Inspection on 19/10/06 for Cross Lane House

This inspection was carried out on 19th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cross Lane House 13/07/09

Cross Lane House 29/09/08

Cross Lane House 04/01/06

Cross Lane House 21/08/05

Cross Lane House 12/01/05

Cross Lane House 24/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Cross Lane House Cross Lane Ticehurst Wadhurst East Sussex TN5 7HQ Lead Inspector Caroline Johnson Key Unannounced Inspection 19th October 2006 10:05 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 Cross Lane House DS0000032397.V311217.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. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cross Lane House Address Cross Lane Ticehurst Wadhurst East Sussex TN5 7HQ 01580 200747 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) Mrs Amanda Patricia Newport Mr Vincent John Newport Mrs Amanda Patricia Newport Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Cross Lane House DS0000032397.V311217.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 eighteen (18) Service users must be aged sixty-five (65) years or over on admission Date of last inspection 4th January 2006 Brief Description of the Service: Cross Lane House provides care and accommodation for 18 older people. The registered providers are Mr V and Mrs A Newport. Mrs Newport is also the registered manager. The home itself is a large detached converted country house, situated in the village of Ticehurst. The house is set back from a quiet road just off the high street. Accommodation is provided in 14 single and 2 double bedrooms on three floors. The homes current policy is to offer the large double bedrooms as singles unless a married couple wish to share. This means that numbers of residents does not go usually go above 16. A shaft lift is available for residents who may have mobility problems. The home is situated within large well-tended gardens. Stonegate railway station is approximately three miles away and bus routes run through the village high street, which is within a few hundred yards from the home. Inspection reports are made available by the home upon request. The range of monthly fees as of 19 October 2006 is between £400 and £650. Additional charges are made for chiropody, hairdressing, toiletries, magazines and papers. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the inspection process a site visit was carried out on 19 October 2006, which lasted from 10.05am until 6.15pm. During the visit there was an opportunity to meet with at least four residents in private, to meet with the owners, deputy manager and with a member of care staff. In addition there was an opportunity to meet with a visiting district nurse. A wide range of records were also examined including the care plans for three residents and record keeping held in relation to staffing, medication, complaints, health and safety and menus. A tour of the building was also undertaken. As part of the inspection process two relatives were contacted and asked their views on the home. One relative stated that their mum ‘has been very happy in the home and the home has been very supportive’. One very positive aspect of the home is that there is ‘a very stable staff team and that staff always have time to chat to the residents’. Another relative described the care as ‘excellent’. She stated that her mum is on half the medication she was on when she was admitted to the home, the manager was thorough when she assessed her mums needs and she now has a new zimmer frame, a new hearing aid and new glasses. Her mum’s clothes are kept clean and the home is always clean. Eight residents completed comment cards that had been sent to the home for distribution. Feedback was given to the manager on the outcome. Overall the responses were positive in most areas but some issues were raised in relation to the meal choices at suppertime and the range of activities provided in the home. What the service does well: What has improved since the last inspection? Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 6 The home has introduced a new format for care planning and all the staff team have received training on the subject. The new system allows for detailed information to be recorded and is designed to be easy to keep up to date. They are continuing with the redecoration of the entire building and the majority of the work has now been completed. Requirements made at the last inspection have all been completed. A new procedure has been put in place to ensure that all staff receive regular supervision and there is a new policy in place on the management of residents’ finances. 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. Cross Lane House DS0000032397.V311217.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 Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very good at ensuring that they have detailed information to assist them in making decisions about whether they can provide accommodation to prospective residents. EVIDENCE: Pre admission documentation was seen in relation to one resident admitted to the home. This showed that the manager had obtained information from the previous care home. In addition she had visited the resident twice and carried out a detailed assessment of her needs and abilities. Information obtained about the resident’s mental needs was queried with the resident’s general practitioner to ensure that the home was not in breach of their registration. It was reported that the resident’s daughter visited the home on a number of occasions prior to making a decision about accommodation for her relative. The home does not cater for intermediate care. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The revised format for care planning is very good and could be enhanced even further by including monthly summary reports. Including information in daily records about residents’ social and emotional needs would ensure a more holistic approach is adopted. The use of the notice board in the office to ensure good communication is considered very good practice. EVIDENCE: Since the last inspection the home has introduced a new format for care planning. Three care plans were examined in detail. All had been updated recently and included detailed information about the abilities and needs of each resident. In addition the action required by staff to ensure that needs could be met was detailed. In relation to one of the residents it was noted that they had a problem with recurrent urine infections and that they had an infection at the time of inspection. Although the care plan stated to encourage fluid intake there was no short-term care plan in place to monitor fluid intake. Care plans are updated regularly. Daily records provide detailed information about each resident’s physical needs but there is little reference to social and emotional Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 10 needs. Residents spoken with stated that staff always knock on the door prior to entering. This was observed during the inspection and staff were very courteous to the residents in their care. A notice board in the office is used to refer staff to any changes that have been made to care plans and to any medication changes. At the time of inspection one of the residents was bed bound and was receiving regular input from the district nursing service. During the inspection there was an opportunity to speak with one of the visiting nurses. She described the home as a `good home with a good staff team’ she stated that the `clients are happy and well cared for’. Medication is stored securely and records seen in relation to medication administered to residents were in order. All but one of the staff team has received training on the medication in use in the home. Training is arranged every two years. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there are a variety of activities available and the menus are varied and well balanced, the home needs to consult in greater detail with the residents to see what they can do to improve the service they provide in both areas. EVIDENCE: An external entertainer visits the home once a month and he plays the guitar and sings. It was reported that there are a range of in-house activities offered including bingo, basketball, keep fit, reminiscence, countdown and walks around the garden. Two religious services are provided each month. The local vicar visits once a month to provide a service and a retired vicar and his wife also visits once a month and they bring a keyboard. Staff advise that activities are offered daily. Residents’ feedback was that there are very few organised activities. The home’s external entertainer had visited the home the day prior to the inspection. Residents spoken with stated that they enjoyed the music session. One resident stated that if they had had more notice of the event they would have attended. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 12 One resident advised that during the summer they decided to go on a holiday independently. She stated that the home were very supportive of her wishes and provided whatever assistance was required to enable the trip to take place. Staff and some of the residents organised and held a garden party during the summer. The money raised was to be put towards day trips. However, due to various reasons the trips did not happen. The manager advised that the money would now be used for Christmas pantomimes and theatre outings. There is a three-week rotating menu in place. The menus seen showed variety and the meals were well balanced. The manager advised that the menus are due to be reviewed. The manager confirmed that they buy all fresh produce and that cakes are homemade. If residents make specific requests for food this is accommodated. The manager was able to provide specific examples of purchases made for residents’ individual tastes. The supper menu consists of soup, hot meal and/or a sandwich. Although a particular sandwich will be named each day, staff will accommodate whatever choice of food is requested. During the inspection one of the residents was heard to ask what was on the supper menu. The staff response was limited and did not reflect the variety of choices available. The manager advised that she would discuss with staff how choices are made available to the residents. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good procedures in place to ensure that anyone wishing to make a complaint can do so. EVIDENCE: The manager advised that there have been no complaints made to the home since the last inspection. Equally no complaints or adult protection alerts have been made to the Commission during this time. There is a detailed complaint procedure in place and there is a complaints/suggestions book in the lobby of the home. Staff received training on the protection of vulnerable adults in June 2005. The manager advised that refresher courses would be booked every two years. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been decorated to a very good standard. There are only a few areas still requiring attention and plans and timescales are in place for work to be undertaken. The fitting of door guards where assessed as necessary needs to be completed as soon as possible to improve fire safety. EVIDENCE: The majority of the home has been upgraded in the past couple of years. Some of the residents spoken with stated that they had chosen the colour schemes for their rooms. Bedrooms are personal and some of the residents have brought items of furniture and ornaments. Residents spoken with stated that having photos and personal ornaments and pictures helped them settle into the home and created a more homely environment for them. In one of the bedrooms there was a very strong odour. The manager described a very good cleaning programme in place to try to eliminate the Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 15 odour. The room is due to be redecorated and a new window installed. It was agreed that consideration should be given to fitting a different type of floor covering in an attempt to improve the odour. Since the last inspection a new ensuite toilet has been fitted in one of the bedrooms. There are also plans to fit an ensuite toilet in another bedroom. It was noted that some of the bedroom doors were propped open. The manager advised that quotes are currently being sought for door guards and that all doors assessed as needing to be guarded would have guards fitted by Christmas. Four radiators that were not guarded at the time of the last inspection have since had guards fitted. Staff have received training on infection control and there are good procedures in place to reduce the risk of cross infection. All areas seen were clean and with the exception of the room referred to above there were no unpleasant odours. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 16 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements in place to ensure that staff have regular opportunities to attend training courses to update their knowledge. It is essential that a CRB is obtained for all staff members and that in the interest of the residents, until this is in place staff must not work unsupervised. EVIDENCE: All of the staff have job descriptions setting out the extent of their individual roles and responsibilities. It was reported that there is not always an even distribution of the workload. The manager advised that she is taking steps to ensure that all staff work to their job descriptions. Since the last inspection all of the staff team have received training on the new care planning system. Four staff attended an external training course on infection control and the rest of the team received in-house training on the subject. One member of staff completed the train the trainer course in manual handling and she will now provide training to the staff team on the subject. All of the staff team are trained in first aid. Eight of the staff team have completed NVQ level two and one member of staff has completed level three. In addition three staff are currently working towards NVQ level two and another three towards level three. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 17 The home has not recruited any new staff since the last inspection. Criminal Bureau checks were seen in relation to the majority of the staff employed to work in the home. The manager advised that there are four staff employed who are still awaiting their CRB checks. It was reiterated that these staff should not work unsupervised until the full CRB has been obtained. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 18 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): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are encouraged to make their wishes known and the home tries hard to address them. They must continue to strive to achieve this. This could be aided by revising the home’s quality assurance system with particular reference to how the views of residents and their relative are obtained. In order to reduce the risk of accidents hot water accessible to residents must be delivered at 43°C. EVIDENCE: The manager has almost completed the Registered Manager’s Award and NVQ level 4. Staff spoken with during the inspection described the manager as `supportive’ and easy to talk to if they need to discuss any aspect of their work. A copy of the home’s policy on the management of residents’ monies was sent to the Commission following the last inspection. A receipt book is kept Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 19 detailing all money received on behalf of residents. Records were seen in relation to the management of two residents’ finances and they were in order. The manager reported that satisfaction questionnaires were distributed to residents but there was no response. Questionnaires were also left in the lobby of the home and some were sent to relatives but again there was no response. As part of the inspection process comment cards were sent to residents. Eight responses were received. Most used the tick system to advise that they were happy with the care they receive. Five of the eight responses raised dissatisfaction about the food and this mainly referred to the supper menu. Six of the eight responses included negative comments about the activities in the home. Comments were raised with the manager and she agreed to raise all subjects at the next residents’ meeting. In relation to food she advised that following comments received at one of the residents’ meetings some of the residents had suggested a new supper menu. This was introduced for a three-week period but the residents then wanted to revert to the old menu. Residents stated that they would like to see more activities particularly more trips. The manager agreed that the trips that they had planned this year did not happen for various reasons. The money raised for activities is still available and there are plans in place to ensure that it is used for the benefit of the residents. One person stated that cleanliness in the home is excellent but another stated that the tops of the cupboards and lamps are not cleaned regularly. The manager advised that there is a cleaning rota in place and she would ensure that attention is given to the areas mentioned. As part of the inspection process contact was made with the relatives of two residents. One relative stated that their mum ‘has been very happy in the home and the home has been very supportive’. One very positive aspect of the home is that there is ‘a very stable staff team and that staff always have time to chat to the residents’. Another relative described the care as ‘excellent’. She stated that her mum is on half the medication she was on when she was admitted to the home, the manager was thorough when she assessed her mums needs and she now has a new zimmer frame, a new hearing aid and new glasses. Her mum’s clothes are kept clean and the home is always clean. A requirement was made at the last inspection to ensure that all staff receive supervision at least six times a year. A new format for carrying out supervision has been introduced and all staff had received regular supervision. In the past two months this had fallen behind for some staff but the manager advised that she would increase her input in this area to ensure that all staff receive six supervisions by the end of the year. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 20 Hot water temperatures were tested at two outlets. One was satisfactory but the second reading was in excess of the recommended 43°C. The owner agreed to have the thermostat adjusted as a matter of urgency. She confirmed that staff check water temperatures prior to each bath given. Health and safety procedures were up to date and there were certificates in place to show that portable appliance testing had been carried out and that fire equipment had been serviced. Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 3 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 3 3 X X 3 3 X 2 Cross Lane House DS0000032397.V311217.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2n) Requirement A written assessment must be carried out in relation to each resident’s individual needs in respect of recreation/leisure. Where possible arrangements must be made to address the needs highlighted. The home must carry out a review of each of the resident’s wishes in relation to the supper menu and review how choices in relation to food are made available to residents. Fire doors must not be propped open. Where is it assessed as necessary to have door guards fitted, arrangements must be made for this to happen. The manager must ensure that a CRB has been obtained for all staff. Until this has been achieved staff must not work unsupervised. The home must review their quality assurance system with particular reference to how the views of residents and their relatives are obtained. Hot water accessible to residents DS0000032397.V311217.R01.S.doc Timescale for action 31/12/06 2. OP15 12(3) 15/12/06 3. OP19 13(4a,c) 31/12/06 4. OP29 19 Sch 2 para 7-9 15/01/07 5. OP33 24(1) 15/01/07 6. OP38 13(4a,c) 30/11/06 Page 23 Cross Lane House Version 5.2 must be delivered at 43°C. 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 Care plans should include monthly summary reports. In addition daily entries should include reference to residents’ social and emotional needs. Cross Lane House DS0000032397.V311217.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 Cross Lane House DS0000032397.V311217.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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