Inspection on 27/11/07 for Carrickfinn

This inspection was carried out on 27th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Carrickfinn 09/10/08

Carrickfinn 06/12/06

Carrickfinn 02/02/06

Carrickfinn 25/08/05

Carrickfinn 26/01/05

Carrickfinn 10/05/04

Carrickfinn 30/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Carrickfinn 29a St Werburghs Road Chorlton-cum-Hardy Manchester M21 0TL Lead Inspector John Oliver Unannounced Inspection 27th November 2007 10:00 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 Carrickfinn DS0000021539.V351249.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. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carrickfinn Address 29a St Werburghs Road Chorlton-cum-Hardy Manchester M21 0TL 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) 0161 860 5889 Sheila Devanney Mary Mills Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2006 Brief Description of the Service: Carrickfinn is a care home for older people providing personal care only for a maximum of 16 people. The home is situated in the Chorlton-cum-Hardy area of Manchester, within easy reach of Manchester City Centre and is well served by public transport to the neighbouring areas of Stretford, Stockport and Didsbury. The home is a two-storey building with a single storey extension to the rear of the property and a new conservatory has recently been added to the front of the property. The home is situated in its own grounds that have an established and accessible enclosed garden for the use of the residents. There are eight single and four double bedrooms and as the home does not have a passenger lift first floor accommodation is restricted to those residents who can access stairs safely. The dining room and lounge are open plan. There is a no smoking policy in the home. The kitchen is situated next to the dining room. There are bathrooms and toilets situated on the ground and first floor. The range of accommodation fees charged was between: £358:09 and £373:54 Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Commission for Social Care Inspection) in relation to the home prior to the site visit. The visit, which the home did not know was going to happen, took place over the course of six hours on Tuesday 27 November 2007. During the course of the site visit we spent time talking to residents, the manager, deputy manager, visitors and staff on duty to find out their view of the home. Before the site visit we went the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information about the service they provide. This was returned to us before the visit took place and contained some basic information provided by the manager that helped us to assess the service being offered by the home. We also spent time examining various files and written information and spent some time looking around the building. We were concerned that some staff had been employed in the home before all pre-employment checks had been fully completed such as Criminal Record Bureau (CRB) checks and we left the manager a letter telling them what they needed to do about this. What the service does well: We found the atmosphere in the home to be relaxed, comfortable and informal and residents spoken to said that they like living in the home and that they can choose for themselves how they would like to spend their day. One resident told us “ I was told all about the home before I came – I’ve not been here long but I really like it”. The significant improvements made to the environment since our last visit demonstrated that the management and staff team had continued to work hard to provide residents with a comfortable place to live. Watching the staff and managers interacting with the residents and visitors gave us a good indication that people living in the home felt comfortable with the staff team and found them to be approachable. Comments from residents and staff in the home included: * * “I get my tablets when I should – twice a day”. “Staff are very good – I’m glad I came to live here”. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 6 * * * “(There is) always enough staff around – they are all very good and help you when you need it”. “The management team are really good”. “Both managers are approachable and very understanding”. 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. Carrickfinn DS0000021539.V351249.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 Carrickfinn DS0000021539.V351249.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before admission into the home. EVIDENCE: The manager told us that all prospective residents receive a pre-admission assessment visit before they move into the home. During this visit the manager gathers information that will help her and the staff decide if the home is suitable to meet the individual needs of the person being assessed. We looked at the files of two recently admitted residents and both contained an assessment carried out by the manager of the home. The information contained within these assessments was basic but was sufficient to give an indication if the home was a suitable placement for the person. Along with the management assessment was the care management assessment from Social Services. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 9 Wherever possible, prospective residents and their family/representative were encouraged to view the home prior to making any decisions about moving in. We spoke with one of the recently admitted residents who told us, “I was told all about the home before I came – I’ve not been here long but I really like it”. The manager told us that the home does not provide an intermediate care service. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The on going health care needs of residents had been identified and were being met. Medication policies and procedures could be further improved. EVIDENCE: We saw that each person living in the home had an individual care plan on file and these had been developed by the manager using the information gathered from care management assessments and the homes own pre-admission assessment documentation. Of those care plans examined, details appeared to be comprehensive and evidence that monthly reviews had been carried out was seen. Since our last visit to the home in December 2006 there had been improvements in the way in which risk assessments are completed and much more detail was included about how the risk was to be managed. Each month the manager reviews care plans and risk assessments and updates them if needed and although the manager said she has encouraged residents to participate in reviewing their own care plans with the staff, most had declined to do this. Wherever possible, care plans should be signed by the Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 11 resident and or their representative to show their involvement in the process. If declined, this should also be recorded in the residents’ notes. We saw from information on resident’s files that other health care professionals such as district nurses and doctors regularly visit people living in the home. One doctor in particular visits the home on a monthly basis to see all her patients and to review their medication. During our visit we watched how staff interacted with residents and noted that good relationships had been developed. Staff were respectful in the way they supported the residents and also ensured that the residents’ privacy was respected by way of knocking on doors before entering and allowing people time in their own rooms should they wish. Medication is administered via a Monitored Dosage System and the manager told us that all staff with the responsibility for administering medication had recently received updated training in the Safe Handling of Medication. We checked the Medication Administration Records (MAR) and most were found to be appropriately completed. However, the supplying pharmacy had made some errors when printing out the MARs and had recorded the same medication a number of times on the current sheets. This was confusing for staff and had resulted in staff being unsure which MAR needed to be signed to show medication had been administered. It is important that when such errors are found staff take appropriate action to rectify the problem in order to minimise any potential risk to residents from medication not being administered appropriately. One resident spoken to about medication said, “I get my tablets when I should – twice a day”. We saw evidence that all prescriptions are received by the home before being sent to the pharmacy for dispensing and are checked to ensure the right medication has been prescribed. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had choice and support to meet their expectations and preferences regarding their daily lifestyle. EVIDENCE: The manager told us that she employed two activity organisers with specific responsibilities to support residents to participate in activities and hobbies they enjoy doing on a daily basis and activities take place for at least 3 hours per day, seven days per week. We watched a number of residents happily making Christmas decorations with one of the organisers ready to decorate the lounge next week. One of those residents involved told us that he “enjoyed doing this type of thing”. The activity organiser keeps records of all residents who are involved in any activity that takes place and makes sure that those who enjoy a particular activity are invited to join in. Seven of the ten survey questionnaires returned to the Commission by residents indicated that activities are ‘Always’ arranged for people to Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 13 participate in. When we asked some of the residents what type of activities are usually available they told us “We play games in the afternoons – I join in if I want to”, “We went to Blackpool a few weeks ago – saw the lights” and “We have a good old sing song now and again”. Menus are planned in consultation with residents using a four weekly menu cycle. Two main choices are available each day and the cook asked residents individually what their preferred choice was. Questionnaires returned to the Commission confirmed that residents were happy with the meals provided and residents we spoke to said “You always get a choice” and “The meals are really good – I like my food”. We saw that menus included healthy option meals that any resident could choose if they preferred. The manager told us that nutritional assessments are carried out as part of the admission process and then reviewed and monitored on regular basis. Residents told us that visitors are made very welcome when they come to the home and during our visit a lady from a local church visited to administer communion to those residents who wished to receive it. The home uses the services of a local mobile hairdresser and on the day we visited some of the residents were enjoying having their hair set. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had relevant policies, procedures and systems in place to enable concerns to be raised and to protect residents from neglect and/or abuse. EVIDENCE: Information about how to make a complaint is included in the Service User Guide and residents have a copy of this in their room. We spoke to a number of residents who told us that if they had a concern or complaint they would “Go to Mary (manager)”, “I would speak with one of the girls” and “I would tell Mary or Jasmine (deputy manager)”. Of the ten questionnaires returned to the Commission, 6 stated ‘yes’ they knew how to make a complaint, 3 stated ‘no’ and one included the comment: “Go and tell who I can find”. We examined the complaints records kept by the manager and these showed one complaint had been recorded since our last inspection visit and that this had been appropriately dealt with. There was a detailed policy and procedure relating to the protection of vulnerable adults, including the Local Authority’s multi-agency procedure ‘No Secrets’. The manager told us that no allegations of abuse had been made or referred since our last inspection visit. When we spoke with the managers and staff they were able to demonstrate that they were clear about the procedure to follow in the event of an allegation of abuse being made etc. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 15 Staff also confirmed that they had received training in the Protection of Vulnerable Adults. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The general environment of the home was clean, tidy and comfortable with systems in place to protect the health and safety of the residents. EVIDENCE: Since the last inspection visit conducted in December 2006 significant improvements had been made to the environment that included the building of a new conservatory and this has made a vast improvement to the space that is available for residents to use. The manager had also carried out an updated audit of the standard of furnishings and decoration of all bedrooms and communal areas of the home. Following this a number of bedrooms had been redecorated and had new furniture supplied, along with new carpets and new armchairs. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 17 The lounge area was appropriately furnished and 15 new armchairs had been purchased for the comfort of the residents along with new tables and chairs for the dining area. All hallways, stairways and landings had been redecorated and new carpets and floor coverings had been laid throughout the home. To help maintain the carpets in good condition two new vacuum cleaners and a new carpet cleaner had also been purchased. Other maintenance work to the premises had also been carried out including the re-landscaping of the rear garden that involved patios and pathways being upgraded and new fencing panels being erected. For the added protection and safety of both residents and staff the fire alarm system has been upgraded and new emergency lighting had been installed at the rear of the premises that will light up should the fire alarm be activated. No unpleasant odours were detected during a tour of the premises and those areas seen were clean, tidy and pleasantly furnished. Bacterial hand wash and paper towels had been provided in toilets, the kitchen and the laundry area. A number of doors were not closing onto their rebates effectively and, as these are fire doors, could place both residents and staff at risk. It is recommended that a full audit of all doors takes place and adjustments be made where necessary. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment and selection policies and procedures that are in place were not being fully adhered to leading to the potential for residents to be put at risk. EVIDENCE: The manager told us that two new members of staff had been employed in the home since the last inspection visit in December 2006. We looked at the files of those staff and information contained within each file was inconsistent and not all relevant information was in place. There was clear evidence that one member of staff had started working in the home before any Criminal Record Bureau Checks (CRB) or POVA First checks had been applied for and no written references had been received. We issued a letter telling the manager what she needed to do about the person who was working in the home without a CRB check or written references. The manager immediately suspended this person from working in the home until all such checks had been applied for and been received back. We had a full discussion with the manager about the importance of gathering all relevant documentation before a new member of staff started work in the Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 19 home including all relevant pre-employment checks. Lack in obtaining such information can place both residents and other staff at risk from unsuitable people being employed in the home. We looked at staffing rotas and they demonstrated that enough staff appeared to be on duty at any one time to meet the needs of those residents living in the home and the manager confirmed this. Staffing was discussed with two residents who said “Staff are very good – I’m glad I came to live here” and “(There is) always enough staff around – they are all good and help you when you need it”. We also spoke with a member of the staff team who said, “There is usually enough staff on duty, we are a good team of staff and we all work well together”. The manager told us that she keeps an individual record of all the training staff undertakes and we saw evidence of this on the computer. We saw that individual records contained the date training took place, the type of training attended, whether the training had been successful and the date of review. The manager also told us that 95 of the care staff team had successfully completed National Vocational Qualification training Level 2. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run in the best interest of residents but some improvements are needed. EVIDENCE: The registered manager has the necessary experience to manage the home and, as she has been in post for a number of years, knows the residents very well. The manager told us that she participates in all the same training that the care staff do and that she has recently re-started the Registered Managers Award. The deputy manager has recently completed this award. Both residents and staff were very complimentary about the managers and comments included, “The management team are really good”, “Both managers Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 21 are approachable and very understanding”. However, poor management of staff recruitment can place residents and staff at risk from unsuitable people being employed to work in the home. In order to try and further develop the service offered by the home, the management team gave residents, relatives and visitors to the home an opportunity to complete a questionnaire that asked relevant questions about the service offered by Carrickfinn. Those questionnaires we examined were all very positive in their responses about the home, the care received and the management. It is recommended that the management team should review the answers to the questions asked and develop an action plan to address any particular issues raised or to further develop the service offered by Carrickfinn. The manager told us that the registered provider (owner) of the home visited every Tuesday and Friday and spent time talking with residents and staff. Since our last visit to the home in December 2006 the owner had been completing a monthly report and these reports were seen on file. Where the management team supported residents to maintain their personal allowance, records were kept of monies spent with receipts obtained. Each resident has a small safe in their bedroom in which they could put small personal items of value etc. We spoke to a number of staff and they confirmed that they received regular one to one supervision from the managers and that written notes are kept. The manager told us that all required maintenance of equipment had taken place and we looked at a random selection of maintenance records to confirm this. Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 22 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 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13 (2) (4) Requirement Staff with the responsibility for administering medication must do so in accordance with policies and procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Managers of the home must ensure that no unnecessary risks are taken when employing new staff to work in the home. New staff must not start working in the home until all required preemployment checks have been successfully completed. (Previous timescale 31/01/07 not met) Timescale for action 04/12/07 2. OP29 19 29/11/07 Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 24 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 It is recommended that care plans be signed by the residents and/or their representative to show their involvement in the process. It is recommended that an audit of all fire doors takes place and adjustments made where they do not fit onto their rebates effectively. 2. OP19 Carrickfinn DS0000021539.V351249.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Carrickfinn DS0000021539.V351249.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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