Care Home: Ashleigh Residential Home

Similar services:

• Snydale Care Home
• Abbey The
• Larchfield Manor
• Hawkhills
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well Overall, the comments received from the surveys is positive. A relative commented that the staff are kind and welcoming and one individual living in Ashleigh said they were happy living at the home and the staff are very good. The manager and staff have worked hard to ensure the care records for people living at Ashleigh are person centred and reflect the choices made by people in their daily lives. The high standard of information available in the care records provides clear information how to care for people and ensure individual care needs are met. Everyone has their care needs assessed prior to moving into the care home.The staff work hard to provide a relaxed environment for people. During this visit positive interaction was observed between the staff and people working at the home. People spoken to during this visit said they were satisfied with the care and support provided by the staff. There were positive comments made during this visit such as staff are "Good" and the staff are "nice". What has improved since the last inspection? There has been some general maintenance works carried out such as redecoration and replacement carpets. The manager has worked hard to meet the required improvements made by the Commission for Social Care Inspection in the last report. The manager has gained the Registered Managers Award What the care home could do better: Greater care is required to ensure the way the staff keep medication records improves to ensure people are fully protected by the medication procedures in the home. Further improvements are needed regarding the general maintenance in some areas of the home, for example, the bathroom identified in this report and the first floor landing. The domestic arrangements need some improvement to ensure all areas of the home are clean and fresh. The current working patterns for the night staff require some management and planning to ensure people are properly supervised. The way the home recruits people requires some improvement to ensure people are protected by the home`s recruitment procedures. CARE HOMES FOR OLDER PEOPLE Ashleigh Residential Home 60 Stile Common Road Primrose Hill Huddersfield HD4 6DE Lead Inspector Bronwynn Bennett Key Unannounced Inspection 19th November 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 Ashleigh Residential Home DS0000060145.V354875.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. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashleigh Residential Home Address 60 Stile Common Road Primrose Hill Huddersfield HD4 6DE 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) 01484 514291 01484 515532 sarah.hirst@eldercare.org.uk Eldercare (Halifax) Ltd Mrs Sarah Rose Hirst Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Caer home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 31 19th January 2007 2. Date of last inspection Brief Description of the Service: Ashleigh is owned and operated by Eldercare (Halifax) Limited. Ashleigh is located approximately 2 miles from Huddersfield town centre and is accessible for public transport and local shops. It is a stone built detached property with a purpose built extension. There are gardens around the home and car parking at the front. There is ramped access to the home. Although not a secure unit, Ashleigh has a coded door lock for entry and exit. The home has one double and 23 single bedrooms with en-suite facilities (toilet and wash-hand basin) over two floors. There are three day/quiet rooms and a dining room on the ground floor. One of the day rooms has toilet facilities within and further toilet facilities are located near to the dining area and the two remaining day rooms. A passenger lift provides access to the first floor. Information about the home in the form of a Statement of Purpose, Service User’s Guide and the most recent CSCI inspection report are displayed in the home’s entrance area. Copies of these documents can also be requested from the home. The registered manager advised the home’s scale of charges are £368.19 to £430.00 per week. Additional charges are made for hairdressing, chiropody, magazines, newspapers, personal clothing, toiletries and outings where a charge is incurred. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit. The visit began at 9.30 am and finished at 1.45 pm. During this visit the inspector spoke to people living at Ashleigh Care Home, some staff and the manager. The inspector read records of people’s care and records about staff working at the home, looked at how medicines are given and looked at the accommodation available in the home. There were twenty-eight people living at the home on the day of this visit. Before this visit, the Commission for Social Care Inspection sent out questionnaires. Questionnaires were sent to people living at the home and their relatives. Prior to this visit, the manager carried out a self assessment to show how they feel the home is performing and gave the CSCI information that had been requested, for example about any illnesses, accidents and incidents and how the home is managed. The inspector would like to thank everyone for their assistance during this inspection process. At the time of this report being published the home’s manager has confirmed that both requirements of the report have been met. What the service does well: Overall, the comments received from the surveys is positive. A relative commented that the staff are kind and welcoming and one individual living in Ashleigh said they were happy living at the home and the staff are very good. The manager and staff have worked hard to ensure the care records for people living at Ashleigh are person centred and reflect the choices made by people in their daily lives. The high standard of information available in the care records provides clear information how to care for people and ensure individual care needs are met. Everyone has their care needs assessed prior to moving into the care home. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 6 The staff work hard to provide a relaxed environment for people. During this visit positive interaction was observed between the staff and people working at the home. People spoken to during this visit said they were satisfied with the care and support provided by the staff. There were positive comments made during this visit such as staff are “Good” and the staff are “nice”. What has improved since the last inspection? What they could do better: Greater care is required to ensure the way the staff keep medication records improves to ensure people are fully protected by the medication procedures in the home. Further improvements are needed regarding the general maintenance in some areas of the home, for example, the bathroom identified in this report and the first floor landing. The domestic arrangements need some improvement to ensure all areas of the home are clean and fresh. The current working patterns for the night staff require some management and planning to ensure people are properly supervised. The way the home recruits people requires some improvement to ensure people are protected by the home’s recruitment procedures. Ashleigh Residential Home DS0000060145.V354875.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. Ashleigh Residential Home DS0000060145.V354875.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 Ashleigh Residential Home DS0000060145.V354875.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): 3. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their care needs assessed prior to moving in to the home. EVIDENCE: The manager discussed how people are admitted into the care home. The care records looked at contained pre-admission assessments, social work assessments and also recorded the involvement of each individual. This is good practice and informs staff of people’s care needs. People were positive in their response to the survey with the exception of one person, people felt they had received enough information about the care home before deciding if it was the right place for them. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health, personal and social care needs are set out in individual care plans and people’s health care needs are met. The way the home keeps medication records needs some improvement to ensure people are fully protected from medication errors. People are treated with dignity, respect and privacy. EVIDENCE: Everyone who responded to the survey said they “always” receive the care and support they need. That staff are available when needed and staff listen and act on what they say. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 11 Four care records were looked at. The information in these records was person centred and reflected individual care needs and preferences for daily living. The detail in some of the records was excellent and easy to follow so that staff are well informed. Nutritional records were cross referenced with eating and drinking care plans. Assessments to assess the risk of developing a pressure sore were linked to care records relating to individual skin conditions and recorded the involvement of relevant professionals such as a district nurse. There were care plans and risk assessments to ensure people are moved safely. These were detailed and recorded the necessary equipment to be used by staff, for example the type of hoist. The content of the daily records is good and reflected the individual’s plan of care and showed continuity by staff. For example, keeping a check on individual needs following an accident or incident. The care records examined were up to date, reviewed and individuals and their relatives are involved in the development of care plans. The manager and the staff should be commended on the standard of care planning and assessments. Four medication records were checked. Some minor errors were noted in the medication administration records. This has identified a training need for some staff in relation to record keeping in medication management. The manager agreed to take immediate action in this matter. Throughout this visit people were observed being treated in a dignified and respectful manner by the staff. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual cultural, religious and social needs are generally being met, and people are supported to maintain contact with their family and friends. People are able to exercise choice and control over their lives. The home provides the people living at the home with a varied and nutritious diet. EVIDENCE: People who responded to the survey were positive about activities arranged in the home that they can take part in. The home has an activities worker and entertainment is also brought into the home. During this visit, some people had chosen to play dominoes, other activities provided are film afternoons, quizzes, sing-along and music. Some Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 13 people enjoy the garden and there are trips organised such as shopping and places of interest. Religious observance was discussed with the manager. She is planning to improve contact between the home and the community church and other places of worship so that everyone’s religious needs are met. During this visit people were seen freely visiting the home and were welcomed by the staff. The manager said there are no restrictions on visiting and people can visit the home whenever they wish. People spoken to during this visit said they enjoyed the meals served at the home. The inspector observed both breakfast and lunch. The staff were supporting people to enjoy their meal in a relaxed and unhurried way. People who responded to the survey said they “always” liked the meals served at the home. The home offers a varied menu that offers a choice of food and specialist diets are catered for such as diabetic. Ashleigh has been awarded a Healthy Choice Award from Kirklees Council. The home has recently experienced problems with storing some fresh foods. This was discussed with the cook and the manager who said this matter will be rectified as soon as possible. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 14 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. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at home and their relatives are confident their complaints will be listened to and acted upon. Individuals are protected from abuse. EVIDENCE: People who responded to the survey said they knew who to speak to if they were not happy, and two out of three people said they knew who to make a complaint. The home has a policy and procedure for dealing with complaints displayed in the home. The manager said that there had been some concerns raised in the home that had been addressed and the individuals concerned were satisfied with the outcomes. The manager said that the majority of staff have received adult protection (safeguarding) training and the remainder of staff are booked to receive this training. The staff spoken to during this visit had a good understanding of the necessary actions that must be taken should there be any allegations of abuse. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 15 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. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, people live in a safe and well-maintained environment. The home is generally clean and people have comfortable rooms with their own possessions around them. EVIDENCE: Everyone who responded to the survey said the home is “always” fresh and clean. Individuals spoken to during this visit said they had a room they liked. The inspector had a look around the home. Some individual rooms were seen that Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 16 had been personalised by the individual with items such as pictures and other personal effects. One room identified lacked a blind or curtain at a small window to ensure individual privacy. This was discussed with the manager who agreed to action this matter. There has been some maintenance works carried out in the home since the last visit by the CSCI. Some bedrooms, the activity lounge and dining room have been redecorated and there is a new carpet in the central area of the home. Some redecoration is also underway in a ground floor hallway. The home was generally fresh and clean, however the toilets and bathroom on the first floor were in need of a thorough clean. Following discussion with the manager, it was suggested that the domestic arrangements in the home should be looked at to ensure all areas of the home are fresh and clean. The manager agreed to address this matter as soon as possible. The inspector requested that a bathroom should not be used until it has been fully refurbished as this area posed a potential safety risk to people living in the home. The corridor on the first floor was dark and in need of some refurbishment and an area of carpet was a potential tripping hazard. It is a recommendation of this report that this area is given some priority as part of the home’s maintenance programme and the poor lighting and the area of carpet identified is addressed as soon as possible. The laundry area was in need of organisation. It is a recommendation of this report that the manager look at ways of improvement, for example, an allocated laundry person. This would keep the area clean, hygienic, and free from odour and improve infection control. Separate hand washing facilities are also required in the laundry facilities that will also promote good hygiene and reduce the risk of spreading infection. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 17 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. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, staff are employed in sufficient numbers and receive training to ensure they are competent to do their jobs. Generally, people are protected by the home’s recruitment practices. EVIDENCE: One relative who responded to the CSCI survey said the staff are caring and address people with respect and good humour. People spoken to during this visit said the staff were “Good” or the staff were “Nice” One individual commented, “I could not choose between the staff, they are all very good”. Ashleigh provides a comfortable and welcoming environment for people. The staff were observed interacting well with people living in the home during this visit. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 18 The inspector was advised that the night staff are required to complete some cleaning and ironing. Whilst it is appreciated these tasks need attention, the manager should ensure that jobs such as these are always of a lower priority than staff being responsive to people’s needs during the night. A relative commented in the survey that it would be helpful if there were more staff on duty. Three staff files were inspected. Two records contained the required information to ensure the way the home employs its staff protects people however, one of the records did not have the required police check. This was discussed at the time with the manager who agreed to take immediate action in the matter. All new staff undertake basic induction training to ensure they are competent to care for people properly. Nine staff have achieved the NVQ (National Vocational Qualification) level 2 in care. The majority of staff have undertaken, or training is planned in, food hygiene, first aid, health and safety and infection control, adult protection (safeguarding) training, fire and manual handling training. However, some staff require further medication training to ensure they are competent. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 19 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. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run and managed by a person who is fit to be in charge and run in the best interests of people who use the service. The financial interests of people are safeguarded. Generally, the health and welfare of everyone is promoted and protected. EVIDENCE: The home’s manager is Ms Sarah Hirst, she has many years’ experience of working with older people and completed the RMA (Registered Managers’ Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 20 Award) in July 2007. The staff spoken to during this visit said the manager is approachable and supportive. The home has a quality monitoring system that seeks the views of people and questionnaires have been sent out to people. In addition, there are resident and staff meetings and regular visits undertaken by the registered provider. The results from the last quality assurance audit have been published and areas of concern for people are addressed by the organisation. Four individual finances and financial records were checked and were correct. The fire records were checked. There is weekly testing of the home’s fire alarm system and emergency lighting and there is an up to date fire risk assessment. The information looked at during this visit showed that equipment and services in the home is serviced regularly. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 22 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. 2. Standard OP9 OP29 Regulation 13(4)(c) 19(1) (b) 6 (i) Requirement Accurate medication records must be maintained. The registered person shall not employ a person to work in the care home unless - they have obtained in respect of that person the information and documents specified in schedule 2 of the Care Homes Regulations 2001. All staff must have a suitable police check before working with vulnerable adults. Timescale for action 19/11/07 19/11/07 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. 2. Refer to Standard OP12 OP19 Good Practice Recommendations The registered person should ensure every effort is made to support people in accessing a place of worship and respect and promote religious observance in the home. The identified bathroom should be refurbished as soon as DS0000060145.V354875.R01.S.doc Version 5.2 Page 23 Ashleigh Residential Home 3. 4. 5. 6. 7. 8. OP19 OP19 OP19 OP19 OP26 OP26 9. OP30 possible so that it is safe and accessible to people living in the home. Suitable screening is required in the identified bedroom to ensure privacy and dignity. The lighting to the first floor landing requires improvement to provide suitable lighting for reading and other activity. The first floor landing requires some refurbishment and redecoration. The identified area of carpet should be refitted to prevent it being a tripping hazard. Hand wash facilities should be provided in the laundry room to promote good hygiene standards. The way the home currently operates the laundry facilities requires some improvement to ensure it is well organised and promotes good hygiene practices. The home should consider appointing a laundry person. The registered person should provide staff with further medication training to ensure they are competent in this area of working. Ashleigh Residential Home DS0000060145.V354875.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Ashleigh Residential Home DS0000060145.V354875.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. 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!