Inspection on 29/08/07 for Walton Heath Manor

This inspection was carried out on 29th August 2007.

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 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

Walton Heath Manor 16/06/06

Walton Heath Manor 12/09/05

Walton Heath Manor 16/05/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Walton Heath Manor Walton Heath Manor Hurst Drive Walton-on-the-hill Surrey KT20 7QT Lead Inspector Eamonn Kelly Unannounced Inspection 29th August 2007 10:15 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 Walton Heath Manor DS0000063264.V339993.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. Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walton Heath Manor Address Walton Heath Manor Hurst Drive Walton-on-the-hill Surrey KT20 7QT 01737 814010 01737 819903 admin@whmanor.co.uk 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) Hamilton House Medical Limited Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2006 Brief Description of the Service: The premises have bedrooms on the ground, first and second floors. The majority (23) of these are on the ground floor. Residents have the benefit of 2 passenger lifts. All bedrooms have en-suite facilities. Residents who have ensuites without baths have the use of communal bathrooms that have Parkertype baths and hoists. There are many communal areas throughout the premises. Residents, staff and visitors have access to excellent external facilities. Car parking at the front is available. Residents and others have easy access to local bus transport. Weekly fees range from £685 to £925. The variation in fees relates to the size and position of the resident’s bedroom. A few residents receive local authority funding and, in these circumstances, there is generally a top-up fee payable by the resident/family. Residents are responsible for costs associated with the following: • • • • • • • • • • • Hairdressing, Chiropody, Private dentistry, Private medical fees and private prescriptions, Newspapers, Private phones and phone bills, Freeview TV converters or SKY TV, Portable appliance test costs at admission stage (for a certificate of safety covering electrical equipment brought in by a resident). Annual portable appliance tests are arranged and paid for by the home. Dry cleaning, Items bought in the home’s shop, Specialist costs (e.g. temporary full nursing care, physiotherapy, speech therapy, or hire of personal medical or nursing equipment). The owners do not supply TVs and other audio/visual equipment in bedrooms. Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 29th August (10.15am-5.30pm). It consisted of meeting with the owner/registered manager, deputy manager, residents, members of staff and visitors. Care practices were observed and discussed with members of staff. A variety of records was seen during the visit principally those that supported the care of residents. The previous manager provided the commission with a completed annual quality assurance assessment (AQAA) and this has been helpful in preparing this report. The improvements requested in the previous inspection report have been addressed or are close to completion. This report contains information about progress made since the previous inspection visit and about how further improvement is necessary for the welfare and comfort of residents. What the service does well: What has improved since the last inspection? A fire safety report has been commissioned from a qualified person and all necessary fire safety procedures are followed. CRB checks are carried out for all staff and volunteers. All members of staff have received support in understanding their responsibilities in relation to Safeguarding Adults (POVA: protection of vulnerable adults). The complaints procedure has been updated. All members of staff administering medicines have received training in how to best administer, store, record and return medicines. Care plans have been updated. Better risk assessments take place including risks due to falls. Consideration is being given to how best residents can be helped and encouraged to remain more mentally and physically active. Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Walton Heath Manor DS0000063264.V339993.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 Walton Heath Manor DS0000063264.V339993.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, 2, 3, 5, 6. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Prospective residents and their supporters have the benefit of receiving good initial advice and guidance that enables them to assess the quality, facilities and suitability of the home. EVIDENCE: Prospective residents receive careful assessment by the manager and/or deputy manager to enable both parties (the home and the resident/supporters) to make the right decision about taking up residency. They receive an information pack and terms and conditions leaflet. The brochure is a useful document for attracting new residents and additional information is also provided. Prospective residents would find a Resident’s Guide (that contains the information listed in Schedule 1 of Care Home Regulations) useful in assessing services and facilities. Residents spoke of the Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 9 careful attention they received at admission stage to help them settle in, personalise their bedroom and establish a routine. Each resident receives a personal contract which covers the terms and conditions of residency. A new contract is provided where residents move to a different bedroom with the weekly fees and room number shown. Residents also are admitted for periods of respite care. Where respite or recuperative care is given, a care plan record is prepared and the resident’s support needs and how these needs would be met are included in the same way as for permanent residents. Walton Heath Manor DS0000063264.V339993.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): 7-10. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents receive good personal and healthcare support. EVIDENCE: Care plan records are seen as operational tools to help with the care and support of residents. Some have useful and up-to-date information about assessed support needs, how each need is to be or is being addressed and the outcomes of regular reviews. In other cases, the care plan does not fully reflect the current disability or need of the resident and how effective support is planned or in place. They do not contain a suitable biography of the resident to whom they refer. The plans list dates of review but do not always show any outcome. Most residents are at advanced ages and this type of close review and update is important to them. This includes implications of higher risk due to falls. In short, the care plans are useful and relevant but are currently fairly crude devices for monitoring resident’s personal care and support. Residents have good access to GP, district nurse and other health services. A number of residents receive private dentistry because of the relative lack of Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 11 access to NHS dentistry. They also receive chiropody and physiotherapy support. Part of a medication round observed indicated that there is considerable concentration on ensuring as far as possible that medicines are administered safely and properly recorded. Where mistakes have occurred immediate action is taken to ensure the safety of the resident and to show staff how to avoid the type of error in future. Members of staff administering medicines receive training from a source considered reliable by the deputy manager. Medicines are securely stored and there are additional facilities for safeguarding controlled drugs. Some residents keep their own medicines and members of staff monitor their continuing ability to safely do so and their wishes to continue over time. Members of staff are experienced in the provision of personal care and residents are helped with all necessary respect and in private. Walton Heath Manor DS0000063264.V339993.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): 12-15. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents receive some opportunities for remaining mentally and physically active. The appointment of a full-time activities co-ordinator and other initiatives are likely to be a significant improvement in this respect. EVIDENCE: A small group of residents spend considerable time in the home’s greenhouse (which is fully lit and heated all through the year) where many plants and vegetables are grown. Some of these, residents say, find their way to the kitchen and elsewhere. Residents referred to organised activities and this programme is displayed. Small groups of residents have occasional shopping trips and outings in the home’s mini-bus. The premises have a hairdressing salon. Residents have the benefit of a bar in the first floor lounge and a shop for purchase of day-to-day items. A few residents still retain their driving licences and keep cars at the home. Some travel unaccompanied by bus into town. A mobile library visits. There are many comfortable rest areas throughout the premises. Residents/staff meetings are held to discuss items of either interest or concern to residents. Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 13 Residents have the benefit of extensive surrounding gardens and some referred to their pleasure in walking through them or sitting in garden seats. Residents also like the fountain. Some residents visited others for conversation in bedrooms or in a communal area. Many have private telephones. Some residents have small fridges in their bedroom. A number of newspapers are supplied each day by the home and placed in the first floor lounge. Many residents also order their own newspaper. The library provides, of course, access to books but is also a quiet room for residents and visitors. Most bedrooms, including those on upper floors, have verandas and balconies. Bedrooms are comfortable and well furnished. During the inspection visit, a number of residents were in their bedrooms during the morning and afternoon. Some watch people in the garden from their bedroom windows or veranda. The imminent appointment of a full-time activities co-ordinator is likely to have a direct impact in enhancing the lives of residents. Special skills are needed to persuade people to take part in activities and to avoid the fears of residents that they are taking part in activities in an inappropriate way. The target market for the home is for the “active elderly” and there are increasing efforts for residents to remain active. To assist with this objective, an activities centre equipped for cooking, painting and other activities is planned. Two skilled professional chefs provide meals. Meals are intended to be of the highest standard. Residents say that this standard is invariably reached. Members of staff ask residents to make a choice for lunch the following day and a note is made of their request. Some residents requested their meal to be served in their bedrooms. On the day of the inspection visit, most had their lunch in the dining room. This was served in a very congenial setting. Special note is taken where people have swallowing difficulties or need help with eating and action is taken to address these needs. Walton Heath Manor DS0000063264.V339993.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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are protected from abuse. EVIDENCE: Residents say they are encouraged to comment freely about how services and facilities are provided. They (and their supporters) are also asked for their views via a questionnaire. According to the annual quality assurance assessment, five formal expressions of concern were received by the home in the past year. These were looked into quickly by the manager and were found to have had some substance. The intention was to alleviate the resident’s concern and see if any lessons might be learned from the outcome. Residents and others are encouraged to make their views known about how they feel services are provided. The complaints procedure is referred to in the personal contract and a copy is included in current information about services and facilities. It is a little out of date and is not prominently displayed. Some residents say that they would not like to trouble matron or other members of staff with what could be seen (in a theoretic way) as adverse comments. Others had no clear idea that they could approach an external organisation if they had concerns. Members of staff know to whom they could turn if there are practices observed or known about which cause them concern. They are aware of their POVA responsibilities and a director visits every week to discuss a range of issues Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 15 including any concerns that may have arisen. The deputy manager says she will update the complaints procedure, include a copy in the revised resident’s guide and display copies prominently in a frame at several locations in the premises. Recruitment checks are made to help prevent access to vulnerable people by those who should not have this access. In the past year, all members of staff are said to have received training on POVA (protection of vulnerable people) and the relevance to staff of the implications for them of referrals to the Dept of Health POVA Manager. They are kept updated on changes to policy and legislation in this regard. Walton Heath Manor DS0000063264.V339993.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, 24, 26. People who use the service experience excellent quality outcomes. This judgement was made using a range of evidence including a visit to the service. The premises are suitable for the accommodation and care of frail older people. EVIDENCE: As referred to earlier in this report, the premises have suitable facilities for frail older people. Bedrooms are suitable for the needs of residents. Most have verandas or balconies. All have en-suites and where en-suites do not have baths or showers residents have access to excellent communal bathrooms. These bathrooms are suitably equipped some with Parker-type baths and electric hoists. There are two passenger lifts one of which also accesses the basement where the laundry is situated. Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 17 The gardens, fountain, greenhouse and all external facilities are highly valued by residents and staff. Kitchen facilities and the dining room enable chefs to prepare and serve good meals in a comfortable setting. The communal areas are comfortable and well furnished. Considerable attention is given to maintenance and upkeep of all parts of the premises. There is also significant concentration on the importance of domestic work. Domestic workers have undertaken NVQ Levels 1 and 2 in Domestic Activities and COSSH. Walton Heath Manor DS0000063264.V339993.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): 27-30. Residents who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are in the care of a staff group that is skilled, enthusiastic and hardworking. EVIDENCE: Five carers are on duty in the morning period (8am-2pm). Four are on duty in the afternoons/evenings (2-8pm). Three carers are on duty at night (8pm8am). During weekdays, an administrator is present. The manager and deputy manager are also available. There is always a chef on duty. Domestic workers, a laundry assistant and a maintenance person are also involved in the running of the home. There is low staff turnover. The deputy manager believes that sufficient members of staff are on duty to meet the support needs of residents. A member of staff is soon to become a full-time activities co-ordinator. This appointment is a necessary and important one that will benefit staff and residents. The current number of carers on duty will not be reduced as a result of this appointment. A check of staff files indicated that most members of staff either have achieved or have begun an NVQ Level 2 or 3 in Care. Some members of staff say they are enjoying the NVQ work and the support they receive from the assessor. Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 19 The objectives for mandatory training are also being met. The deputy manager indicated that the revised Resident’s Guide would contain a full reference to the actual qualifications and relevant other training achieved by each member of staff. This would, of course, include reference to the success of domestic workers in achieving their qualifications. Good recruitment checks are carried out for new members of staff. This is a positive procedure for the protection of vulnerable people. A full list of CRB checks was made available. This shows the name of the staff member, the reference number and date of the check and its outcome. The deputy manager outlined how the induction procedure is being updated to bring it into line with standards recommended by the care-sector training organisation, Skills for Care. This would include sufficient reference in the new booklet to experience or qualification already achieved by new members of staff. She would also update the application form and method of obtaining references including use of telephone corroboration. Aspects of formal staff supervision and recording of outcomes are also being improved so that sufficient support for all members of staff is promoted. This includes an undertaking to provide the required level of recorded supervision for staff on duty at night. Walton Heath Manor DS0000063264.V339993.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, 32, 33, 35, 38. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents have the benefit of living in premises where the management team is committed to conducting the business in the best interests of residents. EVIDENCE: During the inspection, the deputy manager and other members of staff believed they are providing good support for residents. Residents referred to their confidence in staff and said that they feel secure and well looked after. The commission was advised since the inspection visit that the new manager has taken up her post. Members of staff met have a good knowledge of resident’s support needs and how they generally wish to be cared for. Members of staff work hard to support residents. Because of the relatively high number of residents, their Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 21 significant and increasing physical and mental health frailties and the dispersed nature of the premises carers/domestic workers strive hard to engage with residents. Residents recognise and appreciate these efforts. They express an intention not to place additional pressures on staff because they sense the pressures already there. At all times during the inspection visit there was a positive and calm atmosphere. The deputy manger says increased efforts would be made to build on current developments on quality assurance measures. The annual quality assurance assessment (AQAA) submitted by the business to the commission outlined the areas where residents would be involved in regular quality assurance measures and how important incremental improvements are planned. Some monies are maintained on behalf of residents to cover agreed personal spending. From the description given by the deputy manager, the administrator maintains accurate records of all transactions. Fees for additional charges are invoiced every 3 months and at termination of the residency agreement. Residents remain responsible for their financial and legal responsibilities. Where a resident may be losing the ability to continue exercising this direct responsibility, a principal supporter is alerted and advice in obtaining independent financial and/or legal advice is available on request. The required level of public liability insurance is in place. The complex nature of insurances needed by residents to cover personal possessions should be included in the resident’s guide and individually described in personal contracts. The completed annual quality assurance assessment (AQAA) contains a declaration that all essential safety checks and maintenance certificates are in place. The deputy manager says that she will review all of these in some detail when the new manager takes up her appointment. The declared levels of professional and mandatory training evidence the extent of the business’s commitment to making sure as far as possible that residents are safe and well cared for, that the premises are maintained properly and that all members of staff receive the support and guidance needed for residents needs to be met at all times. Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X X X 4 X 4 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 2 3 3 X 3 X X 3 Walton Heath Manor DS0000063264.V339993.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Walton Heath Manor DS0000063264.V339993.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 Walton Heath Manor DS0000063264.V339993.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!