Inspection on 26/04/06 for Eleanor Lodge

This inspection was carried out on 26th April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Eleanor Lodge 27/06/07

Eleanor Lodge 04/10/05

Eleanor Lodge 04/04/05

Eleanor Lodge 06/09/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Eleanor Lodge 25 Camborne Close Delapre Northampton Northants NN4 8PH Lead Inspector Mrs Moira Mosley Unannounced Inspection 26th April 2006 10:00 Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 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 Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Eleanor Lodge Address 25 Camborne Close Delapre Northampton Northants NN4 8PH 01604 764583 01604 768920 SAGreenfield@nothamptonshire.gov.uk www.northamptonshire.gov.uk Northamptonshire County Council 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 Sally-Anne Greenfield Care Home 20 Category(ies) of Learning disability (20) registration, with number of places Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That 25a is a separate facility providing respite services for up to 3 service users within the Learning Disability Category. The Unit to have its own dedicated staff team. That 25b is used to provide an assessment service for up to 3 service users within the Learning Disability Category and to have its own dedicated staff team when in use. 4th October 2005 Date of last inspection Brief Description of the Service: Eleanor Lodge is a home providing care and support for up to 20 adults with leaning difficulties, and is run by the Local Authority. The home is situated within a housing estate, with access to local amenities and transport. The home is divided in three distinct service areas, providing accommodation for assessment, respite and longer-term care. Assessment and respite are provided for a maximum of three people at any one time in houses 25a and 25b that are linked to the main unit by a door. The longer-term care is sub divided into three areas each with its own lounge/dining rooms, kitchen, bedrooms and bathroom. These areas accommodate 4 people in a first floor flat geared towards independence; 5 people in the ground floor west wing and 5 people in the ground floor high support unit. The registered manager confirmed that the current weekly fee for the service is £628. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection by one inspector. The inspection process included the collation of information and pre-inspection planning to gather information and then and five and a half hours were spent in the home. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents and their views of the service provided. This is achieved primarily through the process of ‘case tracking’ which involves reviewing the care of specific residents including looking at their records, talking to them and their families or representatives where possible and talking with the care staff who provide the personal care to those selected residents. The care of three residents was reviewed on this inspection to include care plans, risk assessments, medication and other records. In addition six residents were met and although some have communication difficulties and were unable to voice their views all contributed to the visit and demonstrated their feelings about being in the home. Discussions were also held with two staff members and a period of observation undertaken. There is uncertainty at the moment about the future of Learning Disability services currently provided by Northants County Council and although at present the home is continuing to ensure a good service for the residents it was acknowledged that the impact of the changes might affect the outcomes for the residents. There is currently a freeze on recruitment and the use of relief or agency staff – which is not currently impacting on this service but was identified as an indicator in staffing level management and providing training for staff. The registered manager demonstrates a good understanding and ability to manage the service and demonstrates a commitment to ensure that resident needs are not compromised. What the service does well: All the residents were very positive about the home and the level of care they receive. Comments about the staff team included “they are great” “my keyworker helps me” and observations showed positive interactions between the staff and the residents. The residents had all been to Silverstone with the staff on the day of the inspection and had obviously enjoyed the experience. The residents spoke about regular outings both as individuals and small groups and they really enjoyed the range of activities on offer. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 6 Staff demonstrated a commitment to the residents and this included coming in when not on duty to provide escort and support for activities that residents wanted to attend. One resident was extremely proud of her bedroom and said how she and the others had been involved in the refurbishment of the unit and were able to choose colour schemes and furniture, both for their own rooms and for communal areas. There is a very positive approach to promoting independence and accommodating individual needs that include disability issues and the different cultural backgrounds of the residents with the environment set out and clear documents and policies written to meet the various needs. What has improved since the last inspection? What they could do better: The care plans for residents did not always give sufficient information to ensure that needs are fully identified and for staff to be clear about what they need to do in a consistent way and a requirement has been made. Regular reviews and updating are needed to ensure all needs are being met. Healthcare assessments, for example manual handling, nutrition and weight monitoring are not being documented to show that residents health is being monitored and that staff are addressing the needs identified. One resident needs an additional feeding system via a tube but there was no information within his care plan about why this was needed or how to manage it, staff are relying on verbal information and there knowledge of the resident. A requirement has been made to address this issue. The medication needs an audit system so that the totals of medication in the home can be easily checked against the medication records to ensure that medication is being given as prescribed and a requirement has been made. The registered manager demonstrated a commitment to address issues and further advice was given on the following areas, which she agreed to address: • • Residents’ money should be regularly audited to ensure any discrepancies are quickly identified and the cause can be addressed. Documentation needs to be kept up to date, for example the fire records – which could be evidenced as being done but were not always appropriately recorded. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 7 • Medication needs to be checked regularly and any out of date items disposed of. In addition there was one resident whose medication had been signed for but the tablets remained in the monitored dosage system – the manager would investigate. 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. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s are being fully assessed to ensure their needs can be fully met. EVIDENCE: There are comprehensive assessment documents for the residents that highlight areas of need and the residents sign this. The document includes a section for self help skills, focusing on residents’ abilities rather than disabilities. Residents spoken to said they felt that the staff knew them well and helped them with whatever they needed. Discussions with staff and observations demonstrated that they are knowledgeable about the residents and how to help them achieve their goals. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of documented care plans could put the residents at risk of not having their needs met. EVIDENCE: The residents said that the staff know them well and help them how they want to be helped. Discussions with the staff demonstrated that they do know them well and there are good communication systems in place to ensure any issues are handed over, however there is an over reliance on word of mouth for care practices. There were two residents whose care was tracked who had identified needs in their assessment for specific dietary needs, but neither had a care plan stating what the need was nor any clear direction for staff to ensure a consistent approach and to make sure that the need was being fully addressed. One resident had recently moved in on a permanent basis but his care plans had not been updated to reflect his current needs which staff acknowledged had changed. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 11 It was evident through observation and discussion with service users and staff that people are enabled to make their own decisions. For example one resident had been on the group outing but was unsettled and was supported in his decision to return to the unit. Another resident spoke with great pride about her decision to lose weight and the staff have supported her in joining a weight loss group. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to be as independent as possible with a good range of leisure activities available that enable them to lead full and active lives. EVIDENCE: The residents spoke about their daily activities and these include work placements, group and individual activities to suit their needs. Staff confirmed that they are available to offer support if required and some people choose to use this opportunity for a social evening out rather than a daytime activity. The manager confirmed that staffing can be and is arranged to meet needs. This includes individual activities, for example the one resident who was attending a weekly weight loss group within the community. They have good links with the local community and the home encourages community groups to use and share their facilities. The residents spoke about their family and friends who visit the home and the support given for home visits. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 13 Relationships between service users and staff were positive; staff encouraged and enabled service users rather than taking over and controlling what they were doing. The main meal is prepared in the kitchen by staff at present as there is a cook’s vacancy. The residents assist in the menu planning and preparation of meals and there are smaller kitchens in each area of the home to develop independence skills. All the residents spoken to said the food was good and they were able to make individual choices according to likes and dislikes. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of documented healthcare assessments and medication audit puts residents at risk of not having their healthcare needs fully met. EVIDENCE: The information in residents’ personal care assessments is very good with detail about the level of support needed and gives clear directions for staff to meet individual needs according to their preferred choices. One resident had a manual-handling plan that had not been updated since 2003 despite reference in other documents of changes in mobility and the need for equipment. A resident had a percutaneous tube in situ but there was no care plan identifying how to mange this and what staff should do if any problems arise. It was evident from daily notes that the resident often chose not to have the full feed at night and although discussions evidenced this was acceptable there was no evidence to support what action or advice had been taken. Another resident was identified as having weight loss problems with no plan to address any action needed; again discussions evidenced the management of this but no documented evidence of action taken. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 15 There are medication procedures in place for the safe ordering, storage, administration and disposal of medication. The medication administration records were cross-referenced to the medication stored for three residents. There was no clear audit procedure and the totals of medication in the home were not available making it difficult to ascertain if medication was being given as prescribed. One resident had tablets remaining in the monitored dosage system for one day, despite them being signed for as given on the records. The manager agreed to investigate this further. There were two items within the drug cupboard that were out of date and needed disposing of and this was addressed at the time of the inspection. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective system for the home to respond appropriately to complaints made and residents are protected from abuse with their views listened to. EVIDENCE: The notice board in the main communal areas includes information in a format suitable for the resident group about how to make a complaint. The residents spoken to were very clear about who they would speak to if they had any concerns and their interactions with the staff demonstrated very open and relaxed relationships with the residents encouraged to make their points of view heard. One resident has recently made a complaint and it was evident this was being dealt with appropriately. Staff training records showed that staff had received training on abuse issues and staff spoke to were clear on what they would do if they had any concerns raised about the care of the residents. There have been no allegations made since the last inspection. There is an effective system in place for the management of residents’ money with individuals having their own bank accounts and wallets within the home with the residents encouraged and supported to manage their own finances where possible. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 17 The balances of money kept in the home were reviewed with a minor discrepancy found for one resident; it was advised that a more regular check of the individual accounts is made with evidence of the audit fully documented. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good providing service users with an attractive and homely place to live. EVIDENCE: The home was fully refurbished about a year ago and has been maintained since that time to provide a very comfortable and homely environment. The home is split into smaller units which ensures that the residents live in family sized groups and there is a “non institutionalised” feel. The residents spoken to all said they liked the home and their own rooms. One resident showed her bedroom and it was evident it was highly personalised to include the residents personal and cultural needs and was decorated and furnished to a high standard. Equipment is provided where needed to assist with disability issues. There is a maintenance system in place and satisfactory fire and environmental health reports were available to ensure it was a safe environment. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 19 The grounds are well maintained and give accessible space for the residents to use at any time. One resident spoke about the barbecues and other outdoor events they enjoyed when the weather was good. The home was clean in all areas and the laundry systems are effective, with both a commercial machine in the main laundry for general items, but also several domestic style machines in the different areas, which the residents use for their own laundry so promoting their independence skills. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable qualified and trained staff are provided in adequate numbers to ensure resident needs can be met. EVIDENCE: Staff training records demonstrate that staff have received the training needed in order to perform effectively within their roles. All staff are currently up to date with statutory training although manual handling is due by the end of this month for a number of them and it was identified that due to the recent changes and uncertainty about the Councils proposals for the home it is difficult to ensure training will continue to be provided to as high level it has previously been. There is a detailed induction process in place to ensure new staff receive sufficient information before fully undertaking their role unsupervised. The home has over 50 of its staff trained to National Vocational Qualifications (NVQ) at level 2 or above with 4 staff having completed their Learning Disability Award Framework (LDAF) training. Several staff have completed NVQ level 3 awards. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 21 Staffing levels are being maintained at a safe level and the staff group remains constant with low turnover and low sickness records, which ensures a consistent team to provide the care needed. Recruitment procedures are good with evidence in staff files of a comprehensive system including references and Criminal record Bureau (CRB) checks prior to commencement of employment. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a proactive management approach to address issues identified and residents’ views are being sought with working practices in place to ensure that the health and safety of residents is promoted and protected. EVIDENCE: The registered manager has been in post for several years and demonstrates a good understanding of the role and has vast experience and training to meet the needs of the residents and the home. The residents spoke highly of the management of the home and it was evident through observations of the positive relationship between the residents and the staff team including the manager. There are regular meetings with residents including a mangers meeting and the residents felt they were supported to give their opinions about the running of the home. Thee is a Quality Assurance system including monthly visits from the Northants County Council Quality Team and a new process as part of this Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 23 visit when a resident also completes a quality audit, seeking the views of the other residents which is fed into the report. There was also a resident survey carried out in 2005 with the involvement of advocacy services. Staff training records demonstrated that staff are currently up to date with statutory training. There are effective systems in place for health and safety issues to be addressed and there were no concerns identified at the time of this inspection. Fire records were seen and showed there were regular tests although the weekly fire checks are not consistently being recorded within the fire records. The recording of accidents had been fully documented with no issues of concern noted. Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 3 X Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA6 YA19 Regulation 15(1)(2) Requirement Timescale for action 26/06/06 26/06/06 3 YA20 Care plans must be written and regularly reviewed for all identified needs. 12(1)(a)(b) Assessments and where necessary care plans must be developed giving clear instruction for staff to ensure health care needs are addressed. 13(2) A medication audit must be available to ensure medication totals can be checked and therefore medication is being administered as prescribed. 26/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Eleanor Lodge DS0000034974.V291383.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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