Inspection on 13/02/06 for Kingsley House

This inspection was carried out on 13th February 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingsley House 19/09/07

Kingsley House 17/01/07

Kingsley House 10/11/05

Kingsley House 29/09/04

Kingsley House 05/05/04

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

CARE HOME ADULTS 18-65 Kingsley House 16 Dudley Road New Brighton Wallasey Wirral CH45 9JP Lead Inspector Karen Barry Unannounced Inspection 13th February 2006 10:00 Kingsley House DS0000018906.V284336.R02.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 Kingsley House DS0000018906.V284336.R02.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. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kingsley House Address 16 Dudley Road New Brighton Wallasey Wirral CH45 9JP 0151 630 3714 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 David Christopher Russell Mrs Ellen Ann Crofts Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only fourteen (14) adults (aged 18 - 64 years) may be accommodated. Only two (2) named older persons (aged 65 years and over) may be accommodated. 10th November 2005 Date of last inspection Brief Description of the Service: Kingsley House is a three storey, Victorian house, offering care and accommodation to 14 adults and 2 older people with mental health disorders. Situated in the centre of New Brighton, close to a variety of shops and community facilities. The home is within reach of the main waterfront, bus and rail services. Accommodation is provided in eight single and four shared bedrooms, one double room upon the ground floor has en-suite facilities. There is an additional bedroom on the ground floor, which is used by staff for sleep in duties. The homes office overlooks the front door, this helps to monitor the comings and goings from the home whilst helping the staff to greet / direct visitors as necessary. Two communal lounges are available on the ground floor. The residents have designated the smaller lounge as a no smoking area. The dining room is situated within the conservatory, which overlooks the rear garden area. The kitchen is situated in the middle of the house in between the main lounge and the conservatory. Access between the ground, first and second floor is via the main staircase. There is a stained glass window along the staircase which adds considerable character and history to the home. A passenger lift is not available in this home. The home has access to a mini bus which is registered in the proprietor. This provides various opportunities for outings / activities. Car-parking facilities are available to the front of the building Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector called at the home without prior notice being given, as part of the Commission for Social Care Inspections (CSCI) regulatory duties. The manager was not present for this inspection, however the owner and staff members who where on duty provider the inspector with all the necessary information that was required in order to assess how a range of national minimum standards where being met within the home. The inspector toured the home and examined a variety of records relating to care and services offered and received within the home. Lunch was taken with the service users and staff members, and the views of individual service users and staff members where taken into account through discussion with the inspector. What the service does well: What has improved since the last inspection? A more consistent recording system has been introduced in order to clarify the administration of ‘when required’ (PRN) medication within the home. Further storage facilities have been purchased to hold medication securely. A number of new double glazed windows have been fitted throughout the home. A number of residents have had new curtains fitted within their individual bedrooms. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 6 An appointments notice board is displayed within the office to assist staff in planning for the week ahead. A new wide screen television was purchased on the day of the inspection to ensure residents continued to benefit from the opportunity to watch their favourite programmes together in the main lounge. 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. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 7 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 Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 8 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): 1,2 & 3 Clear information provided to residents before they move into the home ensures that they and their families know how the home will strive to meet their assessed needs. EVIDENCE: The statement of purpose and service user guides where viewed. These where found to provide clear information regarding all the services offered within Kingsley House. This information helps prospective resident’s, their families or representatives make informed decision regarding the suitable of the home and the staff in meeting their needs appropriately. A copy of the service users guide is displayed upon the service users notice board for future reference for residents living within the home. No new residents have been admitted to the home since the previous inspection. However examination of three resident’s files confirmed that it was standard practice to for the home and other professionals to fully assess needs prior to admission taking place. Detailed risk assessments were also seen, these indicated what actions had been agreed to minimise risks to resident’s health and well being whilst promoting independence and choice. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 9 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): 6,9 & 10 Care planning and risk assessment system used provide staff with the essential information they need in order to support residents in meeting their individual needs and aspirations. Its imperative that review are undertaken at regular intervals to assist residents and staff to clearly identify any changes that maybe required to their care plans. EVIDENCE: A key worker system is in place and workers continue to work with individual residents to help build up a fuller picture of who they are and what they really want to achieve at any given time. Care plans examined by the inspector gave information regarding individuals overall aims and objectives. Further information relating to how staff members should support and assist residents in achieving these aims was seen within the various risk assessments that had been completed. Relevant information relating to residents health and social well being had been recorded upon daily records to aid the care planning and review process used within the home. Observation of interactions indicates that the staff Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 10 members use their knowledge and experience of the individual to promote appropriate levels of independence whilst addressing any issues of risk and protection that may have arisen. Records relating to the reviewing of care plans and risk assessments indicated that a number of these have not been complete on or around dates previously set. It’s important that arrangements are made to ensure such plans are reviewed at regular intervals as this provides an opportunity for residents and staff to reflect upon the effects of the support and assistance given, whilst considering any other new needs or aspirations that may need to be addressed. Residents files where stored within the main office, which is locked when not in use, protecting the residents rights in relation to the handling of their confidential information. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 11 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): 11,12,13,14,15,16 & 17 A variety of daily routines are promoted and maintained to ensure they reflect the individual chioces and needs of the residents. Staff within the home appear to recognise the importance of family links, friendships and support networks and do their utmost to enable the resident’s to maintain and develop these as appropriate. EVIDENCE: Records indicate that social activities are determined by the residents individual and groups desires. Predominately activities centre around outings with in the local community either with or without the support and assistance of staff members. Depended upon the outcomes of individual risk assessments. It was noted that trips to other small care homes are often undertaken as the residents enjoy participating in various pool and dart competitions with other residents. The home provides the residents with a dartboard, pool table, playing cards, digital TV, a music centre and a computer. The inspector was told by residents that there are occasions when outside entertainer is supplied to enhance Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 12 parties and events within the home. One resident said “karaoke nights are one of my favourites” Whereas another said “I just like play cards and chatting with the staff about life or nipping out to the shops and the bookies” Support is provided as and when necessary to assist residents in pursuing or attending work or educational opportunities in order to develop their communication, social, emotional and daily living skills. It has been reported that one resident did successfully achieved a move on to supported living arrangements, whilst another one continues to receive support and guidance form the staff to enable him to work towards his personal goal of moving into supported living in the near future. Records and discussion with residents confirmed that a varied diet is provided to aid good health. Residents stated menu’s are based on their various likes and dislikes and that they do receive alternatives if the choices offered are not to their liking. Residents are encouraged to prepare their own breakfast as and when they get up. The lunch-time meal is normal a snack type i.e. Hot dog with or without onions, egg on toast, chicken nuggets and beans, soup, sandwiches etc. It was noted that the timing of this meal is very flexible, as staff need to taking in to account the activities or plans that the residents may have for the day ahead. The main meal of the day is served during the evening and residents are encouraged to join together in the dining room. The kitchen appeared to be adequately stocked with fresh food supplies and staff members where observed preparing various shopping lists to ensure stock that was running low was replenished. Staff confirmed that residents often assist with the weekly shopping and if necessary a number of the residents or staff members would call at local shops to purchase small items that might be required. “It’s just like living in a large family house, we all pull together” stated one of the resident Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 13 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, 19,20 & 21 Residents physical and mental health needs appear to be met appropriately in a sensitive and flexible manner via experienced and knowledgeable staff. Recording of medication received stored administered etc within Kingsley house has notable improved since the last inspection. EVIDENCE: Care plans and risk assessments examined by the inspector highlighted the information staff members need to consider in order to promote and encourage residents to maintain / improve their physical and mental health. Records confirmed that residents, their representative and other healthcare professionals are consulted, to ensure their personal and healthcare needs are met correctly. Residents within Kingsley house are presently able to attend to most aspects of their own personal care independently although on occasions it appears that prompting / advice and guidance is required to ensure a decline in a residents physical appearance is not linked to a decline in their mental health. It was noted that further medication storage facilities have been supplied within the home and that staff members have taken on board requirements Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 14 made during the last inspection. General observations and examination of Medication Administration Records (MAR) and medication held confirmed that improvements have been made by staff members, particularly in relation to the level of maintaining accurate records relating to medication received, stored, administered and disposed of. The inspector was able to confirm that polices and procedures are in place to guide staff in their approach to the changing needs and events that can occur due to ageing, illness and death of residents in their care. Discussion with staff members demonstrated they understood these polices and that there have been occasions when they had supported residents in dealing with the effects ageing, illness and death of other residents or family members. Daily record and activity sheets demonstrated how a number of residents had been supported by staff members recently. Entries seen confirmed that staff had escorted one resident to the cemetery in order for him to place flowers on the grave of a relative. Whilst other entries confirmed that staff had escorted and supported residents in visiting a fellow resident throughout his recent hospital admission, and that as and when necessary they had been able to explain aspects of his situation to them in order for them to understand how the ageing process appeared to be affecting his physical health. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 15 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 & 23 Polices and procedures are in place to ensure residents views are listened to and acted upon and that they are protected from abuse, neglect and selfharm. EVIDENCE: A copy of the homes complaints procedure is displayed upon the residents notice board. Neither the home or the commission have received any complaints regarding the home for sometime. Records seen confirm that issues and concerns raised with the home in the past had been appropriately recorded. Observations of interactions between residents and staff members indicate that residents feel confident raising and expressing any dissatisfaction encountered. The inspector asked a number of residents if they had or had ever had any complaints regarding the home and was told. “we tend to sort things out quickly here, so things don’t really get to the point that we’d have to make a complaint” “The staff are always asking and telling us about things that are happening in the home so that we can work things out together, and that reduces any stress” The home also had a copy of “Protecting Vulnerable Adults in Wirral” staff members confirmed they have received relevant information and guidance regarding dealing with allegations of abuse etc. The inspector was told that recent training had been given in relation to the home whistle blowing policy. Written comments received after the training from staff included the following Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 16 “The training was very interesting and the manager explained the bits I didn’t understand I enjoyed it very much” “Eye opening in some places and gives good advice” Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 17 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 & 30 The home appears to provide a comfortable and safe environment for the residents. EVIDENCE: A programme of redecoration and replacement of fittings is in use within the home. Residents spoken too confirmed that they are involved in the choosing of new items and colour schemes used within the home. Communal areas are well furnished with comfortable furniture including televisions, music, computer and leisure (Dart board, pool table and cards where) facilities. On the day of the inspection the owner arranged for the purchasing of a new wide screen TV for the main lounge as the other TV had broken over the week-end. Residents stated that they had been provided with a spare TV on a temporary basis but it was difficult for them to all watch it together as it was rather small. “This one look great” said one resident. As part of the redecoration programme operated within the home a number of new double glazed windows have been fitted. This work was undertaken to aid the overall appearance of the home. The inspector was told that once this work is fully completed arrangements will be made to touch up décor around window Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 18 frames as some areas of the paint work and wallpapered areas are now in need of some attention. Staff members where observed undertaking general cleaning throughout the home in order to keep it clean and tidy. The majority of the residents in the home are smokers and although there is a small no smoking lounge and a policy of no smoking within bedrooms it was noted that the odour and presences of smoke coming from the main lounge can at times be very heavy. The owner is therefore recommended to consider the purchasing and fitting of a suitable extractor fan system. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 19 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): 31,32,33,34,35 & 36 Residents appear to benefit from the support of an established and competent staff team. Recruitment and selection procedure are robust ensuring the safety of residents at all times. There is a strong emphasis on training and providing staff opportunities to develop their skills. EVIDENCE: There has not been any changes to the staff team since the last inspection and the owner stated that they have always had a low turn over of staff within Kingsley house. This provides residents with excellent levels of continuity. The inspector examined two staffing files, these confirmed that a good standard of recruitment procedures had been followed prior to staff being employed. Information relating to comprehensive induction programme undertaken confirmed that staff members had been given the opportunity to gain necessary skills and knowledge to perform their roles effectively. Documentation and discussion with staff confirm that supervision sessions are regularly ensuring staff have an opportunity to reflect upon their roles and responsibilities, whilst also discussing any issues, concerns and ideas that may have arisen. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 20 A number of staff employed at Kingsley house have already achieved NVQ qualification and a further 2 staff are in the process of completing this form of training. It was evident from talking to staff members that the manager is very committed to promoting a range of training opportunities to aid their personal and professional development. Records examined relating to training undertaken confirm that staff are required to regularly reflect and evaluate the training they’ve received. This is extremely good practice and assist staff members in considering how they have transferred the skills and knowledge they’ve obtained into their daily working practices. All the staff that the inspector spoke with confirmed that they enjoyed working within Kinsley House, and that they regularly attended social functions with their families and friends in their own time as they felt part of a good strong team. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 21 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): 37,38,39,40,41,42 & 43 Residents and staff within Kingsley House appear to benefit from an experienced and organised manager, who ensures the health, safety and welfare of both residents and staff, is promoted and safe guarded at all times. EVIDENCE: Observations and discussion with staff members indicates that the registered managers leadership style ensures the home continues to run with the best interests of the residents in mind. Staff members on duty demonstrated their abilities to oversee the day to day operations of the home in the managers absence. On arrival the inspector was told by a senior staff member “it might takes us a little bit longer to provide you with the information you require but Ann has taught us well to deal with all kinds of situations.” Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 22 The home appears to benefit from a open and proactive ethos. Observations indicate that staff and residents are encouraged to be involved and informed about all aspects of the management of the home. Discussions confirmed that suggestions where listened to and regularly acted upon to ensure benefits for the residents are achieved. Records of staff meeting where seen during the inspection to confirm information relating to policies and procedures used within the home are explained and discussed. Various polices and procedures where available for inspection all appeared clear and accessible to staff members, who may need to refresh their knowledge and experience as various needs and situations arises. Insurance, service and maintenance records viewed where valid and up to date. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 23 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 3 2 3 3 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 24 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. Standard YA6 Regulation 23 Requirement The registered person must ensure that individual care plans and risk assessment are reviewed at regular intervals and suitable records are kept to evidence how this is done in consultation with the residents Timescale for action 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations A form of extractor to be fitted to minimise smoke in the main lounge. Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Kingsley House DS0000018906.V284336.R02.S.doc Version 5.1 Page 26 - 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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