staff then meets with their mentor every two months to discuss their practice and any development needs. Discussion with care staff and the records confirmed that this was taking place. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that the service is run in the best interests of the residents. EVIDENCE: The registered manager has many years experience in nursing and management and has decided not to complete a management qualification. The manager is however supported by a qualified staff team that includes two members of staff who have achieved NVQ Level 4 in management. Residents and staff are also supported by the owners, who visit the home on a regular basis and make themselves available if anyone wishes to see them. Although Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 21 there was evidence to support that the owners carry out the monthly visits to the home, the reports seen lacked detail. The owners and manager were aware of the need for continuous improvement and have introduced a quality assurance system. A number of surveys had been sent out to residents, relatives, staff and other stakeholders involved with the home, for example doctors, care management, community pharmacist. The owner and manager have used the findings of these surveys and made changes as required, for example, introducing a choice of meal at dinner time, better ventilation in the laundry. Residents and relatives were informed that they could see the results of the quality assurance surveys if they wished, although the information did not include what action had been taken. Systems were in place for keeping residents monies and belongings safe. Personal monies were kept in safe keeping for a small number of residents, and the amount held limited. It was not possible to check the amounts held in safe keeping against the records, as access is limited to the manager only, who was not available at the time of this site visit. Information provided prior to this site visit indicated that an annual training plan was in place, and staff are encouraged to attend training events. However, records of staff training indicated that not all staff were up to date with their mandatory training. Staff were observed making good use of the hoist and standing equipment, but were also observed using ‘under arm lifting’ techniques to move people from chairs to wheelchairs. All equipment had been serviced or tested as recommended by the manufacturer or other regulatory body. Systems were in place to minimise the risk of scalding from hot water. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 22 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 23 Yes 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 OP18 Regulation 13(6) Requirement Timescale for action 31/12/07 2. OP29 19 3 OP38 18(1) Staff must receive training on abuse and safeguarding adults procedures. This will ensure that residents are protected from harm. The Registered Providers and 30/11/07 Manager must check, and hold documentary evidence, that all new staff employed have satisfied the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, amended in 2004. This will ensure that the appropriate steps have been taken to safeguard the people using the service. Previous timescale of 27/11/06 not met. Provide all staff with mandatory 31/03/08 training (manual handling, first aid, food hygiene, fire safety, infection control) with evidence to support that this had taken place. This will ensure that people using the service are cared for by staff with the appropriate skills and knowledge. Previous timescale of 31/03/07 not met. DS0000002110.V342497.R01.S.doc Version 5.2 Stanley House Page 24 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. 2. 3. 4. Refer to Standard OP18 OP33 OP33 OP38 Good Practice Recommendations Staff should attend training provided by the local authority on safeguarding adults procedures. The Regulation 26 reports such contain sufficient detail to demonstrate that the conduct of the home has been assessed. The action taken as a result of the findings of the quality assurance surveys should be included in the information available to residents and relatives. The manager should review staff practice in relation to moving and handling to ensure that safe techniques are used at all times. Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 Stanley House DS0000002110.V342497.R01.S.doc Version 5.2 Page 26 - 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!