Inspection on 07/10/06 for Windsor House

This inspection was carried out on 7th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Windsor House 21/06/07

Windsor House 07/06/06

Windsor House 12/12/05

Windsor House 05/05/05

Windsor House 10/03/05

Windsor House 16/12/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 Windsor House 8 Windsor Close Stevenage Herts SG2 8UD Lead Inspector Louise Bushell Key Unannounced Inspection 6th October 2006 10:00 Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 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 Windsor House DS0000062311.V317394.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 Adults 18-65. 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. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windsor House Address 8 Windsor Close Stevenage Herts SG2 8UD 01438 813915 01438 813915 winnett@psycare.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) Psycare Hostels Russell Fletcher Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: Psycare Hostels limited operates Windsor House. It is a Psychiatric Aftercare Hostel / Personal Care Home focusing on providing, psychological, emotional and practical support to 3 male persons with enduring mental health disorders. Windsor House (cluster home) is a three bed home situated within 100 metres from its sister home Winnett Cottage (core home). The primary function of the cluster home is to compliment the rehabilitation programme commenced in the core home, providing a stepping stone into the community whilst working on the final stages of independent living. All service users living within Windsor House are able to access staff resources and support 24 hours a day. The home consists of three bedrooms and a communal bathroom on the 1st floor, a communal lounge and dinning room, kitchen, and down stairs toilet facilities on the ground floor. The home has a 24 hour pager system linked to the main core home. The home is situated down a lane with no through access to the public with ample parking facilities within a quite residential area. The manager stated that there is a range of fee’s starting from £1050 per week to £1150. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second Key inspection of the year for Windsor House. The visit was conducted on the 6th October 2006. This inspection focused on all of the key standards and the requirements and recommendations made following the last inspection. This inspection was completed in conjunction with Winnett Cottage. This inspection aimed to seek the views of both service users residing at Windsor House and Winnett Cottage. The inspection process involved group and individual discussions with staff and service users. Time was also spent discussing and reviewing with the manager, documentation and internal management systems. Where information has remained the same following the last report this has been carried forward. The reader is encouraged to view the previous reports to fully establish improvements made to the running of the home. What the service does well: The atmosphere throughout the inspection was calm and friendly, promoting a good relationship between staff and service users. The ethos of working openly, honestly and with a transparent approach appears to be effective. The home has a stable staff team to promote continuity for the service users. The home is currently adapting and implementing a new care planning system. Care plans in place are a good working examples of meeting individual and changing needs. All service users are supported within the Care Programme Approach framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. Service users expressed that they were happy with the systems and the management and staff within the home. One service user stated that “ since the last inspection, things have got much better here, there is nothing to moan about now and if all I have to moan about is the price of milk then that can’t be bad”. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A number of areas have been carried forward from the previous report as they require additional improvement and development in order to adequately meet the standards. It must be noted that although these have been carried forward, the manager and the staff have worked extremely hard and a marked improvement was noted throughout. The requirements made at this inspection include: Further developments to the quality assurance systems. The replacement of the bathroom shower and medication issues outstanding from the previous report. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 7 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. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service users and the home to continuously review the individuals care package provided. EVIDENCE: A total of three service users files were reviewed and evidence gained regarding the initial assessments that are carried out to access if the home can meet the needs of the service users. Detailed information is held regarding the service users history and current needs. Assessments of each service users needs and aspiration are made before the service user moves into the home. Qualified and competent people complete the assessments. The home also receives and seeks external specialist support to meet the individual service users needs. Whole life and CPA reviews occur to support the service users in achieving and reviewing individual needs, goals and aspirations. The assessment process includes the gathering of information from other professional. Improvements have been made following the last inspection. A service user who was on a trial visit had a detailed initial assessment held on Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 10 file and stated that they had seen the statement of purpose and service user guide. The admissions procedure to the home includes trial visits for the service users to make an informed choice about where to live. A contract is then drawn between the home and the service user. The contract includes the terms and conditions within the home and the rights of the service user. All service users have been issued with a current contract. The Statement of Purpose contains information for the service user to make an informed choice about where to live. The content is suitable to meet individual needs. Following a discussion with a service user that has recently moved into the home it is clear that the home has a comprehensive referrals process including trial visits to the home. The service user was able to describe the process fully and felt that at all stages he was consulted and included within the process. Following the last inspection a new service user file has been developed and this now contains information from all service users new and current and includes the statement of purpose and service users guide. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of care plans are evident, with service users assessed needs identified. Care plans have been implemented following the last inspection and now appear to meet the identified needs of all service users. Risk assessments are in place. EVIDENCE: All service users have an individual care plan and an allocated key worker to support them in the home. Detailed pen pictures are in place for all service users and provide good information about the needs, goals, likes and dislikes of the service user. Information is now continuously reviewed to ensure that it remains current and up to date. The care planning system is a relatively new system introduced by the home. Individual daily notes and guidelines for the service users were observed within the home. All service users are supported within the Care Management Framework and frequent whole life reviews and CPA’s occur to ensure changing Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 12 needs are continuously assessed and reviewed. This will ensure that the methods of the planning are person centred, involve the service user at each stage and ensure that care plans are active working documents. The home holds service user meetings. Direct feedback from a number of service users had determined that service user meeting are now being held frequently and records are now maintained. Ranges of risk assessments are completed within the home for necessary actions. These are detailed and contain all the required information. Activities and outings enjoyed by the service users determined that service users are supported to take risks as part of an independent life style. Risk assessments are in place. Winnett Cottage is at all times trying to empower and promote the development of independence living skills and integration into community living. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Both staff and service users stated that the number of activities available to service users is adequate and encourages independence. EVIDENCE: Service users have the opportunity for personal development were discussing the many options are available to them. Examples were given including development of independent living skills, socialising, working, voluntary placements, college and further education and training. All service users access services within the community and were able to confirm that they were received effectively and through professional channels. The home is currently offering a number of service users the opportunity to receive paid employment through the completion of tasks such as gardening, cleaning and painting and decorating. Service users are encouraged to become part of the local community and many access the local community independently on a regular basis. All service users are supported in gathering Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 14 relevant information regarding employment, further education, employment skills and benefit advice if required. A number of service users spoke about the in house activities that they participate in and this included current affair sessions, reading, relaxing, gardening, themed cooking groups and shopping. Recent trips out have occurred in the homes new vehicle and plans are now in place for festive trips. Some service users have an activities plan on their care plan which they have agreed and signed, this is aimed at promoting motivation and user participation and integration into community living. The daily routines in place promote independence for all service users, using a person centred approach at all times. Staff were observed to interact with all service users well and it was clear that mutual respect was held for both staff and service users. Meals are offered on a flexible basis and all service users are encouraged to participate in the cooking with appropriate support as required. The service users determine the menu and choose a weekly menu specific to the meals that they are encouraged to cook on a rota basis. The staff then orders the shopping into the home. Feedback from the service users determined that this system works extremely well and encourages a homely group environment. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems for the administration of medication are adequate. EVIDENCE: All personal and health care support is well maintained ensuring individual needs, choices and preferences are met at all times. All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. A policy and procedure is in place to support the administration, storage and receipt of medicines. All staff receive training prior to being deemed competent to administer medication. The training is provided by Lloyds and is level II. Following detailed discussions with a number of staff surrounding sound medication practices it was determined that the level of training/ nduction and/or information regarding medication administration systems need to be higher. Following the last inspection the staff are now receiving level III training to further support in the administration of medicines. All staff now signed the homes policy to state that they are fully aware of the policy and procedure. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 16 A system that effectively stores medications has been implemented to ensure safety for all. Date opening was printed on all bottles and box’s to ensure that are kept to the expired shelf live only. The correct coding system was used as prescribed on the MAR records. Staff appeared to administer medication as per the homes policy and guidelines. Gaps must not be present on the MAR record as this indicates incorrect procedures have occurred. All actions recorded to the manager about non-compliance must be recorded as actioned. All staff must ensure that they are following the policy with regards to safe administration and be aware that any errors will be taken seriously with appropriate actions being taken by the management team. All MAR’s must be printed as prescribed by the GP. The manager has introduced a shift checking system to ensure that all roles and responsibilities are staff are fully completed it was felt that medication administration should be added to ensure quality. It must be noted that vast improvements have been made, however a few areas have been carried forward to this report. Staff must be aware of their individual roles and responsibilities around medication errors and safe administration. Following the last inspection a homely remedies policy is now in place with suitable confirmation from relevant GP’s. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff training in the Protection of Vulnerable Adults is adequate to ensure that service users are protected from abuse. EVIDENCE: The complaints procedure is in place and the service users confirmed that they would know who to go to if they wished to make a complaint. The complaints file was not inspected on this occasion as the manager reported that no complaints had been received. Staff have received training in Protection of Vulnerable Adults. The manager reported that this has been provided through the county council. Further staff are still to attend this training however dates and places have been booked and confirmed. The home holds a Hertfordshire Adult Protection Protocol and staff were aware of the basic steps to take to ensure safety for all service users. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Maintenance and housekeeping in this home are adequate. EVIDENCE: Improvements have been made to the environment in general, however due to the effects of smoke, the environment needs refreshing frequently. A nonsmoking section of the home has now been arranged, however all staff and service users must ensure that this remains the case. Any breaches of this must be reported to the manager and actions taken for all. A number of bedrooms have been repainted and a new service user talked about choosing their bedroom paint and furniture. New comfortable chairs have been purchased for all service users who wish for them. Two rooms have been decorated and a new dining room carpet is being laid. One shower room has been completed and plans are in place for the additional shower to be completed. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 19 The service employs a cleaner who supports in the general maintenance and cleanliness of the home. The front of the property looks vastly improved following the clearing of items and general maintenance. The back garden is well cared for and presents as a homely place to sit with peers, friends, guests and staff. There is a new patio table and chairs set. Positive comments were received from all service users regarding this. One service user stated, “The home has made lots of improvements recently and is much better”. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff training has improved in order to ensure service user safety. Staff are suitably supervised to ensure safety for service users. Recruitment practices of the home confirm to regulation. EVIDENCE: Records show that some training has been attended by the management team and the staff. A matrix has been completed showing date completed to give an overview of the homes abilities to meet the service users specialist needs. One member of staff discussed the need for some basic mental health training at the last inspection, this is now being provided by the home. On the day of the inspection an outside GP came to the home to provide some basic in house mental health awareness training. A recent audit of all staff files have occurred and they all now contain the information required by regulation. Training in POVA has occurred for most of the staff and the remaining staff are booked to attend further training in the near future. Following the last inspection a number of additional courses have been booked and completed, this includes, care planning, working with difficult Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 21 to engage service users, introduction to mental heath and substance misuse for support staff, employment and mental health, dual diagnosis, POVA, personality disorder, identifying and dealing with stress and developing socially inclusive practice. The manager confirmed that all staff are receiving an induction refresher in November. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality assurance systems need to be formalised and a policy completed and implemented. Health and safety issues are now adequately managed. EVIDENCE: An effective quality assurance system and policy is required to be implemented and drawn up in full. This must seek and aim to reflect the views of the service users. The company must ensure that basic polices and procedures are in place leading the service in a person centred manner at all times. Quality assurance was discussed with the manager at length and although small elements of effective systems are in place there is no binding of these to make or record an annual quality review of the service. Service users have received a recent service user survey. The manager and the inspector discussed the importance Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 23 of seeking views including those of outside agencies. The manager confirmed that additional works is required in order to fully comply with this standard. Food temperatures, fridge and freezer temperatures and core food temperatures are now recorded. Risk assessments have been completed for the safe food preparation for service users. Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 18 (1) (c) 13 Requirement Timescale for action 30/11/06 • Gaps must not be present on the MAR record as this indicates incorrect. procedures have occurred. All actions recorded to the manager about noncompliance must be recorded as actioned. No hand written entries must be made on the MAR, any entry required must be signed and dated. All MAR’s must be printed as prescribed by the GP. • • • This requirement has been carried forward from the last report. Non Compliance may result in enforcement action being taken. 2. YA39 24 Effective quality assurance and quality monitoring systems, based on seeking the views of DS0000062311.V317394.R01.S.doc 30/12/06 Windsor House Version 5.2 Page 26 3 4. YA35 YA27 18 (1) (a) & (c) 23 service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. Staff must receive a full induction programme. The shower unit must be replaced. 30/11/06 30/12/06 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 Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hertfordshire Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Windsor House DS0000062311.V317394.R01.S.doc Version 5.2 Page 28 - 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!