Inspection on 13/07/06 for Hailey House

This inspection was carried out on 13th July 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

Hailey House 07/08/08

Hailey House 13/06/07

Hailey House 06/10/05

Hailey House 14/04/05

Hailey House 04/11/04

Hailey House 20/05/04

Hailey House 28/01/04

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

CARE HOMES FOR OLDER PEOPLE Hailey House Highlands Drive London Road Maldon Essex CM9 6HY Lead Inspector Jane Offord Unannounced Inspection 13th July 2006 09:45 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 Hailey House DS0000017840.V304024.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. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hailey House Address Highlands Drive London Road Maldon Essex CM9 6HY 01621 854132 01621 842477 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) Mr Frank Stanley Churchill Kam Mrs Susan Jane Hibberd Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 22 persons) 6th October 2005 Date of last inspection Brief Description of the Service: Hailey House is a fully detached property, set in compact grounds in a wholly residential area, approximately a quarter mile from the centre of Maldon. The home is registered to accommodate twenty-two elderly people (over the age of 65). Accommodation is provided in 14 single and 4 shared rooms on all three levels of the home. Access between levels is provided by stair lifts. Hailey House is a listed building and planning restrictions prohibit the installation of a shaft passenger lift. Communal space available comprises an L shaped lounge/dining room with an adjoining conservatory style area at the far end of the lounge. Visitor car parking is available at the main entrance of the property where there is also a small, enclosed garden for residents’ use. At the rear of the home there is a small patio style area with seating. Fees for the home range between£412.09 and £491.89 weekly depending on the accommodation provided and the dependency of the resident. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection looking at the key standards for care of Older People. It took place on a weekday between 9.45 and 15.30. The registered manager was present throughout the day to assist with the inspection process. Two residents’ files, care plans and daily records were seen as were two files for newly appointed staff members. The policy folder, some menus, the duty rotas, maintenance records and risk assessments were all inspected. Part of a medication administration round was observed and the medication administration records (MAR sheets) were seen. Quality assurance results, the minutes of residents’ and staff meetings and the activities book were all seen. A tour of the building was undertaken and a number of residents and staff were spoken with. Care practice and the serving of the lunchtime meal were observed. On the day of inspection the home was clean and tidy. Residents looked comfortable and interactions between them and staff were friendly and appropriate. Visitors were welcomed. What the service does well: What has improved since the last inspection? A new role of ‘care support’ has been introduced. Each morning shift one carer undertakes the care support role that supports the other carers by doing housekeeping tasks allowing the carers more time to spend on personal care with the residents. The bathroom on the second floor was being redecorated on the day of inspection and a new bath was to be fitted. The home has recently purchased a ‘standing’ hoist to aid residents getting out of chairs or off a bed. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hailey House DS0000017840.V304024.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 Hailey House DS0000017840.V304024.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, 6. Quality for this outcome area was good. People who use this service can expect to have their needs assessed and be assured they can be met prior to entering the home. This judgement was made using information available including a visit to the home. The service does not offer intermediate care. EVIDENCE: Both the residents’ files seen contained a pre-admission assessment. One file contained a social care assessment as well but the manager said that they or the deputy manager always did their own assessment of potential residents in addition. The home’s statement of purpose says that pre-admission assessments will be undertaken and offers visits to the home before a decision is made to reside there. The assessment covered areas of care such as mobility, personal hygiene, continence, speech, sight and hearing. Past medical history was noted and the present medication regime for the potential resident. Assessment of memory and mental health was also done. Hailey House DS0000017840.V304024.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 for this outcome area was good. People who use this service can expect that there will be a care plan in place to show how their care needs are to be met and they will be treated with respect. The medication practice is generally safe but the policy needs expanding and the recording of administered doses should offer a clear audit trail. This judgement was made using available information including a visit to the home. EVIDENCE: Two residents’ files and care plans were seen. Both contained records of personal details including the resident’s preferred name, any allergies and past medical history. The care plans had interventions for areas of care such as personal hygiene, continence, mobility, nutrition, communication and night needs. Interventions were written to encourage independence and crossreferenced to previous assessments. There were records of visits from or to health professionals like the GP, a continence nurse, a chiropodist or a physiotherapist. On the day of inspection an optician was in the home offering eye tests for residents that required them and a GP visited to review the medication for one of the residents. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 10 There were records of monthly weights and individual risk assessments for areas of concern. One risk assessment was for the resident leaving the home unaccompanied and another for spilling a hot drink. Each resident has a key worker who writes a monthly report. One reported that the resident had celebrated their 90th birthday and had had ‘lots of visits from family and friends’. Another, for a recently admitted resident, recorded that ‘ XXXX is still unsettled at times and wants to go home’. The care plan for that resident had a social/emotional intervention to help the resident settle into the home. There was evidence that care plans are reviewed regularly. One carer said they use the care plans daily and review them with the resident every month. The medication policy covers ordering, storing, administering and disposal of medication. It does not have guidance on ‘homely remedies’, the covert administration of medication or altering medication from the form licensed by the manufacturers i.e. crushing tablets. Senior carers administer medication and have all had recognised medication administration training and competency assessment before undertaking the task unsupervised. One carer said they had frequent updates of the training. Practice observed during the lunchtime medication round was safe and hygienic. The MAR sheets seen did not have any signature gaps but where prescriptions offer a choice of dose i.e. one tablet or two, or 5-10mls, the actual dose given was not recorded. There were no identification photographs with the MAR sheets but the carer said they never use agency carers to do medication rounds. When the medicine trolley is not in use it is stored in a locked clinic room. The room also has a refrigerator for medication requiring a lower temperature. The refrigerator temperature is recorded daily and showed the refrigerator to be functioning at a safe level for medication storage. The carer said that the community nurses did insulin injections and dressings. Hailey House DS0000017840.V304024.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 for this outcome area is good. People who use this service can expect to experience a lifestyle to suit them with encouragement to maintain contact with family and friends and to receive an appetising wholesome diet. This judgement was made with available information including a visit to the home. EVIDENCE: The home employs an activities co-ordinator who keeps records of the daily activities offered. The book showed that among other things residents had had sessions of playing Velcro darts, reading poems, having a quiz or a sing-along, going for a walk and making lavender bags. There were records that individual residents had one to one sessions to read a newspaper or write letters. The home offers some organised trips during the year and some external entertainers are booked. During the day visitors were seen coming and going. Staff greeted them and offered any assistance needed to settle them with their relative or friend where the resident chose. The relative of one resident wanted to take them to an organ recital being given at a local church that day. Staff were very cooperative in helping get the resident in a wheelchair and collecting a raincoat and hat from their room. Checks were made that the relative had some drink for the resident, as the day was extremely hot. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 12 Residents and visitors spoken with said that staff were respectful and they were given choice about where they spent their time. One resident said they preferred to spend time in their room; they enjoyed their own company and liked reading. They said staff willingly brought their meals to them and popped their heads around the door if they were passing to check everything was alright. ‘Even the manager offers to shop for me if they are going out’. Staff were observed knocking on doors before entering a room and offering residents choices about what they wished to do or where they wanted to go. Help was given in a sensitive supportive manner. One carer had taken a resident for a walk that morning, as the resident had been a little restless. They had gone to the local shop and the resident had bought themselves a packet of biscuits to keep in their room. Menus were seen and showed that the main meal was at lunchtime. Although the menus did not offer a second choice it was clear, from the records kept of residents’ nutritional intake, that alternatives were given if a resident wanted it. There was a roast dinner each Wednesday and Sunday with fish on a Friday. The tea menu offered a hot snack or choice of sandwiches. Fresh fruit was always available and, together with the vegetables, is delivered daily from a local green grocers. The kitchen and food stores were inspected and found to be clean and tidy. The temperatures of the refrigerators and freezers are recorded daily and show they are functioning within safe limits for food storage. The dry goods store is mainly in the cellar that has steps down from the kitchen. Food stored in the refrigerators was covered and labelled. Hailey House DS0000017840.V304024.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 for this outcome group is good. People who use this service can expect to have any complaint taken seriously and to be protected from abuse. This judgement is made using information available including a visit to the home. EVIDENCE: Neither the home nor CSCI have received a complaint about the service since before the last inspection. The complaints policy was seen displayed on the wall in the entrance hall. Residents spoken with were comfortable that they knew whom they would talk to if they were concerned about anything. The policy folder had guidance on ‘whistle blowing’ and training records showed that staff had had POVA training. Staff spoken with, including the maintenance people, confirmed they had received information on recognising abuse and how to report any suspicions. All the staff questioned were clear about what to do if they had any concerns. Hailey House DS0000017840.V304024.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, 22, 26. Quality for this outcome area is adequate. People who use this service can expect to live in comfortable, homely surroundings with special equipment available to help maintain their independence however they cannot be assured that all the floor coverings are kept in a good condition or that their safety is not compromised by wedged fire doors. This judgement has been made using available information including a visit to the home. EVIDENCE: The building is an old grade 2 listed property and has a quirky layout with rooms on different levels. All stairs have a stair lift to aid access. Residents’ rooms are decorated individually and have bright duvet covers and curtains. The carpets in some rooms have been well worn and some had large stains apparent. The stair carpet on the first step from the ground floor is frayed and could pose a tripping hazard. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 15 The home employs two part time maintenance people who have a rolling programme of redecoration. There is system in place for staff to alert them to the need for day-to-day repairs and replacements of light bulbs. On the day of inspection they were decorating a bathroom ready for putting in a new bath. Wheelchairs and walking frames were seen being used by residents to aid mobility. Staff said that after a recent staff meeting when the idea had been discussed the home has bought a ‘standing’ hoist to assist residents who find it difficult to get out of chairs or stay standing unaided for a period of time. Staff spoken with said they had instruction on the use of the hoist before they could use it with residents. The laundry was seen and the member of staff responsible for the care of linen was spoken with. They said all laundry is brought down the back stairs to avoid taking it through the kitchen. Soiled linen is placed in alginate bags that are put directly into the machines to prevent cross infection. The machines have a sluicing programme and a high temperature wash. Gloves and aprons are used if there is a possibility of infection being present. Residents spoken with were very happy with the quality of the laundering service for their personal clothing. The laundry is an add-on structure to the main building. On the day of inspection it was very warm in the laundry and the door to the room, which is a fire door, was wedged open. There is a pipe that carries the gas supply to the kitchen that crosses the laundry room attached to one of the beams. The floor covering was torn in several places revealing wooden floorboards underneath, which would be difficult to clean thoroughly. Hailey House DS0000017840.V304024.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 for this outcome area is adequate. People who use this service can expect to be cared for by adequate numbers of suitably trained staff but they cannot be assured that all the required checks are done at recruitment. This judgement is made using available information including a visit to the home. EVIDENCE: Two new staff files were seen and both contained evidence that a POVA 1st and criminal record bureau (CRB) check had been done and cleared before the member of staff commenced work. There were also two references in each file. One file had documentary evidence that identification checks had been made but the second file did not. Neither file had a complete work history of the applicant. There was evidence of a full induction programme covering first aid, fire training, infection control, POVA, continence, food hygiene, moving and handling and Health and Safety. The care team are encouraged to gain qualifications in the care practice field. There are sixteen care staff and eight have achieved NVQ level 2, one has achieved NVQ level 3 with a further two working towards it. Carers spoken with said in addition to the mandatory training they have received instruction about caring for residents with a diagnosis of dementia or Parkinson’s disease and how to do care planning. The duty rotas were seen and showed that there are four carers and a care support on an early shift with three on a late and two at night. There is a team of ancillary staff rostered each day and an administrator is due to start soon. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 17 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, 36, 37, 38. Quality for this outcome area is good. People who use this service can expect to live in a home run in their interests and managed by a competent person with appropriately supervised staff. Their opinions are sought and their financial interests are protected but they cannot be assured that the home has all the documents on their file that are required under regulation. This judgement has been made using available information including a visit to the home. EVIDENCE: Quality assurance questionnaires are distributed to residents and relatives regularly. The most recent one was in January 2006. The relatives’ questions covered areas of environment, personal care, catering and management. Over 50 of those who responded were ‘quite satisfied’ with the service their relative was receiving. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 18 Residents receive a questionnaire about a month after admission that asks whether the level of information offered was adequate to make a decision about entering the home. It also asked whether enough explanation was given around terms and conditions, if the information was pitched at the right level for the resident’s comprehension and whether they had been made to feel welcome on arrival. The responses seen were very positive. Responses to the later questionnaire were also positive with residents saying they enjoyed the food and activities, knew whom to approach if they had any concerns and that they felt safe in the home. Minutes were seen of meetings held for residents. Discussions were recorded around food and menus, different activities, videos to watch and suggestions for planned outings. Hyde Hall gardens and the Tiptree jam factory were two. Staff meeting minutes covered care practice, household reminders, new practice for consideration and improving mealtimes for residents. The registered manager is a registered general nurse, who has achieved a management qualification and has been at the home for sixteen years. Staff said the manager is approachable and supportive. The system for managing residents’ personal finances was explained by the manager. The safe is in the office and the manager is the only person with access to it. The records of transactions were seen and two residents’ wallets were randomly checked. The contents tallied with the recorded balance. Staff spoken with said they receive supervision every two months. They can raise any subject and training and development needs are explored during the sessions. As noted earlier in this report the residents’ files seen did not contain a recent photograph of the resident. The records of day-to-day maintenance such as checking light bulbs, the dryer filters, wheelchairs, hoists and the stair lifts were all seen and showed these tasks are done on weekly basis. General risk assessments are in place and cover water temperatures, broken glass, upstairs windows, trailing wires and the presence of asbestos in the building, among other things. Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X X 1 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 3 Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NONE. 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 Prescriptions that give a choice of dose i.e. one tablet or two, must have the dose administered recorded to offer a clear audit trail. The stair carpet that is worn and could pose a tripping hazard must be replaced. The fire door to the laundry must be fitted with a self-closure device. The floor covering in the laundry room must be replaced to allow for proper cleaning to take place. Evidence must be obtained and kept on staff files that all the required recruitment checks are carried out prior to employment. A recent photograph of each resident must be kept on their file. Timescale for action 13/07/06 2. 3. 4. 5. OP19 OP26 OP26 OP29 23 (2) (b) 13 (4) (c) 23 (4) (c) (i) 13 (4) (c) 23 (2) (b) 19 (1) (b) (i) Sch. 2 17 (1) (a) Sch. 3 31/08/06 31/07/06 31/08/06 13/07/06 6. OP37 31/07/06 Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 21 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 OP9 Good Practice Recommendations The medication administration policy should be expanded to include guidance on the use of ‘homely remedies’, the covert administration of medicines and the use of medicines in a form not licensed by the manufacturers. Consideration should be given to the addition of a recent photograph of the resident to their MAR sheet. Stained carpets in residents’ rooms should be thoroughly cleaned or replaced if the staining is permanent. 2. 3. OP9 OP19 Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Hailey House DS0000017840.V304024.R01.S.doc Version 5.2 Page 23 - 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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