Inspection on 10/08/06 for Charles Lodge

This inspection was carried out on 10th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Charles Lodge 19/06/08

Charles Lodge 17/01/06

Charles Lodge 24/08/05

Charles Lodge 16/02/05

Charles Lodge 08/09/04

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

CARE HOMES FOR OLDER PEOPLE Charles Lodge 75 New Church Road Hove East Sussex BN3 4BB Lead Inspector Kevin Whatley Key Unannounced Inspection 10th August 2006 10:30 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 Charles Lodge DS0000058240.V300041.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. Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charles Lodge Address 75 New Church Road Hove East Sussex BN3 4BB 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) 01273 777797 Nicholas James Care Homes Ltd Mrs Gloria Elizabeth Draper Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-seven (27) of which a maximum of fourteen (14) can have a dementia type illness. Service users must be older people aged sixty-five (65) years or over on admission. 17th January 2006 Date of last inspection Brief Description of the Service: Charles Lodge is a care home for 27 older people, 14 of those accommodated at any one time can have a dementia type illness. The home is located in Hove being accessed by a quiet drive. The home is a three storey detached building with a passenger lift. The accommodation consists of 17 single rooms of which 14 have en-suite facilities a further 5 bedrooms are double rooms and all of these have en-suite facilities. The home has 8 WC’s, 4 bathrooms and 2 separate shower rooms. The home has a lounge, dining room and additional sun lounge at the front of the home. The home has a level garden around three sides of the building. The home is a short distance away from local shops and connected to other local towns by bus services that run close to the home. As of 10th August 2006 weekly fees at the home ranged between £280.80 to £550 depending on the level of care needs each resident has with additional costs required for personal toiletries, chiropody, hairdressing and newspapers. Information regarding the home and the services it offers are found within the homes statement of purpose and service user guide, whilst a copy of the most recent inspection report is kept at the home. Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Charles Lodge will be referred to as ‘residents’. The unannounced inspection visit took place on a weekday in August being carried out by the Link Inspector for the home. The inspection visit lasted for approximately 5 hours. At the time of the inspection Charles Lodge was accommodating 27 residents and was therefore full. The Inspection included a tour of the premises, both inside and out, and it’s facilities with many residents agreeing for their bedrooms to be viewed. The Inspector spoke with the registered manager, the deputy manager, a senior carer, two members of care staff and the cook. Approximately six residents were spoken to during the inspection; whilst care staff were observed carrying out their duties. A number of records and documents required by regulation were also seen during the site visit including the accident book, the fire safety record, the complaints book, the medication administration record book and a sample of staff records. In preparing this report it was also necessary to assess and consider additional information concerning Charles Lodge. Such information was gathered from a number of sources including service history information held at the Commission for Social Care Inspection (CSCI) offices, 6 surveys returned by residents prior to the inspection visit, and telephone contacts with Social Workers. What the service does well: Charles Lodge provides residents with a home that is suitably furnished and well maintained within an environment that is relaxed, informal and caring. The daily routines of the home are flexible and unhurried and many residents enjoy considerable autonomy, whilst opportunities are available for residents to enjoy the company of others and to engage in activities and events. Meals at the home are home cooked, varied and nutritious with many residents commenting positively on the diet they receive and the choices available to them. Staff offer and provide care in a sensitive and respectful manner and the management approach of the home ensures that the needs of residents are put first. Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Charles Lodge DS0000058240.V300041.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 Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that no resident is admitted to the home without having had their care needs fully assessed, whilst relatives and carers are included in the admission process. EVIDENCE: Since the last inspection just one new resident has been admitted to the home. The care plan of this resident confirmed that their care needs were fully assessed by the registered manager prior to them moving in. This included the resident being visited by the registered manager at hospital where she carried out a care needs assessment that included identifying and assessing all key areas of need such as the physical, emotional and mental health needs of the resident. This resident was admitted with an assessed low level Dementia illness and is the first resident to be admitted with such needs since the home amended it’s registration criteria, whereby a number of residents can be accommodated with a Dementia type illness. Documents also confirmed that Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 9 hospital and social services assessments were forwarded to the home prior to any decision being made to admit the resident. The registered manager stated that she assessed the resident whilst keeping in mind the needs of existing residents to ensure that the overall care needs of existing residents were suitably considered to ensure their care needs and lifestyles were not comprised in any way. Records confirmed that the residents next of kin was involved in the admission process and signed the contract of residency on behalf of them. Charles Lodge DS0000058240.V300041.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal care needs of residents are suitably assessed and incorporated into robust plans of care to ensure their the individual needs, abilities and wishes are met by care staff in a consistent manner. The home must ensure that the medical needs of residents are properly adhered with to ensure they receive the medication they require. EVIDENCE: Five care plans were viewed, these confirmed that all residents have their care needs fully assessed prior to moving into the home and that such needs are incorporated into individual plans of care. Each care plan was seen to contain all necessary details including essential information such as names and contact numbers for the residents next of kin and where relevant the contact details for their Social Worker. Care plans contained details of the resident’s physical, emotional, social and medical needs and outlined how care staff should carryout personal care tasks. Each care plan is reviewed on a monthly basis by the registered manager with named key-workers overseeing particular aspects of individual care support such as liaising with relatives/carers. Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 11 The health care needs of residents are clearly detailed within health care plans and include details of the residents G.P, their medical requirements and how these should be met, health care appointments and visits from health care professionals such as District Nurses and where required weight and skin viability charts. Staff spoken with explained that the care planning process allows them to ‘keep in touch’ with any changes to ‘any resident’s plan of care’ and noted that when a resident has had a review that the details of this are included in staff handovers. All resident’s spoken with and all completed resident questionnaires commented positively on the level and standard of care they receive. One resident stated that ‘they take care of me very well’, whilst another noted that ‘I couldn’t wish for a better place to live’. Residents medication needs are clearly documented with details of the medication they are on and the doses etc. Since the last inspection the home have addressed the need for staff to undertake further medication storage and administration training, with all staff recently participating in the course. Medicines are stored in a suitable lockable cupboard in the staff room. The medicine administration records were viewed and these were found to be generally well maintained with accurate and up to date entries. However an open pot containing a number of tablets was found in the cupboard and on checking these against the medicine administration records the residents in question’s blister pack was found to contain a number of tablets that had been signed as being given earlier that day. The registered manager stated that the rota indicates who is in charge of medication on every shift and noted that this matter will be taken up with the member of staff concerned as a matter of urgency. On discovering this error the registered manager arranged for the resident to receive the full amount of their prescription immediately and commented that she monitors medicine administration records weekly. Charles Lodge DS0000058240.V300041.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 at least once during a 12 month period. 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 benefit from relaxed routines that allow them opportunities to live a lifestyle as they wish. Residents are assisted to maintain contact with others outside of the home and have their individual preferences considered. The home ensures that residents receive a healthy and nutritious diet. EVIDENCE: Residents stated that they can choose where they want to eat and spend their time. A number of resident’s commented that they enjoy spending time in their rooms watching television or reading. Several residents are able to visit the local shops on their own; the home had completed risk assessments for those that venture out alone. The atmosphere in the home was found to be relaxed and it was clear that residents are able to lead a peaceful and unhurried lifestyle. On the day of the inspection visit an afternoon activity took place in the downstairs lounge. The home have acquired the services of a volunteer who visits the home twice a week to facilitate activities including skittles, bingo and quizzes. Residents stated that ‘it is up to us whether we join in or not’ and noted that ‘it can be good fun’. A number of residents have their religious Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 13 needs met by the visit of a priest to the home, whilst a number of other residents attend a local church every Sunday. The homes cook was spoken with, whilst the menu was viewed. The menu confirmed that the residents benefit from a varied, balanced and nutritious diet with a majority of the meals being home cooked. The inspector was invited to join residents for lunch, this was found to be well prepared, well presented, tasty and nutritious. Meals are taken in the main dining area that is pleasant and bright. Residents stated that the food was ‘really very good’ and confirmed that should they wish an alternative to the days menu that ‘they only have to ask for something different’ and the cook is ‘very accommodating with my requests’. Charles Lodge DS0000058240.V300041.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 inspected at least once during a 12 month period. 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 has a suitable complaints procedure that ensures residents and others can express their views easily. Residents are protected from the risk of harm, neglect or abuse. EVIDENCE: The homes complaints procedure clearly outlines the manner that residents and others can make a complaint and how the home must respond to any issues or concerns. The procedure is displayed in a communal area of the home and detailed further in the homes statement of purpose. The homes complaints book was viewed and evidenced that no complaints had been recorded since the last inspection. The CSCI have not received any complaints regarding the home since the last inspection. Residents noted that they felt ‘very able’ to talk to the registered manager if they had any concerns. The home have a suitable adult protection policy that includes ‘whistle blowing’ whilst procedures comply with the local area adult protection protocols. Since the last inspection the home have adopted a new induction programme for staff that addresses key areas of care provision including adult protection. All care staff currently employed at the home have undertaken adult protection awareness training and those spoken with displayed a sound understanding of adult protection issues and procedures. The CSCI have not been informed of any adult protection matters since the last inspection. Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 15 Charles Lodge DS0000058240.V300041.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is reasonably maintained in most areas and residents benefit from spacious, homely surroundings and personalised bedrooms. The health and safety of residents, staff and visitors is adequately addressed to ensure that no one is at risk of injury or harm. EVIDENCE: A tour of the premises confirmed that Charles Lodge is furnished with domestic style fittings and carpets and is kept warm and airy, with a satisfactory level of natural and artificial light. A number of residents agreed to have their bedrooms viewed. These were found to be clean and well maintained and had been individualised by the resident with personal items such as photographs, pictures, and ornaments. One resident stated that they ‘feel really at home in their surroundings’. Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 17 Charles Lodge was found to be reasonably maintained both inside and out, with a satisfactory standard of decoration visible throughout all areas of the home that residents have access to. However the kitchen was found to have storage cupboards and units that clearly require replacing. The home was found to be clean, tidy, and free from offensive odours or smells. The homes lift was tested and was found to be in good working order. Health and safety records, such as the falls and accident book confirmed that incidents are suitably documented and reviewed by the registered manager. The homes fire safety records confirmed that regular fire alarm and lighting checks are carried out, whilst care staff had recently undertaken fire safety awareness training. The emergency call bell system was found to be in good working order. Charles Lodge DS0000058240.V300041.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Charles Lodge deploy suitably experienced care staff to meet the assessed needs of residents. The home ensures that all legislation in respect of the recruitment of staff is adhered with so as to ensure residents are protected from the risk of harm at all times. EVIDENCE: The staff rota was viewed and this confirmed a satisfactory level of staff care cover during both the daytime and night. The home deploy a minimum of four members of care staff during the morning, three during the afternoon, in addition to this the manager is also available during office hours. During the night the home deploy two members of care staff to carryout ‘waking night’ duties. The registered manager stated that the needs of residents are continually reviewed and should the need arise the home would deploy staff in greater numbers to met an increase in residents care needs etc. Records indicate that many care staff employed at Charles Lodge had previous experience in the care industry. The home has recently adopted a new induction programme for all new staff. The programme is run in conjunction with the Skills for Care format that aims to provide new staff with a suitable induction and training programme that addresses all key areas of care provision such as personal care, adult protection, safe handling and lifting, health and safety, first aid, and care values. The induction programme is Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 19 compatible with the foundation criteria for National Vocational Qualifications (NVQ) in Care and will therefore underpin the required NVQ training. Six members of care staff have either completed or are currently undertaking National Vocational Qualifications (NVQ) Level 2 in care and it was clear that many staff are keen to continue to pursue their training to further awards. When those currently undertaking NVQ awards complete their training the home should meet the required level of 50 care staff with a minimum of NVQ level 2 in Care. The home have employed four new members of care staff since the last inspection. Their staff records confirmed that all necessary Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been confirmed as had their character references. All staff spoken with stated that they were ‘well supported’ by the registered manager and her senior team and noted that they ‘can always talk to someone’ if they need help or guidance. The home do not hold regular staff meetings, though any issues are displayed on the notice board in the staff room. Charles Lodge DS0000058240.V300041.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Charles Lodge is managed for the benefit of residents in a manner that is open, caring and committed. The management of the home supports it’s care staff to carry out their tasks and provide residents with support in a caring manner. EVIDENCE: The registered manager of Charles Lodge has managed the home for over five years, whilst she has worked there for fourteen years and within the care profession in general for over twenty years. She has considerable experience of offering care to vulnerable adults and commands a vast knowledge in relation to meeting the assessed needs of residents. The atmosphere in the home was relaxed and informal, whilst interactions between staff and residents was seen as being respectful, supportive and Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 21 caring with an overall sense that Charles Lodge is run for the benefit of those living there. One resident noted that ‘it is a very happy place to live’, whilst another stated the manager is ‘always very helpful’. Care staff stated that they felt ‘very well supported’ in their work by all of the management team and there are clear management structures in place that ensure an appropriate delegation of care tasks. One member of staff stated that ‘you don’t just get stuck doing laundry’ as staff take turns with all aspects of care provision. The area manager completes monthly and informative regulation 33 reports that are subsequently forwarded to the CSCI, whilst bi-annual quality assurance questionnaires are circulated to residents and their relatives/carers. The home do not maintain records for residents personal finances as residents are responsible for this, those that do not have sufficient capacity to manage their own personal finances have relatives, carers or friends who have power of attorney to manage such finances. Records maintained at the home, as required by registration, were legible, relevant and concise, confidential information concerning staff and residents is stored in the office in lockable cabinets. Charles Lodge DS0000058240.V300041.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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 2 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Charles Lodge DS0000058240.V300041.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) Requirement Prescribed medication must be administered as stated, whilst medicine administration records must be accurate. (outstanding from previous inspection). The kitchen storage cupboards and units require replacing. Timescale for action 10/08/06 2. OP19 23(1)(b) 10/02/07 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 OP30 Good Practice Recommendations The home should consider implementing regular staff meetings. Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Charles Lodge DS0000058240.V300041.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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