Inspection on 06/06/05 for The Pines

This inspection was carried out on 6th June 2005.

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 Pines 06/06/06

The Pines 05/12/05

The Pines 09/12/04

The Pines 28/06/04

The Pines 24/02/04

The Pines 14/04/03

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Pines, Mayfield Road, Orrell, Wigan, WN5 0HZ, Lead Inspector Julie Conrad Announced 6 June 2005 th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Pines Address The Pines Mayfield Road Orrell Wigan WN5 0HZ 01942 760015 01942 621320 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wigan Council Social Services Dept Mrs Ellen Prescott CRH Care Home only 29 Category(ies) of LD Learning Disability (29) registration, with number LD(E) Learning Disability over 65 (6) of places The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum numbers registered there can be up to 29 LD and up to 6 LD(E) 2. The service should at all times employ a suitably qualified and experienced maager who is registered with the Comission for Social Care Inspection. 3. Staffing levels are to be calculated in accordance with a Residential Forum Staffing Guidance (Older People) by 1 April 2004. 4. The matters detailed in the attached schedule of requirements must be completed within the stated timescalse. Date of last inspection December 2004 Brief Description of the Service: The Pines is a local authority residential care home, registered to provide care for up to twenty nine adult residents, of either sex who have a learning disability. Six residents may be over the age of sixty five years. Of the twenty nine places, five are used to provide short term care, the appropriateness of providing short term care in a care home where the majority of residents live permanently, is regularly discussed by the manager Mrs Ellen Prescott with senior management. The premises is a two storey building, all residents have a room of their own, there is a large dining room/lounge and a smaller lounge area. There is courtyard, patio with garden funiture surrounded by a lawned area to the rear of the home. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection of the Pines took place on 6th June 2005, from 2.30pm until 5.30pm. The manager was asked for some information about the home before the inspection took place, and we sent Comments cards to visitors to the home and to the residents asking them what they thought of the home. Two nurses and five residents replied in a positive manner. The inspector talked with the manager, staff and residents and asked them questions about the home, how they did things, what training the staff had had, how many staff were on duty. Records were looked at to see if they contained the information staff need to know in order to do their job well, and the environment was looked at to see if it was clean, and well decorated. What the service does well: What has improved since the last inspection? Since the last inspection, the entrance of the home has been redecorated and panels have been fitted to the lower wall area to stop wheelchairs from scuffing the wall. A new carpet has been fitted by the downstairs stairwell. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 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 Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 A service user guide and service agreement is provided for prospective and current residents, which gives relevant information on the service provided at the home enabling them to make a positive and informed decision to live at The Pines. EVIDENCE: The service user guide and the service agreement are presented in a userfriendly format and pictorial guide. The service user guide welcomes the reader to The Pines and explains what the service offers. The residents who attend day care have a full assessment carried out, this assessment is written up in the Help Notes, which focus’ on the individual residents needs and aspirations, aspirations are further explored in the “My Life My Meeting” document, which is also completed with the participation of the resident. The manager at the Pines has introduced a six month review, which involves a meeting between the Link Worker and the resident, to formally check that aspirations, leisure and social needs are being met, the main question is ‘what do you want to do whilst your staying at the Pines’. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 There is an assessment, care planning and risk assessment system in place, ensuring that residents personal care needs are met. EVIDENCE: The different level of ability and understanding of each resident determines how much of their care plan and risk assessment they understand. Link Workers who know individual residents well are the best people to communicate the information. Staff look for non verbal signs, to ascertain whether a resident is enjoying an activity or meeting their goals. Four resident’s files were seen, these were found to be orderly and contained assessment, care plan, risk assessment and Help Notes. One of the files did not yet contain a six month review, this was due to the Link Worker being on sick leave, however, these reviews were introduced three months ago. The care plans seen had recently been reviewed, the manager audits the care plans randomly on a monthly basis to ensure reviews are being carried out. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 10 Risk assessments have been completed on each resident, to assist staff and residents in minimising risk, whilst promoting independence. Residents who have behavioural difficulties receive a risk management assessment, which is carried out by a community nurse. Where possible, staff explain the risk assessment to the resident, who will then put this into practice, for example, residents who are able to go out alone, know they must always let staff know when they are going out, where they are going and how long they might be, they must contact the home if they unexpectedly are to return late. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 17 Leisure activities are promoted and inclusion in the local community encouraged ensuring that residents have an active and full social life. The meals in the home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: Residents are part of the local community, visiting local shops and supermarkets, going to the local public houses sometimes to watch sport on the pubs TV. The majority of residents attend a day centre during the week, where they do lots of activities within and outside the day centre such as visiting the cinema and bowling. When residents return from the day centre, they like to relax, have dinner and settle down to watch the soaps on TV. Some like to have pampering evenings and have manicures and pedicures, some residents like to take a bath or a shower before bedtime or listen to music in their room. At weekends, residents might go to a rugby match, some residents regularly go to church on Sunday, or go to visit relatives or relatives visit them at the Pines. Five residents completed comments cards for CSCI, one resident did not think the home provided suitable activities, one resident said sometimes, whilst three considered activities at the home satisfactory. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 12 The manager has introduced a six month review, where the link worker and resident review their needs, including leisure and aspirations. The cook sets menus two weeks in advance, but these regularly change, sometimes on a daily basis, to cater for resident’s preferences. Menus can be changed as the home no longer buys in bulk, tin foods or dried or frozen foods. Instead twice a week a number of residents and staff go to Asda, were they buy fresh fruit and vegetables. They cook writes a shopping list, to which residents can add extra items, this allows residents to try new foods, such as pak choi. Residents spoken to said the food was good. Five residents who completed the comments cards also said they liked the food. The daily menu is written on the board in the dining room and demonstrates there are a number of alternative meals to choose from. A member of staff is currently in the process of producing a pictorial menu. The cook has bought new modern crockery, which includes plates with curved edges and bowl shaped plates, these modern designs help residents eat from ordinary crockery without having to use plate rings that attach to plates to stop food from falling off the plate. Records of the consumer meetings included items discussed, menus, buffet tea, shopping, holidays and equipment for the home. Some residents go on an annual holiday. Three residents are soon to go to Blackpool, one resident has recently returned from a holiday in Benidorm, which had been arranged by MENCAP. A resident was watching a video of her favourite singer, Daniel O’Donnell, she had recently been to see Daniel O’Donnell live and said she enjoyed it. The inspector joined the residents in the garden, the inspector and the resident who does most of the gardening looked and talked about the border plants, pots and hanging baskets, the flowers were colourful and can be enjoyed whilst sitting on the garden furniture, new plants are to put on a rockery. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 20 Medication systems within the home are generally adequate ensuring that residents receive medication as prescribed. Personal care is offered in a way that promotes and protects residents privacy, dignity and independence. EVIDENCE: Staff follow the initial social work assessment, which sometimes identifies when and how the resident prefers to have personal care carried out. The Link Worker who spends time with the individual resident continues to find out the residents preferences, through conversations and observations and by checking out that everything is OK. The home has a policy and procedure on medication, which includes what should be done if a resident was to administer their own medication. This would involve a community nurse who would visit the resident to carry out a risk assessment and a lockable facility would be placed in the persons room. Medications were not checked at this inspection, as a CSCI Pharmacist Inspector visited the home on 7th June 2005 and carried out a full audit of the home’s medication system. Requirements and recommendations made by the The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 14 pharmacist inspector have been included in this report (please refer to the requirement section at the back of this report). Two community nurses completed CSCI comments cards and commented as follows; “I frequently liaise with staff members around clients on my caseload with complex needs and provide a health action plan for staff to follow, along with specific training, which is client centred, staff are always willing to share information”. Both nurses said yes to the following; staff demonstrate a clear understanding of residents needs, residents have a service plan, reviews take place regularly, they can meet the resident in private, there is always a senior member of staff to speak with, staff notify the nurses of events effecting residents well being, both said they were satisfied with the overall care provided to residents. Neither nurse had had need to ever complain. All the five residents who completed the comments cards said that they feel “well cared for”, that their privacy was “respected” and that “staff treat them well”. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Systems were in place with regard to the investigation of complaints and adult protection issues, ensuring that residents were listened to and protected. EVIDENCE: The home keeps a record of informal complaints that take place within the home. These complaints are recorded and on completion the resident is asked to sign the complaint to demonstrate that the outcome has been explained to them. The home operates the Social Services Complaints policy and procedure, and any such complaints are investigated by the Social Services Department. The complaints procedure is explained to residents in the service user guide, which also includes information and contact details about CSCI. Four of the five residents who completed the comments cards stated they knew about the complaints policy and procedure, one did not. The Protection of Vulnerable Adults Policy (POVA) and procedure is part of the staff (LADF) induction programme and there is a unit based on abuse in the NVQ qualification, followed by regular staff briefings. Four out of five residents who completed comments cards, stated they feel safe at the home, one said they sometimes feel safe. The residents receive a service user guide and a service agreement, which is a pictorial guide, which explains who to contact if they are not happy with the service. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 The standard of décor within the home is poor and does not provide a comfortable, homely environment for the residents. EVIDENCE: Throughout the home, the walls, doors and fire doors are badly scuffed and are in desperate need of attention. The upstairs carpets in the corridors need replacing, as do some carpets downstairs. The carpet in bedroom 22 is stained and needs to be cleaned or replaced. New windows are to be fitted throughout the home during June 2005, this will greatly enhance the living environment and provide improved ventilation, after which, a programme of redecoration is intended. Since the last inspection, a carpet by the downstairs stairwell has been replaced. A cleaning contractor is now responsible for cleaning carpets on a quarterly basis. The entrance to the home has been redecorated and fitted with new wall panelling, which is washable and new radiator covers have been fitted. The exterior of the home is to be repainted in the near future. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 17 Some of the sofas and chairs in the lounge areas are in need of replacing. Water temperatures are regulated and water temperature checks are being carried out on a weekly basis. Staff said that the interior of the home greatly lets down the service provided for the residents. On the day of the inspection there was no odour and everywhere appeared clean. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 The staff team are trained and supervised ensuring that staff have a good understanding of their role and in supporting the needs of residents. EVIDENCE: A new member of staff told the inspector that she was enjoying working at the Pines, she said she felt supported by the staff team and had completed an induction period and was undertaking mandatory training. The member of staff is currently supporting a male resident, who she accompanied to Southport over the weekend and thoroughly enjoyed the day. This member of staff expressed job satisfaction. Another member of staff was concerned about the poor state of the interior of the home and the furniture. Other staff were spending time in one to one contact with residents, staff morale appeared good. Two staff files were read, supervision is carried out every six weeks and is recorded. Staff spoken to said they feel supported by the formal supervision and day to day informal support Staff training over the past twelve months has included; LADF induction and foundation training, moving and handling, food safety, medication awareness, risk assessment training, fire awareness, basic lifesaving, professional development award. Staff continue to undertake NVQ levels 2 and 3. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 40, 42 The manager provides clear leadership and communicates effectively to residents, staff and visiting professionals . EVIDENCE: The manager ensures that information regarding home life is passed on to staff and residents at staff meetings and consumer meetings. Consumer meetings are chaired by an independent person, residents always invite the manager to ensure she is informed of their opinions directly and can act on any choices or decisions made straight away. A community nurse commented, ‘I feel that the Pines is well managed home, it has made good progress over the last two years and the residents are all well cared for. The home has all the required policies and procedures in place, to protect resident’s rights and interests, this is demonstrated in the records kept. The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 20 The health, safety and welfare of residents are promoted and protected, this is demonstrated in the homes policies and procedures, the health action plans provided by community nurses, monitoring and follow up visits by health care professionals. There is ongoing discussion between the manager and senior manager regarding the appropriateness of having five short-term care places in a home that is predominately for permanent residents. The community nurse commented, “Difficulties are usually as a result of large numbers of clients living in one establishment and also having to support people on respite, this situation is less than ideal.” The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Pines, Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x 3 x 3 x 3 x F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? 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 24 Regulation 23 Requirement The scuffed walls and doors and fire doors need redecorating and repainting throughout the upstairs and downstairs corridors. The carpets throughout the upstairs and downstairs corridors need replacing, with matching, homely carpets. The stain on the carpet in bedroom 22 needs removing. A programme of intended redecoration and renewal should be forwarded to CSCI THe manager should ensure that alll residents should be made aware of the homes complaints policy and procedure. The manager must ensure all self-administration is assesed and reviewed. The provider must ensure that all medication records including those for adminsitration and of all medication leaving the home are complete and up to date. Timescale for action 30th September 2005 30th September 2005 30th July 2005 30th August 2005 30th July 2005 15th July 2005 15th July 2005 2. 24 23 3. 4. 5. 24 24 23 23 23 22 6. 7. 20 20 13 13 The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 24 14 40 Good Practice Recommendations The home would benefit from new sofas and chairs in the lounge areas. Each resident should be asked what activities they would like to participate in at their next review. Senior management may wish to consider the appropriateness of continuing to provide short term care for five residents in a home predominately accomodating permanent residents. Hand written MAR entries should be signed, checked and countersigned. Consideration should be given to the inclusion of service user photographs within the MAR file. The Pines medication policy indicates that the homely remedies policy is to follow, a copy of this should be obtained and considered. The determinants for district nurse or for care staff administration of eye drops should be recorded. The supply of medication for administration at the day care centre, should be discussed with the supplying pharmacist. 4. 5. 6. 20 20 20 7. 8. 20 The Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 Page 24 Commission for Social Care Inspection Turton Suite, Paragon Business Park, Chorley New Road, Horwich, Bolton, BL6 6HG. 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 Pines, F56 F06 S32683 The Pines V218075 060605 Stage 2a.doc Version 1.30 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!