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Inspection on 14/06/06 for The Firs Nursing Home

Also see our care home review for The Firs Nursing Home for more information

This inspection was carried out on 14th June 2006.

CSCI 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 CSCI judgement.

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

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 residents are accommodated in a homely environment that is clean and warm. The staffing level is sufficient to meet the high dependency of most of the residents. The personal and professional qualities of the nursing and care staff on duty gave residents comfort with a good standard of care delivery.

What has improved since the last inspection?

The registered manager has carried out a satisfaction survey as part of the quality assurance procedure. An activities co-ordinator is in post for two / three hours each afternoon and a carer is being employed to assist with activities five days per week. The registered manager has involved residents in the development of the menus and has initiated a bi-monthly residents newsletter. Staff read the newsletter to residents who are unable to read it themselves. Residents are kept up to date on progress of the refurbishment programme and other issues relating to the home. A computer has been installed for carers, to aid their training and development. Four carers have begun NVQ training and the registered manager has arranged other training courses for staff. The call system has been upgraded and improved. Staff are able to respond to residents needs quicker. A new gas cooker and washing machine have been installed since the last inspection.

What the care home could do better:

The registered manager could ensure that the home provides a robust training programme for staff to ensure the protection of residents. The robustness of protection procedures must include formal staff supervision which has been identified as a requirement in the last two inspection reports but unfortunately has not been carried out and training on whistle-blowing and adult protection. The registered manager could improve the quality monitoring in the home by developing appropriate risk assessments concurrent with accident records.Although the care plans are detailed they could be more person focused which would enable it to become a working record. The statement of purpose and service user guide are in need of updating along with the complaints procedure.

CARE HOMES FOR OLDER PEOPLE The Firs Nursing Home 251 Staplegrove Road Taunton Somerset TA2 6AQ Lead Inspector Stephen Humphreys Key Unannounced Inspection 14th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 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. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Firs Nursing Home Address 251 Staplegrove Road Taunton Somerset TA2 6AQ 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) 01823 275927 01823 336463 Care West Country Limited Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly persons of either sex, not less than 60 years, who require general nursing care. Up to six places for personal care. A person will be recruited into the position of manager and he / she will complete the registration process within 6 months of the issuing the Certificate of Registration. 4th October 2005 Date of last inspection Brief Description of the Service: The Firs Nursing Home is located in a residential area on the outskirts of Taunton, close to a local pub and Staplegrove Village Hall. In front of the home, next to the car park, is a lawned area with seating. The home is registered to take up to a maximum of 37 elderly persons (aged over 60years) who require general nursing care; six places are registered for personal care only. Over the years there have been alterations to the premises and eight bedrooms have en suite facilities of WC and wash hand basin. There are at least two bedrooms that have a toilet partitioned with a curtain only. Not all of the single bedrooms measure 10 square metres or the double bedrooms 16 square metres. Bedrooms on the first floor are accessed by a 4-person/300Kg lift. Part of the first floor area, known as the flat is accessed via a ramp. The communal toilets are all small and not large enough to allow a person in a wheelchair to access the toilet with one or two helpers and a hoist. In view of this the bathroom toilets are used for disabled access. One first floor bathroom has been converted to create a spacious shower facility. There are two assisted bathrooms, one on each floor. There is planning permission to extend the home and improve facilities and individual accommodation to meet the National Minimum Standards. This work is due to commence this year though no date has been set yet. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection carried out by an inspector from the Commission for Social Care Inspection using the Inspecting for Better Lives methodology. The inspection was carried out over one day from 09:30 – 17:00. At the time of this inspection the registered manager Miss K.Vound was in the home and available during the day. The Firs nursing home is registered for a total of 37 places for older persons, at the time of this inspection there were 18 residents being accommodated. The registered provider has started a complete refurbishment of the home to include larger bedrooms with en-suite facilities and bathroom / shower rooms for residents. The lounge and dining areas will be extended. The project is expected to take approximately twelve months to complete. During this time the registered provider has taken the decision not to admit any new residents. The inspector was shown around four of the rooms that have been completed. The refurbishment is of a high standard which is necessary to meet the national minimum standards. Several of the residents have lived at the property for a number of years and during conversations with the inspector said that they were completely satisfied with the care they received. The inspector was able to meet all the residents and speak at length with four. There were no visitors to the home during the inspection. The inspection involved discussions with residents, staff, the registered manager, a tour of the environment and a review of all the statutory records. Records examined during the inspection were 6 resident care plans, risk assessments, medication records, quality assurance, accident audit records, complaints procedure, staff supervision, staff training records and resident contract and financial records. Due to the large refurbishment programme going on in the home the inspector has not made any assessment of the environmental standards other than the core standards. These will be inspected at the completion of the refurbishment. Two residents were case tracked during the inspection. One resident who was very frail and one resident who had complex care needs. Given that there is a major refurbishment going on the contractors have taken all precautions so as not to cause to much disruption to the residents. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The registered manager could ensure that the home provides a robust training programme for staff to ensure the protection of residents. The robustness of protection procedures must include formal staff supervision which has been identified as a requirement in the last two inspection reports but unfortunately has not been carried out and training on whistle-blowing and adult protection. The registered manager could improve the quality monitoring in the home by developing appropriate risk assessments concurrent with accident records. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 7 Although the care plans are detailed they could be more person focused which would enable it to become a working record. The statement of purpose and service user guide are in need of updating along with the complaints procedure. 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 Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 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 The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 The quality in this outcome group is adequate. Prospective residents are not provided with adequate information to make an informed choice. All residents receive a needs based assessment before admission into the home. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide, however they are both in need of updating. From discussions with the registered manager and senior nurse the service user guide is not readily provided to prospective residents or their relatives. A brief guide to the facilities at The Firs is usually given when relatives / residents look around the home. The results received from a pre-inspection resident survey indicated that of the seven respondents only two said they had received sufficient information on the home. All residents including those who are privately funded had a signed contract. The terms and conditions should be reviewed against the Office of Fair Trading report - guidance on terms and conditions for care homes, as there no clear statement about residents rights and what constitutes a breach of contract. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 10 All prospective residents receive a needs based assessment, carried out by the registered manager before admission into the home. This is recorded in the care plans and based on the activities of daily living model of care. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome group is adequate. Residents can be assured their health care needs will be met and they are treated with respect at all times. EVIDENCE: Each of the eighteen residents had a care plan that was detailed and is based on the activities of daily living model of care. Four care plans were reviewed in depth and were part of the case tracking exercise. Generally the care plans were considered to be a good record, detailing health and personal care needs and recording the current state of the resident. To make the care plan totally person focused social care needs to be included. The registered manager is considering the introduction of new care planning documentation that will help to make them a working record. General issues about improving the care plans was discussed with the senior nurse and the registered manager at the feedback session. At the time of this visit only one resident was considered to be extremely frail and was nursed in bed but did sit out for short periods of time. The inspector visited this resident who was being nursed on a variable height bed with a pressure relieving mattress in situ. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 12 Appropriate monitoring charts were in the room, and each time a care need had been carried out it was recorded. The monitoring charts recorded all food and fluid intake. A record of when the resident was turned was also being kept. The care plan was detailed with a needs based assessment and other dependency and risk assessments determining the care needs. The care plan was being reviewed as necessary and the daily record provided an account of the resident’s condition. The inspector was able to have discussions with two residents whose care plans were reviewed to verify the delivery of care. All the care plans reviewed contained a needs based assessment and other assessments included continence, nutrition, tissue viability and moving & handling. Records of other professional’s visits were dated and the entry described the reason for the visit. A record of when the optician and chiropodist had visited was seen. The care plans contained monthly reviews and also a report of the resident community care review held by staff from the PCT. None of the residents were self administering their medicines. One care plan contained a signed consent form for the resident who had bed rails in place. One care plan had details and dates of when the resident wished to attend a social function centre in the community. The medication procedure including storage, receipt, disposal and administration was checked. Controlled drugs were checked and all correct including administration records. The local pharmacist carried out a medicines inspection on 1st March 2006 and found no problems. The inspector noticed that one hand written prescription had not been witnessed with a signature on the medicine administration record and the specimen signature list needs to be updated to remove the signatures of staff no longer working at the home. The storage of the medicines is safe and receipt and disposal records completed. The inspector observed the nurse administer some medicines during the day, safely. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome group is adequate. Residents are enabled to be as independent as possible and enjoy a flexible lifestyle in the home. EVIDENCE: Resident’s rooms are personalised with small furnishings, photos and entertainment media. One resident attends a social club in the local community. Transport to and from the centre is arranged for them. All residents confirmed that their relatives visited and no restrictions were put on them. An activities co-ordinator is in post for two / three hours each afternoon and a carer is being employed to assist with activities five days per week. Activities are based on the individual’s capabilities and include cooking and one to one chats. The carers spoken to said that activities take place, and on hot days residents like to go out into the garden. Carers felt that activities are limited due to the age and frailty of the residents. Photos are on display in the home as a record of the events residents have enjoyed. All residents spoken too just after they had taken lunch said the meals were always very good. One resident said there is always a snack and drinks available and ‘you can have a drink before you go to bed’. The survey results The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 14 returned indicated that five out of the seven respondents always liked the meals and two sometimes. One resident said “the staff are always pleasant and pleasing, and worth their weight in gold”. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality in this outcome group is adequate. Residents can be assured that they are protected from abuse. EVIDENCE: The complaints procedure is in need of updating. The procedure is on display near the main entrance and can be read easily. The statement of purpose includes a copy of the complaints procedure. All residents spoken to said they knew who and how to make any concerns known and the respondents to the residents survey indicated that they all knew how to make a complaint. Commission for Social Care Inspection has not received any concerns, complaints or allegations about this home since the last inspection. Comment cards received from visiting GP’s stated they had no concerns with this home. Only one member of staff spoken to said they had not received any training on adult protection however they were aware of and how to report any incidents of abuse to residents. The registered manager is arranging as part of an improved training programme, training for staff on vulnerable adult issues. One resident spoken to said “we are all well looked after here”. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality in this outcome group is adequate. Residents are accommodated in a clean and warm environment. EVIDENCE: A major refurbishment of all bedrooms and lounges is taking place that will include building ten new bedrooms. This programme is expected to take up to twelve months to complete. The contractors are working so that there is minimal disruption to current residents. At the time of this visit four rooms have been completed to a high standard. The home is warm, safe and no malodours were noticeable. Due to the refurbishment none of the environmental standards were inspected. This will be carried out when the programme is completed. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome group is good. Residents have confidence in the staff that care for them. EVIDENCE: The nurses and carers spoken to said there are usually four staff on duty during the day and three in the evening. Three waking staff at night. Duty rotas received from the registered manager confirmed this. The registered manager, staff and residents all told the inspector that the home was experiencing some difficulties with staff recruitment and that a large proportion of agency staff have been used recently. The registered manager told the inspector that the registered provider has been recruiting staff from overseas, and three carers were expected to arrive in the next few weeks. At present several carers are working overtime, through choice, to reduce the need for agency staff. Nurses and carers spoken to appeared to understand their individual roles and responsibilities. Generally staff felt they all work together as a team. Apart from the statutory training the registered manager is arranging for staff to receive appropriate training to meet the needs of the client group. A computer has been acquired for staff to use with training materials and to assist them with compiling NVQ portfolios. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 18 Staff files of newly recruited staff were reviewed and found to contain all the information and checks required to be kept by employers to meet the Care Homes Regulations 2001. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,36,37,38 The quality in this outcome group is adequate. Residents can be assured that the homes management is effective and safe. EVIDENCE: The registered manager has recently completed the NVQ 4 in management. To strengthen the management of the home she is planning to recruit a deputy manager. The registered manager has good internal quality assurance questionnaires to identify what areas of the service residents and relatives think highly of or could be improved. Results of the survey are published in the home. The home has formal processes for internal quality assurance that includes accident audits, however this could be improved by ensuring risk assessments are developed concurrent to the accident report. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 20 Since the last inspection twelve accidents have been reported. None of the incidents resulted in any residents being seriously injured. COSHH data sheets were available for cleaning chemicals used in the home. The environmental Health Officer inspected the kitchen on the 8th February 2006. The registered manager is attempting to build the standards up in the home so that it will receive Quality Rating status from Somerset County Council. The frequency of staff supervision has fallen over recent months due to recruitment problems necessitating the registered manager and senior nurses to work more in a hands-on position. This will be monitored at subsequent inspections and the home needs to consider training other staff to be supervisors in order that staff supervision is manageable and maintained. Records examined during the inspection were stored appropriately in order to maintain resident confidentiality. Since the last inspection the bed rails in use are now numbered and checked weekly to ensure safe fitting, this is a good practice. Records checked included the fire logbook, gas boiler safety certificate, Portable appliance tests, passenger lift and hoist service records. Resident’s accounts were checked and appeared to be in good order. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 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 3 X 2 3 X 2 3 3 The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 22 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 OP1 Regulation 5 (1)(2)(3) Requirement Timescale for action 31/07/06 2. OP9 13 (2). 3 OP16 22 4 OP36 18 (2) The registered provider must produce a written service user guide that includes all the information required by the regulation. Hand transcribed medication 30/06/06 entries must be countersigned in order to provide a safe system of managing resident medications. Not met from last inspection. The registered manager must 31/07/06 develop an up to date complaints procedure that includes timescales and contacts in relation to the registered provider and other regulatory authorities. The registered manager must set 31/07/06 up and carry out formal supervision of staff groups, recording formally one to one sessions on the individual’s personal file. The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 23 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 Refer to Standard OP1 OP2 OP7 Good Practice Recommendations The registered manager should update the statement of purpose and have it available in the home. The registered provider should review the terms and conditions to ensure that all information to meet the national minimum standards is included. The registered manager should review current practices when developing the residents care plan to ensure it becomes person focused to include social care needs to make it a working record. The registered manager should ensure that social care needs are included in the residents care plan. The registered manager should ensure that all staff receive and understand adult protection training. The registered manager should improve the quality assurance process by developing appropriate risk assessments on residents who sustain falls or accidents. 4 4 5 OP12 OP18 OP33 The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 24 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 The Firs Nursing Home DS0000003297.V290854.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!