Inspection on 14/08/07 for Ashlea Care Home

This inspection was carried out on 14th August 2007.

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 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

Ashlea Care Home 21/06/06

Ashlea Care Home 24/11/05

Ashlea Care Home 26/07/05

Ashlea Care Home 21/03/05

Ashlea Care Home 14/03/05

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Ashlea Care Home 1 Kings Road Newark Nottingham NG24 1EW Lead Inspector Steve Keeling Unannounced Inspection 14th August 2007 09:00 Ashlea Care Home DS0000008621.V348502.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 Ashlea Care Home DS0000008621.V348502.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. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashlea Care Home Address 1 Kings Road Newark Nottingham NG24 1EW 01636 705206 01636 705334 h2048ashlea.1kingsroad@mencap.org.uk H46013@mencap.org.uk Royal Mencap Society 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) Jayne Ramsey Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories: Learning Disability (LD) (8) The maximum number of service users to be accommodated is 8 Date of last inspection 21st June 2006 Brief Description of the Service: Personal care and accommodation is provided for up to 8 adults with learning disabilities. The home is situated close to the town centre of Newark on Trent, which provides a variety of shops and recreational facilities. All residents are provided with single occupancy bedrooms on the ground and first floor. There is a well-equipped kitchen area, dining room, one lounge and a laundry facility on the ground floor. The home is not equipped with a passenger lift to access the first floor of the building. There is a ramp access to the main entrance and paved external areas provide space for outdoor activities to the rear of the property. The registered provider makes a Statement of Purpose and Service Users Guide available to all residents or their representatives, which provides good information relating to the facilities at the home. The fees currently charged at the home range from £376 up to £716 per week. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit. The main method of inspection used was called ‘case tracking’ which involved selecting residents and looking at the quality of the care they received by speaking with them, observation, reading records and asking staff about the residents needs. The manager and one member of staff were spoken to as part of this inspection. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of bedrooms to make sure that the environment is safe and homely. As part of the inspection process the registration certificate was reviewed with manager and the details on the certificate were correct. What the service does well: Comprehensive information is provided to residents and their representatives to ensure they can determine the suitability of the service in meeting their needs. Needs are assessed and personal goals are identified within individual plans of care. Good ranges of social activities are provided within the home and within the broader community. Residents are encouraged to maintain contact with their family and friends and are encouraged to lead an independent lifestyle. A comprehensive well-balanced menu is provided which is based on the preferences of the residents and residents are actively encouraged to participate in meal planning and preparations. Residents are confident that complaints, concerns and allegations are taken seriously and acted upon; they feel safe within the home. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 6 The home is maintained to a high standard throughout and residents expressed satisfaction with the quality of the environment. The home is run and managed by a person who is fit to be in charge who consults residents on a frequent basis so they can contribute to developments within the home. Recruitment practices are effective in promoting the safety of residents and the health, safety and welfare of residents is promoted through effective routine maintenance 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. The summary of this inspection report can be made available in other formats on request. Ashlea Care Home DS0000008621.V348502.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 Ashlea Care Home DS0000008621.V348502.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information relating to the service provision at the home is contained within the Service Users Guide, which provides residents with up to date comprehensive details relating to the service. People are assessed before they are admitted to the home to make sure their identified needs can be met. EVIDENCE: A Service Users Guide is made available to all potential residents or their representatives so they can decide on the suitability of the service in meeting the resident’s needs. A copy of the guide is made available in all the residents’ bedrooms for their reference. Records showed that the manager obtains a full needs assessment from Social Services departments prior to people gaining residency. The assessments are detailed, and provide good information about the background, support needs and lifestyle preferences of the residents. Ashlea Care Home DS0000008621.V348502.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. 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 this service. Residents’ assessed needs and personal goals are reflected in individual plans of care. Residents are encouraged to make decisions about their lives and are supported to take risks as part of an independent lifestyle. EVIDENCE: Risks to the resident’s safety are identified through effective risk assessments, Person Centred Plans (PCP) are formulated to address the identified needs and risks. The care plans were detailed and provided pictorial representations relating to the content of the care plans the aid residents in communicating their needs. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 10 A “key Worker” system is in place to ensure that the residents risk assessments and care plans are reviewed on a regular basis thus ensuring the changing needs and aspirations of the residents are identified and met. Care reviews are held regularly which include the residents, social workers and Community Psychiatric Nurses as necessary. Records showed that care-planning documentation in relation to pressure ulcer prevention and the administration of “as required” medication is now in place, thus adhering to a recommendation made at the previous inspection. In addition risk assessments for monitoring alarms are now in place. Risk assessments and care planning documentation is well organised and stored securely to protect the resident’s confidentiality. Residents said that they are able to take risks and their independence is promoted both within the home environment and the broader community. Residents confirmed that staff provide appropriate guidance and encouragement to develop their “life skills”. Rotas have been developed by the residents, which demonstrated that residents participate in tasks such as the planning and preparation of meals and domestic duties. Residents are also provided with the opportunity to attend day centres within the Newark area and are also encouraged to interact within the local community. Ashlea Care Home DS0000008621.V348502.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can participate in a range of activities. The resident’s rights and responsibilities are upheld and they can maintain contact with their family and friends. A comprehensive well-balanced menu is provided which is based on the preferences of the residents. EVIDENCE: Residents can participated in a range of educational and recreational activities within the home and the broader community. Residents said that they attend a local day centre 4 days a week and are provided with the opportunity to participate in arts and crafts, dancing sessions, yoga, bowling and cookery classes. One day a week is allocated to Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 12 residents to clean their bedrooms and change their bedding thus enhancing their life skills. Residents confirmed that they have regular walks in the town, go to the pub for meals, have picnics in the local area and attend the cinema. Residents also confirmed that they could utilise the “house car” to access trips to areas of interest. In house entertainment systems are provided in the main lounge, such as a television, music centre, DVD player and SKY television. Residents confirmed that the routines are flexible in the home and residents often stay up late to watch the television if they wish. Residents are also provided with the opportunity to participate in supported holidays if they wish. An “open door policy” is encouraged at the home and residents confirmed that support is given to maintain relationships with their family and friends. The residents, in relation to meal planning and preparation had developed a daily rota, which evidenced that residents take responsibility, under the guidance and supervision of staff, to plan and prepare meals and snacks thus promoting their independent living skills. Residents said that the meals are very good and a choice is always made available. Residents also confirmed that drinks and snacks are readily available. Residents confirmed that their respect and dignity is always promoted and said that the routine in the home is flexible and their choice is respected. We observed that interactions between the staff and residents were very respectful, unrushed and considerate to the needs and wishes of the residents. Residents are provided with keys to their bedrooms to further promote their privacy, lockable facilities are available in the resident’s bedroom to store personal possessions. Ashlea Care Home DS0000008621.V348502.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care support is of a good standard. Medicine management promotes the resident’s safety and independence. EVIDENCE: Residents said that staff provide personal support in a flexible and considerate manner and their independence and choice is promoted at all times. Records showed that interventions from members of the Multi-disciplinary team (MDT) such as General Practitioners, District Nurses, Social Workers, Community Learning Disability Teams and Community Psychiatric Nurses are provided to ensure that the physical and emotional needs are met. Residents spoken confirmed that that staff at the home always responded quickly to requests to see general practitioners if they are feeling unwell. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 14 Records showed that residents are encouraged to be independent in relation to the administration of medicine, if assessed as safe, following a risk assessment. A residents care planning documentation showed that the resident is encouraged, under supervision of staff to administer her daily insulin independently, the care plans provided specific details of the type of support required by the staff and highlighted the roles and responsibilities of the staff should any concerns be experienced. Medication Administration Records (MAR) for the case tracked resident were maintained in a safe manner and medication, which requires refrigeration, was stored securely and temperature monitored. Ashlea Care Home DS0000008621.V348502.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. 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 this service. Residents are assured that their complaints, concerns and allegations are taken seriously and acted upon. EVIDENCE: The residents spoken with said they felt safe and very well looked after. They said that should they have any concerns or complaints they would speak with the manager and felt confident that any issues would be addressed. A complaints procedure is displayed in a prominent position to enable residents or their representatives to access it. The procedure is also provided to all residents within the Service Users Guide and is available in a signs and symbol format to aid residents in highlighting concerns or making complaints. The complaints procedure clearly identifies whom the complainant should contact and specifies times scale in which the complainant will receive a response. To further promote the safety of the residents a Whistle Blowing and Safeguarding Adults policy is available in the home and staff confirmed that the policies are accessible at all times. The manager was not investigating any complaints at the time of the visit and CSCI has not received any complaints relating to the service provision at the Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 16 home since the last unannounced visit. The complaints file was examined and showed that one complaint had been made to the manager since the last inspection, which had been documented with actions and outcomes recorded. Training records showed that staff have received training in relation to the Safeguarding Adults and staff spoken with were able to confirm this. Residents or their representatives are encouraged to manage their own financial affairs. Secure facilities are available for residents to store small amounts of spending money. Records showed that all transactions are recorded and receipts for expenditures are retained thus protecting the residents from financial abuse. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a safe, well-maintained environment which is a very pleasant, comfortable and clean throughout. EVIDENCE: Residents expressed satisfaction in relation to the standard of cleanliness throughout the home. The resident’s bedrooms were homely, safe and personalised with many personal possessions such as family pictures, small items of furniture, a television, radio and ornaments to meet the needs of the residents. A ramp has been recently installed to the front of the building to aid access for people with restricted mobility. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 18 The homes internal environment, which included the dining room, kitchen and lounge area, is clean, fresh and homely. A well-maintained, secure patio area is available which incorporates a BBQ for residents to use in the summer months. Bathrooms were well maintained and odour free. Staff are provided with aprons, liquid soap and gloves to inhibit cross infection. Gloves, aprons and liquid soap are also available in the laundry facility following a recommendation from a previous inspection. Hot water outlets are temperature monitored to minimise to risk of scalds, and windows have opening restrictors in place to promote the security and safety of residents. It was highlighted at a previous inspection that the radiator in the dining room, which is sited close to a chair, should be covered to inhibit the risk of burns to the residents. The concern has not been addressed as yet although the manager stated that she would initiate risk assessments to ensure the residents are safe whilst in the dining area. Two washing machines are available but neither have a sluicing facility. It was identified at a previous inspection that consideration should be made to replace one washing machine with one with a sluicing programme; as yet a suitable washing machine has not been installed. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a well-trained and effectively supervised team of staff and recruitment practices are effective in promoting the safety of residents EVIDENCE: Residents spoken with said there is always enough staff on duty and staff are always available when they need them. The records showed that members of staff only commence employment once satisfactory Protection of Vulnerable Adult (POVA) checks and Criminal Record Bureau (CRB) checks have been obtained, together with two satisfactory references, thus promoting the safety and wellbeing of residents. Record showed that the service has achieved a target of 54 of staff trained, or working towards a National Vocational Qualification (NVQ) level two and above to ensure a suitably qualified workforce is employed at the home. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 20 Records showed and staff confirmed that a comprehensive staff-training programme is also provided in relation to Food and Nutrition, Moving and Handling, Basic Food Hygiene, Safeguarding Adults, Health and Safety, the Control of Substances Hazardous to Health (COSHH) and Infection Control. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run and managed by a person who is fit to be in charge. A resident’s consultation process is performed on a frequent basis to provide residents with the opportunity to contribute to developments within the home. The health, safety and welfare of residents is promoted through effective routine maintenance. EVIDENCE: The manager is experienced and qualified in social care, has worked at the home for many years and has almost attained the degree level Registered Managers Award (RMA). Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 22 Staff spoken with were very confident in the managers leadership and managerial skills and said they felt well supported and valued. Residents spoken with also expressed a great deal of satisfaction in relation to the management structure and said, “The manager and the staff at the home are great”. Records showed that the manager maintains continual high standards through effective quality auditing procedures as she performs a monthly “compliance confirmation report” which assesses all aspects of service provision at the home. The area service manager from the Royal Mencap Society also performs regulation 26 visits. Policies and procedures are reviewed annually and staff confirmed that the documentation is readily accessible for guidance and information. All records seen during the inspection were maintained to a high standard. Residents said, and records showed that residents meetings are performed on a three monthly basis to allow residents to be involved in any development within the home. Resident’s surveys are also performed on a yearly basis to identify any concerns and comments residents might have in relation to the service provision. Resident’s health, safety and wellbeing is promoted by the provision of effective routine maintenance which now includes weekly fire alarm tests. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 23 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 3 2 3 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 3 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 3 3 3 x 3 x 3 x x 3 x Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 24 NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA30 YA24 Good Practice Recommendations Appropriate sluicing facilities could be made available to protect the residents from infection. Risk assessments could be performed to ensure that residents are not placed at risk of burns from the unguarded radiator in the resident’s dining room. Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashlea Care Home DS0000008621.V348502.R01.S.doc Version 5.2 Page 26 - 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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