Inspection on 16/12/08 for The Moat House Residential Care Home

This inspection was carried out on 16th December 2008.

CSCI found this care home to be providing an Adequate service.

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

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Moat House Residential Care Home The Moat House Great Easton Great Dunmow Essex CM6 2DL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: June Humphreys     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Moat House Residential Care Home The Moat House Great Easton Great Dunmow Essex CM6 2DL 01371870192 01371870193 annestrange@retirementvillages.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): RV Moat House Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 24 0 old age, not falling within any other category physical disability Additional conditions: 0 24 The maximum number of service users who can be accommodated is 24 The registered person may provide the following categories 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 Physical Disability - Code PD Date of last inspection Brief description of the care home The Moat House Residential Home (formally known as St. Georges residential home) is registered to provide care for older people over the age of sixty five years. The home can accommodate up to twenty four service users. The home is set in a private woodland area with large gardens, and a patio area accessible to service users who use wheelchairs. The home is set in a quiet rural location, approxamately three miles Care Homes for Older People Page 4 of 28 Brief description of the care home from the town of Great Dunmow. The home has car parking facilities. The Moat house changed registered providers in April 2008, and is now managed by Retirement nt Villages. The current scale of charges range from £484.53 per Week dependent on individual needs. there is additional costs for items such as hairdressing, toiletries and chiropody. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. The Moat House (previously known as St. Georges Residential home) changed registered providers in April 2008 and is now managed by retirement Villages. This was the first inspection of the home since the new provider registered with the Commission for Social Care Inspection (CSCI). One inspector undertook the unannounced visit, on the 16th December 2008. All of the key national minimum standards were inspected, and opportunity was taken to speak with residents, relatives and staff, and both the new Manager, Wendy Morgan and the Care Homes for Older People Page 6 of 28 area Manager Angela Ames. Relevant records and documents were examined and observations of care practice formed part of the inspection, as did observation of staff and resident interaction. A number of surveys were also received from health professionals, relatives and staff, and a sample of information received will be included in the report. What the care home does well: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with an opportunity to visit the home prior to admission, and an adequate statement of purpose is available. But initial assessments do not clearly identify prospective residents individual needs prior to a placement being offered, which potentially could mean that people are inappropriately placed. Evidence: The statement of purpose and service users guide has been updated by the new provider Retirement Villages, and it was looked at as part of this inspection. A copy of the document is provided to all prospective residents, and describes the needs of the people the home aims to meet, and the service that will be offered, including the facilities. Three sample initial assessments were seen, of which all were completed prior to the residents admission. Assessments relied heavily on the information provided from Care Homes for Older People Page 10 of 28 Evidence: health professionals, hospital discharge summaries and social services documentation. A checklist was completed as part of each assessment but the comments section was limited in detail, and did not highlight peoples preferences, or clearly identify the persons needs, and the level of support and subsequent staffing levels that would be required to care for them. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While residents can expect to a plan of care, they cannot be assured that the level and consistency of care will be offered at all times. Evidence: Three care plans were looked at as part of this inspection. All were in the old provider format, and had not been updated by the new provider. An example of this was a resident admitted on the 06/12/04, and the care plan was dated 13/03/06. Current practice does not always involve the resident or their advocate in the development, and review of the care plan. The care plans provide basic information necessary to deliver the residents care but would benefit from being updated more frequently, and further development is needed to ensure that the care residents receive is person centred. There was no clear evidence that risk assessments were evaluated each month or as conditions changed. There was equipment in use for all residents identified as at risk of pressure sores, however one resident appeared to have a grade 4 pressure sore on their left elbow, Care Homes for Older People Page 12 of 28 Evidence: and this had not been reported to the Commission for Social care Inspection. The care plan highlighted that the area noted continues to cause concern. The manager reported that this was not the current situation, and that with the assistance of the district nurse service this had improved. This may have been the case but evidence of this was not clearly recorded in the daily care notes. The health care needs of several other residents were met. There was recorded evidence of district nurse visits, health checks, opticians and chiropodist visits, GP interventions, emergency services being called when required. One relative confirmed that she was very happy with the care provided. They stated that, as her relatives health needs changed the staff acted, and responded involving appropriate specialists. Another relative felt that the staffing levels in the home had been poor, and this had impacted on the levels of support provided. A new medication administration procedure is in place in the home,with most medication now administered from blister packs. This has been introduced since the new provider has been managing the home. The staff spoke positively of the new procedures and felt that the system was less time consuming. Medication administration records (MAR) were viewed and were well maintained. The breakfast medication procedures were observed, residents could eat their breakfast either downstairs in the dinning room, or in their bedroom. Medication was offered before, with their food or after they had eaten. Staff were observed interacting with residents, and showed an understanding of the needs of older people. Staff were observed to be patient and kind, and respectful to residents. The general view expressed was that residents are relaxed and generally happy with the care they receive, but both residents and relatives mentioned the lack of staff. Both the demands on staff, and also the number of hours worked by individual staff members. An example of this is of a resident who said There is often only two staff to care for us all, so need to be patient and wait. A relative said Its been slow to improve, clothes go missing, and my mother does not always wear her hearing aids, some old thing when you complain, staff shortages!. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality and consistency of daily life, and social activities offered to residents has improved but continues to be limited due to the number of staff sometimes available. Evidence: A new activities co-ordinator has been employed in the home, and a range of activities have started to be offered, which was not the case when the home was previously inspected. Residents were observed playing skittles, and participating in a question and answer quiz. However only a limited number of residents were seen to be involved in both activities which were held in the main entrance area of the home where many residents choose to sit. There are two lounge areas, of which one has been redecorated. Both appear to be rarely used. At the current time there is very limited evidence of recording of activities to demonstrate that residents enjoy the activities offered. No activity plans were completed which made it difficult to know what was on offer, and who joined in. This is something that the manager will support the activity co-coordinator to put in place. Staff were seen to engage with residents during the day, encouraging a number of them to participate in activities. The home is remote, and the home does not have its own transport. Residents do go Care Homes for Older People Page 14 of 28 Evidence: out but this is usually restricted to their own family members taking them. One resident had moved from another home and stated that remaining in contact is difficult here, there is no public transport, and I am therefore limited to my sister and brother in law who visit weekly. Visitors are welcome at the home and residents and a visitor spoken with confirmed that they were able to visit whenever they wished. The home currently does not hold residents meetings, but the manager advised that these were to be introduced in the new year. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices in the home safeguard residents, but evidence of complaints being appropriately recorded and investigated could be improved to ensure residents concerns are adequately addressed. Evidence: Two complaints had been received by the home since the new provider had started to manage the home, but records did not show that this had been acted on promptly, i.e. the timescales, or if the complaint had been satisfactorily resolved. Four residents were spoken to about making a complaint as part of this inspection, and all of them said that they knew who to speak to if they were unhappy, and knew how to make a complaint. Three staff were also asked about what they would do if a resident made a complaint. Staff had an awareness of the importance of listening, and reporting any concerns. However an awareness of the new providers complaints policy was limited, and needs to be addressed by the new management team. One relative interviewed, raised a number of concerns about the care provided in the home i.e. clothing going missing, hearing aids not being worn due to staff not assisting to put them in, no regular hairdresser. The person was clear that she had spoken to senior staff and the manager. The relative said that improvement of any kind has been slow, and that no written response had been received. The persons complaint was not written in the complaints log and the new manager said she was not aware that a complaint had been made. A resident also said I dont like it here, Ive lost my glasses for over a Care Homes for Older People Page 16 of 28 Evidence: week. When staff were asked about this person they said Oh she always says that! Her concerns were dismissed, and this issue was not recorded in the residents care plan, nor in the complaints log. When discussing this with the manager I was advised that the residents reading glasses had been sent away for repair and that the person had been informed. Care notes should record discussions and outcomes i.e. where the glasses were, and that the person was aware, as the resident was upset that her glasses had gone missing. A number of staff have attended basic Safeguarding training, and new staff are in the process of completing training, but staff consulted were not fully conversant about what is expected of them, and further in house discussion would be beneficial. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 is comfortable, offering a clean and safe environment for residents to live. Evidence: Retirement Villages has improved the appearance of both the outside, and inside of the home. The manager stated in the AQAA that residents have a choice of having a lock on their bedroom door which is risk assessed. Service users are encouraged to personalize their rooms to create a feeling of being at home. There is an ongoing decorating programme to include all bedrooms. The majority of the communal areas have been redecorated and this will be ongoing. New crockery and table linen purchased, with fresh flowers and daily large print menu to improve the dining experience. New curtains purchased for communal areas. All areas are deep cleaned on a regular basis and carpets maintained. Fire door release system in place on bedroom doors. The new providers should be congratulated on the effort placed on improving the accommodation since April 2008. Residents commented on how nice the home now looks. One resident said its nice to eat in the dinning room since it has been re decorated, I enjoy it very much. One relative said The staff are making every effort to improve things for the residents, this is notable in the decoration of the home. All radiators now have covers, and temperature regulators have been fitted to all hot Care Homes for Older People Page 18 of 28 Evidence: water outlets used by residents. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate numbers of staff need to be available at all times to ensure residents receive consistency in the care provided. Evidence: The recruitment and retention of staff has been a difficulty within the home over a number of years. The new provider has continued to struggle to provide a stable team, which has resulted in the Commission receiving a number of complaints regarding staffing levels, and the numbers of hours some staff have been working. At times this may have impacted on the staffs ability to provide good quality care to residents after working long hours. The Inspection began at 8am in the morning, which was a busy time for the home. There were three staff on duty, and call bells were being pressed continually. Several residents were seen to require two staff to assist in relation to manual handling tasks, which meant there was only one staff remaining. One member of staff was asked about the slow response to call bells, and I was advised that all the residents like to be first for breakfast, and that this is the only time of day that there is usually such a demand on staff. From observation this continued for over an hour, with staff working continuously. Staff were observed to be polite and courteous, but it was obvious that staff were Care Homes for Older People Page 20 of 28 Evidence: under pressure to assist and move on to the next person. In the Morning a large number of residents choose to eat their meal in their bedroom. One relative stated Residents can wait sometime for a member of staff to feed them, theres just not enough staff . Discussing the current staffing levels within the home with the manager it would appear that since her appointment in November she has concentrated on reviewing and recruiting new staff. There remains a deficit in the Senior team due to one person leaving, and another being off sick. The manager stated that it is her intention to recruit a deputy manager which would support, and strengthened the staff team. Further evidence was available in the completed AQAA, in which the manager stated We have recruited permanent care staff, a full time chef, housekeeping staff, activity co-coordinator.We have also have a new Administrator and Manager in place. However evidence from surveys, discussion with relatives and staff suggests that whilst the new Manager has actively worked hard to improve recruitment and staffing ratios, time is required for this to filter through to improve the numbers, consistency and morale of staff, which hopefully ultimately will improve outcomes for residents. Numbers of staff need to be reviewed, particularly at peak times of the day, and a requirement has been made in relation to this. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assurred that the policies and procedures are followed by staff, or montiored by the mnager in such a way to ensure they receive consistent levels of care. Evidence: The current manager had been in post six weeks when the inspection was undertaken. Therefore there had been limited time for them to demonstrate their management ability. Prior to this the service had been initially managed by the previous companys manager until July, and then overseen by the area manager of Retirement Villages. Throughout this time there was limited evidence to demonstrate meetings had taken place with staff, resident or relatives. One team meeting had been held on the 13th August by the area manger. Staff have not received regular supervision, although the current manager stated that meetings had occurred but had not been minuted. As previously mentioned within this report there is a shortfall in records such as care Care Homes for Older People Page 22 of 28 Evidence: plans, which remain in the old provider format, and no clear evidence of review. complaints records were not sufficiently recorded to demonstrate the action taken and several relatives felt their complaints had not been appropriately responded to. One relative said I dont know who the new manager is. The manager stated that she had introduced herself to relatives, of which many visited regularly. As part of the inspection she communicated a number of areas that she has identified for improvement including residents and relatives social meetings. In the AQAA the manager stated that the home had implemented documentation to evidence regular meetings and discussions with care staff. Introduction of a programme of Supervision for all staff every 8 weeks. Staff meetings have been dairies for the period of Jan to November 2009 and a review of staffing shift times, and levels to reflect the needs of the residents. Evidence was not available at the time of inspection to support this. A sample of health and safety documentation was looked at, and was generally maintained to an appropriate standard. Regular fire alarm tests and drills are carried out, although staff attending, needs to be recorded. Fridge and freezer temperatures are recorded daily. The home has also had the lift and boilers serviced. The hoists used for manual handling of resident was serviced in September 2008. The home is generally safe for residents and staff, with no health and safety problems noted on touring the premises. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 All prospective residents 31/01/2009 must have their needs assessed by the home prior to being admitted, to ensure appropriate safe care will be offered. to them. To ensure the needs of people admitted can be met. 2 7 15 The registered person must ensure that care plans are updated regarding changes in residents needs, and that they are kept under review to ensure the health and well being of people living in the home. To ensure the health and safety of residents. 31/01/2009 3 12 12 Residents must be provided 31/03/2009 with regular opportunities to participate in social and recreational activities, which meet their needs both in, and outside the home. Page 25 of 28 Care Homes for Older People Information of activities and outcomes for residents must be clearly recorded. To ensure residents social and emotional needs are met. 4 16 22 Ensure that the complaints 31/03/2009 procedure for considering complaints, both written and verbal, made to any member of staff at the home by a resident, or a person acting on there behalf is documented effectively within the complaint record book. Ensure that the complaints procedure for considering complaints, both written and verbal, made to any member of staff at the home by a resident, or a person acting on there behalf is documented effectively within the complaint record book. Staffing levels must be reviewed and maintained so as to ensure that residents needs are met. To ensure the health and safety of residents. 6 27 16 Sufficient numbers of skilled staff must be available to interact, and subsequently provide stimulation, to ensure residents social and emotional needs are met. 01/02/2009 31/01/2009 5 27 18 Care Homes for Older People Page 26 of 28 to ensure residents social and emotional needs are met. 7 33 24 Effective quality assurance 31/03/2009 and quality monitoring systems, based on seeking the views of service users, must be in place to measure success in meeting the aims, objectives and statement of purpose of the home. To ensure the residents receive a quality service that is reviewed. 8 36 18 The registered person shall 01/02/2009 ensure, that staff working at the home are appropriately supervised. To ensure staff and residents are appropriately supported. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!