Inspection on 18/07/06 for Vicarage House Residential Home

This inspection was carried out on 18th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Vicarage House Residential Home 17/04/09

Vicarage House Residential Home 08/06/07

Vicarage House Residential Home 17/02/06

Vicarage House Residential Home 14/07/05

Vicarage House Residential Home 08/11/04

Vicarage House Residential Home 07/09/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Vicarage House Residential Home 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR Lead Inspector Jane Gurnell Unannounced Inspection 18th July 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 Vicarage House Residential Home DS0000003500.V290598.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. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vicarage House Residential Home Address 1 Honicknowle Lane Pennycross Plymouth Devon PL2 3QR 01752 779050 01752 779050 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) Dr Pepper`s Care Corporation Limited Gaynor Braddon Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability over 65 years of age of places (32) Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17/02/06 Brief Description of the Service: Vicarage House is a detached, two storey property situated in the residential area of Pennycross, Plymouth. The home is registered to Dr Peppers Care Corporation Ltd and the Directors are Dr and Mrs Pepper. Ms Braddon, the Registered Manager currently works part time and is supported by a manager and a deputy manager. The home is registered to provide residential accommodation and personal care for a maximum of 32 older persons over the age of 65 who may also have a physical disability. The home has 26 rooms approved for single occupancy, 17 on the ground floor and 9 on the first floor. There are 3 rooms approved as doubles, two are on the ground floor and one the first floor. No bedrooms have en-suite toilet facilities. There is a chair lift which goes most of the way up the main staircase and a passenger lift that provides access to the 1st floor. There is a choice of communal areas on the ground floor and although at the time of this inspection access to a garden area is restricted due to the building work; when this is completed there will be an attractive and safe area for residents to use. Smoking is permitted in designated areas only within this home. At the time of this inspection the current weekly fee ranged from £275 to £300. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken over a two week period with 3 visits to the care home: the first an unannounced visit on 18th July, the second the following day and the 3rd an announced visit on 31st July to follow up on issues identified on the first day. The Registered Manager was not able to be present for this inspection, therefore, the manger with responsibility for the day-to-day running of the home, the deputy manager and the staff team assisted the inspector. Questionnaires were sent to residents, staff and those relatives who visit the home regularly: 17, 12 and 11 respectively were returned. These questionnaires enable people to comment anonymously about their experiences of the home and the services and support it provides. The inspector also spoke to 2 social workers who confirmed they have a good relationship with the home and are confident that the residents’ needs are being met. Prior to the inspection the Commission had received a complaint by a former resident about the conduct of a number of staff and, since the inspection, 3 anonymous phone calls have been received regarding the management of the home. Although no breaches in the Care Homes Regulations 2001 were identified in relation to these issues, it was identified that there are management issues that the Registered Providers have been asked to investigate. The inspector made a tour of the building and spoke to the staff on duty, many of the residents and 5 family members who were visiting the home at the time. Care plans and documents relating to the running of the home were reviewed. What the service does well: What has improved since the last inspection? On the first day of the inspection the care plans were so brief that the inspector was unable to identify one resident’s care needs from another. However over the 2-week period of the inspection, the care plans had been Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 6 greatly improved to provide more details of the residents’ care needs and the action required by staff to meet those needs. At the start of the inspection the oven and extractor fan were not working and this resulted in restricted menus being offered and also the kitchen being extremely hot to work in. By the 3rd day of the inspection the extractor fan had been repaired and the oven replaced. Two carpets identified as posing trip hazard have been replaced. The extension to provide 5 en suite bedrooms and a laundry room is well underway and is expected to be completed by the end of September. The passenger lift has been repaired and is now in full working order. 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. Vicarage House Residential Home DS0000003500.V290598.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 Vicarage House Residential Home DS0000003500.V290598.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents are given the information they require to make a choice about whether to be admitted to this home. EVIDENCE: Two newly admitted residents described that they had been able to visit the home and had received written information about the home and the services provided. They said that they had been made very welcome. The manager had undertaken pre-admission assessments for these two residents. These assessments were brief and didn’t fully record the information the manager had gained with regard to their care needs: the manager was advised to record as much information as possible to enable her to make an informed decision about whether a prospective resident’s care needs could be met at Vicarage House and also to identify the information from which she was making a decision. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents’ health, personal and social care needs are being met and residents are treated respectfully. Medication storage and administration practices are safe. EVIDENCE: Residents said they are well cared for and the care staff are kind and competent. Staff were described as “very good” and “excellent”, one resident said that “the staff make it a very homely place”. One relative said that her mother was very happy at the home and that her health had improved since her admission. At the start of the inspection, the care plans were very brief with only one or two words indicating a resident’s needs and the inspector was unable to tell one resident’s care plan from another. Advise was give to expand these plans and by the 3rd day of the inspection, the plans had been rewritten. These now include much more detail about the residents’ personal and health care needs as well as their preferred routine. Many of the residents preferred to get up Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 10 quite early each morning, some before 6am and therefore were retiring to their rooms shortly after supper. The Commission received information anonymously that residents were being assisted to get up early whether they wished to or not. The manager denied that any resident would be forced to get up and will make it clear that under no circumstances should a resident be getting up before they wish to do so: the morning routines of the home must be flexible to allow for this. Residents are assessed for whether they are at risk of falling or developing pressure sores due to poor mobility or frailty. These assessments did not provide sufficient information for staff when a risk had been identified: following advise these documents were amended to include the measures that must be taken to reduce the risk, such as pressure relieving mattresses and ensuring a resident has assistance from staff when walking. Only significant events were recorded in the residents’ care plans and in a number of the plans examined by the inspector no entry had been made for a considerable period of time. In one plan an entry had been made regarding the resident being upset, but no subsequent entry as to why that may have been or if an action was required to resolve the matter for the resident. The manager was advised to record the care provided by the staff as well as a note regarding the well being of the resident and how they had spent their day. This would give a clear picture of the care and support provided by the home as well as evidence that care needs were being met. Medication is stored safely and the records were accurate: should residents wish to retain the responsibility for their medication they are supported to do so. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents can be assured of a comfortable lifestyle that encourages them to be independent and make choices. EVIDENCE: Many of the residents said they enjoyed the activities facilitated by the care staff. Activities are planned throughout the month and include musical entertainment, bingo, keep fit and games. Staff raise money and once a month, if funds allow, endeavour to arrange a visit to a local place of interest, or for a meal at a local restaurant. One relative and three residents thought that there were insufficient activities provided by the home. One resident wanted to see more exercises and another the opportunity to go for a walk around the local area. The manager was advised to consult with the residents to ascertain their views regarding the activities and to ensure that those residents who prefer not to become involved in group activities are offered time to participate in activities of their choice. A monthly Newsletter and 3monthly residents’ meetings provide residents and relatives with information about the home and forthcoming events. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 12 Residents said that in general the food was satisfactory. The oven had not been working for some time and therefore the cook was restricted in the meals she was able to offer. The food storage area was well stocked but it was noticed that there was no fresh fruit available: residents said that they purchase their own fruit. The manager was advised that as part of a wellbalanced, nutritious diet and for the residents’ enjoyment, the home should provide fresh fruit. The manager said that she would consult with the residents with regard to their preferences and would purchase fruit. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. Residents are listened to and issues resolved promptly. EVIDENCE: The residents said they are confident that any issues of concern would be dealt with promptly. Of the 16 relatives consulted either in person or through the questionnaires only 2 were not aware of the home’s complaints procedure: the manager may wish to consider providing all relatives with a copy. Records were available of issues brought to the attention of the manager and these detailed the action taken to resolve the matter. These records included information relating to the complaint made to the Commission by a former resident. From discussions with the manager and a review of the documentation no breaches in the Care Homes Regulations 2001 were identified. The Registered Providers have been asked to review the arrangements for staff supervision and the management of the home and the staff have been asked to consider how their behaviour might be perceived others. Some of the care staff have received training in the protection of vulnerable adults: dates have been arranged for the remainder of the staff group. It is important that all staff receive this training to ensure they have the skills to recognise those residents who may be at risk and the procedure to follow should they suspect that abuse has occurred. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25, 26 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents live in a pleasant, well-maintained home that is comfortable and which provides sufficient facilities to meet their needs. EVIDENCE: During the tour of inspection the inspector looked into most bedrooms, bathrooms and toilets. Residents were seen in the lounges and dining room. Residents said that they found the home warm and comfortable. Bedrooms and communal areas were pleasantly decorated and furnished. The home was very clean and tidy. Locks had not been fitted to the bedroom doors of a number of residents to ensure their privacy and provide security for their possessions. The extension to provide 5 en suite bedrooms and a new laundry room was well underway and is expected to be completed by the end of September 2006. Whilst the building work is being undertaken, access to the rear garden is restricted to protect the safety of the residents and staff. Seating was available at the front of the home should residents wish to sit out of doors. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Residents are cared for by well-trained and motivated staff in sufficient numbers to meet the needs of those currently living in the home. Recruitment processes must be improved to protect vulnerable residents. EVIDENCE: Residents said they are well cared for and the staff were competent and very kind. Many of the staff have worked at the home for a number of years and as such have a great deal of experience in caring for older people. At the time of the inspection there were 27 residents at living at Vicarage House. The duty rota indicated that there are 3 care staff on duty throughout the day and evening and 2 waking night staff. These numbers do not include the manager and deputy manager when they are on duty. Care staff are supported by domestic staff and a cook each morning. Care staff prepare the evening meal which means that for this period of time only 2 care staff are available to support the residents. The manager was asked to review this in light of the number of residents at the home, some of whom need 2 staff to assist them with their personal care and many require assistance with mobility. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 16 Of those staff files examined 2 did not have 2 written references. Both had Criminal Record Bureau checks and a check made against the Protection of Vulnerable Adults list prior to their employment to ensure there was not any known reason to prevent their employment. The manager was advised that 2 written references are a requirement to confirm the prospective member of staff is a suitable candidate and of good character. In-house induction training is provided for newly appointed staff: the manager was advised to consult the training provider to ensure the training met with the National Training Organisation’s specifications. The manager, who is a manual-handling trainer and has undertaken an advanced course in health and safety, undertakes the majority of staff training. This training is supported by the use of training videos and tests, ensuring the care staff have the knowledge and skills to deal with emergencies. Video training is also available for health related topics such as high blood pressure, diabetes, pain management and osteoporosis. External training providers are used for basic food hygiene and first aid training. Advise was given to consult an external trainer to support the fire safety training as they will be aware of the changes in legislation and will be better placed to advise the home. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. The absence of the Registered Manager has led many staff to feel unsupported which in turn has effected morale: this may place in jeopardy the well being of the residents. EVIDENCE: Residents said that the feel the home is well run and that the manager works hard to ensure their needs are met. Twelve surveys completed anonymously from staff and 3 anonymous telephone calls received by the Commission raised concerns over the management of the home now that the Registered Manager no longer works in a full time capacity. Care staff said they do not feel well supported; they do not Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 18 have regular supervision or staff meetings and have not seen the Registered Manager for any length of time. Comments were made that manager is too busy to attend to these issues and that morale within the staff team was very low. This low morale has not yet affected the welfare of the residents but should staff continue to feel unsupported in their job this may place in jeopardy the stability of the staff team. The Registered Providers have been asked to consult with the staff team to address these issues and review whether the Registered Manager is able to fulfil her responsibilities. The Registered Providers visit the home weekly and meet with residents and staff. Residents meetings are arranged every 3 months and allow the residents to comment upon any issues of concern and to receive information about the running of the home and more recently the extension to provide extra facilities. The Registered Providers formally consult with residents annually to gain their views of the quality of the care and services provided at the home. The results of last year’s survey were available. Comment cards were available periodically for relatives to voice their views. The manager was advised to make this a more formal arrangement in line with the consultation with residents and from this an action plan should be developed to demonstrate the Registered Providers’ commitment to the continual improvement of the service. From discussion with the manager and staff it was evident that the home would be able to support residents with differing religious or cultural needs and would seek advise from the resident and relatives should the routines of the home need to change to accommodate an individual’s needs. The home provides safekeeping for a number of residents’ money: individual records were maintained and receipts obtained for all expenditure: those examined by the inspector were accurate. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 19 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 X 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 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 3 3 Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation 10 Requirement The Registered Providers must consult with the staff team with regard to the management of the home and review whether the Registered Manager is able to fulfil her responsibilities. All staff employed in the home must have 2 written references: preferably one form the last employer. This requirement has been carried over from the previous inspection. Care staff must receive formal supervision to review their work performance and to identity their training needs. Timescale for action 30/09/06 2 OP29 19 31/08/06 3 OP36 18 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 21 No. 1. Refer to Standard OP3 Good Practice Recommendations Pre-admission assessments should be expanded to record all the information known about the personal and social care needs of the prospective residents, as well as any identified risk to their health and safety. Daily care notes should record staff interaction with residents and how the resident has spent their day to evidence that care needs are being met. Residents should be consulted to gain their views on the variety and frequency of activities offered. Residents should be offered fresh fruit of their choice. The Registered Manager should review the staffing arrangements in the afternoon and evening during the time when the evening mal is prepared. The Registered Manager should consult with a training provider to ensure the in-house induction training meets with the required specifications. An annual development plan detailing the commitment to continual service improvement should be produced. Locks should be fitted to bedroom doors to provide residents with privacy and security. 2. 3 4 5 6 7 8 OP7 OP12 OP15 OP27 OP30 OP33 OP24 Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Vicarage House Residential Home DS0000003500.V290598.R01.S.doc Version 5.2 Page 23 - 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!