Care Home: The Laurels

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What the care home does well The service told us in the Annual Quality Assurance Assessment that they provide a good service because: `We encourage those who live in the home to lead active and fulfilling lives. We will endeavour to provide high quality support and try to meet the needs and wishes of the residents`. This statement was confirmed in the feedback we received and our observation of life in the home. Residents are supported by a skilled and stable staff team who have the skills and knowledge to meet peoples` changing needs. What has improved since the last inspection? Work has been carried out to repair and paint exterior window frames. The kitchen/diner has been refurbished. A new bath and toilet have been installed. The home has fully developed person centred support plans for the benefit of the residents. What the care home could do better: The registered manager must ensure that the storage for any controlled drugs meets current legal requirements. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Laurels Highfield Road Shanklin Isle Of Wight PO37 6PR     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: Annie Kentfield     Date: 2 0 0 5 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Laurels Highfield Road Shanklin Isle Of Wight PO37 6PR 01983867297 01983865777 lin.sims@islecare.org 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) : Islecare Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Laurels is a registered residential home providing care and accommodation for up to six adults who have a learning disability. The manager is responsible for both The Laurels and Highmead, a similar home on the first floor of the same building and has experienced deputy managers to assist her in each home. The Laurels occupies the lower ground floor of a larger building, which, in addition to Highmead, houses Islecare management and training rooms on the ground floor. Residents have their own bedroom with wash hand basin. There is a lounge and kitchen/diner and a bathroom with shower/wet room and separate toilet facilities. Outside there are private gardens with some seating and limited parking spaces can be found at the front and side of the main building. The building is accessible. Weekly fees are determined by the social services funding arrangements and may Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home vary. Additional charges are listed in the information about the home. Care Homes for Adults (18-65 years) 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We made an unannounced visit to the home on 20 May 2009 with one inspector (Annie Kentfield) and the visit lasted for 5 hours. We spoke to one resident who was at home, the manager and some of the staff. We looked at some of the homes records including support plans, medication records and staff recruitment and training records. We received the Annual Quality Assurance Assessment when we asked for it. This is a self assessment and gives us information about the service and what has improved and where further improvements are planned. We sent surveys to residents, staff and health and social professionals who visit the home. We received completed surveys from all of the residents and three members of Care Homes for Adults (18-65 years) Page 6 of 27 staff. Feedback about the service is positive. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures that the care and support needs of the people who use the service will be met; by undertaking a comprehensive assessment prior to them moving into the home. Evidence: All of the five residents at The Laurels have lived there since 1995. The manager told us in the Annual Quality Assurance Assessment (AQAA) that there have been no new admissions to The Laurels since the last inspection. The AQAA told us that any new or potential residents would be invited to visit the home for a series of planned visits, meet the other residents and staff, and a full assessment of care and support needs would be carrried out. The manager demonstrated a good understanding of the importance of the assessment process and liaison and consultation with everyone involved in the care of prospective residents to ensure that residents are able to make an informed choice about moving into the home. However, we did not look at this in detail as there are no new residents to the home. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a person centred support and care plan and make decisions about their lives with assistance as needed. Evidence: Since we last visited the home in 2007, the service has fully developed a person centred approach to individual plans and has met the previous regulatory requirement, made at the previous inspection. Each resident has a support plan that has been drawn up with the resident and their key worker. The support plan clearly records residents choices and preferences on all aspects of care and daily living activities. The Annual Quality Assurance Assessment (AQAA) stated that residents are consulted on activities, menu choices, going out, clothes, holidays, how they wish to spend their time, who they would like to invite for a visit, everything which affects their lives as far as they are able. This was confirmed in the evidence from the two individual plans that we looked at. The plans focus on Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: how staff can provide active support for residents, and promote dignity and respect at all times. The plans contain a communication passport, and details of how the resident participates in home activities and community activities. The plans also contain detailed information for care staff on how residents want care to be provided and a health action plan. Any risks to residents are identified and a risk management plan is recorded and reviewed. All support plans are regularly reviewed with residents and their key workers and this was evidenced in the plans that we looked at. When we visited the home one resident was at home and another resident arrived home a little later, the other residents were involved in day centre activities. We spoke to one resident who told us about some of the things they like to do. We also saw lots of photos that demonstrate the wide range of activities that residents have participated in, both in the home and in the community. Some of the residents do not use verbal communication and the AQAA stated residents are assisted to make choices based on the skills and knowledge that staff have in knowing the residents and how they use body language and facial expresssions to indicate their likes and dislikes. We saw evidence of this in our observation of interactions between staff and residents in the home. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents in the home are supported to choose and take part in activities they like and encouraged to try new activities. Meals and menus are offered based on residents choices and preferences. Evidence: In the AQAA the manager told us that the focus of the service over the last 12 months has been to actively support the residents to try new things. We saw examples of this in the record of activities that include going on day trips, holidays, meals out. We were told that outings have been arranged to the cinema, bowling, speedway, ice hockey and theatre trips. We saw evidence of this in the photos in individual plans and in photos on display around the home. Four of the residents choose to go to community day services and take part in organised activities outside of the home. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: The Annual Quality Assurance Assessment told us that some of the residents belong to a drama group and have been involved in making DVDs for other service users, such as how to complain. We were told that some of the residents are planning to have a holiday at a Center Parc Resort and some of the residents are going to stay in a holiday camp. Some of the holidays are arranged jointly with Highmead, another service in the same building. We saw photos of the Christmas party and visits to Amazon World and Waltzing Waters. The service has its own transport and residents pay a contribution towards any travel expenses that are incurred. The policy of the home is that personal monies are paid straight into the residents own bank accounts and each resident has a family appointee. Any purchases made on residents behalf are checked with family appointees and all transactions are double checked and signed, and checked by the registered manager. Support staff take it in turns to cook and residents have a kitchen/diner that is newly re-furbished and homely and attractive. The menu is planned in advance but with some flexibility depending on personal choices and preferences. We were told that staff offer regular cooking sessions with the residents and one of the residents has enjoyed making pizza and cakes. The Laurels has a small area of garden for the use of residents in The Laurels only. The manager told us that some of the residents enjoy gardening and we saw evidence that residents were in the process of planting out new plants. The garden area also has a seating area for residents to enjoy in the warmer months. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal care and health care needs are met consistently and flexibly. Residents receive their medication, as prescribed, by staff who are trained to do so. The home does not have any controlled drugs at present but the storage for controlled drugs does not meet current legal requirements. Evidence: Each resident has a key worker and people are supported to make decisions and choices in respect of all aspects of daily living and these choices and preferences are recorded in the individual plans, and regularly reviewed. Staff demonstrated a good understanding and knowledge about residents health care needs and showed us information/guidance that staff have drawn up in the event of residents being admitted to hospital, so that other health care professionals have all the relevant information needed to meet the health care needs of the residents. Records show that residents receive checks from GP, dentist, optician and specialist health care services, as required. Residents health care needs are identified in their personal plan and each person has a person centred health action plan. The manager Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: confirmed that residents receive annual health checks and medication is reviewed annually or more frequently, if required. We spoke to staff who have responsibility for ensuring that residents receive their medication, as prescribed. Medication is safely stored and recorded and it was confirmed that staff who dispense medication have received appropriate training in the safe administration of medication. The home does not have any controlled drugs at present, however, the legal requirements for the storage of controlled drugs in care homes has changed and the cupboard that the home has does not meet legal requirements. This was discussed with the registered manager. Guidance on storing and recording controlled drugs is available on the commission website www.cqc.org.uk Staff told us that they have access to relevant information about medicines, their uses, and any relevant information about possible side effects. The Annual Quality Assurance Assessment told us that the service plans to improve outcomes for residents by actively promoting healthy living and health promotion with the residents. The records for staff training demonstrate that some of the staff have completed recent training in nutrition. The manager told us that where training has been identified as being of benefit to residents care, at least one member of staff is delegated to undertake the training so that information can be cascaded to all staff, for example, sexual health training. We looked at the staffing rota and discussed this with the registered manager. The rota demonstrates that there are enough staff on duty to meet the needs of the residents. The manager told us that the staff rota always reflects the gender mix of the residents to ensure privacy and dignity are always promoted and respected. We observed practice in the home during our visit and staff practice was respectful of privacy and dignity at all times, for example, staff made sure that bedroom and toilet doors were closed when providing personal care, and residents are always asked for permission before staff enter bedrooms and bathrooms. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure their comments or concerns will be listened to and taken seriously. Residents are protected from the risk of harm or abuse. Evidence: There have not been any complaints about the service but there are systems in place to respond in a serious and timely way if any complaints are received. The Annual Quality Assurance Assessment states that information for residents about how to complain is available in an easy read format and in DVD format. The AQAA also told us that the area manager for Islecare visits the service each month to speak to residents and staff, and this is an additional opportunity for residents and staff to feedback any comments or concerns. The service has policies and procedures in place for staff to report any concerns they may have about residents being at risk of harm or abuse. Training records show that all of the staff have either attended or are in the process of attending awareness training in safeguarding, and also deprivation of liberty - in relation to the Mental Capacity Act. Care Homes for Adults (18-65 years) 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, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely, comfortable and safe environment. The home is clean, pleasant and hygienic. Evidence: At the previous inspection of The Laurels in 2007 we made a regulatory requirement for the window frames and sills to be repaired and painted and this has been done. The home has also refurbished the kitchen/diner which gives the residents more scope to participate in the preparation of meals. The bathroom has a new parker bath and toilet and is fitted with a ceiling hoist. Residents bedrooms are well decorated and furnished according to personal taste and choice. All residents have access to the shared bathroom/shower and toilets. Previous inspections have made mention of the door openings in the home which are less than the 800mm width that would be a requirement in a new purpose built care home. The manager told us that it is not possible to change the door openings in the building, however, all of the rooms that residents use are just wide enough to allow access with a wheelchair. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: Residents have a large and comfortable sitting room, kitchen/diner, and outside garden and seating area. Residents have access to a laundry area and where residents are able, are supported to use this. At the time of our unannounced visit, the home was very clean, tidy and pleasant. The AQAA told us that the home has a cleaning schedule and staff are aware of the homes procedures for maintaining good hygiene and control of infection. The AQAA told us that the home plans to make a patio area at the side of the home for residents to use. Care Homes for Adults (18-65 years) Page 20 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, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home have the necessary skills, experience and qualifications to meet the needs of the people who live there. Residents are protected by thorough staff recruitment checks and procedures. Evidence: We looked at the recruitment records for two new members of staff. Records demonstrate that the service operates robust and thorough recruitment checks to ensure that new staff are suitable to work with the people living in the home. Islecare have an ongoing staff training programme to ensure that staff have the skills, knowledge and qualifications to provide support and care to meet the needs of the residents. We looked at the record of training in the training matrix. This shows that all staff receive training and regular updates in all mandatory areas of safe working practice. The manager told us in the AQAA that all staff have to achieve a Learning Disability Qualification. The AQAA stated that 8 out of 15 staff have already achieved a National Vocational Qualification (NVQ) in care at either levels 2 or 3. Additional training is offered to staff in areas of specific health or care topics that are relevant to the needs of the residents, for example, epilepsy and diabetes awareness. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Staff in the home receive regular supervision and appraisal - this was confirmed in the records of supervision and in discussion with staff. The manager told us that she meets with the senior staff team for regular peer reviews and staff meetings for all the staff are held every 6 weeks. The AQAA told us that before new staff are recruited, residents are given the opportunity to meet potential staff, informally. Residents are asked for feedback from the meeting. Residents know when staff are on duty because there are photographs of all the staff in the main entrance and photos of which staff are working that day. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience 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 managed and run in their best interests. The health, safety and welfare of the residents and staff is promoted and protected at all time. Evidence: The registered manager is experienced and qualified and jointly manages The Laurels and Highmead - another small care home located in another part of the building. The Laurels has a team of experienced senior staff who are responsible for running the home when the manager is not there. Observation of practice, and feedback received from staff and residents, demonstrate that the manager is open, supportive, and approachable for residents, staff, and families or visitors to The Laurels. The information in the AQAA contained information about what the service does well, what has improved, and where further improvements will be made, for the benefit of the residents. For example, the AQAA said all residents are treated as individuals and Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: we support them to make choices throughout their daily lives, and to access the community without facing predjudice or bias. This was confirmed in the evidence in residents person centred support plans and from our observations and discussion with some of the residents and staff. The support and care that residents receive at The Laurels is monitored and reviewed in a number of ways as part of the homes quality assurance process: keyworker and resident reviews, yearly care reviews with community care managers, residents meetings and staff meetings, monitoring and supervision of staff practice, and regular inspections of the service by the responsible individual from Islecare, as well as an annual service audit. Records show that the health and safety of residents and staff is promoted through checks and risk assessments, to meet relevant health and safety legislation. We looked at some of the records for fire safety within the home: there is a new fire risk assessment that includes an evacuation plan and the manager told us that new emergency outside lighting has been installed as part of the evacuation plan. The fire alarm and emergency lighting is tested weekly, in conjunction with Highmead. Care Homes for Adults (18-65 years) Page 24 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 Adults (18-65 years) Page 25 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 20 13 The storage of controlled drugs must meet current regulatory requirements. Controlled drugs must be safely stored to meet legal requirements. 18/09/2009 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 Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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!