Inspection on 11/04/05 for Woodberry Grove

This inspection was carried out on 11th April 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Woodberry Grove 30/11/06

Woodberry Grove 22/06/06

Woodberry Grove 25/10/05

Woodberry Grove 01/09/04

Woodberry Grove 01/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE WOODBERRY GROVE 91 Wellington Road Bush Hill Park Enfield, Middlesex EN1 2PW Lead Inspector Duncan Paterson Announced 11 & 12 April 2005 at 09.45 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 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. WOODBERRY GROVE Version 1.10 Page 3 SERVICE INFORMATION Name of service Woodberry Grove Address 91 Wellington Road, Bush Hill Park, Enfield, Middlesex EN1 2PW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8360 2214 Mr Kathiresu Cumareshan & Mr Araru Shandakumar of SSS Care Ltd Vacant Post PC Care Home only 26 Category(ies) of OP Old Age registration, with number DE(E) Dementia over 65 of places WOODBERRY GROVE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1 September 2004 Brief Description of the Service: Woodberry Grove is a care home registered to provide a service for 26 older people. The service has recently been granted registration to provide dementia care services. A respite care service is also provided. The stated aim of the service is to provide a high standard of individual care, support and a pleasing environmnet for all the residents to enjoy a good quality life. Woodberry Grove is a private care home owned by Mr Cumaresham and Mr Shandakumar of SSS Care Limited. Mr Cumaresham and Mr Shandakumar own a number of other care homes in England. The service is provided in a large detatched property with rear extension, that has been converted for use as a care home. There are eighteen single bedrooms and four double bedrooms. Bedrooms are on the ground, first and second floor with a shaft lift serving all three floors. In addition, there is a chair lift linking the ground and first floors. There are bathrooms on all three floors. There are two lounge areas and a dining room on the ground floor and a room on the second floor which is used by the hairdresser and can also be used by staff and service users as a sitting area. There is a garden to the rear which includes a grassy area with trees and shrubs as well as a paved area with seating for residents. Woodberry Grove is in an quiet road in an attractive residential area of Bush Hill Park, Enfield. It is close to local shops, a railway station and bus routes. WOODBERRY GROVE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two days. The manager, Mrs Janet McGuigan, assisted with the inspection. Seventeen of the nineteen residents were spoken with as well as nine members of staff, including the manager. Three visiting relatives were also spoken with. Care and staff records were inspected as well as medication records, health and safety documents and certificates of the servicing of the home’s equipment and installations. A tour of the premises took place. A pre-inspection questionnaire was returned by the manager as well as twelve questionnaires from relatives and eight from residents. What the service does well: What has improved since the last inspection? The manager, who was newly appointed just before the last inspection, has been able to develop the service. For example, the plans of care have been updated and form a good basis on which to develop the service for those residents who may have dementia. A requirement has been given to extend the information on plans of care about dementia needs. Staff have received dementia care training. Staff training needs have been audited and there is clear information about staff training skills which can be used to plan new training. The home’s quality assurance systems have been improved with new standards of care and service provision published and made available to residents. There have been décor improvements and re-furnishing including new chairs in the living areas and decoration of some of the bedrooms. WOODBERRY GROVE Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. WOODBERRY GROVE Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection WOODBERRY GROVE Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,& 5 Clearly written information about the home and the services provided are available for service users. The assessment arrangements provide a sound base on which to develop assessment and care planning information to meet the needs of persons with dementia EVIDENCE: A new statement of purpose and service users’ guide has been produced as part of the home’s recent extension of services to include a dementia care service. CSCI has agreed registration for this service. The new documents provide clearly written information for service users about the home and the services provided. However, there is no information in the statement of purpose about the provision of respite care even though a respite care service is provided. A requirement is given about this. Residents and relatives told the inspector that they had chosen to live at the home often through relatives visiting on behalf of residents. Seventeen residents were spoken with during the inspection. Overwhelmingly, the comments made about the service, and particularly the staff, were positive. Residents said that staff were helpful and kind and provided care WOODBERRY GROVE Version 1.10 Page 9 sensitively. Three visiting relatives said that they were pleased with the care provided and felt that staff assisted their relatives properly. One relative confirmed that staff had acted on information she had provided about her relative’s health care needs. Staff have had dementia care training but the assessment and care planning information needs to be more detailed particularly concerning the dementia care needs of service users and the methods followed by staff to meet those needs. A requirement is given about this. An intermediate care service is not provided at this care home. WOODBERRY GROVE Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 Service users receive respectful and sensitive care from staff who know them well and are able to provide a friendly and personal service. Care arrangements are clearly set out in good basic individual care plans. EVIDENCE: The records for four residents provided details of resident’s health and care needs and the objectives to be followed by staff to meet those needs. Staff were knowledgeable about resident’s needs and were observed to work with residents in a relaxed, friendly and courteous manner. There was a pleasant, friendly atmosphere at the home. Residents receive preventative health care support as well as the district nursing service, where appropriate. There is a variety of pressure relieving equipment, such as cushions, throughout the home. Staff who handle medication have had recent training and the medication storage and recording arrangements were well organised and clear. There is a section on the care plans which allows details to be recorded about service users wishes concerning death. There is also a death and dying policy which sets out the arrangements to follow after a service user’s death. WOODBERRY GROVE Version 1.10 Page 11 The care plans provide useful information about residents but could be improved by providing more detail about dementia care needs. This was discussed with the manager who said that she intended to develop the care planning information over the coming months. Further improvements can be made to the arrangements to meet resident’s manual handling needs. For example, there is a mobile hoist at the home but it is not being used. The manager said that consideration is being given to buying a more suitable type of hoist. The resident’s manual handling risk assessments are brief and some staff need manual handling training. At least one resident is not mobile and needs assistance from staff with all transfers. Requirements are given for a new manual handling risk assessment form to be introduced and mechanical equipment, such as a mobile hoist, used as indicated by the risk assessment. Two other requirements are given. One, for the manager to arrange an occupational therapy assessment for those service users who have mobility difficulties. Two, for manual handling training to be provided for staff who have not completed such training to date. A recommendation is given for records of resident’s preventative health care to be recorded on a specific form in their care plans. The current arrangement relies on visiting health care workers to record their visits and information is kept in a number of places. WOODBERRY GROVE Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The range of activities has improved since the last inspection with service users now provided with choice and a variety of pursuits. Meals are good offering choice as well as comfortable surroundings to eat in and careful assistance from staff where needed. EVIDENCE: Residents are given the freedom to choose how to spend their time. A range of activities is provided including trips out of the home, movement exercises, manicures and quiz games. A flexible approach is also taken. For example, a group of service users sat out in the garden after lunch as the weather was fine. Service users said that they had visitors whenever they wished. Three visiting relatives confirmed that they were able to visit whenever they wished and said that they were always welcomed by staff. The serving of lunch and supper was observed. The cook demonstrated a good understanding of resident’s food preferences and was able to plan for meals based on that knowledge. The meals served were attractively presented and served by staff. Staff assisted residents to eat where necessary. Staff, including the manager, were observed to help residents patiently and sensitively. There is a dining room where most residents eat with a small number of residents, usually because of mobility difficulties, eating in the lounge areas. WOODBERRY GROVE Version 1.10 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 The arrangements to protect residents from abuse are not sufficiently robust. There is a lack of staff training and an adult protection policy that does not sufficiently detail the actions for staff to follow after incidents or allegations of abuse. EVIDENCE: Since the last inspection there have been two complaints about the service made to the CSCI. There were records at the home providing details of the complaints and actions taken. These complaints had involved adult protection proceedings and requirements were given to the home by the CSCI about reporting notifiable incidents to the CSCI as required by regulations. A satisfactory response from the home had been received. There is a need for staff to receive adult protection training. Staff told the inspector that they had not received this training. This was confirmed by the manager. A requirement is given for staff to be provided with this training. A requirement is also given to extend the home’s adult protection policy and procedure. Currently, it does not provide sufficient information about the actions that will be taken following incidents or allegations of abuse. WOODBERRY GROVE Version 1.10 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 There have been improvements to the décor and furnishings at the home. The standard of the environment is relatively good providing residents with an attractive and comfortable place to live. EVIDENCE: Improvements have been made to the home’s physical standards. These include decoration of the communal areas, new furniture, new carpets and the decoration and provision of new furnishings in a number of the bedrooms. Overall, a pleasant, well maintained, comfortable home is provided for residents. Two minor matters requiring attention are listed in the table of requirements. A number of resident’s bedrooms were visited. All were comfortably furnished and contained some of the resident’s own possessions. The communal areas offer a choice of seating for resident’s including a separate dining room and a space for seating in the garden. WOODBERRY GROVE Version 1.10 Page 15 To improve the service and provide a safe environment for residents more attention to health and safety is needed. For example, radiators are guarded in bedrooms but not in corridors or communal areas. Some of the window restrictors need adjustment to be made more secure or for decreasing the window opening. The infection control risk assessment needs to be extended to cover the washing of soiled items of laundry. A requirement is given to cover all these matters. WOODBERRY GROVE Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The staff morale is high resulting in staff on duty who are knowledgeable about residents and their needs and enthusiastic about their work. There have been improvements to the provision of staff training and the manager is clear what training is required for new staff and to increase the number of staff with NVQ qualifications. EVIDENCE: Nine members of staff, including the manager, were spoken with. Without exception, staff said that they enjoyed working at the home. Many made the point that staff worked well as a team. Staff were observed to work well together and that they were lead through the example of the manager. The management style involved a high degree of contact time with residents. Many of the staff have worked at the home for a number of years thereby providing a level of consistency for residents. The staffing numbers, four care staff in the morning shift and three in the afternoon shift is adequate for the nineteen residents currently living at the home. When resident numbers rise, up to the maximum twenty-six, the staffing levels will need review. Recruitment arrangements are robust. Criminal Records Bureau (CRB) checks had been obtained for each member of staff. Improvements are needed to the staff training arrangements to ensure that staff receive training in order to complete their work competently. This breaks down into three broad areas WOODBERRY GROVE Version 1.10 Page 17 • • • The induction training for new staff is limited. An induction programme for a new member of staff showed that, although basic information about the home had been provided, the range and detail of that set out in the TOPSS staff induction and foundation standards, is not covered. A requirement is given about this. Only three of the sixteen care staff have NVQ qualifications. A requirement is given for a timetabled programme for the provision of NVQ qualifications for staff to be drawn up. The staff training profile, although on the whole well presented and detailed, has gaps for some of the staff. For example, not all staff have received manual handling training. In addition, no staff member has undertaken the four day First Aid at Work course. Requirements are given about all these matters. WOODBERRY GROVE Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 , 37 & 38 The manager provides strong leadership and support for staff which assists in the development of the service. The manager has an awareness of how the service can be developed to meet the quality standards agreed and set out in the home’s statement of purpose. EVIDENCE: The manager has been at the home since August 2004. She is an experienced manager who has worked in a number of care homes for older people. She has applied to the CSCI for registration. She was observed to work with residents sensitively and to provide a good example of care provision for staff. One visiting relative said that the manager was, “good at her job”. There is a detailed quality assurance procedure for the home which sets out standards for achieving a quality service and the means by which they such a service will be achieved. The quality standards cover aspects of the service WOODBERRY GROVE Version 1.10 Page 19 such as meal provision, involving residents in planning and reviewing the service and providing competent and well trained staff. Completed questionnaires from residents were seen. Although there is an aim of completing a review of the quality management system, no evaluation report of the quality system was available. A requirement is given for such a report to be produced at regular intervals. A requirement is also given for the registered person to carry out monthly inspections of the home and to provide the CSCI with a copy of the inspection report. Such inspections and reports have not been carried out to date. Staff supervision arrangements are good. A sample of staff supervision records were seen indicating that supervision was provided regularly and in depth. Staff spoken with said that they had supervision regularly and that they found it helpful. Overall, a robust approach is taken in relation to health and safety matters and the maintenance of the home’s installations and equipment. For example, there are detailed risk assessments for the premises and for fire safety. Some of the maintenance certificates for the home’s equipment, such as the mobile hoist and chair lift, were not available for inspection. A requirement is given for these certificates to be made available. In addition, there was no evidence that the home’s water systems had been maintained and risks from legionella assessed. A requirement is given about this. WOODBERRY GROVE Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 2 3 3 3 2 2 WOODBERRY GROVE Version 1.10 Page 21 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 1 Regulation 4 Schedule 1 14 (1) (a) & 15 Requirement The registered person must ensure that the statement of purpose is extended to include information about the respite service provided. The registered person must ensure that assessments and care plans detail the needs of service users with dementia and that action is taken to meet those needs. Previous timescale of 1/11/04 not met. This requirement is re-stated. The registered person must ensure that individual occupational therapy assessments for service users with mobility difficulties are carried out. The registered person must ensure that the manual handling risk assessment form is reviewed. A new form must be introduced where indicated. Mechanical equipment, such as a mobile hoist, must be used for moving and handling service users, subjcet to a risk assessment. The registered person must ensure that the manager and Version 1.10 Timescale for action 01 June 2005 2. 3&7 01 August 2005 3. 8 13 (1) (b) 01 June 2005 4. 8 13 (5) 01 June 2005 5. 18 13 (6) 01 August 2005 Page 22 WOODBERRY GROVE 6. 18 13 (6) 7. 19 23 (2) (b) 8. 28 18 (1) c (1) 9. 30 18 (1) c (1) 10. 30 18 (1) c (1) 11. 30 18 (1) c (1) 12. 30 13 (5) & 18 (1) c (1) 13 (4) 13. 30 staff are provided with adult protection training. The registered person must ensure that the adult protection policy and procedure is extended to include the action to take when responding to incidents or allegations of abuse. Reference must be made to the Department of Health guidance No Secrets and the local council adult protection policy. The registered person must ensure that the following repair and improvement is carried out: a) repair broken tiles behing toilet in the ground floor bathroom b) provide a lock on the refurbished first floor bedroom. The registered person must ensure that a timetabled programme for the provision of NVQ qualifications for staff is drawn up. The registered person must ensure that staff are provided with training on care planning and activities. Previous timescale of 1/1/05 not met. This requirement is re-stated. The registered person must ensure that a staff induction programme, that covers the TOPSS induction and foundation standards is drawn up. The registered person must ensure that the staff training profile is updated to include details of all training undertaken by staff. The registered person must ensure that staff who have not completed manual handling training are provided with such training. The registered person must ensure that at least one member Version 1.10 01 June 2005 01 June 2005 01 June 2005 01 August 2005 01 June 2005 01 June 2005 01 August 2005 01 August 2005 Page 23 WOODBERRY GROVE 14. 33 24 (2) 15. 37 26 16. 25, 26 & 38 13 (4) (a) 17. 38 13 (4) (a) & 23 (2) (c) 18. 38 13 (4) c of staff is provided with the four day First Aid at Work course. The registered person must ensure that a report, detailing the findings of the homes quality assurance initiatives, is produced at regular intervals. The registered person must ensure that inspections of the home, in accordance with Regulation 26 of The Care Homes Regulations 2001 are carried out. A report of the inspection must be written and sent to the manager and the CSCI. The registered person must ensure that the premises risk assessment is extended to cover risks associated with unguarded radiators and unrestricted window openings. The infection control risk assessment must be extended to cover laundry arrangements and the washing of soiled items of laundry. The registered person must ensure that certificates confirming that the following equipment has been serviced is available for inspection: a) the mobile hoist b) Kingscraft easibath c) chair lift. The registered person must ensure that evidence is provided that the homes water system has been maintained and that risks from legionella have been assessed. 01 September 2005 01 June 2005 01 June 2005 01 June 2005 01 June 2005 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 Good Practice Recommendations Version 1.10 Page 24 WOODBERRY GROVE 1. Standard 8 The registered person should ensure that records of service users receipt of preventative health care checks are recorded on a suitable form and placed on service users care plans. WOODBERRY GROVE Version 1.10 Page 25 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 WOODBERRY GROVE Version 1.10 Page 26 - 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!