Care Home: Applegarth

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What the care home does well Managers and staff spend a lot of time finding out about people`s needs. This means that staff can meet people`s needs in the right way People`s support plans tell staff exactly how they like their needs met. People receive very good support to stay healthy. Staff help people to stay in contact with their families People go on holiday. They go out to pubs, to the shops and the theatre Staff receive lots of training to make sure that they know how to meet people`s needs. Managers give lots of support to staff so staff can do their job well. What has improved since the last inspection? The last time we visited Applegarth was on 6th February 2007 We did not ask them to make any improvements. What the care home could do better: We did not ask Applegarth to make any improvements at this visit. Key inspection report Care homes for adults (18-65 years) Name: Address: Applegarth 1 Rutland Close Leicester Forest East Leicestershire LE3 3PN The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ruth Wood Date: 1 9 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 29 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Applegarth 1 Rutland Close Leicester Forest East Leicestershire LE3 3PN 01162395392 01162395392 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.vistablind.org.uk VISTA care home 6 Number of places (if applicable): Under 65 Over 65 6 6 0 0 learning disability sensory impairment Additional conditions: No person falling within category LD may be admitted to the home unless that person also falls within the category SI - ie dual disability. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home Applegarth is a residential care home for 6 people. It provides care for people with a visual impairment, who also have a learning disability. Applegarth is a clean and comfortable place to live. Each person has their own room. All the rooms have their own shower and toilet.All bedrooms are on the ground floor. There is a large lounge/dining room, a kitchen and a conservatory on the ground floor. People pay different amounts of money to live at Applegarth. The manager can give information about how much it costs to live there. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home Before we visited Applegarth we looked at information sent to us about what has happened there since we last visited on 6th February 2007. We sent surveys to the families of people who live in the home, the staff who work in the home and to people like nurses who visit the home. We visited Applegarth on Tuesday 19th January. We arrived at 1pm and left at 5pm. We looked at some of the rooms in the home. We spoke to 2 people who live at Applegarth. We watched how staff spoke to the people living at Applegarth. We looked at 3 peoples support plans We spoke to staff about how they support people. We spoke to staff about the training they did. We looked at staff records. These told us about the checks done to make sure staff have the right skills and are safe to work in the home. We spoke to managers about how the home is run Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well Managers and staff spend a lot of time finding out about peoples needs. This means that staff can meet peoples needs in the right way Peoples support plans tell staff exactly how they like their needs met. People receive very good support to stay healthy. Staff help people to stay in contact with their families People go on holiday. They go out to pubs, to the shops and the theatre Staff receive lots of training to make sure that they know how to meet peoples needs. Managers give lots of support to staff so staff can do their job well. Care Homes for Adults (18-65 years) Page 8 of 29 What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ruth Wood CPC1 Capital Park Care Homes for Adults (18-65 years) Page 9 of 29 Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An excellent initial and ongoing assessment process ensures that peoples needs are effectively met Evidence: To assess this outcome group we focused primarily on the assessment and admission process for one person who has recently come to live at Applegarth. Information and assessments were obtained from all the people already working with the person, but in addition to this the service conducted an intensive and detailed assessment of the persons needs. This involved a series of visits to the persons existing placement to observe their routine and how existing staff communicated and worked with the person. The visits took place at a variety of times early morning, bedtime, lunchtime etc. so that the assessment team could build up a comprehensive picture of the persons needs. After each visit Applegarth staff involved would write a detailed assessment report, which helped the service to build up a picture as to how the person reacted to various situations and people and the most effective ways of meeting their needs. In addition to this the person made many visits to Applegarth so that he could get to know their room, the building and the wider environment. During the two weeks before Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: they finally moved into Applegarth they were visiting on a daily basis. The persons advocate has been actively involved in the assessment and moving in process and visited the person on the day of the inspection. She said, ever thing has gone really well and I see that X is happy. We also looked at how the service continually monitors the ongoing and changing needs of people living in the home to ensure that they can continue to meet them. Recently this has included arranging training for staff in understanding and working with people with dementia, and end of life care. Assessment documents detail changes to peoples needs and the response made to these. Care Homes for Adults (18-65 years) Page 13 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from excellent and detailed attention to their individual needs and choices Evidence: We looked at three peoples support plans, including the plan of the person who has recently come to live at Applegarth. The plans explain to staff how each person wants to live their life, how that person likes to communicate and the kinds of things that they like and dislike. The two staff who responded to our survey said that they were always given up to date information about the needs of the people that they support and that the ways of sharing information about peoples needs, consistently work well. The Deputy Manager explained that consistency of support for people living at Applegarth is very important, otherwise people can quickly become disorientated and distressed. This is why plans contain such detail and outline to staff the communication that they should use at any given stage when supporting a person, so that they remain orientated to the sequence of events. For example we directly observed one person with a dual sensory impairment being given their object of reference for dinner (a plastic knife and fork) together with blocks that indicated to them that this would be in fifteen minutes time. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: People are effectively supported to make choices and detailed risk assessments outline how people can be supported to live the life they choose but still be kept safe. The deputy manager explained that the assessment and care planning process was an ongoing one, as peoples needs and their choices changed. The service tries to allow people time to make choices at their own pace. For example if a person does not eat a certain food on one day, the service will not simply record that they do not like that food, reasoning that the person may simply not have wanted to eat that food at that particular time. If however the person regularly refuses a food, then this will be recorded as a preference. Each persons care plan includes a discussion and decision section, which records more complex decisions and the people involved in the process. Staff have received training in the implementation of the Mental Capacity Act and know how and when to access outside professionals such as independent advocates, Independent Mental Capacity Advocates or professionals working for the team that deals with the Deprivation of Liberty Standards. Care Homes for Adults (18-65 years) Page 15 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported in living a varied lifestyle that meets their needs and reflects their choices and interests. Evidence: Many people have lived at Applegarth for a number of years and are entering their 60s and 70s; their lifestyle and activities are subsequently changing. One person spoke to us about the specialist resource centre and social club that they regularly attend with other visually impaired people. They regularly meet up with friends at the club. This person also told us that they attend a local church every Sunday and a member of the church community gives them a lift. They also enjoy meeting their sister for lunch and going out shopping with staff support. Another person told us that they went to Leicester every Friday, on the bus with staff support and that they also enjoyed going shopping with staff for the homes groceries and made sure that the home did not run out of things. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: The person who has recently come to live at Applegarth enjoys walking to the local shop and to the local pub. His advocate spoke enthusiastically about this as the person had been limited to using a wheelchair before he moved to Applegarth, as their previous environment was not suitable for a person with a sensory impairment, neither were staff trained to support and guide someone with visual impairment. The move to Applegarth has greatly increased this persons choices about how they get around and where they go. Four relatives responded to our survey; all said that the service helps their relative to keep in touch with them and that they are always kept up to date with important issues, Whenever we ring its never too much trouble to the staff. They all said that the service always or usually supports people to live the life they choose, Applegarth provides a safe and happy environment that caters for individual needs. People have the opportunity to go on holiday and for short breaks with staff support. Two people particularly enjoy theatre trips, where they will visit a city, go to the theatre and then stay overnight in a hotel before returning home. A record is kept of what each person eats at each meal and this helps staff to monitor the diet of the two people with diabetes as well as the nutritional quality of what each person eats. People living in the home are involved with food preparation and some make their own hot drinks with staff support and using specialist equipment such as a level indicator. Care Homes for Adults (18-65 years) Page 17 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from excellent personal and healthcare support Evidence: Support plans outline in great detail how each person likes their personal care needs to be met. This includes information for staff about the prompts that they should give at each step of the process, in what sequence the person likes to get washed and dressed and the responses to look for which would indicate that a person is unhappy with anything. Each person has a health action plan and a grab sheet with key information, should the person be admitted to hospital in an emergency. Three professionals who work regularly with the service responded to our survey. They said that peoples health care needs are always properly monitored, reviewed and met by Applegarth and that the service always seeks advice from outside professionals if required and acts upon it. Discussion with the deputy manager and examination of care records, confirms that the service works closely with a variety of professionals (e.g.consultant psychiatrists, speech and language therapists, physiotherapists, dietitians, community nurses) to meet peoples health care needs. The deputy manager said that as people living in the home had aged, several had experienced significant changes in their health, which has Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: required, in some instances, increasing levels of investigative tests and treatment. Role play is used to enable people to get used to these interventions and the service liaises closely with the other people involved in the persons care to ensure that this is carried out safely and effectively. Several people have chronic health conditions that require regular monitoring, such as taking blood sugar levels for people with diabetes and blood pressure readings for people on certain types of medication. Staff confirmed that they had received training in these areas and the professionals who responded to our survey said that managers and staff have the right skills and experience to support peoples health needs. Staff have also received training in how to support people when they reach the end of their life so that they can enable people, where at all possible, to remain in their own home. Good arrangements are in place for the storage and administration of medication, including controlled medication. Medication Administration Records are completed accurately and well-written protocols are in place for those people who take as required medication. Staff members on duty confirmed that they had received training in medication administration and the two staff members who responded to our survey said that they had been given training in medication. Care Homes for Adults (18-65 years) Page 19 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from good protection from abuse and harm Evidence: We observed that staff treat people with dignity and respect and that there is an open and friendly relationship between the two groups. Support plans contain information about how each person expresses their distress; this is particularly important for people who do not express themselves using formal means of communication such as speech or sign. The deputy manager said the service did not have formal residents meetings but communicated with each person on an ongoing basis to determine their choices and monitor if they were unhappy with anything. The service does have a formal complaints procedure, which the relatives who responded to our service said that they were aware of. All three said that the service had always responded appropriately to any concerns that they had raised. All staff have completed the alerters training in safeguarding vulnerable adults and training in safeguarding is updated for each staff member on an annual basis. The two staff that we spoke to during the inspection, said that they had also received specialist training to help them deal with any behaviour by people living in the home that they may find challenging. Robust systems are in place to ensure that peoples finances are protected with each individual transaction being recorded and signed for and witnessed by two staff members. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The persons placing authority acts as an appointee where this is required. Care Homes for Adults (18-65 years) Page 21 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home, which is tailored to meet their needs Evidence: The environment is tailored to meet the needs of the people with a visual impairment who live in the home. For example surrounds to doorways are painted in contrasting colours so that people with residual vision are better able to distinguish the entrance to a room. The grounds of the home have guide rails to enable people to navigate outside of the building. All peoples bedrooms and all communal rooms are on the ground floor and are easily accessible for everyone living in the home. Each person has their own bedroom with en suite facility. Bedrooms are very spacious, have been decorated according to the persons own choice and reflect their personalities and interests. Any special equipment that people require, such as special beds, is provided by the service. On the day of the inspection all areas of the room were exceptionally clean and tidy. Staff have received training in infection control. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are effectively supported by competent and very well trained staff Evidence: The two staff who responded to our survey said that the service had carried out employment checks, such as obtaining Criminal Records Bureau checks and references, before they started work at the home. We looked at three peoples recruitment records during the inspection and saw their references and records of previous employment. Evidence of two peoples CRBs and checks against the vulnerable adults register were sent to us after the inspection visit. The two staff that we spoke to on the day of the inspection were very enthusiastic about the services attitude to training and development. Both said that they received regular support from their managers and had never had so much training at any other job. One staff member commented that managers were very concerned about the quality of the external training they received and asked for feedback about whether staff felt it helped them to do a better job. Staff have received specialised training in visual impairment, communication, working with people with dementia and autism and also have the opportunity to do the Learning Disability Qualification. Staff have also received training in supporting people with different kinds of health conditions, such as epilepsy and diabetes. The two staff members who responded to our survey were very positive about their Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: employment at Applegarth, I am proud to work for Applegarth as they do amazing things with the individuals. I have never worked somewhere that cares as much or organises as much for the individuals as they do. I am very pleased to have been given the opportunity of working at Applegarth. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from very good management in this home, which is run in their best interests. Evidence: The manager and deputy manager have supported people living at Applegarth for a long time but continue to develop their practice to ensure that they can meet peoples continuing and changing needs. The management team have recently been on a training day to discuss the changing needs of people and how the service can adapt to these as people living at the home become older. The management of the service benefit from being part of a wider group of managers of other Vista services,where they can discuss changes taking place in health and social care, and share good practice. Vista is a registered charity and the service is regularly visited by trustees, as well as a residential services manager to monitor the practice in the home. We looked at copies of the reports of the visits made by the residential service manager. The manager directly observes practice and speaks to people living in the home, any family members who are visiting and to staff members. She also examines documents in the home, such as peoples support plans. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Staff receive training in all aspects of health and safety as well as training in first aid, food hygiene and moving and handling. We looked at the arrangements in place to ensure fire safety in the home. The fire risk assessment was updated in November 2009 and will be updated again to reflect recent changes in legislation in this area. There were good records in place to evidence that fire systems and equipment were regularly tested and serviced. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!