Inspection on 20/03/07 for Windsor Lodge

This inspection was carried out on 20th March 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

Windsor Lodge 14/12/05

Windsor Lodge 10/12/04

Windsor Lodge 12/07/04

Windsor Lodge 08/12/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Windsor Lodge Windsor Road Gerrards Cross Bucks SL9 8SS Lead Inspector Ms Chris Schwarz Unannounced Inspection 20th March 2007 09:30 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 DS0000023033.V328732.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. DS0000023033.V328732.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windsor Lodge Address Windsor Road Gerrards Cross Bucks SL9 8SS 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) 01753 662342 01753 662342 Mr Thomas Glynn Mrs Margaret Glynn Mrs Deborah Dry Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places DS0000023033.V328732.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: Windsor Lodge is a small residential home for eight elderly people but is registered to provide care for up to nine persons to accommodate a couple who may wish to share accommodation. The home is privately owned and managed. The home is the family home of the proprietors who live on the premises. It is a large dormer style bungalow set within large landscaped grounds. Accommodation for service users is on the ground floor while the proprietors have accommodation on the first floor. The home is sited in a semi rural area on the edge of Gerrards Cross. All bedrooms provide single room accommodation unless a couple choose to share the one double room. Two bedrooms are en suite and there are additional toilets and an assisted bathroom. Communal areas are light and comfortable. Planning application was made for a conservatory to add to the facilities for service users but to date, this has been denied by South Bucks Council. The home is accessed by electronic gates that are activated through a CCTV intercommunication system. The drive takes the visitor through the landscaped garden to car parking areas adjacent to the home. Fees range from £550-£700 per week, according to information supplied with the pre-inspection questionnaire. DS0000023033.V328732.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of a day and covered all of the key standards for older people. A key theme of the inspection was assessment of how the home meets needs arising from equality and diversity. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Comment cards were received from seven service users, three doctors, two community nurses and a chiropodist. Any replies received from the comment cards have helped form judgements about the quality of care at the home and reflect a well run care home that provides good standards of care to older people. Specific comments are contained under the relevant sections of the report. The inspection consisted of discussion with the manager and owners, observation of care practice, a tour of the premises and examination of some of the required records. There was opportunity to speak with service users to gain their views. At the end of the inspection, feedback was given to the manager and owners. Staff and service users are thanked for their hospitality and co-operation with this unannounced visit. What the service does well: Information about the service is contained within a statement of purpose and service users guide so that prospective service users and their families have the necessary information to help make a decision about moving into the home. Contracts are in place, setting out the terms and conditions of residency so that service users know what to expect and their rights. Assessment is undertaken of prospective service users to ensure that needs are identified and that the home is able to meet these needs. Care plans are in place for each service user, ensuring that needs are identified and can be met by staff. Health care needs are being effectively met, to ensure that service users stay well. Medication is well managed, ensuring that medication practice is safe and follows good practice. There is good regard for service users’ privacy and dignity and they are treated with respect, ensuring that care is provided sensitively and appropriately. DS0000023033.V328732.R01.S.doc Version 5.2 Page 6 Social, religious, cultural and recreational needs are well met, providing service users with continuity and stimulation. Contact with family, friends and the local community is enabled, maintaining important social links. Service users have opportunities to exercise choice and control over their lives, where able, to retain independence. Meals and mealtimes are well managed, ensuring that service users’ nutritional needs are met. There are effective complaints procedures, to ensure that views of service users and their representatives are listened to. There are adult protection and whistle blowing procedures in place to ensure that the risk of harm to service users is reduced. A positive, homely environment has been created for service users, which is safe and clean, providing service users with pleasant and well-maintained surroundings. The number and skills mix of staff is sufficient to meet the needs of service users, ensuring that they are in safe hands at all times. An induction is in place for all new staff, to ensure that staff have the necessary skills and knowledge to meet care needs. Recruitment of staff is generally well managed, to ensure that unscrupulous persons do not have contact with service users. There is effective management at the home, ensuring continuity and that the home is run in the best interests of service users. Quality assurance measures are sufficient to monitor standards of care, ensuring that service users receive the support they require. Service users’ finances are effectively and safely handled, reducing the risk of error. Due regard is shown toward health and safety to ensure that the risk of accidental injury to staff, service users and visitors is minimised. What has improved since the last inspection? What they could do better: Some training needs to be updated, to ensure that skills are refreshed. This is planned to take place over the coming year and subsequently no action has been required of the home but scoring of the standard reflects this deficit. Evidence of a current work permit is required for a member of staff who holds a non European Union passport, to ensure that the person has the right to work in the country. DS0000023033.V328732.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. The summary of this inspection report can be made available in other formats on request. DS0000023033.V328732.R01.S.doc Version 5.2 Page 8 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 DS0000023033.V328732.R01.S.doc Version 5.2 Page 9 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 and 6 Quality in this outcome area is good. Information about the service is contained within a statement of purpose and service users guide so that prospective service users and their families have the necessary information to help make a decision about moving into the home. Contracts are in place, setting out the terms and conditions of residency so that service users know what to expect and their rights. Assessment is undertaken of prospective service users to ensure that needs are identified and that the home is able to meet these needs. Intermediate care is not provided. This judgement has been made using available evidence including a visit to this service. DS0000023033.V328732.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has a statement of purpose and service users guide to provide prospective service users with sufficient information about the service. A copy of the service users guide is kept in the entrance hall for reference. Some of the service users who completed comment cards said that they had received enough information prior to moving in and some who were spoken with during the visit said that relatives had made arrangements on their behalf with sufficient information to help them. There had not been any new admissions to the home since the last inspection. At that time, pre-admission assessments were examined and found to be satisfactory, showing that no one had been admitted to Windsor Lodge without thorough assessment. Files examined during the course of the inspection contained copies of contracts of residence, which set out the terms and conditions of residency at the home. DS0000023033.V328732.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is excellent. Care plans are in place for each service user, ensuring that needs are identified and can be met by staff. Health care needs are being effectively met, to ensure that service users stay well. Medication is well managed, ensuring that medication practice is safe and follows good practice. There is good regard for service users’ privacy and dignity and they are treated with respect, ensuring that care is provided sensitively and appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans was looked at. These contained a photograph of the service user, basic information such as next of kin and doctor details and various documents such as nutritional assessments, person centred summaries and risk assessments. All information was up-to-date with evidence of review. There were records of service users’ weights and it was noticed that the manager has been incorporating the gold standards framework on advanced care planning. Information on religious needs was noted. All personal care was carried out in private. DS0000023033.V328732.R01.S.doc Version 5.2 Page 12 There was a detailed policy of medication practice, which covered all necessary areas. The drugs trolley was locked when not in use and medication administration records found to be accurately maintained. None of the service users was managing part or all of their medicines. Staff were observed to be attentive to service users’ needs and responded promptly to them. Service users were well dressed in co-ordinating clothes that had been ironed neatly, some service users had been enabled to wear jewellery and hair and nails had received good attention to promote positive self-image. Service users spoken with said that staff were respectful towards them. All the health care professionals who returned comment cards said that they were satisfied with overall care provided to service users. None had needed to make a complaint about care provision and indicated that they can see service users in private, that staff communicate clearly with them, medication is appropriately handled and specialist advice is incorporated into care plans. A district nurse commented, “This is an excellent home – one of the best I have served in 45 years district nursing. No problems at all.” Another nurse commented, “Windsor Lodge is a care home of the highest quality. It strives to offer superb care for its clients, and succeeds. They have an excellent relationship with the district nursing team through effective communication.” A doctor commented “Excellent environment and standards of care. A pleasure to work with the Glynns.” Service users also confirmed that their health care needs are met and they receive prompt medical attention. One person commented, “Windsor Lodge is a very caring home from home. It is small enough to be very personal and I am well looked after.” Another said that they had received the influenza vaccination and were enabled to attend regular clinic appointments. DS0000023033.V328732.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. Social, religious, cultural and recreational needs are well met, providing service users with continuity and stimulation. Contact with family, friends and the local community is enabled, maintaining important social links. Service users have opportunities to exercise choice and control over their lives, where able, to retain independence. Meals and mealtimes are well managed, ensuring that service users’ nutritional needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users who completed comment cards said that plenty of regular activities are arranged and one person commented “I take part in as many activities as possible.” Some of the service users spoken with during the inspection said that the garden, which is exceptionally well maintained, extensive and with various points of interest, was something they liked looking at through the lounge window. Some of the service users enjoy knitting and reading and the activities programme showed that clergy visit the home, as well as a manicurist, hairdresser, musician and trips out were planned to the garden centre and shopping in Gerrards Cross. Newspapers, Scrabble, bingo and crosswords were also available and a scrapbook of photographs showed DS0000023033.V328732.R01.S.doc Version 5.2 Page 14 that birthdays were celebrated and events such as an Easter egg hunt were put on to include relatives. Some service users had made decorative items in a craft session and the home had taken part in the Royal Society for the Protection of Birds annual bird watch. A newsletter had been produced for the home to update service users and relatives on events. Contact with family was being encouraged and there were numerous attractive floral arrangements following Mothers’ Day. Information about local advocacy services was available within the home. Service users commented that food was good at the home. One person said, “If I don’t like what’s on offer they make me something else I do like.” The menus reflected a range of wholesome and nutritious meals on offer to service users and the advice of a dietician was being taken into consideration. Fresh fruit was available in the lounge and the lunchtime meal consisted of three different options served with fresh vegetables. Service users said that they had enjoyed their meal and one was particularly pleased to have had strawberries and cream for dessert. Service users were seen to be free to have the meal in their room, at the dining table or in an armchair, as they wished. Drinks were offered to service users throughout the morning, including sherry, which seemed to be particularly enjoyed. DS0000023033.V328732.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. There are effective complaints procedures, to ensure that views of service users and their representatives are listened to. There are adult protection and whistle blowing procedures in place to ensure that the risk of harm to service users is reduced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All those who responded via comment cards knew how to make a complaint or who to speak with if unhappy. No one indicated that they had needed to make any complaints and the pre-inspection questionnaire indicated that no complaints have been received at the home. The Commission has not been contacted by any service users or their representatives to express concerns or complaints. The complaints procedure was available at the home and included in the service users guide. There have not been any Protection of Vulnerable Adults issues to refer to Social Services that the Commission is aware of and the owners confirmed that they are not aware of any. There are adult protection and whistle-blowing procedures in place and some training has taken place on abuse awareness, with more planned for the coming year. DS0000023033.V328732.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. A positive, homely environment has been created for service users, which is safe and clean, providing service users with pleasant and well-maintained surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located on the road linking Gerrards Cross to Stoke Poges and is set amongst countryside. The grounds are extensive, very well maintained and accessed via a security gate with closed circuit television. All bedrooms at Windsor Lodge are single occupancy and have been decorated and arranged to different tastes. Some have en-suite toilets and washbasins and communal bathrooms are close by to all rooms. Adaptations, such as raised toilet seats and grab rails are in place and the home has a shower suitable for people with disabilities and a bath with hoist. DS0000023033.V328732.R01.S.doc Version 5.2 Page 17 The lounge and dining area is bright, open plan and overlooking the garden. All areas of the home were clean and odour control was well managed. Laundry was under control and clothes taken good care of, judging by the appearance of service users. Service users completing comment cards said that the home is kept clean. Specific comments were “Very, very clean and fresh” and “A high standard of cleanliness – visitors have often commented on this.” DS0000023033.V328732.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The number and skills mix of staff is sufficient to meet the needs of service users, ensuring that they are in safe hands at all times. An induction is in place for all new staff, to ensure that staff have the necessary skills and knowledge to meet care needs. Some training needs to be updated, to ensure that skills are refreshed. Recruitment of staff is generally well managed, to ensure that unscrupulous persons do not have contact with service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users indicated on comment cards that staff listen to them and are available when they need them. They also indicated that they have key workers. Staff cover was more than sufficient on the day of inspection, with both owners working at the home plus two carers; the manager was not technically on duty but wished to assist with the inspection, which was appreciated. Information supplied with the pre-inspection questionnaire indicated that five staff have achieved at least level two National Vocational Qualification. The home was fully staffed and had recruited two new carers since the last inspection, with evidence of satisfactory Criminal Records Bureau checks. One member of staff had a passport from a country outside of the European Union with no confirmation on the file of a work permit. A requirement is made to address this, to ensure that the person has a right to work in this country. It is also recommended that the application form DS0000023033.V328732.R01.S.doc Version 5.2 Page 19 completed by prospective staff is revised to ask for a complete work history since leaving secondary education, explaining any gaps such as unemployment and raising families. Induction of new staff covers three days and includes a pack which the person takes with them containing documents such as the General Social Care Council code of practice, and the aims, objectives and philosophy of the home. Training records showed a mixed picture with some courses up-to-date and others needing refreshing, for example manual handling, Protection of Vulnerable Adults and first aid. Attempts were being made to rectify this via local training cluster groups, over the coming year. Until training has been brought up-to-date, standard 30 cannot be scored as fully met. DS0000023033.V328732.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. There is effective management at the home, ensuring continuity and that the home is run in the best interests of service users. Quality assurance measures are sufficient to monitor standards of care, ensuring that service users receive the support they require. Service users’ finances are effectively and safely handled, reducing the risk of error. Due regard is shown toward health and safety to ensure that the risk of accidental injury to staff, service users and visitors is minimised. This judgement has been made using available evidence including a visit to this service. DS0000023033.V328732.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home has a registered manager who has the necessary skills and qualifications to run the service and ensure that service users’ best interests are promoted. The owners live on site and have active, daily involvement with care provision and contact with service users, visitors and staff. A quality assurance questionnaire had been used with service users last summer and a report made of the findings and subsequently an action plan produced. The manager has devised a visitor questionnaire for feedback from a different perspective. The home looks after money deposited by relatives for three service users, to cover expenses such as hairdressing and chiropody. The money was kept secure with individual records kept to verify expenditure. Recorded balances tallied with actual balances in all three cases. Health and safety was being well managed. Accident records showed that there were two accidents last year and just one so far this year. All service users had been assessed by a physiotherapist last year in respect of falls and fractures. Fire safety was being handled well with appropriate checks undertaken and kept up-to-date. Adaptations were in place to meet the needs of service users and assist with daily living tasks. Policies on health and safety, missing persons and management of medication were in place and appropriate for the home. Some training on health and safety topics needs refreshing, as mentioned under the staffing section. DS0000023033.V328732.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000023033.V328732.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19 Requirement Evidence of a current work permit is required for the member of staff who holds a non European Union passport. Timescale for action 20/04/07 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 OP29 Good Practice Recommendations The job application form should be revised to request full working history since leaving secondary education, with gaps explained. DS0000023033.V328732.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000023033.V328732.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. 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