Care Home: St Mary`s Care Home

Similar services:

• The Highlands
• Turret Villa Retirement Home
• Blenheim House
• 1 Lanark Close
• Mendip House
• Beaconsfield Court Care Home
• Ann Charlton Lodge

What the care home does well The needs of the people who live at the home are assessed before and after they move into the home. This means that their care needs can be planned and properly met. Accurate and up to date information is kept in the care plans so staff know how to meet their needs. Information about the home is available to help people decide if it is the right home for them to move in to. Health care needs are well met by using a multi agency approach. This helps the people who live at the home to stay healthy. The home has medication systems for the staff to follow to make sure that the people who live at the home are not put at risk. The people have opportunities to take part in some leisure pursuits and interests which provides them with a stimulating environment and helps them keep their social skills. The staff team at the home value the differing needs of the people who live there and make sure that they are aware of each person`s preferences. They treat the people who live at the home as individuals and support them to live the life they choose as much as possible so they know they are valued. There are procedures in place at the home that make sure that the people who live there are protected and kept safe from abuse. The staff are trained so they know how to provide the people with good care. The manager is qualified and experienced. They are approachable and clearly present in the home to give direction and support to staff and make sure that the service is centered on the people whom live at the home. What has improved since the last inspection? There weren`t any requirements made at the last visit. What the care home could do better: If the odour was removed in the corridor and two of the bedrooms this would make the home a more pleasant place for people to live. If all of the care plans had sufficient detail and risk assessments were reviewed when needed staff would know that the information in them was up to date and correct. This would mean that they would be sure they were providing the people at the home with the support and care they need. If sufficient staff were on duty every day at the home this would demonstrate that theorganisation have made sure that the residents are safeguarded and provided with good care. Staff fire instruction will make sure that staff are clear about what they must do in the case of a fire to keep the people at the home as safe as possible. If the registered provider visited the home to check on the welfare of the residents this would be an additional way of safeguarding the people who live there. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Mary`s Care Home Church Chare Chester Le Street Durham DH3 3PZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Hilary Stewart     Date: 1 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. that people have said are important to them: They reflect the things 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. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Mary`s Care Home Church Chare Chester Le Street Durham DH3 3PZ 01913890566 01913882806 smnh@btconnect.com 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) : Carewell Healthcare Limited care home 54 Number of places (if applicable): Under 65 Over 65 54 0 old age, not falling within any other category physical disability Additional conditions: 0 2 Convalescence. Persons over the age of 55 requiring convalescent care may be accommodated commensurate with the home`s statement of purpose and function. Physical Disability. Up to 2 persons with a physical disability, over the age of 55, may be accommodated commensurate with the home`s statement of purpose and function. Date of last inspection Brief description of the care home St Marys is a purpose built care home. It is registered to provide personal and nursing care for up to fifty-four older people. The home is also registered to provide care for up to two younger adults with physical disabilities whose needs are primarily those of an older person, and up to three people who have special needs due to a terminal illness. Fifty-two of the bedrooms are single occupancy, four of which have en-suite toilet and washing facilities. One larger bedroom is used as a double bedroom. Communal space is located throughout the home with a selection of lounge areas, quiet rooms and dining facilities. Downstairs a conservatory area leads out into an enclosed courtyard garden. Eight bathrooms, four shower facilities and fourteen toilets are appropriately placed throughout the home. The home is located in Chester-le-Street, close to the Care Homes for Older People Page 4 of 27 Brief description of the care home local high street with shops and amenities. St Marys has close links with four local GP practices, enabling residents to keep their own GP where possible. Care Homes for Older People Page 5 of 27 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. How the inspection was carried out. Before the visit we looked at the information we have received since the last visit on 29th May 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people and the views of people who use the service and the staff. An unannounced visit was made on 18th June 2009. Care Homes for Older People Page 6 of 27 During the visit we talked with people who use the service staff and the manager. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept and checked that staff had the knowledge, skills and training to meet the needs of the people they care for.We also looked around the building to make sure it was clean safe and comfortable. We checked what improvements had been made since the last visit. Then we told the manager what we found. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. At the time of the visit the manager had been in post since November 2007 but is not yet registered with the Commission. The home charges £390.50p to £603.18p per week. What the care home does well: What has improved since the last inspection? What they could do better: If the odour was removed in the corridor and two of the bedrooms this would make the home a more pleasant place for people to live. If all of the care plans had sufficient detail and risk assessments were reviewed when needed staff would know that the information in them was up to date and correct. This would mean that they would be sure they were providing the people at the home with the support and care they need. If sufficient staff were on duty every day at the home this would demonstrate that the Care Homes for Older People Page 8 of 27 organisation have made sure that the residents are safeguarded and provided with good care. Staff fire instruction will make sure that staff are clear about what they must do in the case of a fire to keep the people at the home as safe as possible. If the registered provider visited the home to check on the welfare of the residents this would be an additional way of safeguarding the people who live there. 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 Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an assessment by their care manager before they move into the home. The manager looks at this assessment to see if the home can meet the persons needs. They then carry their own assessment out prior to the person moving in so they can use this information for the care plan. People can visit the home before they make a decision. The home does not provide intermediate care. Evidence: The manager said that the people who live at the home have had their needs assessed before and after they move in. They receive information about the assessed needs from a persons care manager and then they carry out their own assessment. A person is only offered a place at the home if the manager is sure that the persons needs can be met there. If a person decides to move into the home they can visit before they move in permanently, so they can be gradually introduced to the home and other people who live there. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All of the people who live at the home have individual care plans through which staff monitor and promote the health of the people at the home to maintain their well being as well as managing risk. This helps the people stay healthy. Furthermore the manager and staff respect the privacy and dignity of the people who live at the home. This is so the people know that they are valued as individuals. Some plans needed more detail and others needed to be reviewed. Written changes in the medication records need to have two staff to sign them to comfirm that they are accurate Evidence: The manager said and records showed that each person who lives at the home has an individual care plan. Each plan is kept in their own individual file. Records showed that the plans covered health and areas of daily living. The care plans looked at were general and each persons needs were presented in a similar way. Some needed more detail about how to meet the individual needs of each person. For example one persons care plan said that the behavior they exhibit could be aggressive and that they may bite,swear or nip. However the care plan did not give staff any guidance on Care Homes for Older People Page 13 of 27 Evidence: how to manage this behaviour. Also some people need staff to assist them to have a bath but the care plans did not clearly state how many staff, of what gender the person needed. There are risk assessments in each person plan both general and individual, the manager said they are updated regularly. The risk assessments described the measures that staff need to take to minimise risk. For instance two people had a risk of falling out of bed and bed rails had not been suitable so one was being cared for on a mattress on the floor and another person had a mattress on a low wooden base. Records showed that one person had moved form their mattress and spent most of the night on the floor. This creates a health and safety risk both for the person and the staff caring for them. They are at risk from cross infection as the person is incontinent and the flooring will probably be contaminated and there is also a risk of injury for them and the staff by either tripping over the person or having to lift them from the floor. This was discussed with manager who took action to arrange a review of both peoples care with the Primary Care Trust. Records showed that people at the home had regular access to health professionals such as their GP, chiropodist and that they are supported to attend hospital appointments. One person said I have to go to hospital tomorrow and staff are coming with me. The manager said that tissue viability nurse was visiting that afternoon. There are procedures for staff to follow when they deal with medication. The manager said that only nursing staff administer medication. Staff said and records showed that any changes of medication or medication procedures are recorded and followed in the home. The manager said that people are supported to manage their own medication if, following a risk assessment it was found to be safe enough. At the present time they are looking at how to improve the medication procedures in the home. Handwritten entries in the medication records had not been double signed. The medication records were up to date and an audit of four peoples medication for that day were correct. Records showed that the peoples health care needs are met at the home. Care Homes for Older People Page 14 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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 people who live at the home are able to follow their own daily routines which satisfy their social cultural and religious needs. They can see their family and friends at any reasonable time. This helps to prevent them from feeling and becoming isolated. Social activities are limited by staffing levels. Evidence: The manager and staff said that they are a variety of activities for the people who live at the home. An activities coordinator is employed at the home and they plan the activity programme. They are listed on the activities board in the reception area. On relative said the coordinator is very good. Records showed that people are asked to suggest what they would like to do. At the time of the visit people were talking in the lounge one person said I like the motivation classes and a relative said a lady comes to do movement and motivation sessions which everyone seems to enjoy. The manager said that they have made staff more aware of the need to include social activity in the care of the people at the home. There is a monthly church service at the home and a library service every three weeks. Some staff said that although there were sufficient staff at the home to keep people safe it would be improved if there were more to spend time with individual people and be able to take people out. One Care Homes for Older People Page 15 of 27 Evidence: relative said they never go out another said they could have more interesting things to do if there were more staff. One person said I would like to go out into town. Records showed that some people had been involved in a variety of activities such as arts and crafts, baking and bingo. Staff and the people who live at the home said that relatives and visitors are welcome and encouraged to visit at any reasonable time throughout the day and evening. Visitors were observed during the visit. One relative said I visit a lot and another said I visit most days the staff are always nice. The manager said that they are at present putting together a questionnaire to gather information about peoples food preferences. They also intend to introduce a nutritional care plan for each person. A cook is employed and they said that there are choices at meal times and if people want something different they will make it for them. Special diets can be catered for. One person said I can have what I ask for another person said the food is fine. The manager said that they have gone out to buy residents particular foods to encourage them to eat. Hot drinks and snacks are always available throughout the day and evening. The kitchen was well stocked and there were fresh fruit and vegetables. Staff were observed sitting with people at meals times and talking with and supporting them. Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using 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. Complaints are dealt with so any problems are taken care of quickly which helps good relationships to be maintained. The manager and staff know about and most have had training in how to protect people from harm, so the people who live at the home are kept safe. Evidence: Copies of the homes complaints procedure are in the information about the home. It is also displayed within the home. The manager and staff said that the people who live at the home and their relatives know how to make a complaint. There is a complaints record which looked up to date. It showed that twenty one complaints had been made to the home since the last visit. The manager said that all complaints had been resolved and since they had started an open door policy for the residents and their relatives, complaints have drastically reduced. There had only been one complaint made in the last twelve months. Any complaints or concerns are now being resolved at the time or as soon as possible following the event. One of the people at the home said I would tell the staff if I had a complaint. Another person said they felt they could speak to some staff about any problems a relative said I would tell the manager, I have done in the past. The manager said that they plan to introduce a system for recording concerns raised about the home so they can use this information to improve the service. Care Homes for Older People Page 17 of 27 Evidence: The manager said that all staff have had training in how to safeguard the people they care for. There is a copy of the Local Authority procedures and the home has copies of their own adult protection procedures for staff. Staff said that they have had the training and they could describe what they needed to do if someone disclosed abuse to them. The manager said that all staff have had training on the homes whistle blowing policy and procedure. A possible safeguarding issue was highlighted during the visit this was discussed with manager at the time who then took immediate action. Care Homes for Older People Page 18 of 27 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, 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. This is what people staying in this care home experience: Judgement: People using 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 live in a safe and clean home, although some repairs and improvement are necessary. Evidence: The home is comfortable, warm and clean. There are enough bathrooms and showers for the people who live at the home.The manager said that there are plans to improve the bathrooms. All of the bathrooms had hand soap and paper towels. Each person has their own bedroom and they looked comfortable and clean. They were all personalised and made very individual. Two of the rooms had a noticeable odour as did the corridor this was brought to the attention of the manager who said that this was an on going issue. Even though the carpets are cleaned regularly the odour remains. The laundry is organised and clean. The manager said that they plan to continue improving the garden and hope to develop an internet cafe for the residents. Care Homes for Older People Page 19 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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. Sufficient numbers of staff are on duty most of the time to meet the diverse needs of the people who live at the home and they have opportunities for training so they know how to give them good care and meet their needs. Furthermore the home has recruitment procedures in place, which help to prevent risk of harm to the people who live there. Evidence: Staff said that they receive training, which helps them with their work. The manager said that all staff receive the training and support they need. However as there has been a shortage of nursing staff at the home as they are a nurse they have been working a lot of night shifts and this reduced their time to manager the home. Staff said and records showed that they all have mandatory training such as first aid food hygiene and safeguarding adults training. The manager said that twelve staff have vocational qualifications. Sufficient staff were on duty at the time of the visit. Staff said and records showed that sufficient staff had been on duty in the home most of the time but some weekends the home had been one member of staff short. However the home has not been fully staffed and have been using agency staff. The manager said that new staff Care Homes for Older People Page 20 of 27 Evidence: are being recruited at this time. As stated earlier staff and relatives said that there are sufficient staff to keep people safe but more would improve the quality of care as staff would have more time to talk to people and engage them in meaningful activities. One relative said that after eight at night sometimes the people in the downstairs lounge are left alone as staff have to take people upstairs to bed. This was discussed with the manager who said that they would look into this issue immediately. The manager said that all staff have been CRB (Criminal Records Bureau) checked at an enhanced level to make sure they are suitable people to work at the home. All staff go through a recruitment process and they cannot not start to work at the home until this is completed. They are interviewed and are only successful when they have two satisfactory references. Copies of staff records showed that checks had been carried out. Staff said that they had all gone through the recruitment process before they started work and that they have had a CRB check. Care Homes for Older People Page 21 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using 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 registered person is experienced and runs the home in the best interests of the people who live there and there are procedures in place that make sure they are protected as much as possible. Monitoring visits are not carried out. Evidence: The manager said that the people who live at the home and their families are asked their views about the running of the home as much as possible. They hope to start resident and relatives meetings again. A newsletter is sent out to inform people of events. One person said the staff are nice and another said I cannot fault them or the manager. The manager said safety checks have been carried out on the equipment in the home such as testing electrical equipment and the servicing the central heating boiler. Fire safety risk assessments had been completed. The fire logbook showed that fire drills take place but fire instruction was not recorded. Staff said that fire drills take place Care Homes for Older People Page 22 of 27 Evidence: and that they have received training in fire safety. Records showed that regular training is provided for staff in fire safety and first aid. The manager said that they are qualified as a nurse and are experienced to run the home effectively. They have started vocational qualifications. It was observed that there was a friendly atmosphere at the home and a pleasant rapport between the people who live at the home the manager and staff. The staff said that they could approach the manager with any concerns. There is a quality assurance system in place at the home. Staff said that they liked working at the home. Unannounced visits are not carried out by the registered provider. The home has procedures for staff when they deal with the peoples money so it is kept safe. Records showed that staff sign records when any of the residents money is used and the manager checks them regularly. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Older People Page 24 of 27 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 Requirement 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 Requirement Timescale for action 1 7 15 The Registered Manager 31/08/2009 must make sure that care plans have sufficient detail and are accurate and that risks are regularly reviewed. So that staff have up to date and accurate information about how they provide each person with good care. 2 33 26 The registered provider must carry out an unannounced visit to the home once a month and prepare a report on the conduct of the home. This will help safeguard the people who are living there. 31/08/2009 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 1 9 The manager should make sure that any written entries in the medication records are signed by two staff to confirm Page 25 of 27 Care Homes for Older People that they are accurate. 2 12 The manager should make sure that residents at the home are all given opportunities for stimulation through leisure and recreational activities in and outside of the home. Staff fire instruction should be recorded in the fire records book. 3 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: 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 © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 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!