Inspection on 24/11/05 for Buxton House

This inspection was carried out on 24th November 2005.

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 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buxton House 22/04/08

Buxton House 12/12/07

Buxton House 31/05/07

Buxton House 05/07/06

Buxton House 15/08/05

Buxton House 23/03/05

Buxton House 11/11/04

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

CARE HOME ADULTS 18-65 Buxton House 50 Barrow Road Streatham London SW16 5PG Lead Inspector Mary Magee Unannounced Inspection 24 & 25 November 2005 10:00 Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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 Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Buxton House Address 50 Barrow Road Streatham London SW16 5PG 020 8679 2846 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) janet-yeboah@uku.co.uk Buxton Healthcare Ltd Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2005 Brief Description of the Service: Buxton House is a care home located in an end of terrace house on a residential road in Streatham, South west London. It was first registered in July 2004 to provide care and accommodation for up to six people with mental health related issues. There are six bedrooms laid out over three floors, a lounge, dining room/kitchen and a conservatory. It is a short distance away from public transport facilities and the local shopping area. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a two-day period. On day one the pharmacy inspector also assisted with the inspection. The owner as well as the newly appointed manager met with the inspectors. Feedback was received from three of the four service users. They spoke to the inspectors individually, their comments are included in the report. Comments received also include those of a visiting social worker. A number of records were viewed. These included service records and personnel records of service users and staff.A tour of the building was conducted. All communal areas were viewed as well three bedrooms.There are currently two service user vacancies. . What the service does well: What has improved since the last inspection? A new qualified person with a wealth of experience and knowledge has taken over the management of the home. There has been a notable improvement in the care planning arrangements. Risk management strategies have also been adopted that respond swiftly to identified risks. Staff have become more competent and monitor effectively the psychological and physical conditions of service users Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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 Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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): 1234 Staff competencies have developed so that service users’ needs are recognised and understood. EVIDENCE: All four service users were out of the home attending a variety of activities in the community on the first day of inspection. These ranged from college courses to voluntary work at a garden centre. On weekdays service users spend most of their time engaging in fulfilling activities and preparing to lead lifestyles that are more independent. The inspector found that there had been progress at the home. Feedback was received from an approved social worker visiting the home. He spoke positively of the progress made by service users at the home. Service users conditions are monitored closely especially the psychological state of individuals. Early warning signs such as behaviour changes are responded to. There is a close working relationship with the mental health team, with action taken promptly to deal with relapses and involve the Community Psychiatric Nurse (CPN) or Approved Social Worker (ASW). Three service users were spoken to individually. All three have found that the home is meeting their needs. They said that since they moved there they had made steady progress. They also found that the home was comfortable and the staff were supportive. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 9 Members of staff have received training in looking after people with mental health needs. One morning is set aside each week dedicated to training staff in a relevant subject. Support staff are currently attending NVQ training programmes at college to acquire NVQ Level2 & 3 in care. The home has a new manager in post. The service users’ guide and the statement of purpose should be updated to reflect current changes to staffing personnel. Service users’ needs are considered and fully assessed before they are admitted to the home. Both the owner and the new manager visited a prospective service user at the hospital. They discussed with the inspector the referral as well as other referrals that were considered inappropriate. Decisions are taken not to accept new admissions unless they were confident that they can meet their needs at the home. Service users have a trial period at the home before deciding if they will move there temporarily. The owner showed the inspector evidence of when a service user had his trial period extended by six weeks to allow more time for testing the home. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 10 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): 6789 Service users receive assistance and support to make decisions as needed. Systems are in place to assess, monitor and meet changing needs as they arise. Risk management strategies have been developed and agreed to try and ensure that unnecessary risks to the health and safety of service users are identified and as far as possible removed. EVIDENCE: Service users were spoken to individually when they returned to the home. They expressed the views that the home promoted opportunities for them to make every day choices in their lives. The majority of service users access services externally independently. For service users that require more support and encouragement support workers provide this. Service users on return to the home were seen interacting with staff. Staff were keen to find out the experiences of service users during the day. There are limitations as well as some restrictions for service users, all are and detailed in care plans. These are linked to early warning signs of relapses. Agreements were signed by service users to acknowledge these limitations. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 11 There were also copies of restrictions imposed by the NHS prior to admission. For one service user he had not received a copy of these as the mental health team had considered it a catalyst to provocative behaviour. Service users’ needs and short term and long-term goals are set out in care plans. Daily progress reports are maintained for each service user. Monthly reports are written by key workers that give a clear picture of how service users are progressing. There is evidence that service users’ health both physical and psychological is closely monitored. In the event of indicators of an imminent relapse, there was evidence that CPN involvement was sought promptly. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 12 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): 11 13 14 17 Service users receive a service that is flexible, consistent and reliable. Staff support service users to access leisure and educational facilities in the community. Meals served take into account individual cultural and religious requirements. EVIDENCE: All four-service users are in the younger age group and come from minority ethnic backgrounds. They have plenty of opportunities for personal development. Service users have made steady progress and grown in confidence and self esteem. One service user spoken to found that the support he received helped him in his recovery. The home is conveniently located to a number of leisure facilities, swimming pool, large common and cinemas and bowling centre and gyms. Service users take part in a wide range of fulfilling and stimulating activities, these range from independence training and education to voluntary employment. One service user enjoys gardening with the First Step Trust. Two service users spoke of the knowledge that the provider had of local facilities Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 13 and of her encouragement and support for service users to pursue their interests. Service users have regular house meetings where they discuss and plan activities and meals. Minutes were held of these for reference. A dietician was consulted on meals provision for service users. There is a booklet/cookery book in the kitchen, used for new ideas and for recipes in preparing culturally appropriate meals. Service users like the locality and explore the facilities locally. One service user spoken to said that he liked living at the home as it was convenient for his family to visit or for him to visit his relatives. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 14 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 Staff are vigilant in monitoring service users’ conditions. They work closely with healthcare professionals and seek their advice promptly to early warning indicators and to prevent relapse. EVIDENCE: Service users receive the support they require to manage their own healthcare and access community and hospital health facilities. Service users are registered with local GP surgeries. Service users have experienced mental health difficulties and are vulnerable. The health of service users is monitored closely and potential complications are identified and dealt with early by staff that are vigilant. There is good information available on service users’ files. These include the early warning/indicators of changes to individuals’ conditions. For one service user deterioration was observed in his psychological state. Staff were concerned and alerted his CPN. The ASW was also called. He was admitted to hospital to prevent further relapse. Service users attend weekly appointments with the mental health team out of borough. They also collect their weekly medication while there. One service user has transferred to local mental health team. He is progressing well at the home and is consistent at attending his appointments. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 15 Regular reviews and CPA meetings are held for service users. The minutes of these are held on service user files. The pharmacy inspector examined the medication procedures and is producing a separate report on this. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 16 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 The home operates a system that is effective at hearing and responding to issues or concerns raised by service users. EVIDENCE: Service users feel that their views are listened to and taken on board. They hold regular house meetings and put forward their ideas and suggestions. The home has produced a new complaints format outlining the procedures. All three-service users spoken to are familiar with the complaints procedure to be used. The complaints log was viewed. These indicated that issues raised were responded to within agreed timescales. The home has procedures and policies in place to safeguard people from neglect or abuse. The staff team have received training in this field at the home. There local authority Adult protection coordinator has planned to deliver additional training on local procedures in January 2006. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 26 27 30 Service users live in homely comfortable and safe environment. It is totally domestic in style. There are pleasant good sized bedrooms so that service users can accommodate their belongings. EVIDENCE: Service users enjoy living in comfortable and homely surroundings with personal possessions around them. The house is semi-detached and is not recognisable as a care home. It blends well with surrounding properties. There are six bedrooms in total, a large lounge, dining room and kitchen and a conservatory. All the communal rooms are pleasantly maintained. Bedrooms are located on the ground floor, first floor and second floor. Four rooms were viewed. These were pleasantly presented and personalised. In one bedroom, the bed linen was soiled and shabby and needs to be replaced. The premises were clean and well ventilated. Care is taken to ensure that fridges and freezers are monitored and maintained at correct temperatures. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 18 It is well located and convenient to many services. There are six bedrooms. Two of these rooms were vacant at the time of inspection. Bedrooms are comfortable Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 36 The staff team reflects the cultural composition of service users and relate well to service users’ needs. Staff require further training and development so that the home has a quality workforce in place. EVIDENCE: From discussions with staff it was evident that they were clear about their roles and responsibilities. Staff members interacted well with service users. Service users spoken to have developed a trust in the staff team and value the support given. There has been progress made in terms of training provided to staff in house. Staff were motivated and felt that they had made good headway and that they had developed new skills. Four support workers are attending college for NVQ training. The owner said that the assessor came to the home weekly to work participating staff. Those spoken to told of the training sessions dedicated to providing knowledge on specific conditions experienced by service users. Weekly training sessions are held at the home. The newly appointed manager has extensive experience in the mental health field and has been engaged as a consultant to assist with training prior to her management appointment. A social worker visiting the home spoke of the benefit service users received from living at the home. He said, “he saw service users mature since admission and develop in reliability and stature”. This he felt was due to the input of the staff at the home. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 20 Rotas were viewed. Two members of staff are normally on duty during the day. On occasions, it was evident that less than the required number were available and working at the home. The registered person must ensure that at all times there are suitable numbers of qualified staff working at the home appropriate to the needs and welfare of service users. One member of staff is employed as waking night staff. The owner said that she was on call and lived locally should there be any emergency. The emergency numbers of persons from the mental health team are also displayed for staff. There are clear guidelines in place on management of service users if there are concerns identified. Training in specific topics has been good but provision has not been developed to respond to staff training needs. A training needs assessment has not been carried out for the staff team to identify benefits for service users or to influence future planning. The training and development programme needs to be planned to respond to the training needs of individual staff members as well as to service users assessed needs. The evidence from viewing the induction and foundation training was that it was very basic but not according to Sector Skills Councils (SSC) specifications. There was no specific training budget set aside for staff training and development for the staff team. It was the subject of a requirement at the two previous inspections that staff training must be considered. While the inspector recognises that there have been positive steps taken to provide staff training, a structured induction training programme to SSC specifications as well as training and development programme for the staff team are needed. Requirements were within timescales however due to the change of management additional time is required to comply with this. Two staff files were viewed. Both contained CRB enhanced disclosures and two references, however one file contained only one reference. It was the subject of a requirement at previous inspection that recruitment procedures are thorough. It is restated as a requirement. The owner confirmed later with the inspector by telephone that the second reference had been misfiled and was asked to forward a copy for confirmation to the inspector. Staff team meetings are held but one to one supervision is not consistent or regular. The owner was confident that the home would benefit from the qualifications and experience of the newly appointed manager. She said that the manager placed the emphasis on developing the staff team and to providing regular and consistent supervision. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 41 42 A new manager with vast experience in the mental health field has been appointed. Already she has begun to share her expertise by delivering training to the staff team. Some improvements are needed to the recordkeeping procedures as the required information is not always stored and held appropriately. EVIDENCE: A new manager has been appointed for the home. She had received an application form to register with the commission. She is a qualified Registered Mental Nurse (RMN) and has many years experience in the mental health field. She is known to the home as she has been assisting with pre admission assessments as well as internal reviews for service users. It was not possible to evaluate the management approach of the home as she was in post for such a short period. A completed application form to register as the manager must be forwarded to CSCI. Positive comments were received from service users and the social worker regarding the input of the owner. They have found her to be interested in Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 22 and play a supportive role for service users. Recordkeeping is not very good, examples such as staff personnel files with information misfiled, the records with staff signatures acknowledging training and competencies had also been misfiled and were unavailable on the first day of inspection. Records relating to the upkeep of the premises and the equipment in it were viewed. A recent gas certificate was available. Regular checks are made of fire fighting equipment, fire drills are also undertaken. The registered provider’s son carries out health and safety checks every three months of the premises. Recommendations were made by LFEDA last year. The registered person must forward confirmation that fire recommendations made have been addressed. Visits in accordance with Regulation 26 are undertaken every month. Copies of reports made of these visits are sent to the Commission. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 X 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 2 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Buxton House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X 2 2 X DS0000041799.V256522.R01.S.doc Version 5.0 Page 24 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 Standard YA30YA26 Regulation 16 (2) c 16 (2) e Requirement Timescale for action 30/01/06 2 YA35YA33 18 (1) c 3 YA33 18 (1) a 4 YA34 19 (1) a,b,c. The registered person must ensure that service users are provided with bedding of good quality. which is suitable. This is to be kept laundered and maintained to satisfactory standards. 30/03/06 The registered person must ensure that staff working at the home have the qualifications suitable to the work they are to perform, and the skills and experience necessary for such work. An Induction and Foundation Training as well a training and development programme that meets Sectors Skills workforce training targets are needed for the staff team. The registered person must 30/01/06 ensure that at all times there are suitable numbers of qualified staff working at the home appropriate to the needs and welfare of service users The registered person must 30/12/05 ensure that references for staff applying to work at the home are checked. DS0000041799.V256522.R01.S.doc Version 5.0 Buxton House Page 25 5 YA36 18 (2) 6 YA37 8 7 YA39 24 (1) a b 8 YA41 17 (2) 17 (3) b 9 YA42 23 (4) a b cde There has been progress but remains unmet in timescale of 30/09/05) The registered person must ensure that staff are regularly supervised and supported. Previous timescale of 30/09/05 not met. The registered person must ensure that an application form for the registration of the manager is completed and submitted to CSCI The registered provider must ensure that a system is established and maintained for reviewing at appropriate intervals and improving the quality of care provided at the home. The registered person must ensure that all the records specified in Schedule 4 are maintained and available at all times The registered person must forward to the inspector written confirmation of evidence that recommendations made by LFEDA were addressed. 30/01/06 30/12/05 30/03/06 30/12/05 30/12/05 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 YA1 Good Practice Recommendations The registered person should ensure that the statement of purpose and the service user’s guide is updated to reflect staffing changes including qualifications. Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Buxton House DS0000041799.V256522.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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