Inspection on 10/02/06 for The Normanhurst Residential Care Home

This inspection was carried out on 10th February 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.

Other inspections for this house

The Normanhurst Residential Care... 27/02/07

The Normanhurst Residential Care... 18/05/05

The Normanhurst Residential Care... 14/12/04

The Normanhurst Residential Care... 23/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Normanhurst De La Warr Parade Bexhill-on-sea East Sussex TN40 1LB Lead Inspector Niki Palmer Unannounced Inspection 10th February 2006 10:00 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 Normanhurst DS0000021254.V281937.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 Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Normanhurst Address De La Warr Parade Bexhill-on-sea East Sussex TN40 1LB 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) 01424 217577 01424 734650 Mr David Lewis Mr Robert Hebbes Ms Claire MacMillan Care Home 82 Category(ies) of Old age, not falling within any other category registration, with number (82) of places The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That only older people will be accommodated. The maximum number of residents to be accommodated is eighty two (82). Residents should be aged sixty five (65) years or over on admission. Date of last inspection 18th May 2005 Brief Description of the Service: The Normanhurst Care Home is situated on Bexhill seafront and provides accommodation and personal care for up to 82 older people. The building is interconnected with The Normanhurst Nursing Home and The Annexe (a registered home for older people with a dementia type illness). Each of the homes are independently registered, although under the same ownership. The home is close to local shops with rail and bus services in easy walking distance. Care staff are on duty 24 hours a day. All rooms are centrally heated and most have en-suite facilities. Residents are welcome to bring their own furniture and other personal possessions to the home on admission. Each room has a telephone connected to the central switchboard with a direct dial facility. In addition, all bathrooms and toilets have a call system. Televisions can be installed free of charge. There is a shop on site selling a range of goods. Care staff will shop in the local area on behalf of residents on a daily basis. A range of activities are provided in the home, however residents are encouraged to be independent and access local community activities whenever possible. The home aims to create a hotel-like, warm, friendly atmosphere whereby residents feel safe. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at The Normanhurst will be referred to as ‘residents’. This unannounced inspection took place on Friday 10th February 2006 between 10.00am and 2.30pm and was carried out by two Inspectors. The inspection began with discussions with the Registered Manager of the home in respect of progress made since the last inspection. In order to gather evidence on how the home is performing, individual discussions took place with approximately 10 residents, four care staff, a housekeeper and one visiting relative. 68 residents were accommodated at the time of the inspection. Other records and documentation inspected included: the home’s Service Users’ Guide and Statement of Purpose, four individual plans of care, the systems in place for handling complaints and safeguarding residents from harm, staff training records, a sample of recruitment files, quality assurance systems and the home’s procedures for handling residents’ monies. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection report carried out on 18th May 2005. What the service does well: What has improved since the last inspection? The majority of requirements and recommendations made during the last inspection have been met. It is acknowledged that the Registered Manager has spent much time and effort improving the home’s admissions, assessment and care planning procedures. Most of the staff have received Adult Protection The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 6 training and the home is working towards the required target of 50 care staff trained to NVQ level 2 in Care. The home’s complaints procedure has been amended to make it easier for residents, their relatives, or visitors to the home to raise any concerns directly with the home. Many improvements to the home’s environment were noted during this inspection e.g. the re-decoration of some communal areas and private rooms. 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 Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 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 Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 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): 1, 2, 3 and 4. Detailed written information is provided to all prospective residents prior to admission. The home has improved systems in place to assess prospective residents; this ensures that no person is admitted to the home, whose needs cannot be met. EVIDENCE: Since the last inspection the home has updated it’s Statement of Purpose and has integrated within this, a Service Users’ Guide. This now provides both prospective and existing residents with the home’s aims and objectives, philosophy of care, admissions policy, details of the accommodation, provision of activities, organisational structure, complaints procedure and a copy of the home’s terms and conditions of contract. It is required that a copy of the homes most recent inspection report is included within this also. Each of the residents spoken with confirmed that they had received sufficient information prior to admission and had made a positive choice to move into the home, most having viewed a number of alternatives. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 9 A monitoring visit took place in October 2005 following concerns raised during the home’s last inspection regarding the home’s pre-admission assessment procedures. It was pleasing to note that since this time, work has been carried out to ensure that all residents’ needs including any specialist requirements are comprehensively assessed prior to admission. Four pre-admission assessments were inspected. These showed that clear information regarding individuals’ needs had been recorded and that there was evidence of good multidisciplinary working taking place with the prospective resident and his/her family, hospital discharge team, physiotherapists and Social Workers, where necessary. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 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 and 11. Good progress has been made by the home to ensure that all residents’ assessed needs are identified within their plans of care. Steps are taken to ensure that individual’s personal wishes are observed in the event of becoming unwell, dying and death. EVIDENCE: Significant work has been carried out by the Registered Manager to update the home’s care planning procedures. All residents now have a personalised plan of care, which covers the following areas: - a personal profile, communication, mobility (including risk assessments), social interaction with others, health and social care needs, emotional needs and individuals’ aspirations for the future. Four individual plans of care were inspected, each were found to provide care staff with sufficient information to meet the assessed needs of residents. All residents and their relatives are asked on admission or shortly afterwards, their personal preferences and wishes in the event of becoming unwell and arrangements to be made in the event of their death. These are clearly recorded within plans of care and there was evidence of good working practices being adopted with local hospices and Age Concern. Issues were raised with The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 11 the CSCI by a relative in relation to this matter in November 2005. Although this was addressed directly by the relative with the home, a recommendation has been made for the home to ensure that this sensitive issue is dealt with, as far as possible, directly by the Registered Manager. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 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): 13, 14 and 15. Residents are encouraged to remain in close contact with friends and relatives and are supported to make decisions and choices in most areas of their lives. The arrangements in place for the provision of food are improved. EVIDENCE: All residents spoken with said that their friends and relatives are made to feel welcome by the home, when visiting and that there are no restrictions placed on visiting times. Relatives who were visiting during the inspection confirmed that this is the case. Throughout the inspection it was evident that positive relationships have been formed between residents. Comments included: ‘it is a community atmosphere here, you know’, ‘we all look out for one another and we notice if someone is not there’. Residents are encouraged by the home to exercise choice and control over their lives as much as possible. The vast majority of residents spoken with said that they do view the home as a hotel and can ‘come and go’ as they wish, get up and go to bed whenever they choose and participate in a variety of activities - or not. Due to the size and layout of the home, mealtimes take place over two sittings. Residents confirmed that they are given the preference and choice at The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 13 which time they would prefer to eat. Both of the Inspectors enjoyed a meal with the residents. The meal itself was nicely presented and tasty; a choice of main-course and sweet was offered, as were any requested additions for example a roll and butter to enjoy with the soup of the day. It was pleasing to note that the majority of residents spoke highly of the provision of food, which has been a cause for concern in the past. Since the last inspection the home has reorganised the arrangements for serving food. The dining area is ‘waitress served’ by care staff on a rotational basis. The members of staff on duty over the lunchtime period were observed to be attentive towards residents. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 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 and 18. Adequate systems are in place to ensure that all complaints are handled appropriately and that residents are safeguarded from harm. EVIDENCE: The home’s complaints procedure has been updated to inform residents and visitors to the home that any concerns or complaints can be made directly to the home or the CSCI (Commission for Social Care Inspection). Records showed details of all complaints made and that these had been dealt with appropriately by the home. No complaints have been made to the CSCI since the last inspection. Residents spoken with said that they would feel confident in raising any concerns or complaints directly with the Registered Manager. The Inspector viewed this as encouraging. Since the last inspection a high number of care staff have received Adult Protection training, provided externally; those spoken with said that they had found this to be helpful and informative. An Adult Protection alert was raised and investigated under local procedures in December 2005. Although this was found to be not upheld, a number of good practice recommendations were made in relation to maintaining residents’ personal safety. The home was found to have implemented these on the day of inspection. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 15 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, 20, 21, 22, 25 and 26. Many areas of the home have undergone improvements in consultation with residents. The Normanhurst provides residents with a safe, comfortable and well-maintained place to live. EVIDENCE: Since the last inspection the outside of the building has been repainted. Building work is also being undertaken to provide residents with a more accessible, graded ramp to the main entrance of the home. Residents spoken with said that they are keen for this work to be completed for their ease of access. They also expressed that they would like improved access to the rear garden area. The Registered Manager confirmed that this work has begun and will be completed when the weather improves. Electricians were in the process of updating and reinstalling a new nurse call system throughout the home on the day of inspection. The Inspector was pleased to have it confirmed that this work has so far caused minimal disruption to residents. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 16 New carpets have been laid on the second and third accommodation floors and new dining room furniture has been purchased, although this will not be in use until the dining area has been repainted. Residents said that they had been consulted regarding the new dining furniture, however one resident described the new lighting as ‘grotesque’. This has been raised directly with the Registered Manager who has already taken their views forward to the owners of the home. Bathrooms are also in the process of being updated and improved with some having new basins, toilets and specialist equipment installed. In addition new wheelchairs and a mobile hoist have been purchased by the home following a quotation put forward by the Registered Manager. Gloves and aprons are now readily accessible in each of the bathrooms throughout the home. Broken window restrictors have been mended since the last inspection; one windowpane on the second floor corridor was found to be cracked and it is required that this be replaced. During a guided tour around the home, which appeared clean, fresh and tidy in all communal areas and the private rooms visited, one of the Inspectors spoke with the Housekeeper, in charge of the cleaning and laundry staff. She presented as most competent and these services appeared to be efficiently managed by her and her staff. She confirmed that repairs to any items of residents’ clothing would be carried out on site; a sewing machine was seen to be provided in the laundry for this purpose. The Normanhurst DS0000021254.V281937.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 and 30. Staffing arrangements are good and ensure that residents’ needs are met by sufficient numbers of skilled and motivated staff. Recruitment procedures remain unsatisfactory and potentially place residents at risk. EVIDENCE: In addition to the Registered and Deputy Manager, the home employs a total of 30 care assistants, three of whom have achieved NVQ level 2 in care, four others are awaiting certification and a further 12 are currently working towards this qualification. One newly appointed member of staff expressed enthusiasm about the amount of training she was receiving through the NVQ scheme. Residents spoke quite freely and were particularly praiseworthy of the staff at the home. They also commented that the home is adequately staffed with enough carers to meet their needs. Three staff files, including recruitment records were seen on the day of inspection. Since the last inspection the home’s application form has been amended to allow for full details of previous employment to be recorded. No member of staff is now employed to work within the home without satisfactory Police checks i.e. PoVA First and Criminal Record Bureau (CRB) checks. Whilst there was evidence of proof of identification and two written references being applied for, the Inspector was concerned to note that both references had not necessarily been received, prior to staff being appointed. The seriousness of this was again highlighted to the home and a requirement made. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 18 Staff training records showed that regular mandatory training and refresher courses are taking place. All staff have recently been provided with training for the newly purchased mobile hoist and fire safety training is planned for March 2006. The Normanhurst DS0000021254.V281937.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, 35 and 38. The Normanhurst is a well managed home that is run in the best interests of residents. EVIDENCE: The Registered Manager has been in post for the last two years and has been working at the care home since 2001. She has recently completed her Registered Managers Award and is due to commence a foundation degree in Care and Management later this year. In addition she holds NVQ levels 2 and 3 in Care and is an NVQ assessor. Throughout the inspection she demonstrated a clear understanding of the needs of the residents living at The Normanhurst Care Home. Observations and discussions with staff and residents confirmed that she is respected, approachable and provides clear leadership throughout the home. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 20 Residents’ questionnaires were given out by the home in early 2005. The questionnaire covered the following areas: catering and food, personal care and support, activities of daily living, premises and management of the home. Whilst the results were published and made available for residents and visitors to the home to see, they are organised in the form of a numerical list, which are not easy to read, or understand. This is unfortunate as the outcome of the questionnaire was very positive for the home. In addition, whilst residents and care staff informed the Inspectors that residents’ meetings take place on a bimonthly basis, no copies of the minutes taken were available for inspection. Requirements have been made in respect of the home’s quality assurance systems. Most residents and/or their relatives manage their own finances. The home does however, have safe storage facilities for residents’ money, cash cards, or other valuables, to which only three senior members of staff have access. Clear records are kept, however no details had been recorded on the safe custody form of a resident’s cash card and PIN number, being held by the home. Although this was reported to be an oversight following a change of administration forms a requirement was made in respect of this. The home has a mobile telephone mast installed on the top of the care home. A requirement was made in the previous inspection report for the home to collate up to date clinical research and evidence from the Department of Health regarding the possible health risks that telephone masts may pose and make this information available to all existing and new residents, with reference to be included within the home’s Statement of Purpose. Whilst some efforts have been made by the home to do this, the information was full of technical jargon, which did not provide the reader with any useful information. Another requirement has been made for this information to be collated in an easy to read and meaningful format. The Normanhurst DS0000021254.V281937.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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 The Normanhurst DS0000021254.V281937.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)(d) Requirement That a copy of the home’s most recent inspection report is included within the combined Statement of Purpose and Service Users’ Guide. That the cracked windowpane on the second floor corridor is repaired/replaced. That two written references are obtained prior to any person being deployed to work in the home [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT]. That the results of residents’ questionnaires are published in an easy to read and understand format. That copies of minutes taken from residents’ meetings are available for inspection. That a record of all valuables deposited by a resident for safekeeping is kept up to date. That current evidence regarding the possible risks associated with the sitings of mobile phone masts is gathered and provided to all existing and new residents. DS0000021254.V281937.R01.S.doc Timescale for action 30/06/06 2. 3. OP25 OP29 23(1) 23(2)(b) 19(1) & Schedule 2 28/02/06 10/02/06 4. OP33 24(2) 30/06/06 5. 6. 7. OP33 OP35 OP38 24(2) 17 & Sch 4 (9)(a) 12(1)(a) 13(3)(4) (a) 30/06/06 10/02/06 30/04/06 The Normanhurst Version 5.1 Page 23 This information must be available in an easy to read and understand format and included within the home’s Statement of Purpose [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT]. 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 OP11 Good Practice Recommendations That the Registered Manager takes responsibility for discussing with residents and their families their personal preferences and wishes in the event of becoming unwell and arrangements to be made in the event of their death. The Normanhurst DS0000021254.V281937.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Normanhurst DS0000021254.V281937.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!