Inspection on 10/11/09 for Sylvan House

This inspection was carried out on 10th November 2009.

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

Sylvan House 09/02/10

Sylvan House 09/06/09

Sylvan House 03/06/08

Sylvan House 25/10/07

Sylvan House 25/05/06

Sylvan House 29/11/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Sylvan House 2 - 4 Moss Grove Prenton Wirral CH42 9LD Lead Inspector Inger Moynihan and Diane Sharrock Key Unannounced Inspection 10th November 2009 09:00 DS0000064575.V378205.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sylvan House DS0000064575.V378205.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sylvan House Address 2 - 4 Moss Grove Prenton Wirral CH42 9LD 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) 0151 608 1401 Prime Care (UK) Ltd Carol Dixon Care Home 22 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (22) of places Sylvan House DS0000064575.V378205.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 22 Date of last inspection Brief Description of the Service: Sylvan House is a large converted property situated in the Prenton area of Birkenhead, Wirral. It is close to local shops and bus routes to towns on the Wirral and Liverpool. The home offers care and support to 22 residents who are over the age of 65 years. This registration includes providing a service to 6 people who have dementia. Accommodation is provided on two floors with passenger lift and stair access. The home has some shared bedrooms. On the ground floor there are two sitting areas and a separate dining room, some bedrooms, an adapted bathroom and toilets. Outside the home there are garden areas and some parking spaces. Basement areas in the home are used as an office, a staff room, a laundry and for storage. The weekly fees for the service range from £366.17 to £395.22. Additional charges are made for hairdressing and chiropody. A service user guide and a statement of purpose, which describe the services, offered is made available to people who are interested in using the service, their relatives and professionals before a person comes to live at Sylvan House. A copy of the most recent inspection report can be obtained from the manager. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. Information about the home was obtained through discussion with the service users, proprietor, manager and members of the staff team. Policies, procedures and supporting documentation were also looked at along with a selection of service users’ case files. We also obtained information from the Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment document that is filled in once a year by all providers. It is one of the ways that we get information from providers about how they are meeting outcomes for people using the service. What the service does well: Service users are treated with respect and their right to privacy is upheld. The service users spoken to during the visit said the staff are very kind and caring. One service user said ‘The staff very good and always available when you need them’. Systems are in place for the administration of service users’ medication. One of the service users spoken to during the visit said ‘I always have my medication on time’. A range of social activities are now provided. This includes exercises, art work, reminiscence, local history and beauty therapy. This means service users can meet the other people living in the home and prevents them from becoming bored. One of the service users said ‘There are always activities going on, but sometimes I prefer to stay in my room and watch the television. The staff always respect my choice’. Friends and relatives can visit at any time so that service users can maintain personal relationships and continue to be part of family life. The service users spoken to said they enjoy the food and always have plenty to eat. One service users said ‘The food is lovely and there is always plenty to eat’. Another service user said ‘The food is very good’. Diets based around service users’ medical and cultural needs are met. A complaint procedure is available to service users and their relatives so they know what to do if they are unhappy with the standard of the care they receive. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.2 Page 6 Staff have completed training on how to safeguard service users from abuse. One service user said ‘The staff are all lovely’. Another service user said ‘The girls are always there to help, nothing is ever any trouble’. Overall the home is well maintained and provides a comfortable and homely environment for service users to live. The manager reported that there are sufficient staff employed at the home to support the number of service users living there. Staff are now provided with regular training to support them in their role and keep them up to date with new ways of working. The recruitment and selection procedures ensure suitably qualified and competent staff are employed. The staff spoken to during the visit said they enjoy their work and feel well supported in their role. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Sylvan House DS0000064575.V378205.R01.S.doc Version 5.2 Page 7 order line – 0870 240 7535. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 8 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 Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users’ care needs are not properly assessed which means they may not receive the care and support they need. EVIDENCE: Before a service is offered an assessment of service users’ care needs is carried out so they know they will received the care and support they need. More detailed information needs to be gathered during the assessment to ensure staff have the information they need on how to provide the right level of care. Without this information, important aspects of service users’ care needs may be missed and they could be left vulnerable to the risk of harm. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users’ care needs are not clearly identified which means staff do not have clear instructions on how to provide the right level of care. EVIDENCE: A plan of the care given to each service use is in place and provides staff with information on how to look after the service users in line with the individual care needs. The information held in the care plans was not always up to date and important information about service users’ health care needs had not been addressed such as their nutritional needs, dementia care and pressure areas. Assessments had been completed in some areas of care but this information had not been transferred into the care plan. The records also lacked appropriate guidance and advice that was necessary to help staff provide the right type of care to keep service users healthy and safe. To ensure service users’ health care needs are met and planned for properly, records need to state clearly how service users’ will be supported while living at Sylvan house. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 11 This lack of information could leave service users vulnerable to the risk of harm and ill health. The manager stated the staff were finding it difficult to complete these documents. In light of this staff should be provided with training in this area. Systems are in place for the administration of service users’ medication. Appropriate facilities are provided for the safe storage of medication and supporting policies and procedures are available to staff if they need clarification on a specific issue. The medication administration record sheets were accurately maintained and staff who administer medication are trained in this area of care. An audit of the medication does not take place. The manager should check all medication on a regular basis to ensure it is being managed efficiently. One of the service users spoken to during the visit said ‘I always get my medication on time’. Staff spoken to during the visit demonstrated an understanding of how they ensure service users are treated with respect and their right to privacy is upheld. The service users spoken to during the visit said the staff are very kind and caring. One service user said ‘The staff very good and always available when you need them’. Staff were seen interacting with service users in a friendly and informal way. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s routines are flexible and service users are helped to exercise choice and control in their lives. EVIDENCE: A range of social activities are now provided. This includes exercises, art work, reminiscence, local history and beauty therapy. This gives service users an opportunity to meet the other people living in the home and prevents them from becoming bored. One of the service users said ‘There are always activities going on, but sometimes I prefer to stay in my room and watch the television. The staff always respect my choice’. A religious service providing communion is held each week visitors from the local Methodist church visit regularly. Plans are being made for the Christmas festivities. Although a programme of activities is in place, this is flexible and staff respond to service users’ social care needs as they arise. Friends and relatives can visit at any time so that service users can maintain personal relationships and continue to be part of family life. The home’s Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 13 routines are flexible and service users are encouraged to make their own decisions to maintain their independence. The service users spoken to said they enjoy the food and always have plenty to eat. One service users said ‘The food is lovely and there is always plenty to eat’. Another service user said ‘The food is very good’. Diets based around service users’ medical and cultural needs are met. A varied menu is in place and staff are available to help service users with their meals if necessary. Mealtimes are relaxed and informal. The cook has completed training in food hygiene, nutrition and first aid. He said the food delivered to the home is of a good quality and there is always enough for the number of people living at the home. The kitchen was clean and tidy and regular cleaning schedules are in place. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure service users are protected from abuse and they know how to make a complaint. EVIDENCE: A complaint procedure is available to service users and their relatives so they know what to do if they are unhappy with the standard of the care they receive. Service users spoken to said they are aware of the home’s complaint procedure. We have not received any complaints about the standard of the service provided at Sylvan House. The manager has not received any complaints. Staff have completed training on how to safeguard service users from abuse. During discussion they gave a basic understanding of the different types of abuse that can occur and what they should do if they know or suspect abuse is happening. A copy of the adult protection procedure is in place. The manager was clear on the procedure to be followed in the event of an allegation being made. Safeguarding adults from abuse is included in the staff training programme and the training they are given when they are first employed. No allegations of abuse had been made at the home. Service users reported the staff are very kind and caring. One service user said ‘The staff are all lovely’. Another service user said ‘The girls are always there to help, nothing is ever Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 15 any trouble’. Information is available to service users on the different agencies they can contact if they are concerned about the way they are being looked after. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the building is well maintained and provides a comfortable and homely environment for service users to live EVIDENCE: Overall the home is well maintained and provides a comfortable and homely environment for service users to live. Since the last inspection some improvements have been made to the overall standard of the facilities. Service users’ bedrooms are clean and tidy and service users have personalised their rooms with their own belongings. There is a large lounge and dining room along with a small sitting room on the ground floor which service users can use if they want to spend time alone. These rooms are decorated in a traditional and homely way. A number of issues arose during the visit that require improvement. Food in the basement needs to be stored somewhere else as Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 17 this room is warm and has rising damp. The Environmental Health Department visited the home this year and made a number of recommendations which have not yet been met. Systems are in place to prevent the spread of infection and there are sufficient laundry facilities for the number of people living at the home. The laundry needed cleaning. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by suitably qualified and competent staff. EVIDENCE: The manager reported that there are sufficient staff employed at the home to support the number of service users living there. There is training to the National Vocational Qualification standards which is a recognised qualification for staff involved in the care profession. Staff are now provided with regular training to support them in their role and keep them up to date with new ways of working. Further training is provided for next year. The recruitment and selection procedures ensure suitably qualified and competent staff are employed. Appropriate checks are completed prior to staff being employed. All staff have completed a Criminal Record Bureau (CRB) check before they started working at the home. Good practice states this check should be completed every three years. The provider is advised to introduce a policy whereby staff must declare any criminal offences following their CRB check to ensure they continue to be suitable to work at the home. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 19 Newly appointed staff now receiving induction training which is a line with Skills for Care. This is a recognised training programme for staff involved in the care profession. This means they are clear on their responsibilities and know what is expected of them. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the management systems to ensure the efficient and effective running of the service. EVIDENCE: The manager has worked at the home for over four years and currently works long hours with few holidays. Working excessive hours may have a detrimental effect on the service as this does not support the wellbeing of the service users and does not give the manager sufficient time to complete her work properly. The provider should change and improve the manager’s working conditions to allow her the time to plan for the future development of the service. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 21 Although systems are in place to improve the service and support staff in their role, and it is acknowledged that improvements have been made to the service since the last visit in September 2009, further improvements still need to be made to the way the home is managed. The manager must be proactive in establishing effective quality assurance systems rather than responding to the requirements and recommendations issued by the Commission during inspections. There should be a clear plan of how to improve the service and the quality of life for service users. The manager must show a stronger leadership on how to improve the service in line with current good practice and organise her time to ensure this change comes about. The staff spoken to during the visit said they enjoy their work and feel well supported in their role. They confirmed the manager meets with them regularly to give support and discuss how they are working and they receive an annual appraisal of their work. This support system ensures staff are clear on their responsibilities and gives them an opportunity to develop in their role. The provider does not deal with service users’ money. The health, safety and welfare of both staff and service users is promoted through the provision of staff training, supporting policies and procedures and regular health and safety checks. The provider must ensure the bath hoist is checked as the last inspection indicated that ‘all fixtures require replacement’. ‘Doorguards’ (these are safety appliances used to safeguard people in the event of a fire) should be used in all bedrooms to ensure service users’ safety in the event of a fire. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 X 2 Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 23 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 15 Requirement A detailed assessment of service users’ care needs must be completed. This will ensure staff have the information they need on how to look after the service users properly. Detailed care plans, including risk assessments, must be documented for each service user. This will ensure staff have the information they need on how to look after the service users properly and minimise the risk of accidents happening. Staff must be provided with training on care planning. This will ensure service users’ health care needs are monitored and planned for properly. The management systems should be changed and improved. A development plan should be produced and shared with the service users, their DS0000064575.V378205.R01.S.doc Timescale for action 08/01/10 2. OP7 15 08/01/10 3. OP7 18 08/01/10 4. OP33 10 08/01/10 Sylvan House Version 5.3 Page 24 relatives and staff to show what the future plans are for the home are. This will ensure the effective and efficient running of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard 1. OP9 2. OP19 Good Practice Recommendations A regular audit of all medication should take place. This will ensure medication is being managed efficiently. Some improvements need to be made to the fabric of the building. This will ensure a more comfortable environment is provided for service users to live. The recommendations of the Environmental Health Department should be implemented in the kitchen. This is to help make sure that it is safe and hygienic for the preparation of food. A staff CRB should be completed every three years. This will ensure staff continue to be suitable to work at the home. A policy which asks staff to declare any criminal offences between CRB checks should be implemented. This will ensure staff continue to be suitable to work at the home. 3. OP26 4. OP29 5. OP29 Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 Page 25 Care Quality Commission Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Sylvan House DS0000064575.V378205.R01.S.doc Version 5.3 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!