Inspection on 18/05/05 for Highfield House

This inspection was carried out on 18th May 2005.

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

Other inspections for this house

Highfield House 20/07/06

Highfield House 27/10/05

Highfield House 27/09/04

Highfield House 14/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highfield House 4 Highfield Road Shanklin Isle of Wight PO37 6PP Lead Inspector Mark Sims Unannounced 18th May 2005 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 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. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Highfield House Address 4 Highfield Road, Shanklin, Isle of Wight, PO37 6PP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01983 862195 01983 866364 Island Healthcare Ltd Ms Teresa Shirley Cornelius Care Home 23 Category(ies) of Dementia -over 65 years of age (3), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (6) Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/9/2004 Brief Description of the Service: Highfield House Residential Home is located towards the mid-point of Highfield Road Shanklin, a quiet residential street situated just off of Victoria Avenue as you approach the town coming from Newport. The property is a large Victorian house that has been extended and adapted to provided residential accommodation for 23 people under three registration categories, OP - Older Person, DE(E) Dementia (elderly) and PD(E) Physical Disability (elderly). A passenger lift provides easy access to both floors, although for those ambulant enough the stairs are reasonably wide and of a manageable gradient. The premises is well maintained and provides adequate communal facilities for the service users, including a large lounge and separate dining room able to sit all residents comfortably. The gardens are substantial and ramped access has been provided for ease and convenience. Off road parking is provided but spaces are often difficult to come by and occasionally diffcult to negotiate. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a four hour period with time spent with service users, reviewing records and observing staff practices. The inspection was unannounced and forms part of the planned inspection programme for the 2005 / 2006 inspection year. At the completion of the inspection process the home was provided with an immediate feedback sheet, detailing all areas addressed, positive and negative aspects of the service. What the service does well: What has improved since the last inspection? The premises was in the midst of being redecorated (externally), although the scaffolding encasing the property obviously detracts from the natural charms of the build temporarily, which should ensure all woodwork and guttering, etc. is readied for the throes of summer and subsequent if not inevitable winter. Whilst at the home new carpeting was delivered, although the staff seemed a little uncertain which area of the home was to be re-carpeted, especially given that no area of the home visited appeared in particular need of re-carpeting, Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 6 although the proprietary company has reasonably high standards and expectations of the their own in such matters. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 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 standard(s) St 1, St 2, St 3. The home provides service users and their representatives with access to a comprehensive and detailed service users’ guide and statement of purpose document. The contract, terms and conditions document contains detailed information relating to the service user’s stay at the home and important aspects of the service, such as fees, rooms to be occupied, periods of notices, etc. Pre-admission assessment information is gathered and copies of the assessment sheets are retained on the service users’ plans. EVIDENCE: In discussion with the deputy manager and from a review of the documentation it was clear that the company provides both service users and visitors to the home with access to up to date and comprehensive ‘statement of purpose and service users’ guide’ literature. Unfortunately due to the frail conditions (physically and mentally) it was not easy to test out how much people understood regarding these documents, although it is known that one resident (interviewed at previous inspections) Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 9 not only read all of the information provided by the home but also regularly reads the inspection reports produced by the Commission, following visits to Highfield House Residential Home. The same process for ascertaining the suitability of the contract, terms and conditions document was undertaken, in as much as the inspector ensured each resident has a contract (either via the social service department or a privately) and that everyone is issued with detailed terms and conditions. Again it was difficult to gauge people’s understanding of these documents, although everyone was quick to point out how happy they were with the general service and attitudes of management and staff in providing for their needs. Three care plans were reviewed at length during the visit and all were found to contain informative pre-admission assessment sheets. In discussions with the deputy manager it was established that either she or the manager undertakes the reviews and visits people either at home or more commonly in hospital. The deputy manager also pointed out that since the home has started providing day care, that this has become a focal point for new service users and that a great deal is known about people entering the home via this route, as a result of being already involved with the service. On the day of the visit a lady admitted for day care was interviewed and whilst she knew she normally visited the home, a problem with short-term memory prevented her from recalling that she was staying at the home or how she was settling. However, where clients could recall parts of their admission history it was clear that they had met staff prior to arriving at the home and that this was normally the manager or deputy (service users referred to these individuals by name). Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 7, St 9. Each service user is provided with an individualised care plan, which contains a large amount of relevant information. However, the information is not always being used to update the care plans, some of which also have no review dates or evidence of having being monitored. Despite the best efforts of the management people are still making mistakes when handling service users’ medications. EVIDENCE: The care planning files of three service users were inspected and crossreferenced against accident and incident records for the home. It was clear from this process that staff, on occasions, are omitting to properly transfer information logged in one record across to another and this is leading to potential care planning issues not being identified or addressed. It was also apparent that staff are not always remembering to develop care plans from information documented in the running records of residents, one example being a clear instruction to fellow staff to take a ‘service user their breakfast first in the morning if awake in an agitated state, in order to allow that person time to calm and settle’. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 11 Whilst it is acknowledged that at least this information had been documented, recording it within a running record and not producing a specific plan of care means the advice or guidance stands the chance of being lost, as additional information is recorded on the same sheet and it is filed away. It is also important to remember that records should be dated and where possible signed, so people are able to identify who is responsible for making entries on official documents. On reviewing the care planning file of the most recently admitted resident it was evident that four personalised plans of care had been produced, from information gathered via the assessment process but these plans bore no assessment or review dates. In conversations with service users it was clear that some people understood that the home maintained records about their health, etc. but no-one really appeared to appreciate to what extent or showed any sign of wishing to see the files. It was also apparent on the files inspected that where possible the service user or their families are encouraged to produce a social history or pen-picture of the resident, which is an invaluable tool for relationship building; and also evidenced that people are involved in the production of their plan. Reviewing the home’s medications was a priority for this inspection as a number of errors have been reported to the home over proceeding months, which despite actions by the management of the home do not appear to have abated. An audit of the system again revealed issues, which will need to be addressed as part of an overhaul of the home’s entire system, issues including: wrong codes used to denote why medications were not administered, wrong information transferred between medication sheets and verbal instructions from doctors not confirmed in writing or with a second staff member to verify the changes requested. This was evident, as a post-it was used to document the new prescription information but contained no supporting signatures. In conversation with the deputy manager it was understood that plans to address all errors were in hand and included the purchasing of a drugs trolley (this had actually been ordered), the introduction of a front sheet to each medication file containing a photo of the resident and information relating to allergies, etc. and the relocating of the medications room. The types of actions and plans being considered by the management are typical of this forward thinking, pro-active service, which has also made available to all staff copies of the medications policy, arranged team meetings to explore issues and has arranged further medication training sessions, although these are in house and it may be more valuable to arrange for staff to complete courses provided by some local educational centres. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 12, St 13, St 15. The home provides a wide range of entertainments and activities to service users and offers appropriate support in order to enable people to access and participate in events. Service users are appropriately supported in the maintenance of contact with families and friends. The service provides residents with wholesome, nutritious and varied diets that take into consideration individual preferences, likes and dislikes. EVIDENCE: The company employs a specific activities organiser who is responsible for planning the activities programme of the home, taking into account the wishes and desires of the service users and any particular events of significance. On arriving at the home the inspector noticed that a schedule of forthcoming events and activities was on display within the main concourse, the schedule covering a calendar month and including both internal activities and external outings, etc. In discussion with the service users it was established that regular activities, delivered in accordance with the schedule, are ongoing and that there is a Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 13 great appreciation amongst the resident group for the opportunity to participate in such a varied programme of activities. It was also established with one group that bingo is a particular favourite, as the deputy manager oversees this activity and her attempts to introduce traditional bingo calls cause amusement, an observation not denied by the deputy manager herself. Service users also confirmed that they are provided with regular trips out in the people carrier provided by the company, these trips taking in general outings, shopping trips, quick trips out with staff running errands and supported visits to appointments. Normally people like to sit out in the gardens, although this visit occurred a little early in the year for this particular activity. However, the inspector undertook a visit to inspect the grounds and noted that the gardens, normally so well maintained were looking overgrown with weeds in flowerbeds, lawns appearing uncut and furniture covered in algae and damaged. Whilst as stated the inspection occurred relatively early on in the summer, people should feel able to go out and enjoy the grounds, which normally are so attractive and inviting. Throughout the inspector’s time at the home it was noticeable that a great number of people visit and are entertained by service users both within their private accommodation and communal areas. In discussion with one service user it was pleasing to hear how she is helped in maintaining contact with her family who live abroad, both in writing and via the telephone. In an attempt to make visits easier for relatives, friends and representatives the home has created a quiet lounge, which whilst not used during the day, is understood to be a useful addition to the home’s facilities. One of the most highly praised aspects of the home’s service is the food, which again was a key feature of most people’s feedback to the inspector during this visit. What people appeared to appreciate most, apart from the food, is the time the catering team spends with the service users ensuring they are happy with the meals and the general service. The cooks, who cover all mealtimes, operate a rotational menu system, which provides people with a wide variety of meals to choose from and two main meal choices daily. In addition to the meals prepared the afternoon cook often prepares homemade cakes, which people clearly appreciated, including the staff who are entitled to sample the cooks’ wares. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 17. Service users are supported to register on the electoral roll and to participate in civic events/processes. EVIDENCE: In discussion with the deputy manager it was established that all service users were entered onto the electoral roll and that those who wished had participated in the general election. Where people had decided to participate in the election this had been achieved by postal voting alone, with no-one electing to visit the local polling station or use the proxy voting option. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 15 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 standard(s) St 19, St 23, St 24, St 26 Some areas of the home were noted to require attention, although generally the environment was well maintained. The private accommodation provided at Highfield was felt to meet the needs of the service users. Bedrooms visited during the inspection had clearly been personalised by the occupant in accordance with their own wishes. The home was clean and tidy with no odours detected during the tour of the premises. EVIDENCE: On arriving at the home it was evidenced by the scaffolding erected around the property and the presence of the decorator within the home, that the premises was being redecorated (externally). This being a planned event, which the proprietary company had scheduled to coincide with the improving weather conditions of the spring/summer. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 16 Generally the property was found to be in a good state of repair, with not only the external aspects of the house being upgraded but also arrangements having been made to replace carpet(s) within communal areas. This being evidenced by the carpet delivered during the inspection and the statement of the deputy manager. During the tour of the premises some minor remedial items were noted and brought to the attention of the deputy manager, who entered these into the maintenance log for addressing. An issue of a more immediate nature was the need to re-lay carpets along the first floor corridors, which were rucking up and presenting a trip hazard. The issue of the gardens not looking at their best was raised earlier within the report and is a issue that will require attention, as to leave the garden to deteriorate further could lead to people not being able to enjoy and use the attractive surroundings. The tour of the premises took in only a handful of service users’ bedrooms, revealing individually set out, decorated and furnished rooms, which clearly reflected the wishes of the occupant and created a personal space that was familiar to them. In conversation with service users it was evident that they were happy with the accommodation and felt it met their immediate needs, most people opting to retire to their bedrooms in the evening to watch their own televisions, etc. in peace. The tour of the premises also confirmed that the domestic staff’s approach to cleanliness is good, with no signs of dust, cobwebs or any offensive odours to be detected anywhere around the home. All staff are provided with access to infection control procedures and the home ensures a representative of the care team attends all ‘bug busters’ meetings organised by the Local Authority Infection Control Nurses. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 27, St 30. The duty roster identifies that sufficient staff are on duty to meet the needs of the service users. Documented accounts of interactions between service users and staff suggest that staff would benefit from training on the management of aggression or challenging behaviours. EVIDENCE: The management ensure that duty rosters are produced a month in advance with copies prominently displayed within the main office. The rosters indicate that staff work across three shifts per day, with three carers on duty in the mornings, two carers working in the afternoon, until a twilight shift 16.00 hrs to 19.00 hrs raises staffing levels to three, before dropping back to two carers each night. In addition to the care staff the home also employs, co-ordinator, domestic, catering and administrative staff, as well as management staff who work supernumerary hours within the home. In discussions with the staff it was evident that they feel the role has changed over the years and that service users are far more dependent when coming into the home than they used to be. However, despite their observations staff Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 18 generally believe they are providing a good service, which meets the needs of the service users. Staff also discussed access to training and development, which they feel again is generally good and meets their day-to-day practice needs; and provides them with a good grounding in care on which they can grow and evolve. Staff discussed National Vocational Qualifications (NVQ’s) and the numbers of units left to the completion of their awards. One area of the home’s training and development schedule, which should be reviewed is the staff’s awareness of how to manage challenging situations, as it is evident from entries in care plans that far from calming potentially flammable events, the actions of some staff might actually be provoking further escalations in people’s aggression and anger. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 38. Staff are not operating the home’s accident and incident procedures in accordance with the company’s policy. EVIDENCE: It was noticeable on reviewing accident and incident reports that staff are not adhering to the home’s internal policies and procedures. Where accidents are recorded, the company expects staff to follow these up on three separate occasions, post the incident. However, despite the pro-forma containing three sections for completion by staff, the majority of forms inspected were not completed correctly and had either been reviewed only once or not at all. It was also noticed that information documented in the incident reports was not being transferred to the care planning file, as would be expected or that Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 20 staff are recording in the running records of the care plan but not completing incident reports. All of these issues have been drawn to the attention of the deputy manager, who will address the findings with the manager. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 x x x x x x x x 2 Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 22 YES 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. Standard Standard 7 Regulation Requirement Timescale for action 13.07.05 Regulation Information within the care plan 15 running records must be used appropriately in the creation of care plans. 2. Standard 9 3. Standard 30 All care plans must be reviewed and updated monthly. Regulation The home must review its 13.07.05 13 medication system to ensure staff errors are minimised and the policies of the service are adhered to appropriately. Regulation Staff who require training around 13.07.05 18 the management of aggressions must be enabled to access that training. 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. 2. 3. Refer to Standard Standard 19 Standard 19 Standard Good Practice Recommendations The management should ensure the garden receives appropriate attention. Uneven flooring should be replaced or re-layed to reduce the possibility of trips and falls. Staff should ensure they complete the accident and H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 23 Highfield House 38 incident record in accordance to the companys policies and procedures. Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 Page 24 Commission for Social Care Inspection Mill Court Furrlongs Newport PO30 2AA 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 Highfield House H55H04_S12497_Highfield House_V218179_180505 Stage 1.doc Version 1.20 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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