Inspection on 27/11/08 for West Hallam Residential Home

This inspection was carried out on 27th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Hallam Residential Home 08/08/06

West Hallam Residential Home 26/01/06

West Hallam Residential Home 27/10/05

West Hallam Residential Home 09/03/05

West Hallam Residential Home 09/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: West Hallam Residential Home 8 Newdigate Street West Hallam Ilkeston Derbyshire DE7 6GZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Richards     Date: 2 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: West Hallam Residential Home 8 Newdigate Street West Hallam Ilkeston Derbyshire DE7 6GZ (0115)9440329 01159440329 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Gerald Poxton,Mrs Sandra R Poxton,Mrs Ann Theresa Poxton,Dr Michael G Poxton,Ashmere Care Group,M Name of registered manager (if applicable) Mrs Carolyn Edge Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The West Hallam is a Care Home providing residence for 17 older persons. The Home is situated in a village location near to the town of Ilkeston, and a few miles from Derby. Accommodation available includes 1 double bedroom with the remainder being single occupancy. There are a range of communal lounge areas including a smaller lounge near the entrance which offers a quieter area where some service users choose to see visitors and also a separate dining room. The services provided are 24hour staff support, heating, lighting and personal laundry, three meals per day and a range of social activities. Care Homes for Older People Page 4 of 29 Over 65 17 0 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received survey returns from eight people who use the service and seven relatives who visit people living there. At this inspection there were thirteen people accommodated. We used case tracking in our methodology, where we looked more closely at the care and services that two of Care Homes for Older People Page 6 of 29 those people receive. We did this by talking with them, observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the manager, who has managed the home for a number of years, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people What the care home does well: What has improved since the last inspection? What they could do better: Consider how individuals opportunities to exercise choice in relation to leisure and social acitivities, including community access and the tea time meal menu can be optimised and take action as necessary to achieve these. Identify the cause of stale urine odours that are prevalent in areas of the home and take the necessary action to eliminate these. Care Homes for Older People Page 8 of 29 Ensure that waste bins in communal toilets have suitable lids and are fully occlusive. Use a formal recognised staffing tool, which accounts for peoples individual dependancies and activities needs, in order to best determine staffing arrangements in the home. Consider the provision of dedicated staff hours for the preparation of and clearance from tea time meals at the home. Take measures to ensure that all key staff are fully conversant with reporting procedures concerned with accidents and incidents at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported during the admission process and their needs are suitably accounted for. Evidence: At our last key inspection we judged that peoples admission arrangements and the homes assessment process ensured that the home is able to meet peoples individual needs. In our annual quality assurance questionnaire that we asked the home to complete, they told us that they ensure that people are provided with the information they need during their admission to the home and their needs are acccounted for. Improvements they told us that they have made and also those aimed for tells us that they strive to ensure accurate service information is provided for people and that they Care Homes for Older People Page 11 of 29 Evidence: are actively considering the implications of of the Mental Capacity Act 2005 when assessing peoples individual needs. At this inspection, people told us that they received the information they needed about the service and have a written contract. We also saw that copies of the most recent inspection report and homes service guide are openly displayed. We are advised that these can be provided in alternative formats, such as large print, although they are not available in a format that may assist people with significant sight impairments. We looked closely at the recorded needs assessment information for two people who live at the home. These were comprehensive and person centred in the way in which they were recorded. And people told us that their needs are discussed with them. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are well accounted for in consultation with them. Evidence: At our last key inspection we judged that peoples care plans accounted well for how their needs were to be met and we made a requirement relating to medicines ordering practises. This was found to be complied with at this inspection. In our annual quality assurance questionnaire that we asked the home to complete, they told us that they continue to ensure individuals care plans are effectively maintained and that they have made some improvements, to promote a more person centred approach to formulating and recording these and also to ensure that care plan reviews are recorded. They also told us how they will monitor these improvements. At this inspection people told us that they usually receive the care and support the need, including medical care and two people said they sometimes do. We were advised by the manager that there had been recent changes in peoples chosen medical Care Homes for Older People Page 13 of 29 Evidence: support in consultation with them, which was felt to provide better outcomes for people. Surveys from relatives told us that they also feel people usually get the care and support they need, although one person felt that individuals personal care could be improved by way of more assistance being offered. (See staffing section of this report). The written care plans that we looked at up to date and well recorded in accordance with peoples risk assessed needs. They were also reflective of recognised practise concerned with older people. People told us about how they accessed outside health care professionals for the purposes of routine health screening and specialist inputs and we saw that these were well accounted for within peoples individual care planning records. They also told us that staff were kind and treated them well and that their dignity and privacy was upheld. We examined the arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines and looked closely at the arrangements for the two people we case tracked. These were satisfactory and in accordance with recognised practises concerned with the management and administration of medicines in care homes. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Judgement - Further development of activities and meals arrangements may better ensure that these satisfy peoples expectations and preferences Evidence: At our last key inspection we judged that activities offered did not necessarily meet with peoples needs. And we recommended that people have written care plans detiling how their social needs are to be met. In our annual quality assurance questionnaire that we asked the home to complete they told us that they record peoples engagement in activities within their care planning records and consult with people about these, providing regular entertainments for them. They also told us that they had sought to improve activities for people offering a wider variet and listening to peoples preferences. But feel they could improve further by increasing peoples access to the local community, which they aim to do over the coming twelve months. Care Homes for Older People Page 15 of 29 Evidence: At this inspection we received variable feedback from people with regard to activities. Some found the arrangements to be satisfactory and said they enjoy joining in with activities provided. Examples were given, which included knitting, quizzes, reminiscence, newpapers, kareoke, bingo, board games, dominoes, flower arranging, hand manicures, music and one person told us they had recently helped prune the garden roses, which as a keen gardener they had enjoyed, although said that this was not reguarly offered. Staff that we spoke with also felt that activities arrangements are an area that could be improved, although felt that staffing arrangements limited these, particularly during the evening, where there are usually two staff on duty. However residents and staff told us that where there are planned events, such as Christmas parties additional staff are provided during this period to assist. Five people said there are only sometimes activities that they can engage in, making comments that these could be improved. One person told us that she regularly goes out each week with her family and some said they had visited a garden centre during the warmer weather. People said they could have visitors when they chose and relatives told us that they were always made welcome from friendly staff. People also said they were looking forward to some evening entertainment which was booked to take place soon, but said that even though they enjoy this, it is the same entertainer each time. People also told us about a carol singing event due to take place at the home, which involved visiting school children. Peoples care planning records that we looked at detailed their familial, social and activities interests, although activities routinely offered, did not always meet with those detailed in their care plans. We could see from feedback that we received and by looking at individual care records, that people may be offered some activities that they frequently declined, suggesting that these may not be to their expectations or preferences. Many people told us that they enjoy the meals provided, although some said they sometimes do. Comments made with regard to the latter were that the tea time choice could be improved to provide more variety. Feedback from a recent resident survey that the home had conducted told them that most people were not fond of soup as a tea time menu choice. However, this remained listed as a daily menu item. We observed lunches being served and saw that people were properly assisted where Care Homes for Older People Page 16 of 29 Evidence: necessary and consulted with. Tables were attractively set with cloths, napkins, cruets, drinking glasses and flower posies. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously by the home and the homes systems and arrangements satisfactorily promote peoples protection from harm and abuse. Evidence: At our last key inspection of this service we judged that complaints were suitably handled and people enabled to voice their views. We also judged that the providers action should ensure the provision of robust safeguarding written procedures. We made a requirement that the home must have a written procedure for the handling of allegations of abuse, which should refer to Derbyshires agreed joint agency safeguarding vulnerable adult procedures. The above requirement was found to be complied with at this inspection. In our annual quality assurance questionnaire that we asked the home to complete they told us that all complaints and concerns are taken seriously and act on, but said that they had not received any over the previous twelve months. They also told us that they aim to continue to maintain standards in this area by way of ongoing staff training and instruction. At this inspection people told us that they know how to complain, although one person Care Homes for Older People Page 18 of 29 Evidence: surveyed indicated they did not. We saw that a copy of the homes complaints procedure was openly displayed in the home and that information about how to complain is also provided with the homes service guide. Staff that we spoke with were conversant with their roles and resonsibilities concerned with dealing with complaints, recognising abuse and procedures to follow in the event of any suspicion or witnessed abuse of any service user. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home which is overall well maintained, comfortable and which suits their needs Evidence: At our last key inspection we judged that some aspects of the environment required work to ensure that the home was well maintained and comfortable for people. We made two requriements about specified repairs to be made and in ensuring safe storage of cleaning materials. Both of these were found to be complied with at this inspection. In our annual quality assurance questionnaire completed by the home, they told us that they provide a safe and clean environment for people and regularly consult with them about their environment. They told us about some improvements they have made with regard to revised health and safety policy and procedural guidance and key information for staff to follow. And about improvements they aim to make over the coming months with regard to their environmental risk assessment process and development and upgrading of the environment. This tells us that these should be to the benefit of people living at the home. At this inspection around half of people we consulted told us that the home is usually Care Homes for Older People Page 20 of 29 Evidence: fresh and clean and around half said it sometimes is. Comments we received regarding the latter referred to there often being a smell of stale urine in areas of the home and a lack of hygiene and attention with the cat and the litter tray. During our tour if the building we did not observe any hygiene issues concerning the homes two cats, however there were areas which had a stale urine smell. With the exception of this area, all parts of the home that we saw were clean, comfortable and also suitably equipped in terms of hand washing facilities and the central laundry., although many communal toilets had waste bins with no lids and some toilet seats were ready for replacement. The environmental health officer had inspected the kitchen earlier in the year and awarded a four star rating there. Peoples own rooms were personalised and bathrooms were accessible and homely and inviting. Suitable locks are provided to peoples bedroom doors enabling staff access in an emergency and people are offered the choice of having their own key. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fairly well supported from staff that are suitably recruited, inducted and trained although not always best deployed. Evidence: At our last key inspection we judged that the people were supported from a stable staff group that are suitably trained. We made a requirement about the homes recruitment process that was seen to be complied with at this inspection. In our annual quality assurance questionnaire that we asked the home to complete, they told us that they ensure staff are suitably recruited, inducted, deployed and trained. They told us about some of the ways they monitor their staffing arrangements and identify that they could make further improvements by ensuring that staffing levels are always adequate to meet peoples needs. They also gave us some statistical information that we asked for about their staffing provision. At this inspection we received variable responses as to staff availability to meet peoples individual needs. Around two thirds of people we consulted with said that staff is usually available when they need them and and the remainder said they sometimes are. The same responses were also received when we asked people if staff listen and act on what they say in terms of a usually or sometimes response. Care Homes for Older People Page 22 of 29 Evidence: Comments from relatives also varied, from they really look after people well, staff provide excellent care and support, to often find commode left and not emptied and staff could do better by giving people more input and encouragement. Two comments were received that night staff ask people to wait when they call for assistance until the day staff come. Staff that we spoke with described their satisfactory recruitment, induction and training and associated staff records that we looked at verified this. However, most felt that whilst people receive decent basic care and their safety is maintained, that there are sometimes not enough staff to be able to provide a more person centred approach to care and that this could also affect time spent with people and for activities. Staff said that tea time and evenings were key times when this could be a particular issue, depending on the number and needs of people accommodated as there are no additional hours provided for the kitchen to cover the tea time meal. Rotas that we saw showed us that staffing levels for the thirteen people accommodated reduced from three care staff to two staff from 5pm until 9 pm. Hotel services staff time is mainly concentrated on the first half of the day. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be well managed and run with peoples health, safety and welfare promoted and protected. Evidence: At our last key inspection we judged that there was stable and competent management of the home within a quality monitoring framework. We made a requirement relating to an area of environmental risk assessment, which is seen to be complied with at this inspection. In our annual quality assurance that we asked the home to complete they told us that they continue to ensure the home is well managed and run in consultation with people us use the service or have an interest there. At this inspection we looked at the homes quality assurance and monitoring system, which includes regular auditing of all aspects of the service and with regular monthly Care Homes for Older People Page 24 of 29 Evidence: visits undertaken by a representative of the registered provider and discussed these with the registered manager. This, together with information provided in the AQAA tells us that the provider knows what the home does well, what could be improved and for the most part, how they aim to achieve these. Staff told us about satisfactory arrangements for safe working practises in the home, including training and provision of equipment and records that we examined and observations that we made during our tour of the building confirmed these. Staff also told us that they are well supported and that issues they raise are always taken seriously by the manager. During discussions they were mostly conversant with their role and responsibilities relating to the reporting and recording of accidents and incidents in the home. The manager had also recently revised and updated the homes policy and procedural guidance concerned with the reporting and recording of accidents and incidents. We looked at these and saw they they provide clearer guidance for staff as to who they should notify following an accident or incident involving any service user, although some staff that we spoke with were not aware of the Environmental Health Officers role in terms of when to report matters to them. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 The cause of stale urine odours in the home should be investigated and appropriate action taken to ensure that these are eliminated. So as to ensure that the home is pleasant, clean and hygienic. 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Consideration should be given to the provision of the homes service guide in an audio format that may assist people who have significant sight deficits. NMS 13 also applies here. The home should consider how individuals opportunity to excercise choice in relation to leisure and social activities, including community access and the tea time meal menu can be optimised and take action as may be necessary to achieve these. Waste bin lids in communal toilets should be fully occlusive, with suitable lids provided in order to promote good infection control. 2 12 3 26 Care Homes for Older People Page 27 of 29 4 27 The home should use a formal recognised staffing tool, which accounts for peoples individual dependency and activities needs in order to best determine staffing arrangements for the home. Consider the provision of dedicated staff hours to cover for tea time preparations and clearance in the home. Staff should sign to say they have read and understood the homes accident and incident reporting policy and procedures and it should be ensured that key staff are conversant as to when any incident or accident may require reporting to the environmental health officer. 5 6 27 38 Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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!