Inspection on 03/10/06 for 218 Kingsway

This inspection was carried out on 3rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

218 Kingsway 14/11/07

218 Kingsway 21/02/06

218 Kingsway 31/08/05

218 Kingsway 25/02/05

218 Kingsway 03/06/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 218 Kingsway St George Bristol BS5 8NS Lead Inspector Sandra Jones Unannounced Inspection 3 & 6 October 2006 09:30 rd th 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 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 218 Kingsway DS0000026582.V314975.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 Adults 18-65. 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. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 218 Kingsway Address St George Bristol BS5 8NS 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) 0117 9476315 0117 9709301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Ms Nicola Jane Josefowicz Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged between 18 and 64 years with Mental Disorder. 21st February 2006 Date of last inspection Brief Description of the Service: 218 Kingsway is a care home for five younger adults with mental health care needs of both sexes. It is operated by Aspects and Milestones Trust and managed by Ms. N. Jozefowicz. The property is semi-detached, with an appearance of a domestic dwelling, which blends well with its local environment. It is adjacent to a shopping precinct and major bus routes. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key visit was conducted unannounced over two days in October 2006 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the residents, ensure the premises are well maintained and to examine health and safety procedure. During the site visit, the records were examined, a tour of the premises conducted and feedback sought from residents and staff. What the service does well: What has improved since the last inspection? Since the last inspection, the person centred approach to meeting needs has been further developed. Individual profiles endorse a person centred approach to meeting needs by including the person’s likes, dislikes and preferred routines. There was a new admission to the home since the last inspection and the resident confirmed that the admission procedure was followed. Introductory visits took place in advance of the admission and a trial period was offered to ensure compatibility. Key information was provided to ensure a smooth transition into the home. 218 Kingsway DS0000026582.V314975.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. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents needs are assessed in advance of the admission to the home. Care plans must be developed from the assessed needs and initial assessments. EVIDENCE: The member of staff on duty explained that the most recent vacancy was as a result of a resident moving into supported living. A person living in another care home has moved into the home. The case records of the most recently admitted resident was examined and it is evident assessments were undertaken by the care coordinator. Care plans and past core assessments were provided to the home in advance of the admission to the home. While there is a care plan in place, the plan does not reflect the person’s current changing needs. The most recently admitted resident agreed to give feedback about the process followed. It was explained that introductory visits took place before the admission to the home. The resident confirmed the procedure followed during the assessment process and stipulated that the complaints procedure and tenancy agreement was explained. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 &9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A person centred approach is being developed at the home. Residents make decisions about their daily lives and assessments are in place to support restrictions. Risk assessments are conducted for activities that may involve an element of risk. EVIDENCE: Individual personal profiles are developed on all aspects of the person’s lifestyle, which is signed and dated by the person. Information about staying at the home alone, financial arrangements, physical, mental and personal care needs are described. Social, relationships and domestic abilities are also included in the profiles. The profiles endorse a person centred approach to meeting needs by including the person’s likes, dislikes and preferred routines. Care plans list the individuals and staff aim along with the long tern plan and for some there is also short-term plan. Action plans guide staff to consistently meet the assessed needs. Residents comments about their plans are appended onto the care plan evidencing their input into the care planning 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 10 process. Some of the comments acknowledge the reasons for the plan although they disagree with the aim of the plan. Individual Care Programme Approach (ICPA) meetings are convened annually for the residents accommodated. For the residents with acute mental health care needs, the care plans lists their mental health care need. Care plans detail the potential sources of stress, early warning signs and behaviours exhibited, with a plan of action to be followed. Residents giving feedback confirmed that they are involved in the care planning process and reported that their views are sought during the meetings. For one resident the care plan is based on behavioural reinforcement and for another the care plan is based on physical care needs. Restrictions are imposed on one resident to encourage positive behaviour. To develop sleeping patterns the stereo is taken out of the bedroom, the water is switched off and drinks after 8:00 pm are restricted. Risk assessments on decision-making processes are in place for turning the water off at night, in the bedroom. Described is the task, with the advantages and disadvantages of the risk and the decisions reached and why. The member of staff on duty explained that residents are able to communicate verbally. Four residents have family involvement in their care and an independent advocate supports one person. For one person decision-making is determined by past decisions and the staff’s knowledge of the person’s likes and dislikes. Residents level of competency to undertake tasks such as crossing the road, smoking, bathing, using electrical equipment and COSHH are assessed. Where risks are identified, risk assessments are completed. The home maintains an accident book and two residents have fallen since the last inspection. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 19 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are opportunities for residents to experience meaningful activities. Residents are supported to be part of the local community. Staff support residents to maintain links and develop relationships with friends and family. Residents are respected as individuals and assisted to become independent. Residents prepare meals and there is a varied diet served. EVIDENCE: The residents accommodated participate in community-based activities. One person attends college courses, two people are employed on a voluntary basis and three attend Activity Resource Centres (ARC). A member of staff on duty explained that during reviews residents aspirations with education and occupation are discussed. One person is developing employment skills at college to gain employment in the future. It was further understood that there is an expectation that keyworkers discuss college courses with residents. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 12 Personal profiles describe the person’s abilities to leave the home without staff support. For one person the profile states that staff support is necessary because of safety issues with crossing the road. The home is attached on one side to a domestic dwelling and a small shopping prescient is on the other side. Staff on duty explained that the residents are known by the neighbours and the local community. Residents visit local shops, cinemas, restaurants and one person attends the local church. The residents also use local colleges, pubs and bowling alleys. Residents use the local bus service and Dial a Ride. Residents are registered onto the electoral roll. The home’s visiting arrangements are displayed in the office and foyer. It states that visitors are welcome as long as they are respectful and refreshments will be offered. With the exception of one person, residents have visitors and bedrooms can be used for additional privacy. The Trusts rules are listed within the terms and conditions of residency and relate to payment of fees, damaging the property, abiding by the laws and house rules. House rules are based on group living, right to privacy, respecting others and household chores. There are additional rules for smoking and alcohol. Smoking is permitted in designated areas only and alcohol can be consumed on occasion. It was understood from a member of staff that the home respects the individual by having lockable bedrooms and bathrooms and handing mail unopened to residents. Each resident has a house day where they clean their rooms, do their laundry and assist with the cooking and cleaning. In terms of household tasks, chores are allocated at residents meetings and a schedule is in place. Residents giving feedback confirmed that there is an expectation that residents undertake household chores. Residents described their allocated chores and stated that staff will assist depending on their level of ability to undertake the task. A resident at the home explained the arrangements in place for meal preparation. It was explained that a rota that lists the residents responsible for meal preparation is in place. Residents generally prepare their own breakfast and weekday meals, at weekend’s staff prepare the meals. The manager prepares menus. One person is vegetarian and a separate menu is prepared for this person. There is a wide range of frozen, fresh and tinned foods at the home, compliments the menus in place. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A care plans for one resident, with personal care needs must be developed. Residents health care needs are monitored by the staff and where necessary referrals are sought from health care professionals. Safe handling practices of medications are in place and protect the residents at the home. EVIDENCE: Personal profiles incorporated within care plans, describe the person’s abilities with managing their hygiene. It is evident from the profiles that three residents require minimal personal care support from staff. The staff assists one person and a daily needs care plan supplements the profile. Routines for rising, retiring and bathing are detailed in the care plans. From the daily reports, it is clear that another person requires assistance with person care. A care plan to support the person with meeting personal care must be developed. Two residents giving feedback stated that the staff assist them with personal care and ensure their rights are observed whenever personal care is provided. The manager stated that female residents are invited for routine screening and one person has refused these checks. Residents visit the health centre annually for health checks. One person is a diabetic, which the person can 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 14 manage by controlling their diet. Two members of staff will be attending college courses on diabetes to increase their awareness and to support the resident if necessary. Residents access local NHS facilities. Residents visit the optician and dentist regularly and two residents visit the chiropodist. It was understood from the manager that members of staff generally accompany residents on hospital and GP’s visit. Records demonstrate that where appropriate specialist advice is sought from health care professionals. Residents have input from a psychiatrists through Individual Care Programme Approach (ICPA). Comments from the manager indicate that advice is not currently being sought for residents from other health care professionals. Three residents self-medicate their regular prescribed medications and competency assessments were completed. For the other two residents, the staff administer medication. The records demonstrate that staff sign the records immediately after administration. Household remedies are administered from a stock supply when required and recorded separately. Prescribed, “When required” medications are administered by the staff and administration guidelines are in place for staff to follow. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents state that their views are sought. Policies and procedures in place indicate a clear commitment towards safeguarding residents from abuse. EVIDENCE: The staff on duty reported that the complaints procedure is regularly discussed with residents. The residents are familiar with the procedure and are able to approach staff with complaints. It was felt by the staff that the residents would be able to follow the procedure without staff support. Residents confirmed their awareness of the procedure and would approach the manager or staff with complaints. Since the last inspection, the manager has discussed the complaints procedure with residents. Signed copies of the procedure are kept in case records and state that the manager has gone through the procedure with the resident. There were no complaints recorded at the home since 2005. The staff on duty confirmed that Safeguarding Adults training was provided to all staff. The procedure to be followed for alleged abuse was described by the staff on duty. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The environment for the residents is comfortable and is decorated to a reasonable standard. Personal space is arranged to meet the individuals needs and to maintain their lifestyle. The home has enough toilets and bathrooms enabling to enable residents to have personal privacy. There is sufficient communal space for residents to share activities and for private use. The home was found to be clean and free from unpleasant smells. EVIDENCE: 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 17 Kingsway is a semi-detached property located in a residential environment, next to a small shopping precinct and close to bus routes. The property is arranged over two floors, with shared space on ground floor and bedrooms on the both floors. Bedrooms are single occupancy and lockable furnished with a combination of the home’s furniture and the person’s personal possessions. Each bedroom reflects the individuals personality and is suitable to meet the individuals lifestyle. One bedroom is fully en-suite with toilet, shower and hand basin. The home operates above the NMS of no more that three people sharing toilets and bathrooms. Current ratio of residents sharing bathroom and toilet is two people sharing. There is a lounge/dining room, smoking lounge and kitchen shared by the residents. The lounge/dining room offers sufficient seating for resident group to sit together and watch television and dining space to eat their meals together. The smoking room has a large sofa, easy chair and desk for residents. It is well ventilated and can be used by non-smokers. The kitchen is large enough for three people to sit and at the dining table. The home provides sufficient communal space for shared activities and for private use. The laundry is sited away from the kitchen. The walls are painted and there is vinyl flooring for ease with cleaning. There is a domestic washing machine and tumble dryer with hand washing facilities. One resident is occasionally doubly incontinent and foul linen can be put through the washing machine. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The Trust recruitment procedure ensures that suitable staff are employed at the home. Training to be provided will ensure that staff have the skills to meet residents changing need. EVIDENCE: There are six staff employed at the home and their personnel records are kept at the home. Within staff files are signed copies of the Trusts Codes of Conduct, Terms and Conditions and letters of notification from the Trust that satisfactory enhanced criminal disclosures were obtained. Completed application forms and written references are in place for two staff and for the others there is information regarding their transfer from the NHS employment. It was understood from the manager that all staff attend statutory training and training needs are discussed during supervision. Within the home’s business plan, the manager has identified two non-statutory training courses for the staff. Additionally, staff must complete accredited mediation training and Mental Health training will be provided to correspond with the introduction of the Mental Capacity Act. The staff at the home can undertake NVQ level 3 because they are lone workers and currently over 50 of the staff have completed NVQ level 3. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager is experienced and competent to manage the care home. Quality audit will provide a measure for making judgements about meeting the aims and objectives of the home. Visual fire fighting checks must be conducted to fully promote the Health and Safety of the residents and staff at the home. EVIDENCE: The manager described the role as ensuring that residents are receiving a good service and their needs are being met through assessments and care planning. Ensuring that the staff employed are suitable to work with vulnerable adults, that they fulfil the roles they are employed to undertake. Keeping within set budgets, supervision of staff and making joint decisions are all part of being a registered manager. The manager stated that a Quality Assurance system will be introduced in the next six months. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 20 The records that relate to fire safety checks and practices were examined and, indicate that practices are conducted at the stipulated frequencies. In terms of checks conducted by the staff, the visual checks of fire fighting equipment were out of date. The staff at the home must conduct visual checks of fire fighting equipment monthly. Steps to ensure that the residents and staff are taken by the Health and Safety checks undertaken. Certificates are in place from contractors about the safety of portable appliances, fire systems, gas and electricity. 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 3 x x x x 2 x 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard YA2 YA18 YA42 Regulation 14(1)(d) 15 (1) 23 4(c) (iv) Requirement Homes care plans must be developed for residents on admission. A care plan for a resident with personal care needs must be developed. The staff at the home must conduct visual fire fighting equipment checks monthly. Timescale for action 30/11/06 30/11/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 218 Kingsway DS0000026582.V314975.R01.S.doc Version 5.2 Page 24 - 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. 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