Inspection on 24/08/06 for Aegel House

This inspection was carried out on 24th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Aegel House 21/09/07

Aegel House 27/02/07

Aegel House 07/02/06

Aegel House 05/07/05

Aegel House 04/01/05

Aegel House 24/06/04

Aegel House 04/12/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Aegel House Burgh Road Aylsham Norfolk NR11 6AS Lead Inspector Ann Catterick Unannounced Inspection 24th August 2006 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aegel House Address Burgh Road Aylsham Norfolk NR11 6AS 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) 01263 733171 01263 731456 aegelhouse@norfolk.gov.uk www.norfolk.gov.uk Norfolk County Council-Community Care Ms Molly Swee Tin Lim Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 35 Service Users only Older People not falling in any other category Date of last inspection 7th February 2006 Brief Description of the Service: Aegel House is a purpose built, two-storey residential Care Home managed by Norfolk County Council. The Home is situated on the outskirts of the market town of Aylsham and provides care for up to 35 older people. Originally built in 1962 the Home was extensively modernised during 1996/7 and now provides attractive accommodation in mainly single rooms. Aided bathing and toilet facilities are strategically positioned around the building and the Home is well equipped with hoists and handrails, etc. A shaft lift provides assisted passage to the first floor. There are a variety of communal areas dotted around the Home including a small library room. There is a large dining room on the ground floor that leads to a small room used as a shop for the residents where they can make small purchases of toiletries and confectionary. The Home stands in its own extensive grounds, which include a large, secluded garden area to the rear of the premises, with a bowling green; this is overlooked by a patio area. The patio area is furnished with very acceptable garden furniture that has been provided by the Friends of Aegal House, who are a very supportive group to the home. A day centre for older people is located within the Home and this is in active use on weekdays. The day centre, which can cater for up to twelve persons each day has its own exterior entrance, facilities and staffing compliment. This area of the building was not inspected, as it does not form part of the residential accommodation. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a key inspection and took place on 24th of August over a period of 8.5hrs. The registered manager was absent from the home and Elizabeth Lockwood temporary manager had been seconded to the home. Prior to the inspection a pre inspection questionnaire had been sent to the manager for completion and comment cards had been sent for service users and staff. All comments made were positive although all service users stated that usually there were enough activities but not always. Prior to this inspection the Pharmacist Inspector had inspected the home and a Statutory Requirement Notice was issued. On the day of the site visit the inspector was able to speak with service users, management, staff and a relative as well as make a tour of the building and look at files documents and policy and procedures. All service users and staff were very positive about living and working in the home and the overall quality of care provided was good. What the service does well: All of those service users spoken to were well cared for having their care needs met. Staff working in the home are caring and competent able to provide a good quality service to the service users. Some comments from service users: “Good food” “Visitors can just come and go when they like” “Staff are kind, nothing is any trouble.” “Lovely bedrooms, you get a clean towel and flannel every morning.” “Its lovely.” Individual bedrooms are of a good size. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. All evidence suggests that the home completes comprehensive assessments prior to service users being admitted and service users within the home are having their needs met. EVIDENCE: Prior to a service user being admitted to the home the manager receives an assessment from the placing social care worker. A member of the senior team would also visit the prospective service user and complete and assessment to ensure that the home could meet their needs. Evidence of this process was seen on the day of the site visit. Two service users who had been recently admitted to the home felt that their care needs were being met. The home does not offer intermediate care. Two places are used for respite care. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. This includes the outcome of a pharmacist inspection and this influenced the overall quality of this outcome area. The home is changing the care plan format and as this is further developed and used care plans should continue to improve. The care provided to service users and their relatives when service users are coming to the end of their life is very good. EVIDENCE: Three care plans were looked at in some detail. The home is in the process of changing the format of care plans and the old and new format were seen. The new care plans are an improvement and have an index page including headings with different aspects of care. The last heading is titled ‘details of death’ and as the care plan is shared with the service user it was felt insensitive to have this as part of the care plan. The care plan had a heading Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 10 with regard preferences after death and this seemed sufficient. A recommendation has been made in this area. The pre placement assessment was part of the care plan and although the details of this were fine it was not clearly identified as an assessment. A recommendation has been made in this area. Three omissions were noted in the care plans, pressure care, nutritional care and falls information. The temporary manager is aware of these omissions and intends to ensure that they are completed and included in care plans. A care plan of a service user who was being cared for in bed was inspected and good practice was evidenced in this area. An example of person centred care was that a carer informed the inspector that although the service user was now not able to say what they preferred she always was very fastidious about her oral care and of wearing a favourite perfume and the carer always ensured that these needs were met. Daily records for this service user were seen. Some staff were very detailed when noting information about pressure care and some were less detailed. The manager was advised that a separate turning chart might be the best way to ensure the correct information is recorded. A recommendation has been made in this area. A relative of the service user, who was very coming towards the end of her life, was spoken to and she felt the quality of care that their relative received was very good. The relative also felt supported within the home. A care plan of a service user who had recently moved into the home was inspected. Again a good social history was included and information about preferences and interests. There was information on the assessment of concern re weight loss and again no nutritional record was included in the care plan. A recommendation was made in this area. The service user was spoken to and was satisfied that her care needs were being met. Those care plans seen had been reviewed and the temporary manager aims to ensure all care plans are reviewed on a regular basis. At an independent pharmacy inspection a Statutory Requirement Notice was issued and this standard was not inspected within this site visit Staff were seen to care for service users in a way that promoted their privacy and protected their dignity. All of those service users spoken to spoke very well of staff and felt their privacy and dignity was promoted and protected. All bedroom doors are lockable if service users wish to lock their bedroom door. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is opportunity for further activity and occupation to take place. Relatives are always made welcome within the home. The menu is not always followed and this is not helpful when aiming to monitor the nutritional value and variety of food provided. EVIDENCE: On the day of inspection no activities were taking place and many service users appeared to spend significant periods of time sitting in their bedrooms or the lounges with little occupation or activity. It is acknowledged that some may choose to do this but many service users in the home may prefer to be more active. When speaking with several service users in one of the lounges they felt that little went on in the home. The TV was on but nobody was watching it and when I went to talk with them they asked for it to be turned off. They said that staff were very busy and had no time to sit and chat. They said they would enjoy activities and/or one to one contact. One service user stated, “All we do is sit and fall asleep.” The service users thought there was Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 12 no video or DVD in the lounge although a member of staff thought there was one. If there was it was not being used. Some trips out had been planned over the summer months. Staff felt there was little time for activities or one to one although the rota suggested that there was a time in the afternoon when there was additional staff on duty. This is an area that needs to be further developed. A requirement has been made in this area. Service users said that relatives were welcomed into the home at any time and many of those service users spoken had visitors on a regular basis. A relative said that she was always made welcome within the home. Service users have choice with regard what time they rise and retire. There are several communal areas to sit as well as their own bedrooms. No one has to share a bedroom. Those service users spoken to felt they had choice and could make decisions about their lives. One service user had decided to move to more independent accommodation and this was being supported. All service users spoke very positively about the food provided within the home. The inspector was disappointed to find that on the day of inspection the menu was not being followed fully. The vegetables with lunch were not as on the menu. Sauté potatoes should have been served but mashed potato was provided. Mash potato was already on the menu for three days. The vegetarian menu had changed and the desert had changed from chocolate pudding and custard to cherry flan. If the habit of menu changing is a regular occurrence it makes the written menu of no value. A requirement has been made in this area. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Complaints are now recorded in an appropriate way and those complaints received had been investigated. Staff spoken to were aware of how to protect service users from abuse. EVIDENCE: The record of complaints was inspected. In the past these records were recorded together but a new system has been created and they are now recorded separately. Complaints had been dealt with appropriately. Those service users spoken were comfortable with approaching the manager if they had any concerns and received a copy of the complaints procedure in the Service User Guide. Since the last inspection some staff had completed training around safeguarding adults and the temporary manager has purchased a video that has been approved by TOPSS. Staff have not seen this yet but sessions are planned for the near future. Further training in this area is being arranged. The senior member of staff on duty was asked what they would do with regard this matter and they were aware to inform the manager or if she was not available to contact a senior member of staff in the department or a manager from another home. Written guidelines for senior staff on what to do would be helpful, especially as the registered manager and two care coordinators are on Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 14 at work and senior carers are being seconded into care coordinator positions. A recommendation has been made in this area. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24 and 26 The quality in this outcome area is poor. This outcome is poor because of the poor condition of the smoke room and laundry room. This judgement has been made using available evidence including a visit to the service. Not all areas of the home are well maintained. Bedrooms are of a reasonable size and reflected the personality of the occupant. Bathing and toilet facilities are in sufficient numbers to meet the needs of service users. The laundry room is of a poor standard and is not clean or hygienic. The main areas of the home were clean and free from any offensive odours. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 16 EVIDENCE: There is not a programme for maintenance and renewal for the home and there are areas of the home that are in urgent need of repair, renewal and redecoration. A requirement has been made in this area. The home has a handyperson for a few hours a week and he does as much as he can but his time is limited. The communal areas are varied, being on the ground and first floor. Some of these would benefit from redecoration. The smoking room has a carpet that is covered in burn holes. The walls and ceiling are dirty and have been painted nicotine yellow. Chairs are shabby and generally this is an unwelcoming room. The temporary manager informed the inspector that there were plans to redecorate and re carpet this area. A requirement has been made in this area. Bedrooms are of a good size and give opportunity for the service users to have some of their own belongings around them. The metal laundry room window frames was the worst the inspector had ever seen. The ceiling in the laundry room was flaking and the area was generally dusty and unkempt. A requirement has been made in this area. The home, other than the laundry room, was clean and free from any offensive odours. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff seen were competent and skilled able to fulfil their role in full. There appeared to be sufficient staff on duty to meet need. The care needs of service users were being met. Recruitment practice is sound and appropriate induction and training is provided to staff. EVIDENCE: The home appeared to have sufficient care staff hours to ensure needs are met but the pattern of the rota meant that there were some times when less staff were on duty. Staff felt that there was not enough time to spend on a one to one with service users but with some more planning of the rota the temporary manger felt this could be possible. Service users spoke very positively about the quality of the care provided but felt staff were often too busy with practical tasks to spend much quality one to one time with them. One concern identified was that the staff spent a significant amount of time in the laundry room and making beds and if there were additional housekeeper hours staff would be free to spend more social Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 18 care time with service users. A recommendation has been made in this area. A new member of staff was spoken to and she had received an induction that included three shadow shifts and a general induction that included fire training and moving and handling training. She was awaiting further training and was hoping to complete NVQ level 2. Staff files were seen and included all of the information required. All care staff other than the new recruit have received first aid training and 10 staff have had medication training. All staff receive a copy of the GSCC booklet. Thirty eight per cent of staff have NVQ level 2 or above. All of those service users spoken to were very complimentary of staff saying that they worked in a competent caring way. This was confirmed by comment cards received before the inspection and observation on the day of inspection. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The registered manager has been absent from the home for some time, however, the home had a temporary manager and the home was being managed in the best interests of the service users. The financial interests of service users are protected by the administration systems around any monies that are looked after by the home. The policies procedures and practices promote the health and safety of service users. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home has a registered manager but due to her being absent from the home a temporary manager has been seconded into the role. Staff supervision needs to take place on a more regular basis. The home has a quality assurance system and this will continue to be further developed. Service users money that is looked after by the home was checked and the processes in this area were sound. Good records are kept and two signatures are required if the service user is unable to sign for themselves. Three were randomly audited and were found to be correct. The fire records were inspected and were in good order. Incidents and accidents were recorded. General risk assessments are made. The laundry area is of poor quality and was dusty and grubby. Due to the poor state of the laundry and the fact that no one takes overall responsibility for it infection control would be difficult in this area. Some training regard the safeguarding of adults has taken place and the manager has purchased a video in this area. All staff are to watch a food hygiene video. Twenty-one staff hold a first aid certificate. On the day of inspection some chemicals were found in the bathrooms and the manager removed these straightaway and will discuss this issue with domestic staff. A recommendation has been made in this area. Staff receive induction and foundation training. Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 2 3 x 3 x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 22 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. Standard OP12 Regulation 12 Requirement The registered person must ensure that those persons living in the home have the opportunity to participate in meaningful activity and occupation. The registered person must ensure that the home provides a nutritious and varied diet. To achieve this the home needs to ensure that it follows the menu otherwise there is no record of what is provided. The registered person must ensure that an improvement plan is produced that specifically relates to standard 19 and the outcomes for this area. The registered person must ensure that all communal areas are well decorated with appropriate furniture and flooring. This relates particularly to the smoking room. The registered person must ensure that all areas of the home are kept in good order externally and internally. This relates particularly to the poor state of DS0000035120.V309955.R01.S.doc Timescale for action 01/10/06 2. OP15 16.2 (i) 01/10/06 3. OP19 24A 01/11/06 4. OP20 23 2 (d) (e) 01/11/06 5. OP26 23 2 (b) 01/11/06 Aegel House Version 5.2 Page 23 the laundry room. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager should consider removing the heading, ‘details of death’ from the care plan index. The care plan is seen and should be completed with help from the service user and this could be viewed as insensitive. The pre admission assessment of service users should be identified as such and not just included in the care plan without note of it being the initial assessment. The manager needs to ensure that information relating to the care of keeping service users pressure areas healthy when caring for them in bed is clear. That staff are offered written guidelines on what action to take if and allegation of abuse takes place. This is particularly important when some members of the senior staff have been on sick leave fro some time. That consideration is given to the employment of further housekeeper staff to free care staff from some of their domestic roles. That domestic staff are reminded of the importance of ensuring chemicals are always stored safely and not left in bathrooms or toilets. 2. 3 4. OP7 OP7 OP18 5 6 OP27 OP38 Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Aegel House DS0000035120.V309955.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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