Inspection on 23/11/06 for The Gables

This inspection was carried out on 23rd November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gables 19/06/07

The Gables 07/10/05

The Gables 23/06/05

The Gables 29/11/04

The Gables 15/07/04

The Gables 20/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Gables 13 St. Mary`s Road Netley Abbey Southampton Hampshire SO31 5AT Lead Inspector Mrs Michelle Presdee Unannounced Inspection 23rd November 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 Gables DS0000011862.V313618.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. The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 13 St. Mary`s Road Netley Abbey Southampton Hampshire SO31 5AT 023 8045 2324 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) Mr David Jackson Mrs Thelma Jackson Mrs Karen Pauline Edney Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7/10/05 Brief Description of the Service: The Gables is a care home offering accommodation and personal care to 24 people over the age of 65, some of whom may have dementia. The home is owned by Mr and Mrs Jackson, who have an active role in the home, and managed by Karen Edney. The home is located in the quiet residential area of Netley, which is on the outskirts of Southampton. There are local shops and amenities nearby. The accommodation is on two floors, and there are 14 single bedrooms and 5 shared. Communal space is comprised of a lounge, dining room and large conservatory on the ground floor. There is an enclosed garden and patio area at the rear of the property and a car park at the front. The fees for the home range from £385.00 to £406.00 per week. The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the manager of the home assisted the inspector. The majority of service users and staff on duty were spoken with. Two health professionals and three service users visitors were spoken with. All comments received were of a very positive nature with relatives stating the home cared very well for their relatives. During the inspection a tour of the building was undertaken and many bedrooms were looked in, these were chosen on a random basis. Written policies and procedures were examined and a selection of records were examined. Information had been sent to the Commission prior to the inspection. At the beginning of the inspection staff records were not available in the home but were later brought in by Mr. and Mrs. Jackson the proprietors of the home. What the service does well: What has improved since the last inspection? The home has an improvement plan and is continually improving the physical environment of the home. The home has had a new bathroom, which includes a new bath with fitted shower and a self-cleaning system. The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gables DS0000011862.V313618.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 The Gables DS0000011862.V313618.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre-assessment does not provide sufficient information for care staff to meet service users needs. Competing the life history for all service users would be of benefit; giving care staff more background information on the service user. The home does not provide intermediate care. EVIDENCE: The assessments of three service users were examined. The inspector was advised a representative of the home would always go and visit and a new service user before they entered the home. However information gained on these visits, which would be considered part of a pre-admission assessment were not available and it was unclear if they are made. Service users are always asked to come and view the home before they decide to move in. Basic assessments were available, but gave very little information. A matrix (tick box) assessment was available and for one service user the family had The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 9 completed a family history. Discussions were held on the need to complete pre-admission assessments, to establish a service users needs and ensure the home is able to meet their needs. Care management assessments were also not available and discussions were held on the need to have a copy of these if the service user is funded before the service user moves in. The home then needs to provide an assessment of need for each service user. The home does not provide intermediate care. The Gables DS0000011862.V313618.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans give detailed information to ensure care staff have up-to-date and sufficient detail to meet a service users needs. The medication records are not being completed satisfactorily to ensure service users safety. The core values in the home are being promoted and service users are treated in a dignified manner and their right to privacy is upheld. EVIDENCE: The same three service users files were looked at. It was found that all had care plans, which detailed each service users care needs. Care plans were kept in each service user’s room and the service user had signed the care plans. It was noted care plans had been reviewed monthly and changes had been recorded. Care plans gave details of a service users health and social needs. All visits by health professionals were clearly recorded. On the day of the visit the district nurse called into the home who reported the surgery has a good The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 11 relationship with the home. She felt the home always called her appropriately and they worked together to care for service users. Daily notes were included in the care plan and gave a good account of each service user. A moving and handling assessment had been completed for each service user. Risk assessments had been completed; discussions were held on the need to include a risk assessment for a service user who smokes. It was clear from care plans viewed and from discussions with service users and visitors all health care needs are fully met. The home has regular visits from the district nurses, community psychiatric nurses, doctors, dentist, optician and chiropodist. One visitor I spoke to stated their relative had been in the home for over two years and felt the home was “fantastic”, stating “they do everything and they are so caring”. All visits by health professionals are recorded in the service users care plans. The home has a medication policy and procedure in the home, which is available to all staff. Care staff receive in-house training on medication including the administration of medication. Only when a care staff member feels competent and the manager is satisfied they are competent do they become involved with the medication. The manager explained the medication is delivered on a monthly basis and she always checks the medication into the home. All medication is kept in a locked medical trolley, which is kept in the office. All controlled medication is stored and recorded appropriately. The medical administration records were checked against the medication held. It was found most were correct but three errors were found for three separate service users. Drugs had been administered and not signed for and drugs had not been administered but had been signed for. The manager’s attention was brought to this who agreed she would discuss with all staff. No service users currently self medicate. It was clear from observations and discussions on the day service users are treated with respect and their right to privacy is upheld. For all medical consultations the service user is seen in their own room; this was witnessed on the day. A visitor confirmed they can always see their visitor in private. Another visitor confirmed their relative is always dressed in their own clothes and always looks clean. Whilst walking around the home it was noted all care staff knocked on doors before entering a room. All bathrooms and toilets had appropriate locks. Double bedrooms had screens. One relative reported although their relative stayed in their room, care staff were always calling in to ensure she was ok and to have a chat. The Gables DS0000011862.V313618.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of social activities are arranged in the home, which meet service users needs. Visitors are made welcome to the home and they can see service users in private. A varied menu is available and good quality food is served to service users. EVIDENCE: Service users spoken to on the day felt the home matched their expectations and felt the home offered enough adequate social activities. The home had a range of photographs, which showed service users enjoying some of the outings and events arranged in the home. These included the summer barbeque, Halloween party; a trip to Hamble and some service users had recently been to a local garden centre to view the Christmas decorations. Other social activities included a visit from an outside entertainer once a week, clothes party every six months, exercise to music, pantomime in the home and reminiscence sessions. The travelling library visits on a regular basis, giving service users the opportunity to regularly change their books. A church service The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 13 is offered once a month and some service users receive a private service on a weekly basis. Discussions were held on the benefit of having a clock in a communal area, which would give the day, date, month and year. Visitors confirmed they can visit the home at any time and are always made welcome. A visitors book is in the hallway and the inspector reminded the manager to encourage all visitors to make a note in the visitors book, as it was clear visitors did not always sign in. Service users are encouraged to exercise choice and control over their lives. Service users can bring their own furniture into the home. Service users are part of the care planning process and sign their care plans. Visitors felt the home was “excellent” at communicating information with them and were always aware of what was happening with their relative and in the home. Service users confirmed there was a choice at meal times and they could choose their own clothes. The home has a three-week rotating menu. Meals are served in the dining room, which has five tables, which are laid at meal times. Service users spoken to felt the meals in the home were very enjoyable and reported they could always have an alternative if they did not like the main choice. On the day of the inspection roast lamb with fresh carrots, cabbage, parsnips, Yorkshire pudding and potatoes was served. The mealtime was unhurried and assistance was given to service users who needed help in a dignified manner. The cook is aware of service users likes and dislikes and has this information recorded in the kitchen. The cook on duty reported there is no restriction on the food budget and good quality food is provided. The two cooks in the home have completed their basic food hygiene certificate. The Gables DS0000011862.V313618.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which visitors felt they would be able to use. Staff have adequate knowledge on dealing with suspected abuse and the procedures they should take but training in this area would ensure staff have the necessary knowledge to ensure service users are not at risk. EVIDENCE: The home has received no complaints since the last inspection. The home does have a complaints procedure, which details all the necessary information. The inspector was advised details of the complaints procedure are given to service users and visitors in the service user guide when they enter the home. When the inspector looked at the service user guide it was noted it did not detail the complaints procedure. A copy was then found in the home’s policies and procedures file, and the inspector was advised it is given to all service users and their relatives. Visitors spoken to on the day confirmed they would know who to complain to, and felt the home would deal with their complaint satisfactorily. To begin with the manager could not find Hampshire’s Adult Protection procedure, but later located it. Other literature regarding adult protection and abuse was available in the home. No care staff have been referred to the Protection Of Vulnerable Adult (POVA) list. From records seen on the day training on protection from abuse has not happened in the home since January 2004.The inspector was advised Mrs Jackson carries out the training on abuse The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 15 in the home. The training takes the form of a video followed by a questionnaire. It was unclear on the day if Mrs Jackson had been deemed competent to carry out the training. Staff spoken to on the day did have knowledge of what to do if abuse was suspected in the home. The Gables DS0000011862.V313618.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a clean, pleasant environment for the enjoyment of service users. Attention is needed to ensure service users are not put at risk by the lack of radiator covers in communal areas. EVIDENCE: A tour of the building was undertaken and several bedrooms, which were randomly chosen, were looked at. It was noted all areas of the home were clean and no unpleasant odours were detected. Service users and visitors spoken to confirmed the home is always clean and does not smell. The home has a large lounge, which had a selection of library books, an electric organ and was decorated to a good standard. The home also has a conservatory, which looks out onto the garden and a separate dining room. It was noted in these communal areas the radiators had not been covered and were very hot to touch. It was agreed these would be covered as they could pose a risk to The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 17 service users. The home has an attractive garden, which is enclosed and service users are free to use. The home has a lift to the first floor and a chair lift to the second floor. Bedrooms seen were clean, decorated to a reasonable standard and had been personalised by service users. It was noted service users had a range of equipment to meet their needs, including special mattresses, hoist and stand aids. One of the main bathrooms in the home has been totally refurbished. The bathroom was pleasantly decorated and very inviting. A new bath had been installed, which was also fitted with a shower and a self-cleaning system. The Gables DS0000011862.V313618.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff on duty meets service users needs. Training must ensure care staff have the needed skills to care for the service users in the home and training records must reflect the training undertaken. Staffing records should be available at all times. Staff records confirmed the home has a robust recruitment procedure protecting service users. EVIDENCE: The home has a written duty rota, which is followed by all staff. The home employs nineteen members of care staff and eight members of ancillary staff. The home tries to ensure there are always four members of staff on duty in the mornings, three members of staff in the afternoons and two waking night staff. If there are staff shortages or a service user has extra needs Mrs Jackson will work as one of the carers. The inspector was advised Mr. and Mrs. Jackson work in the home on a daily basis. The home also has two domestic staff five days a week working 5 hours. The home also has a cook and an assistant on seven days a week working from nine in the morning until two in the afternoon. Three members of staff spoken to and all visitors felt there was always adequate staff on duty. The inspector was advised from information sent to the Commission eleven members of care staff have achieved National Vocational Qualification (N.V.Q.) Level 2. This is above the 50 the Commission recommends. The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 19 On request of staff records it was found these were not on the premises and the manager was not able to access them. Later in the day the records were brought back into the home by Mr. and Mrs. Jackson who reported they had taken them out to do some work on them. It was agreed they should be available at all times. The records for the last two members of staff employed were checked. It was found these were accurate and contained all necessary information. A written application form was available, two written references, photo identification and the necessary checks had been undertaken. Care staff spoken too stated training was available and Mr. and Mrs. Jackson would provide training. The manager stated it was difficult to get staff to undertake training. From records seen it was established staff had up-to-date training in moving and handling, fire training, basic food hygiene and at least one member of staff on duty had in date training in first aid. New staff undertake induction training and the manager and member of staff sign when they are competent in each area. The last recorded training on abuse was in January 2004, infection control April 2004 and the most recent training recorded for dementia was in September 05. The inspector was advised future planned training included first aid, activities for the elderly, manual and patient handling and catheter care. The Gables DS0000011862.V313618.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Service user and visitors views contribute in the development of the home. Service users finances are protected and the health and safety procedures in the home ensure service users are protected. EVIDENCE: The registered manager has many years experience of working with older people and has completed her Registered Managers Award. It was clear from discussions with service users, visitors and professionals the manager is held in high regard and all spoken to felt she was very approachable. Comments were also received about the Proprietors Mr. and Mrs. Jackson who were also held in high regard by all those spoken to. The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 21 It was clear from observations and comments made on the day the home is run in the best interests of service users. Visitors felt the home “would do anything” and some spoke how well their relatives had done since coming into the home. The manager and staff felt the homes routines were organised around service users. The views of service users and their families have recently been obtained in a formal questionnaire. All forms returned, which were seen by the inspector were of a positive nature. The home manages the personal allowance for many service users. The inspector randomly choose three service users and checked their records. It was found all were accurate with a record being maintained of all money in and out. Receipts are kept on file and the cash held matched the balance on the records. Whilst walking around the home the inspector noted most health and safety procedures are followed, with the exception of the radiator covers in the lounge, dining room and conservatory. It was noted in the kitchen all equipment was in good working order and the crockery was in a good condition. The fridge and freezer temperatures were recorded and a probe thermometer was used to test the protein in each meal. All food in the fridge was covered and dated. When looking in one cupboard it was noted two jars of condiments were out of date, these were immediately put in the bin. The home has a separate laundry, which is well equipped and there are two sluices in the home. Liquid soap, antibacterial gel, gloves and aprons are available in the home. The Gables DS0000011862.V313618.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement A pre-admission assessment, and assessment must be completed for all service users before they enter the home, giving an account of their needs at that time. Medication records must accurately reflect all medication administered or refused. Records as defined in Schedule 2 must be available in the home al all times. All radiators in the communal areas must be covered for the protection of service users. Timescale for action 31/01/07 2 3 4 OP9 OP29 OP19 13 (2) 17 (2) (3) 13 (4) (c) 31/01/07 31/01/07 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP29 Good Practice Recommendations References should be dated to show the date they were returned. The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 24 2 OP30 All staff must have in-date training in the core areas of first aid, basic food hygiene, abuse and infection control. Records must reflect the training undertaken. The Gables DS0000011862.V313618.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Gables DS0000011862.V313618.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!