Care Home: Park Lodge

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

What the care home does well "It`s tidy, clean and friendly", "the staff do wonderfully", "It`s very nice" and "I`m lucky to be here" were comments from people who live there. One relative, friend or advocate said "the home is clean, the meals are good" and "the staff are friendly". The service has a nice homely atmosphere and staff were seen to relate well with the people who live there. People enjoy the food provided at the home. People`s health needs are met well and the arrangements for the administration of medication are generally good. The activities co-ordinator has done some good work and individual social needs are being addressed. What has improved since the last inspection? The Requirements made at the June 2007 inspection have been addressed. Training is provided for care staff around safeguarding and good records are kept for any money held on behalf of individuals. Fresh fruit is provided and table napkins are used instead of bibs. What the care home could do better: The home needs to continue building on the good work done over the past year. The service is clearly moving forward and the outcomes for people living there improving. The challenge is to make the service even more person centred and to continue to move away from task based care. Activity, engagement and positive interaction should be promoted and staff should see this as very important parts of their caring role. The bathrooms need to be improved to make sure that people can bathe or shower in comfortable and homely surroundings. The manager needs to be registered with the CSCI. CARE HOMES FOR OLDER PEOPLE Park Lodge 11-15 Park Road Berrylands Surbiton Surrey KT5 8QA Lead Inspector Jon Fry Key Unannounced Inspection 4th April 2008 09:50 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 Park Lodge DS0000065224.V362169.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. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park Lodge Address 11-15 Park Road Berrylands Surbiton Surrey KT5 8QA 020 8390 7712 020 8547 1580 parklodge@supanet.com 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) CHD (Care Homes) Ltd ** Post Vacant *** Care Home 35 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (35) of places Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two (2) places for service users over the age of 65, with dementia, can be accommodated 29th June 2007 Date of last inspection Brief Description of the Service: Park Lodge provides nursing care for up to thirty five older people, two of whom may have dementia care needs on admission. The home is owned and managed by Care Homes of Distinction Ltd. It is situated in a quiet residential street close to local bus routes and community facilities in Surbiton. Information about the service is available in the Statement of Purpose and Service User Guide. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We spent just over eleven hours in the home over two separate visits. We spoke to nine people who live at the home, three relatives or friends of an individual, the manager and four staff members. We looked at records and documents kept at the service including three people’s care plans. Completed surveys were received from two people who live at the home and three relatives, friends or advocates. The home sent us an annual quality assurance assessment (AQAA). This is a self-assessment that gave us information on how well outcomes are being met for people using the service. What the service does well: What has improved since the last inspection? The Requirements made at the June 2007 inspection have been addressed. Training is provided for care staff around safeguarding and good records are kept for any money held on behalf of individuals. Fresh fruit is provided and table napkins are used instead of bibs. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to people about the service. Assessments are completed before people move in and these are kept under review. EVIDENCE: “My relative inspected it”, “my relative helped choose it” and “my home is nearby” were comments from individuals about how they came to live at the home. The home has a pack that gives good information about the service. This document needs to be made available in different user-friendly formats. We have recommended that the guide be produced in large print and in picture Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 9 format also. It would be good for people to see pictures of the staff, the facilities available and places in the local community. We looked at the care files for three people and saw that individual needs are assessed before they come to live there. The assessments record some good information about the individual but tend to be focused on physical needs. We have recommended that the home look at ways of capturing information about the person’s life history and social preferences. This could include questionnaires for relatives or friends of the individual if the person is unable to volunteer the information themselves or the outline of a life story book for the person. Park Lodge DS0000065224.V362169.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, 10 and 11. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are well maintained but could be made more person centred. People’s health needs are met well. Arrangements for the handling, storage and administration of medication are generally good. EVIDENCE: “They all come and care for me” but “some do different things” were the comments from one person. We saw that care plans do give some good information and are reviewed regularly but they are sometimes too general in describing the care the person needs. Phrases like ‘to be washed and dressed with the assistance of one carer’, ‘bath to be given once a week’ and ‘keep privacy and dignity at all times’ are too generalised. Staff need to think about how the person likes the care to be Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 11 delivered and be specific in describing this. The plan needs to say when, where, what and how for each area of support needed. This should help to make sure that care is delivered in the same way and as the person likes it. It is recommended that the activity co-ordinator be involved in reviewing the social care plans in place. These also need to be specific about individual interests and give clear information about things the person enjoys. All the staff who work there need to know this information and use any opportunities they have to do the things people enjoy. Risk assessments we looked at were fully completed and had been kept under review. This makes sure that areas such as risk of falls, developing pressure sores and nutritional intake are looked at regularly. Daily notes kept by staff should be discussed within the team. We saw that some of these contain very repetitive and general statements such as ‘had a comfortable day’, ‘due medication given’ and ‘all care given as planned’. Notes kept by staff need to contain good quality information which can then be used to evaluate and review the care being provided. It is recommended that the home look at developing life story books with the people living there and these could then be shared with others in the home. This may also help staff to relate to people as individuals and encourage more interaction. Staff may also wish to develop their own life story books as part of this process. “The Doctor comes periodically – they send for him” and “I see the GP when I need to” were comments from individuals. A chiropodist was visiting people while we were there and we saw that health records were kept well. Medication is managed well by staff. We saw that administration records were up to date and that items were generally stored properly and securely. Two issues were found that needed action – these concerned quantities of boxed medication and items wrongly stored in the fridge. We saw that the home had addressed these on the second day we visited. The home has joined the Gold Standard Framework for Care Homes (GSFCH) to develop its practice around care for people in the last years of their life. Park Lodge DS0000065224.V362169.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 using the 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 offers a good range of activities but there is scope for developing these. People living at the home generally enjoy the food provided to them. EVIDENCE: The people who live there said “the food is very good indeed”, “I enjoy the food – it’s nicely cooked”, “very good”, “it’s alright” and “the cook comes and asks me what I would like”. We saw the cook asking people what they wanted for lunch on both days we visited. The meals being served at the home do not currently match the fourweek menu in place. We have asked the service to review the menu with the people living there and come up with a new one that reflects people’s preferences. Other ideas could be used such as international menus, recipes from the past or recipes from individuals or their families / friends. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 13 We have recommended that the home display the new menus in large print or pictures to make sure that everyone knows what is being served. There may also be opportunities to make mealtimes for those eating in the dining room a more social occasion. Ideas to consider include protected mealtimes, people serving themselves at the table and for staff to eat their meals at table alongside the people living there. We saw that the home had already started to try out some of these ideas on the second day we visited. “I’m going out this afternoon”, “I like to be quiet” and “I play chess” were comments from people who live there about activities. One relative, friend or advocate said “they need a full time activity officer to provide mental stimulation with quizzes etc and physical stimulation”. A part-time activity coordinator is currently employed. The programme of activities includes visiting entertainers, newspaper reviews, reminiscence, arts and crafts, manicures and spelling bees. Day trips are sometimes arranged and, if required, a minibus is hired to take people out. We have strongly recommended that the organisation purchase a suitable vehicle that can be used regularly by the home. We have recommended that the service look at making the activity coordinators hours full time. This will help to build on the good work already being done and allow for even more person centred care. The home could also look at how care staff could be more actively involved in social and emotional care. This is important in continuing to develop a service that is person centred rather than task based. Life story work could also help with developing this culture within the service. Park Lodge DS0000065224.V362169.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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are protected from abuse. Concerns about the care provided are listened to and acted on. EVIDENCE: People we spoke to said “no complaints” and “I’d talk to the staff if I had a problem”. Relatives or friends of individuals we spoke to said that they felt able to raise any issues with the manager or administrator. One person said “they respond promptly to my concerns”. A complaints procedure is in place and this is included within the information pack. As talked about previously, it is important that this be made available in large or other formats. It would be good to have pictures of the manager or other senior staff so people know who to go to if they are unhappy. We saw that records are kept of concerns or complaints and these show what action has been taken by the service. Letters of compliment were also seen. One more recent letter talked about ‘how kind all the staff were’ and how their relative always ‘looked so nice’. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 15 Staff have training in Safeguarding of Vulnerable Adults (SOVA) and a refresher day was about to take place for some staff members. The home has a procedure for staff to follow as well as a copy of the Local Authority procedures. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home generally enjoy a comfortable and safe living environment with the exception of the bathrooms. EVIDENCE: The people we spoke to were generally happy with the environment and comments from individuals included “ok”, “it’s clean” and “fine”. One person responded in a survey that ‘carpets could do with a clean’. We saw that the home is maintained to a satisfactory standard and generally provides a comfortable and clean place for people to live. As stated in the June 2007 report, a complete refurbishment and rebuilding of the home is planned. We saw that the bathrooms in particular do need these Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 17 improvements as they are not very pleasant places for people to take baths or showers. The adapted shower units are very old and need replacement. The staff we spoke to reported that a new electric ‘standing’ hoist had been bought for the home but that it could only be used with a small number of people who live there. We have asked the home to review this and make sure that the hoists provided are suitable for the service. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are generally happy with the care they receive. Staff recruitment practices and training are of a good standard. Staffing levels need to be kept under review to make sure they meet the needs of people using the service. EVIDENCE: Feedback about the staff was very positive. Comments included “the staff are excellent”, “friendly”, “very good”, “always polite” and “nice”. People living at the home felt that there were enough staff around. One person said “I’ve got my bell – they come up”. Staff we spoke to all said that they thought one extra floating staff member would help particularly in the morning. We saw that staff generally interacted well with the people living there. Some staff shared news about their own families with individuals and this was clearly appreciated. As stated previously, the home should look to encourage person centred care within the service and focus on the importance of staff spending time with people. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 19 We looked at the records kept for three members of staff. Recruitment checks are completed and these included a Criminal Records Bureau (CRB) check. Staff are offered training in a number of topics such as manual handling, Health and Safety, Fire Safety, care planning and First Aid. Some staff have the NVQ Level Two or Three qualification and training for other staff members is ongoing. Records of induction training are kept for new care staff and these are to the Skills for Care Common Induction Standards. In order to support the development of the service, we have recommended that care staff have further training around dementia, person centred care and care planning. It is also recommended that the manager looks at increasing the numbers of staff meetings. This may give more opportunities for the staff to discuss their practice and how the service could be developed. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the 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 live in a home that is well run. There are generally good arrangements to make sure that the health and welfare of people using the service is protected. EVIDENCE: There is an acting manager in post who has a good knowledge and experience of running a care service for older people. The manager told us that she was applying to be registered with the CSCI. Feedback from care staff was positive about the way the home was managed. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 21 A system for staff supervision is in place. This means that staff meet with their manager to discuss their work but the manager needs to make sure that these sessions take place regularly with records kept. The home sent surveys to individuals and their relatives or friends in January 2008 to ask what they think of the service. We saw that a summary of the results was available. Meetings are held with people living at the home and for relatives. We have recommended that the home looks at how individuals can be consulted on at least a monthly basis. This could be done through social activities and get togethers where people could be informally consulted. We looked at the financial records for three people. The home only keeps small amounts of cash for individuals and the records checked were correct and up to date. Health and Safety is generally well managed. We found one instance where cleaning fluids were kept in a container originally used for a different product. This is potentially dangerous for people living and working at the home. Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 Standard No Score 16 3 17 X 18 3 3 X 2 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23 (2) (b) Requirement In order to make sure that people are able to bathe or shower in pleasant surroundings, the bathrooms need to be renovated and new adapted equipment provided. In order to make sure that staff have the correct equipment to help the people living there, the service must review the type of hoist equipment provided. Hoists must be suitable for the people living there. The Manager must make application to be registered with the CSCI. In order to protect the safety of people living at the home, cleaning substances must not decanted into other containers. Potentially hazardous substances must be kept locked away if assessed as necessary. Timescale for action 01/10/08 2. OP22 23 (2) (n) 01/07/08 3. 4. OP31 OP38 8 (1) (a) & CSA 2000 13 (4) 01/06/08 01/06/08 Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 24 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 OP1 OP3 Good Practice Recommendations The information pack about the home should be made available in a variety of formats such as large print or pictures. The assessment format should be reviewed to make sure that good quality person centred information is captured. This can then be used to inform the care plan from when the individual moves in. Relatives, friends or advocates could be asked to contribute information if the person cannot give this himself or herself. 3. OP7 The home should continue to look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person orientated and less task based. Care plans need to give specific information about how the person likes the care and support to be delivered. Better background information about the person and their life should be recorded. 4. OP7 Life story books could be developed with the individual and their family or friends. These books should be used to help communication and engagement. Staff should also think about developing their own life story books to share. Care staff should look at the daily notes they keep to make sure that good quality and useful information is being captured. It is strongly recommended that full-time hours be allocated for the activities co-ordinator(s). Care staff should also see the provision of social and emotional care as important parts of their work. 5. 6. OP7 OP12 Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 25 Care staff could look at how people could be more involved in the daily life of the home. This could be helping with preparation of meals, serving food and drink, helping with laundry or cleaning. 7. 8. OP12 OP15 It is strongly recommended that a suitable vehicle be purchased for use by the home. The menus should be reviewed and produced in accessible formats for the people who live there. Ideas such as recipes from the past, individual favourites and international days could be looked at. Mealtimes need to be looked at to make sure they are a positive occasion for all concerned. Practices such as protected mealtimes, staff eating with people who live there and varying times / numbers of mealtimes should be considered. The home should keep the staffing levels under review to make sure that individual needs are being met. It is strongly recommended that further training be provided to staff around person centred care, dementia care and care planning. It is recommended that staff meetings take place regularly in order to discuss and reflect on practice. It is recommended that the home continue look at developing systems for consultation with people living at the home. Informal methods could be used to consult people about their life at the home. Care staff should have supervision at least six times a year with full records kept. 9. OP15 10. 11. 12. 13. OP27 OP30 OP30 OP33 14. OP36 Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Park Lodge DS0000065224.V362169.R01.S.doc Version 5.2 Page 27 - 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!