Inspection on 10/04/07 for Welbourn Manor

This inspection was carried out on 10th April 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

Welbourn Manor 11/04/06

Welbourn Manor 21/11/05

Welbourn Manor 16/06/05

Welbourn Manor 01/02/05

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

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

CARE HOMES FOR OLDER PEOPLE Welbourn Manor High Street Welbourn Lincoln LN5 0NH Lead Inspector Moya Dennis Key Unannounced Inspection 10th April 2007 09:15 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 Welbourn Manor DS0000061236.V335442.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. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welbourn Manor Address High Street Welbourn Lincoln LN5 0NH 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) 01400 272221 None Guardian Care Homes (UK) Limited Mrs Susan Hughes Care Home 31 Category(ies) of Dementia - over 65 years of age (4), Learning registration, with number disability over 65 years of age (1), Mental of places disorder, excluding learning disability or dementia (1), Old age, not falling within any other category (31) Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories: Old age, not falling within any other category (OP) 31. Dementia, over 65 years of age (DE (E) (4) on a named basis only. Mental Disorder, under 65 years (MD) (1) on a named basis only. Learning Disability (LD)(E) (1) on a named basis only. The maximum number of service users to be accommodated is 31. 2. Date of last inspection 11th April 2006 Brief Description of the Service: The house dates from mediaeval times and was originally a large, country, manor house, enclosed in mature and attractive gardens, one area of which is enclosed, accessible and safe for the residents to use. It is a Grade 1 listed building so any alterations or adaptations to the inside or outside require local council authority. It is situated in the centre of the village of Welbourn, which is between Lincoln and Grantham and has good road and public transport links to both. The home is owned and run by Guardian Care Homes UK Ltd. The care home is registered to provide personal care, not nursing care, for up to thirty-one people of both sexes over 65 years. The home can also provide care for up to four named people with dementia needs and one named person who is under 65 years of age. Seventeen residents are accommodated in single rooms and there are six double bedrooms on the ground and upper floors, with access to the upstairs by passenger lift. The home has no en suite facilities. There are four communal bathrooms and eight toilets. Parking is available at the front of the building. Fees range between £335 and £446 per week. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place in April 2007. It consisted of a visit to the home, lasting 5 hours and a review of all the information known about the home. All key standards were inspected. The main method of inspection was tracking the care received by particular residents, checking their records and discussing the care they received with them, with care staff and observations of care practices. A number of residents were confused or had a form of dementia so alternative methods were used to ensure their views were included. We looked at regulatory records, policies and procedures and toured the premises. We spoke to eight residents and three care workers. Sixteen residents completed ‘Have your Say’ questionnaires about their experiences of life in Welbourn Manor, and the information contributed to this report. There were 24 permanent residents and one person having respite care at the time of inspection. The feedback received during the inspection was positive. Residents said they got on well with staff and could find no fault with the home. The manager was present throughout the inspection and was given general feedback about the outcomes at the end of the visit. What the service does well: Many of the staff had worked at the home for several years, providing continuity of care for residents. Staff had a good knowledge of the needs of older people and dealt with difficult situations in tactful, professional ways. Residents said they had good relationships with staff, “They look after me very well here”. Communal areas of the home were well furnished and comfortable. The home employed an activities coordinator and activities were varied and appropriate to individual levels of ability. Residents reported via questionnaires that there were ‘always’ or ‘usually’ activities going on that they could take part in. Residents also said the home was ‘always’ or ‘usually’ fresh and clean. Over 50 of staff had NVQ awards. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 6 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. Welbourn Manor DS0000061236.V335442.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 Welbourn Manor DS0000061236.V335442.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): 1,2,3,4,5,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had access to sufficient information to decide if the home could meet their needs. Prospective resident’s needs were assessed and they had opportunities to visit the home before moving there. EVIDENCE: Prospective residents were given a brochure of the home on initial enquiry. After consultation with them, relatives and any other professionals involved, the manager would visit to assess their needs. Following the assessment process, the manager wrote to confirm whether the home was able to meet the assessed need. During the inspection, the manager was contacted by the local hospital, asking if she would accept a new resident without assessment. The manager refused and confirmed this was not accepted procedure. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 9 If the home was able to meet the assessed needs, prospective residents and/or their relatives would be invited to visit and look round. Relatives confirmed via questionnaires that they had been given the opportunity to do so. All stays were on a trial basis. All residents, or their relatives, had received a service user guide, statement of purpose, a contract and terms and conditions, as confirmed by relatives via questionnaires. Training programmes evidenced that staff had skills and experience to meet assessed needs. The home did not provide intermediate care. Welbourn Manor DS0000061236.V335442.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): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ independence and development were promoted and supported by comprehensive risk assessments. EVIDENCE: Three residents’ care was case tracked. Care plans set out assessed health needs and evidenced that these were monitored. One resident was receiving palliative care at the time of the inspection and appropriate fluid intake and nutritional charts were used. Plans were reviewed monthly, or more often if needed. However, there was no evidence that residents or their representatives had been involved in any reviews. Risk assessments were completed for activities of daily living, such as bathing, dressing, feeding and managing challenging behaviour. Referrals to health care specialists were made, as necessary. Residents saw health professionals in the privacy of their rooms. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 11 None of the residents whose records were looked at in detail looked after or took their medicines themselves. During the inspection, a medication round was observed and correct procedures were seen to be followed. The senior carer dispensing medication had received appropriate training and confirmed the homes’ homely remedy policy. This, and policies for administration, recording, storage, training, ordering and safe returns of medication were robust. General care practices were observed throughout the inspection. Staff addressed residents by the preferred name recorded on their care plans and were seen to give residents their unopened mail. Staff said the need to be respectful to residents at all times was paramount. They were aware of the home’s policies regarding privacy, dignity, choice, rights and independence. Care plans gave details of end of life wishes, when these had been made known. Staff had not received specific training in giving palliative care. However, they were aware of the need to support relatives, as well as residents, during the end of life stages. Welbourn Manor DS0000061236.V335442.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. Residents were offered a range of leisure activities. Meals were well balanced and varied and all residents were assisted to make choices. EVIDENCE: People said via questionnaires that there was ‘usually’ something going on that they could take part in. Residents had made bonnets and cards for Easter and told the inspector about recent social events. Forthcoming events included Strawberry teas, karate exhibitions, street dancers, ‘sixties’ type singers and a garden party. Social events were advertised in local magazines and the local newspaper had covered past outdoor events. One residents said she was very grateful to staff who had shown her how to operate the TV remote control. “I can choose what to watch without having to get up and change channels. It’s marvellous”. She said she did everything for herself. Staff were there if needed but encouraged her to be as independent as possible. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 13 The room being used as a hairdressing salon was also the nominated staffroom. The manager said there were plans to move the hairdressing room downstairs, which would make access easier for residents. The proposed room was well sited and the move would provide a staffroom that could use at any time without disturbing residents. Most residents were unable to maintain links with the wider community but relatives said they were made welcome. All said they knew how to raise concerns and that they would feel confident in approaching any member of staff. The cook was aware of resident’s individual likes, dislikes and needs. There was written information in the kitchen regarding special dietary needs. Menus were on a four-week rota, based on residents’ preferences. Sample menus were provided for inspection. Choices included a ‘full English’ breakfast, which could be taken at a time residents preferred in the homely dining room. Residents said they enjoyed the meals. “The food is very good … you can have what you like for breakfast and there’s always a choice at lunch time”. Relatives said, “The meals always looks nice … it’s nice homely food”. Welbourn Manor DS0000061236.V335442.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 good. This judgement has been made using available evidence including a visit to this service. Residents and relatives benefited from a clear complaints procedure and they were assured that any concerns would be listened to. Residents were protected from abuse by well-trained staff. EVIDENCE: Copies of the home’s complaints procedure were included in the Statement of Purpose and Service User Guide. Copies were left in each resident’s room. Completed surveys evidenced that relatives knew how to make a complaint but had had reason to do so. The complaints file was made available during the inspection. No complaints had been received since the last inspection. Staff had received recent training on adult protection issues. They demonstrated a clear understanding of the need to protect vulnerable people and were able to recognise various forms of abuse. All staff were aware of the whistle blowing process and said they would feel confident to raise any concerns with the manager. The homes’ adult protection policy reflected Lincolnshire Adult Protection Committee (LAPC) guidelines. Procedures for responding to suspicion of abuse were robust, further ensuring residents’ safety and protection. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 15 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): 19,20,21,22,24,26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some furniture, fixtures and fittings needed replacing. Fire alarm and call bells systems were unreliable. The environment had a negative effect on residents’ quality of life. The bathrooms had been upgraded but lifting equipment was insufficient to meet the needs of all residents. EVIDENCE: Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 16 Service histories evidenced that the boiler and water servicing had not taken place. Lifting equipment had been serviced the previous week and one hoist declared unusable. Communal areas were clean and homely. The home had large attractive gardens. Paving was uneven so not accessible to all residents. The garden was secure and residents and staff said it would be nice to sit out in warm weather but there was insufficient seating and no sunshades. Residents and their families were encouraged to personalise rooms with their own furniture and choice of décor. Furniture provided by the home was shabby and mis-matched. Drawers and doors on cupboards and wardrobes were ill fitting or damaged. Shared rooms had privacy screens. Bathrooms were much improved and the shower room had been completed. Staff said residents used it “several times a day”. One resident said, “It makes such a difference, being able to have a bath in comfort”. There was one hoist for three bathrooms. A fixed hoist was unusable because the floor joist was unable to bear the weight. Staff wheeled the mobile hoist from one bathroom to another, as needed. The call system was inadequate and engineers had declared too old to repair. Few bells had cords attached; residents had to walk to the button to summon help. Bells rang in the manager’s office, where they were muted, and the stairwell. Staff were not always within earshot, leading to delays in residents receiving help. The manager said the providers were aware of the problem and had obtained quotes for a replacement system. There were plans to move the manager’s office to a larger building within the grounds. This would provide more office space, enable the call system board to be more efficiently sited and provide space for confidential discussions and staff supervision. The fire alarm was tested during the inspection and found to be faulty. Immediate requirements were made concerning both these issues. The manager provided written confirmation the following day, in the form of a service report, that the fault on the fire alarm system had been rectified. Grab rails were fitted in the home but staff and residents said more were needed in toilets. The standard of cleanliness was good throughout the home and there were no noticeable odours. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 17 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. Residents’ needs were met by competent staff in adequate numbers and they were protected by robust recruitment procedures. EVIDENCE: Residents and relatives said there always seemed to be enough staff on duty. The residents were very positive about the care they received from the staff. One said ‘they’re very nice and sociable’. Staff confirmed that they were able to meet residents’ needs and spend social time with them. Rotas showed adequate cover at all times. 56 of staff had received National Vocational Qualification (NVQ) awards. Five more staff were waiting to start training. Three staff files were inspected. All contained the information required by Schedule 2 of the Care Homes Regulations. One member of staff had been recently recruited. Evidence showed they had not started work before a satisfactory Criminal Record Bureau (CRB) check had been received. Staff confirmed they had clearly defined job descriptions. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 18 New staff spent two days at the home, learning about working policies and procedures, getting to know residents, observing general care practice and becoming familiar with the layout of the home. They shadowed experienced staff and had a mentor throughout the induction process. One member of staff said that within the last few months they had received training in first aid, moving and handling, medication administration, dementia care, infection control and adult protection. No staff had received specific training on palliative care, although all had practical experience. The manager agreed that this learning need had been neglected and would discuss the matter with the providers. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was generally well managed but shortfalls in staff supervision could lead to residents’ needs not being met. Arrangements need to be improved to ensure staff complied with best practices and the philosophy of care within the home. Health and safety issues were promoted by safe working policies and procedures Residents’ financial interests were safeguarded. EVIDENCE: The previously acting manager was registered with the commission as manager of the home in December 2006. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 20 Although new to the role of manager, she had several years experience in providing care to older people. Changes implemented by her, such as shift patterns, had improved morale within the staff team. Some staff had worked at the home for several years and remarked on the good teamwork and management support. The home had quality assurance systems, which showed that residents were encouraged to express their views about the services provided. The latest results had been collated in January 2007 and would be used to further improve the service. Records of residents’ finances were checked and had been satisfactorily maintained. Two signatures were required for all transactions. Only the manager or senior carers had access to personal allowances and monies were kept securely. Records evidenced that staff had not received regular appraisals or supervision sessions. These were necessary to provide staff with support and to enable them to do their job confidently. The manager confirmed that she had started a programme of supervision but only a few staff had received formal supervision so far. She was aware that this was something that needed addressing and would seek advice from the provider about supervision format and content. It had been hard to find space, as the office was small and shared with the administration worker. The proposed office move to the larger building would provide room for confidential discussions. A requirement was made that all staff received regular formal supervision. Records showed that servicing and maintenance checks in relation to fire equipment, gas appliances and electrical installation had been carried out. The fire alarm was tested weekly and was tested during the inspection. Although the fire alarm was found to be faulty on the day of inspection, this was rectified later the same day. Lifting equipment, such as bath aids, were serviced on a regular basis. The call system had not been serviced as providers had been informed some months ago that the system was beyond repair and needed to be replaced. Emergency lighting was tested every week. During a recent power failure the system had provided light to the home for six hours. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 1 2 1 1 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 3 Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP22 Regulation 23 (2) © (n) Timescale for action All residents must have access to 10/04/07 call bell systems. These systems must be maintained in good working order. Bath aids and equipment must 10/06/07 be provided in sufficient numbers to meet the needs of all residents. The equipment must be maintained in good working order. Furniture provided in residents’ 10/06/07 bedrooms must be of domestic style and easy to use design. The manager must take action to 10/05/07 ensure staff are appropriately supervised. This will support staff and ensure that policies, procedures and best practices are employed. Requirement 2. OP22 23 (2) (n) 3. 4. OP24 OP36 16 (2) © 18 (2) (a) Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP22 Good Practice Recommendations When care plans are drawn up or reviewed, they should be signed by the resident whenever possible, or their relative or representative, to evidence user involvement. Welbourn Manor DS0000061236.V335442.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Welbourn Manor DS0000061236.V335442.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!