Inspection on 05/12/06 for The Ridings

This inspection was carried out on 5th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Ridings 01/12/08

The Ridings 09/12/05

The Ridings 18/05/05

The Ridings 11/10/04

The Ridings 19/04/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Ridings Calder Close, Daventry Road Banbury OX16 3WR Lead Inspector Philippa MacMahon Unannounced Inspection 5th December 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 Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ridings Address Calder Close, Daventry Road Banbury OX16 3WR 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) 01295 276767 01295 277107 armstrongr@anchor.org.uk sharon.blackwell@anchor.org Anchor Trust Mr Richard Martin Armstrong Care Home 40 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (21) The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 40. 9th December 2005 Date of last inspection Brief Description of the Service: The Ridings opened in 1996 and was purpose built to provide accommodation in flats or bed sitting rooms. It is situated on the outskirts of Banbury. The home offers 39 permanent places and one respite place in a designated room. Among the facilities at the home are a large lounge and dining room with a bar, shop, activity room, library and small sitting room on the ground floor. There are two laundry rooms and a telephone kiosk for residents use. On the first floor there is another lounge, a small sitting room and a hairdressing room. There are two lifts that are fully wheelchair accessible and equipped with a seat. The grounds and the gardens at the rear of the home are very attractive with a gazebo and garden ornaments and a large patio area for service users to enjoy. There is an adjoining day centre, which is staffed and managed separately from The Ridings. The fees for this service range from £483.44 to £584 per week. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10.10 hours and was in the service for six hours. It was a thorough look at how well the service is doing and took into account detailed information provided by the service’s owner or manager, and any information that the CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has, in this report, made judgements about the standard of the service. On arrival at the home the inspector was afforded a warm welcome by the staff and all co-operation was given throughout. A sample of care plans was examined and this was followed up by meeting with the relevant person in order to see if the care plan reflected the residents care needs, and how these were being met. The medication system was examined, and a tour of the building took place. The inspector was also able to observe lunch being served in the dining room. Time was spent in talking to residents, visitors and staff. Records required by regulation were examined. The registered manager, although not on duty on the day, did come into the home and the inspector was able to disucess various management issues with him. What the service does well: The Ridings offers a comfortable, homely and well maintained home. The home is well managed and the staff are all appropriately trained to provide the best care. There is evidence of good teamwork and clear lines of accountability amongst the staff. The provision of activities is of a high standard and is available five days a week. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 6 In the Commissions document “Have Your Say About The Ridings” residents had commented: “The majority of staff listen and give me the support I need.”; “The meals are very good”; “The food is always good and the place is always clean. Staff are always very helpful”; “I am very happy here, staff and management are very kind to me”; “I get the support I need”; “The Ridings is a very nice place to be. It is a very popular home in the area, also the hospitality to relatives and friends is well known!”. A relative also commented that her mother benefits from exceptional care. The staff are all so caring and helpful and nothing is too much trouble. The registered manager responded in a timely manner to the immediate requirement that was made. What has improved since the last inspection? What they could do better: Every resident must have a care plan in place to ensure that his or her assessed needs are met. All prospective residents, once a decision has been made to move into the home, must have it in writing that the home is able to meet their assessed needs. The staff who carry out risk assessments should review the policy and procedure. The home’s complaints procedure must have the full address and telephone number of the local office of the Commission included. The system of care planning is in a state of flux due to implementing new documentation. This is being addressed and hopefully once the new system is fully implemented, and the staff become familiar with the new documentation, the level of care planning should improve. Eye drops should be dated when they are opened to ensure that they are used in date. The medication fridge must be kept locked at all times and only used to store medication. Alternative storage of protective gloves and plastic bags needs to be considered, rather than cluttering up the bathrooms and toilets. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has an assessment of his or her care needs prior to being admitted to the home. The decision to admit a resident is not put in writing at the present time. Sufficient information is made available to all prospective residents for them to make an informed choice. Each resident has a contract. The home does not provide an intermediate care service. EVIDENCE: The registered manager, his deputy or the senior carers carry out pre-admission assessments. The inspector examined a sample of the residents’ care plans and found that in each case there was a pre-admission assessment of the individual’s care needs. This in some cases was supported by a care management care plan, or information from a hospital admission. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 10 One of the assessments was not dated and did not identify where the assessment was carried out. A relative, rather than the person who carried out the assessment, signed it. It is recommended that the registered manager should review the assessment process with the relevant staff members who carry out the pre-admission assessments. All prospective residents are given a copy of the service users’ guide and the statement of purpose that set out very clearly what the service provides. Once an agreement has been reached and a decision to be admitted to the home has been made, arrangements are made for the admission. This is not at the present time confirmed in writing stating that the home is able to meet the person’s assessed care needs. It is a requirement that once a decision has been made for admission to the home, confirmation must be made in writing that the home is able to meet the individual’s assessed needs. Prospective residents are invited to attend the home and spend time meeting the other members of the “family” prior to making any decisions. Each resident’s file examined contained a contract containing all the information as set out in the National Minimum Standards. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning is in a state of flux at the moment and needs to be progressed to avoid the situation of new residents not having a care plan. Risk assessments are in need of reviewing so that meaningful assessments and outcomes are achieved. EVIDENCE: The inspector examined a sample of the residents’ records. The company has recently introduced new documentation for care planning and the staff are incrementally transferring the old documentation information into the new. This is a lengthy process and, until it is completed, the staff are finding it difficult to work with two systems in place. Two of the sample of records examined was found to have assessments of care needs but no care plan had been written. One was for a resident who had been in the home for five weeks and the other was for a person on respite care. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 12 It is a requirement that every resident must have a care plan in place identifying their individual assessed needs and how these will be met. The inspector made this an immediate requirement. (Subsequent to this inspection the registered manager did supply an action plan that had been completed, stating that every resident had a care plan in place.) The remainder of the sample of records were found to be comprehensive and gave a clear picture of the person and how they are being cared for. Risk assessments are not always in place or are incomplete. It is recommended that a review of risk assessment should be undertaken to ensure that staff understand and are able to carry out appropriate assessments. One of the residents is receiving nursing care from the district nurses, and is identified as having a problem with eating and drinking and yet there was no risk assessment in place. It is recommended that the registered manager or his deputy should approach the district nurses to ask if they have, or would carry out, a nutritional assessment so that the appropriate action can be put in place to improve the resident’s nutritional status. The inspector met with a member of the community team and was told that there is very good communication between the staff and the community team. The staff are very good at carrying out any instruction between visits, and the residents are well looked after - “It is always a pleasure to visit this home”. Residents spoken to said that the care was really good and that the staff are really good. The inspector observed that the residents are well cared for and content to be at The Ridings. All residents have access to local GPs, district nurses, chiropody, dentists and opticians. The medication system was examined and overall found to be in good order. The system is well supported by a pharmacist from the supplier who also provides training for staff who administer medication. Eye drops were found to be opened without the date of opening being recorded on the package. Eye drops lose their efficacy after four weeks from being opened. It is a good practice recommendation that all eye drops should be dated on opening. The medication fridge was found to be unlocked and storing both medication and food. It is a requirement that the medication fridge must always be locked and only used for storing medication. The inspector observed staff assisting residents in a kindly and appropriate manner, and always calling them by there chosen name. Staff also always knocked on the residents’ private doors, bathrooms and toilets before entering. There was a record in the care planning documentation about the residents’ wishes at the time of their death. This is good practice although not easy to carry out. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The activities provision is of a high standard and tailored to the needs of the residents. Meals and mealtimes are an important part of the residents’ day and a nutritious and wholesome diet is provided. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religions, race, and culture. EVIDENCE: The sample of care plans examined by the inspector had a record of the individual’s preferred lifestyle and the activities that they had taken part in. Residents spoken to said that there was always something interesting going on that they could take part in or just sit on the sidelines. The activities co-ordinator is in the home five days a week and provides a varied programme to suit the assessed needs of the residents. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 14 There is a large activities room and this was found to be very busy in preparing for the Christmas festivities. The home is a member of a national organisation which specialise in the provision of social and leisure activities, and offer guidance and support to the staff. The home has a link with Age Concern who provide a telephone call twice a week to any resident who wishes to participate in this service. One of the key focuses is that of “user empowerment” so that the resident can make real choices about the life they wish to lead. Residents are able to attend church services locally if they wish and a service of Holy Communion is provided monthly in the home. The inspector observed lunch being served in the dining room and noted that there was a relaxed atmosphere, with staff assisting residents in a kindly and appropriate manner. Residents are encouraged to eat in the dining room, particularly for the main meal of the day. The layout of the dining room is appropriate to the residents’ needs and each of the tables was set with colourful tablecloths. The meal provided looked appealing and wholesome and each resident’s meal is individually plated with his or her specific choice from the serving hatch. Afternoon tea was served later in the day and this included a fresh baked cake that was very popular with the residents. Residents spoken to said that the meals were always good and that they had a lot of choice, and could have whatever they wanted. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an accessible complaints procedure in place that needs to include the address and telephone number of the local Commission for Social Care Inspection office. Every effort is made to protect residents from abuse. EVIDENCE: The inspector examined a copy of the complaints procedure, both within the service user’s guide and displayed on the noticeboard in the corridor, and noted that this did not provide sufficient information about the Commission as required by the Care Standards Act 2000. It is recommended that the full address and telephone number of the local office of the Commission should be included in the complaints procedure. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The home’s training programme includes training in the protection of vulnerable adults, and there are records showing that all staff have received this training, both as part of the induction programme and ongoing. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All areas of the home are clean, pleasant and hygienic. The premises and grounds are well maintained. EVIDENCE: The inspector toured the building and overall found all areas to be clean and free from any unpleasant odours. The standard of furnishings and fittings are of a good quality, although these are about to be replaced with new ones as they are beginning to show signs of wear and tear. Some areas of the home are also in need of redecoration and a programme is in place to address this. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 17 The inspector noted that in a number of bathrooms and toilets there were plastic bags holding plastic bags and protective gloves left on the side. This, in the inspector’s view, is not conducive to a homely atmosphere. It is recommended that alternative storage space should be considered for keeping protective clothing and plastic bags in the bathrooms and toilets. The laundry was found to be in good order, and clean, and good systems are in place to ensure good standards of hygiene. The grounds are attractively laid out for the enjoyment of the residents and are well maintained. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The recruitment procedures in the home are robust. Training and development of the staff is of a high standard. EVIDENCE: Staff rosters were examined and found to have sufficient numbers and skill mix of staff on all shifts. The inspector examined a sample of staff files and found that these were complete and in accordance with the home’s recruitment policy and procedure. The training and development of staff is very good and a training matrix was displayed in the staff office showing the training dates and who had attended. The percentage of care staff with NVQ Level 3 or above is in excess of the 50 target and there are still staff working towards the qualification. This is commendable and helped by having five members of staff who are assessors. One of these assessors is the administrator and this shows the level of teamwork in the home. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well managed and supported by the company and the quality assurance systems in place. Residents’ financial interests are protected. The health, welfare and safety of residents and staff are promoted and protected. EVIDENCE: The registered manager is well qualified and experienced to manage the home. He was not on duty at the time of the inspection and his deputy was in charge. However, the registered manager did attend later in the day and had a discussion with the inspector. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 20 The home is very well managed and this is supported by the company’s management structure, policies and procedures. The internal management structure is very clear and there is evidence of good teamwork and clear lines of accountability. The company has a quality management system in place that included the Investors in People award. There is continuous audit taking place of all systems throughout the home. The views of the residents are actively sought in monthly residents’ meetings, and the registered manager and his deputy have an “open door” style of management. The inspector met with the administrator and discussed how the residents’ financial interests are safeguarded. The inspector found good systems in place with excellent records of all transactions, and receipts kept. Mandatory training in fire safety, food hygiene and moving and handling are in place for all staff. Thirteen members of staff hold a current first aid qualification. Other training provided includes health and safety and specific COSHH (Care of substances harmful to health) training. Records required by regulation are all complete and up to date. The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 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 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 3 3 3 The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 14(1)(d) Requirement It is a requirement that once a decision has been made for admission to the home, confirmation must be made in writing that the home is able to meet the individual’s assessed needs. It is a requirement that every resident must have a care plan in place identifying their individual assessed needs and how these will be met. Timescale for action 22/12/06 2 OP7 15 05/12/06 The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 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 Refer to Standard OP3 Good Practice Recommendations It is recommended that the registered manager should review the assessment process with the relevant staff members who carry out the pre-admission assessments. It is recommended that the registered manager or his deputy should approach the district nurses to ask if they have or would carry out a nutritional assessment so that the appropriate action can be put in place to improve the residents’ nutritional status. It is a recommended that the full address and telephone number of the local office of the Commission should be included in the complaints procedure. It is a good practice recommendation that all eye drops should be dated on opening. The medication fridge was found to be unlocked and storing both medication and food. It is a requirement that the medication fridge must always be locked and only be used for storing medication. It is recommended that alternative storage space should be considered for keeping protective clothing and plastic bags in the bathrooms and toilets. 2 OP8 3 4 OP16 OP9 5 OP19 The Ridings DS0000013127.V322235.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 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 © 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 Ridings DS0000013127.V322235.R01.S.doc Version 5.2 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!