Inspection on 13/03/08 for Torr Home

This inspection was carried out on 13th March 2008.

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

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

Other inspections for this house

Torr Home 11/02/09

Torr Home 07/06/07

Torr Home 15/02/06

Torr Home 23/06/05

Torr Home 18/01/05

Torr Home 12/08/04

Torr Home 03/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Torr Home The Drive Hartley Plymouth Devon PL3 5SY Lead Inspector Mandy Norton Unannounced Inspection 13th March 2008 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 Torr Home DS0000003514.V360882.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. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Torr Home Address The Drive Hartley Plymouth Devon PL3 5SY 01752 771710 01752 782300 info@torrhome.org.uk www.torrhome.org.uk Devonport & Western Counties Association for Promoting the General Welfare of the Blind 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) Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Sensory Impairment over 65 years of age of places (40) Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Age 60 yrs One named individual under 65 years Date of last inspection 26th October 2007 Brief Description of the Service: Torr Home is a care home registered for up to forty people who have care needs within the categories of Old Age, not falling within any other category (40), and Sensory Impairment over 65 years of age (40). It is not registered to provide intermediate care or nursing care. Torr Home is owned by Devonport & Western Counties Association for Promoting the General Welfare of the Blind, a registered charity, and overseen by a board of trustees. It is a large home developed in 1926 from a former large country house that has been successfully modified over the years to provide residential care. Torr Home is located in the Hartley area of Plymouth, close to Mutley Plain and Hyde Park shopping areas. There is easy access to the city centre and other parts of Plymouth by bus. Torr Home also offers respite care for older people to have a short break; convalescent care for older people recuperating from hospital admission; and day care three days per week for older people living in the local community. The current scale of residential fees is £425.00 to £600.00. These fees do not include hairdressing, chiropodist, telephone, newspapers and magazines, incontinence pads, and toiletries. Information about additional charges is available in the Service User’s Guide (brochure) provided by the home. This information was given to the Commission for Social Care Inspection (CSCI) in March 2008. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place from 10.20 am until 2.45 pm on the 14th March 2008. The inspection was conducted with the new manager( who had only been in post for 4 days prior to the inspection) and the Chief Executive Officer. This report also contains information taken from the completed annual quality assurance assessment (a document that is completed annually detailing ongoing improvements and achievements), a number of completed staff and ‘Service User’ surveys and discussions with staff and people who use the service during a tour of the home on the day of the inspection. There were 34 people living in the home at the time of the inspection. The home is currently undergoing extensive building, refurbishment and redecoration. The disruption and noise has been a nuisance to some of the people living in the home, who are looking forward to its completion estimated to be at the end of April 2008. What the service does well: The home is homely, comfortable and clean and hygienic. The staff are very friendly and work well together to deliver good quality care to the people living in the home. The registered providers have worked hard to meet the requirements and recommendations made following the last inspection. They have appointed a new manager who has previous experience of managing a home. She has arranged meetings for the senior staff, care assistants and residents and relatives so that they can get to know her and offer any comments or ideas they may have. The catering manager attends the end of the residents/relatives meeting to take comments about the meals and ideas of what the current residents would like to see on the menu. A recent infection control audit by the local health protection agency (HPA) made a number of recommendations that have been well received and the manager has already bought some new cleaning trolleys and introduced Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 6 cleaning schedules for domestic staff to use. They then sign to say who has completed which job. People who are able to administer their own medications are encouraged to do so following a risk assessment of their ability. This helps to maintain their independence especially if they are going home. What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. This service is not registered to provide intermediate care. EVIDENCE: The manager said that she will initially carry out all of the pre admission assessments. She intends to use a standard pre admission form that once completed will form the basis of the care plan. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 9 The last inspection report is available in the home the manager was advised that it should also be on display in the entrance foyer. During a tour of the home it was noted that each person had information about the services and facilities at Torr Home in their bedroom. The manager is aware that this information will need to be updated once the building and refurbishment work is completed. The manager said that people are encouraged and welcome to come and look around prior to admission. One person spoken to said that they had had the opportunity to visit, but the local reputation of the home meant that this was not necessary and was happy to move in. All of the completed Service User surveys said that they had had enough information about the home prior to moving in. The administrative staff, based on site, issue each person (or their representative) with a contract and ensure that it is signed and returned. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be always be met. EVIDENCE: Peoples health and personal care needs are met by the effective and friendly staff team. During a tour of the home it was observed that people’s privacy and dignity was respected by staff knocking on doors before entering rooms, personal care being carried out behind closed doors and conversations being held that were appropriate to the individual. Care plans examined had information about what a person likes to be called and their personal likes and dislikes. Any radios or Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 11 TV’s on in the home were on appropriate channels for the people listening to and watching them. Care plans examined were up to date and had been reviewed. They contained a comprehensive profile of the person and their care needs including a appropriate risk assessments, and the daily evaluation sheets had ongoing information about a persons day to day welfare. The manager said that she wants to introduce more person centred care plans in the near future. All visits by GP’s and other health care professionals are recorded separately for easy access when needed by staff. The chiropodist had visited during the inspection and his visits were seen to be recorded straight away by the senior carer. The manager and senior carer on duty said that the care staff are very good at reporting changes to people so that the trained nurses can reassess their needs. The senior carer demonstrated the systems in place for management and administration of medicines, they were found to be in accordance with laid down legislation. The medicines management policies and procedures should be reviewed and updated by the manager to ensure they are consistent with current good practice advice. The senior carer said that staff who are responsible for administering medication have all had training. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities within the home and community meaning the people have a range of opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed making them an enjoyable, social occasion for people. EVIDENCE: Discussions with the manager and a volunteer confirmed that various recreational activities take place, either individually or in groups. The home has an activities co-ordinator who is responsible for arranging various activities, the manager said that she will be interviewing for an additional activities co-ordinator the week following the inspection. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 13 The activities are displayed at beginning of the week and people are reminded of what is happening on the day and can chose to take part or not. The grounds are extensive and have numerous paths and seating areas for people to use if they are able to go outside. People were seen coming and going freely throughout the inspection. The home benefits from a number of volunteers who come in to help with activities and see people on a personal level. The local community is involved with the home and events are held in the grounds during the Summer to which the general public are invited. A number of completed Service User surveys indicated that they liked the food provided in the home and can choose what they want. One comment was that the portions are too big and it is good to have fresh fruit available another commented that the vegetables could be crisper and that the quality depends on who is cooking on that day. The catering manager said that personal preferences and special diets are catered for. Meal timings are flexible and people spoken to said that they are able to enjoy their meals in an unrushed atmosphere. Staff are available at all times during meals to provide assistance as required. There were menus with today’s choices on each table in the dining room. The manager said people are asked the day before the meal what they would like to eat but they can change their mind on the day if they want to. The catering manager said that she attends the end of the residents/relatives meetings to take questions, discuss future menu choices and to generally discuss any issues with the meals. She feels this is very useful. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Formal complaints and reporting of abuse policies and procedures are in place, although they are not up to date so staff may not know the correct procedures for reporting any concerns. People feel their concerns are listened to and acted upon meaning that they raise concerns or make complaints when they should. EVIDENCE: A complaints procedure is displayed in the entrance foyer, it needs to be updated and produced in larger print and displayed at a level where anybody entering the home can see it. The manager said that she could arrange for this to be done immediately. The complaints and adult protection (safeguarding) procedures need to be updated and made are available to staff at all times. The training record seen showed that some staff had some adult protection training in the past. The new manager is aware of the local adult protection training and will ensure that senior staff attend the training and that all staff Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 15 will then receive ongoing adult protection training. This was made a requirement following the last inspection and will remain one following this inspection. The Commission has received no complaints about Torr Home since the last inspection. Comments received on completed Service User surveys indicated that people know how to make a complaint and to whom. Staff files were not examined on this occasion. The manager confirmed that application forms have been updated to reflect new legislation and a blank one was seen to confirm this. She said that new staff are not employed until satisfactory references and a clear Criminal Records Bureau check are received. Torr Home DS0000003514.V360882.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, 20, 21, 23, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is undergoing building work, refurbishment and redecoration and once completed the improvements mean that people will have a more homely, comfortable and safe environment in which to live. EVIDENCE: A tour of the home found a homely and generally comfortable environment. There is currently ongoing building work and refurbishment and redecoration of the home. This has been ongoing for sometime and some of the people spoken to and some of the completed Service User surveys indicate that the noise and Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 17 dust are becoming tiresome. The work is now nearing completion and what has been already completed has been finished to a high standard. The staff have been aware of ongoing health and safety issues and have been vigilant in making sure the environment is a safe as possible. The communal rooms are comfortable and decorated in a style in keeping with the age and purpose of the home. There is a shaft lift to all floors and level access to the extensive gardens. Bedrooms seen were individually furnished and contained many personal possessions, some benefit from en-suite facilities. People spoken to in their rooms find them very comfortable. A number of the bathrooms and toilets have been refurbished and are now spacious and practical. Observation showed that the home is kept clean and there were no unpleasant odours. Gloves and aprons are readily available throughout the home. A recent infection control audit carried out by the local health protection nurse made a number of recommendations to improve practices. The manager has already implemented some changes such as cleaning schedules for the domestic staff and has purchased some cleaning trolleys that will be able to store more items, be easily moved around the home and generally help to implement good working practices. The infection control and clinical waste policies need to be reviewed and updated and made available to staff at all times. Torr Home DS0000003514.V360882.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 good. This judgement has been made using available evidence including a visit to this service. The board and new manager show a responsible attitude and are implementing changes and improvements in order to keep improving quality and outcomes for people living in the home. The staffing levels ensure peoples needs are being met at all times. The staff are trained and competent in their jobs however the new manager needs to implement a training planner to ensure that staff continue to receive appropriate training within the required timescales. EVIDENCE: A tour of the home and feedback from a number of the completed Service User surveys indicated that the staffing levels are fine for the number of people living at Torr Home. The manager and care staff are supported by domestic, catering, laundry and maintenance staff. The company has an office in the grounds where Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 19 administrative staff deal with contracts, fees, completion of recruitment procedures and peoples personal allowances. The manager is hoping to move the administrative office into the main home so she has better access to the records described above. The ‘Annual Quality Assurance’ assessment states that a number of staff have achieved at least level 2 National Vocational Qualification in care with some studying for level 3. The new manager wants to increase the number of staff studying for National Vocational Qualifications. She wants to ensure all staff attend some adult protection training with preference being given to the senior staff in the first instance. She also wants to ensure staff have ongoing training in disorders associated with old age and sensory loss as the home caters for people with sight problems as well as those requiring personal care only. Staff spoken to and completed Service User surveys indicated that training was given and the current staff group are well able to meet peoples needs. The manager said she will implement a system to record training and ensure people are updated as required. The current system does not adequately show which staff have attended which course/study day. Training opportunities were advertised on the staff notice board. The manager said that she checked when she started the job that people have been recruited using proper procedures including a criminal records bureau (CRB) check and 2 written references being obtained. She says she will be looking at the staff files herself to ensure that they contain all of the required information in a useable format. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The changes the manager is implementing are designed to meet the needs of the service, and to continually improve the service the home offers to meet the needs of the people that live there EVIDENCE: The manager had been in post only 4 days at the time of the inspection. She has managed a large care home before and is qualified, competent and experienced to run the home. A number of completed Service User surveys stated that they were looking forward to the new manager starting. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 21 The manager is keen to include staff and residents in any changes that are implemented and will rely on their feedback as to whether it is working or not. She said she will do this via formal staff meetings and residents and relatives meetings (dates already arranged and displayed on the notice board) and ongoing supervision and appraisal sessions, once she has a system in place. There is a formal quality assurance process in place consisting of satisfaction surveys sent to people who live at the home or their representative. Recent results were sent to the Commission and were generally positive. The manager said she will want to review the current system to see if it asks the right questions and what feedback is given to negative responses. An up to date insurance certificate is displayed in the entrance foyer. The administrative staff deal with peoples personal allowances and fees. There is clear system for managing peoples money which includes income and expenditure recording and receipts as evidence of the activity. The office has secure facilities for storage of money and personal information. These processes were not examined during this inspection. Peoples records and personal information kept within the home that was examined was in good order and stored appropriately. The home has a maintenance team who carry out routine maintenance within the home and are responsible for checking safety equipment such as the fire alarm. Any ongoing health and safety concerns and required repairs are put into the maintenance book which is checked daily (week days) and the work carried out that day or as soon as possible thereafter. The accident report book and fire log - book examined were up to date and completed as required. The manager said she wants to review the care plans to ensure they have the relevant individual and general risk assessments included in them. The ongoing building and refurbishment work has been a concern for the people living in the home and the staff. The board made a lot of effort to ensure the home was safe at all times following the last inspection and have ongoing fire and health and safety risk assessments in place. The manager is assured that safe practices are in place with ongoing electrical rewiring for example. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 22 Once the work is completed a complete fire and health and safety risk assessment needs to be carried out and then be reviewed and updated as necessary. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 23 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 2 3 x 3 3 2 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 X 3 2 Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 24 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 OP18 Regulation 13 (6) Requirement All staff who have contact with the people using this service must be trained about how to recognise abuse (financial, physical or emotional), how to prevent abuse, and how to report any incident of abuse if they suspect that it is happening within the home and is putting people at risk. This will ensure that the relevant authorities can take immediate and suitable action and that people using the service are safe. (Carried over from previous inspection) Timescale for action 30/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Torr Home Refer to Good Practice Recommendations DS0000003514.V360882.R01.S.doc Version 5.2 Page 25 1. Standard OP38 All policies and procedures need to be reviewed to ensure they are up to date with good practice issues and recent legislation changes. Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Torr Home DS0000003514.V360882.R01.S.doc Version 5.2 Page 27 - 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!