Inspection on 08/06/05 for Lewis House

This inspection was carried out on 8th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Lewis House 23/01/10

Lewis House 14/01/09

Lewis House 21/07/08

Lewis House 21/01/08

Lewis House 28/08/07

Lewis House 07/03/07

Lewis House 21/06/06

Lewis House 13/02/06

Lewis House 22/02/05

Lewis House 25/08/04

Lewis House 18/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Lewis House Higher Merley Lane Corfe Mullen Dorset BH21 3EG Lead Inspector Sophie Barton Unannounced 08 and 13 June 2005 10:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lewis House Address Higher Merley Lane, Corfe Mullen, Nr Wimborne, Dorset, BH21 3EG 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) 01202 887255 01202 887255 thisislewishouse@aol.com Mrs Jillian Elborn Mr John Francis Elborn CRH PC - Care Home Only 6 Category(ies) of LD Learning Disibility (6) registration, with number of places Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 22 February 2005 Brief Description of the Service: Lewis House is a care home offering accommodation to a maximum of six adults who have a learning disability. The premises are located in a quiet semi rural setting in the village of Corfe Mullen. Local amenities are close by and include churches, a supermarket and a public library. Public transport operates close to the home, taking residents into Wimborne, Broadstone and Poole. The property is a well-maintained detached family style house. The home is staffed 24 hours a day. Mr and Mrs Elborn own the home and work there full time along side a staff team. Mrs Elborn’s mother and a family friend / member of staff also reside at Lewis House. Mr and Mrs Elborn and their family also run 2 other homes, Woodside and a self contained flat. Lewis house offers care and support to service users who are moving towards increasing their independence. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days. The first day was unannounced, and was between the hours of 10.30am and 4.00pm. The Proprietors (John, Jill and Simon Elborn) were present throughout the day. The Inspector had lunch with three of the service users, and spoke privately with two service users. A range of documents were examined (health and safety log, two care files, diaries, staff files, and medication records). The second day was announced, between the hours of 12.00pm and 2.00pm and involved examining another two service users’ files in more detail. What the service does well: What has improved since the last inspection? Staffing remains stable and consistent. Staff have also been given the opportunity to attend statutory training courses in health and safety, adult protection and new staff are due to start the Learning Disability Award Framework training. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 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. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 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 standard(s) 1, 3 and 4 The home has a satisfactory admissions process with service users and representatives having good information to make an informed choice. Prospective admissions are carefully considered and planned by the proprietors and only service users whose needs can be met by the home are admitted. EVIDENCE: The Inspector was shown the Statement of Purpose and Service User Guide for the home. The Manager confirmed that each service user had been given a copy of the Guide, and that the Statement of Purpose is given to relatives and other professionals. One of the Proprietors has also made an audio tape of relevant information about the home. The Proprietors informed the Inspector that a prospective service user was coming for a second tea visit, that they had already visited this service user at his local Day Centre and met with his family. The Proprietors work towards an eight week initial settling in period followed by a review. The service users stated that they are involved in the decision about compatibility of any prospective new resident. The Proprietors are very clear about the needs that can be met by the home, and showed evidence that referrals for prospective new service users are not accepted where the compatibility with other service users would not be conducive and where staff have not got the knowledge to meet specialist needs. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 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 standard(s) 6, 7, 8 and 9 Assessment and care planning systems are poor, with service users not having an up to date care plan and no record of their personal goals or aspirations. Risk assessment systems are also limited and fail to ensure staff know how to protect service users from harm. Improvement is still needed in relation to the home promoting service users independence with finances. The home is committed and proactive in ensuring service users are fully consulted and participate in the running of the home, with all practice and routines led by the service users themselves. EVIDENCE: Evidence of how service users’ independence and participation is encouraged was noted by discussions with the staff, the Proprietors and the service users. Service users stated that they are given a choice about what activities they partake in, what food they eat, how they spend their leisure time, and in relation to control over their money. The Proprietors have advocated for a service user in relation to being able to go on holiday abroad, and for a service Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 10 user to visit a friend independently by balancing the potential for risk against the service user’s rights and choices. The service users confirmed they are informed about any potential changes to the home, and consulted about new staff. Where service users’ rights are restricted (i.e. not having own bank account, not being able to go out unsupervised) the reasoning for this is not clearly evidenced in care plans, and there are minimal risk assessments completed for each service user. One service user who is at risk due to severe health problems has no associated risk assessment detailing how staff are to support him with this. Three care files were examined. One service user had a care plan dated 2002 and two had care plans dated 2003. There was no evidence of a review being held for 18 months for all three service users. There was no list of goals or aspirations that the service user might have, although in discussion with the Proprietors they were able to clearly articulate what goals were being aimed at for each service user. The care plans that were seen were limited in detail, especially in relation to health, behavioural issues and identified risks. The care files did not evidence at all what the service users needs were or how the staff were to meet them. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, and 15. Service users are strongly encouraged and enabled to lead active and ‘meaningful’ lives. Links with the community are excellent and enrich service users’ social and educational opportunities. Considerable focus is given in supporting service users in maintaining contact with family and developing appropriate friendships. EVIDENCE: The activities service users take part in include work experience, going to the local Day Centre, swimming, horse riding, being a member of a football club and marching band, going to an Advocacy Social Forum, and attending evening social clubs. Daily diaries also evidenced that service users go to the pub, to the shops, out for lunch and visit other towns on a regular basis. One service user confirmed that he chooses whether to attend band practice or go to a social club each week, as unfortunately they fall on the same night. The Proprietors also arrange annual holidays for the service users. The service users informed the Inspector how they went to Spain last year and to France. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 12 One service user told the Inspector how the staff help him to see his girlfriend, and another service user confirmed that she can have her family visit when she chooses. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 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 standard(s) 18, 19, 20 The home provides a high level of flexible personal support to service users, but limited working records limit the information staff have to ensure they are providing appropriate levels of guidance. The home’s systems for assessing, reviewing and monitoring the healthcare needs of service users are poor, and allow for the potential for needs to be unmet in the long term. The home has not maintained accurate medication records, or provided staff with acceptable information to ensure service users medication is administered appropriately and safely. EVIDENCE: Although following discussions with the Proprietors who could clearly articulate the health needs of service users and how the home was meeting these needs, there was no recorded evidence of this. For instance the staff were supporting a service user with having specialist health tests and appointments in London, but the outcome of the appointments and reasons for tests were not recorded anywhere. There was no evidence that service users had been for checks ups with the dentist, opticians or had a hearing test. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 14 One service user requires oxygen. There was no care plan detailing the treatment and responsibilities of all those involved in this care, and no system to record when care workers provide Oxygen to service users. There were also inaccuracies noted on the medication administration record for one service user. In discussion with staff, service users and the Proprietors it was evidenced that flexible personal support is provided to service users, and that service users are encouraged to be independent in choosing clothes, times for getting up and going to bed, having baths etc. Two service users have very limited verbal communication, but there were no records setting out their preferred routine, likes or dislikes in order to aid consistency and privacy. Without working records or an assessment the staff cannot be sure that they are providing the care that is wanted or needed. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 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 standard(s) 22 and 23 Systems within the home provide service users with an open, encouraging environment, where their views are listened to and acted upon. Adult Protection is appropriately and well addressed in staff training, policies and practice in order to safeguard service users from potential abuse and harm. EVIDENCE: The three service users spoken with confirmed that they are able to raise any concerns they may have with staff. They also confirmed that they did not have any concerns or complaints. A service user stated that the Proprietors listen to what he does say, and allows him to voice his wishes. Although there are no formal resident meetings, the service users were observed all talking together and arranging trips and discussing a forthcoming holiday. There have been no formal complaints made to the home or the Commission about the care provided at Lewis House. The Proprietors themselves have a good understanding of adult protection and have discussed concerns with the appropriate professionals in the past. The staff have access to the home’s adult protection and whistle blowing procedures and the Proprietors confirmed that staff have attended training on Adult Protection and the No Secret guidance. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 28, 30 The home is kept to a high standard of cleanliness and service users enjoy a comfortable, homely and well furnished environment, with ample shared space to meet individual and group needs. EVIDENCE: Lewis House is a large domestic family house. It accommodates the six service users, and two further adults also reside at the home (the Proprietor’s mother and a family friend/member of staff) who also share the communal areas. There are ample shared spaces however, a lounge, dining room, TV/quiet room, conservatory, garden and patio area. Service users have unrestricted access to all areas. The furniture is domestic, homely and well maintained. The service users confirmed that they like the house, that it is sufficiently heated and ventilated. The home is near to local amenities. The Proprietor has recently been inspected by Health and Safety and Environmental Health officers. He confirmed that the recommendations made are currently being actioned. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 17 Laundry facilities are sited away from the kitchen, and have impermeable wall finishes and flooring. The Proprietors are aware of infection control good practices. On the day of the inspection the home was found to be clean and free from offensive odours. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 The service users benefit from continuity and stability of staff support, staff who are accessible and approachable and who are able to meet their basic individual and collective needs. Staff lack the skills to meet service users specialist needs. Staff recruitment practices are inadequate, putting service users at potential risk of abuse. EVIDENCE: The service users confirmed that they get on with all staff, and have positive friendly relationships with them. Observations made by the inspector also confirmed this. The Proprietors continue to work in the home full time, and they are very committed and interested in the service users and ensure that they are always approachable. The ethos and way the home is run is like a family, with the service users being integrated into the Proprietors family and the Proprietors getting to know the service user’s family well. The staffing hours provided average 165 hours per week (plus sleeping in hours and management hours). This meets the recommendations from the Department of Health, and allows for service users to spend uninterrupted time with staff, and individual support with activities. There are regular staff meetings. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 19 There have only been two staff members leave in the past two years, and this was due to them moving house. The Inspector examined the recruitment files of recently appointed staff members. A current Criminal Record Bureau check had not been obtained, or a POVAFirst check, and the Proprietors did not have the correct understanding of the regulations concerning these checks. There were also no copies of the staff member’s birth certificate or passport as per the regulations. An application form had been completed and two references sought. Staff training provided is basic, with the Proprietors confirming that staff have attended statutory courses in first aid, and food hygiene. Two new staff members are due to start the Learning Disability Award Framework training. 50 of staff have yet to complete a NVQ 2, and no specialist training has been provided for staff in relation to autism / aspergers syndrome, challenging behaviour or communication. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 41, and 42 Service user’s rights and interests are not promoted due to the significant lack of appropriate record keeping. The Proprietors have not monitored or reviewed the care they provide, which has resulted in some poor practice being maintained. Health and safety checking systems are poor which could potentially put service users safety at risk. EVIDENCE: As stated previously service users do not have a current assessment or care plan, which are two documents the service users have a right to. The service users’ care files shown to the Inspector were unorganised. Also as stated previously staff files lacked the necessary documents. The proprietors have also not kept a copy of the worked duty roster. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 21 The Proprietors have not kept on top of the regulations. The record keeping, and care plans are not regularly monitored. There are no quality assurance systems in place with the Proprietors not reviewing the quality of care being provided by the home. Although the staff undertake regular checks of fridge and water temperatures, and fire alarm checks, the proprietors have not arranged for the fire alarm systems, and prevention equipment to be checked by a specialist at regular intervals. No evidence was found that the alarm system had been seen by a specialist for over a year. There was no evidence that staff had received 6 monthly training in fire evacuation and prevention. A fire drill/evacuation had not taken place at night. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 1 3 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 4 4 3 x x Standard No 31 32 33 34 35 36 Score x x 3 1 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lewis House Score 3 1 1 x Standard No 37 38 39 40 41 42 43 Score x x 1 x 1 1 x D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 23 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 6 Regulation 14, 15 Requirement Each service user must have an up to date care plan, detailing how the home is to meet their day to day needs. Assessments and Care Plans must be regualrly reviewed. The Registered Providers must support service users to have their own bank accounts, so that their money is paid into this account and not the homes account. A clear record must be made, and agreed with the service user and/or their representative, for when restrictions are placed on the service users rights, choice and freedom. Risk assessments must be completed and made available to staff for when a risk is identified, detailing how the risks are to be minimised. The Registered Providers must ensure that a record is kept of how the home is meeting the health needs of service users. Records must be kept of when service users attend health appointments and the outcome of these appointments. Timescale for action 01.08.05 2. 7 20 01.09.05 3. 9 13 01.08.05 4. 19 12, 13 01.08.05 Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 24 5. 20 13 6. 34 19 7. 39 24 8. 9. 41 42 17 23 The Registered Providers must ensure that staff complete accurate medication administration records. Staff must not begin work in the care home without a satisfactory POVAFirst check. Criminal Record Bureau checks must be sought for each new employee. A copy of new employees passport and birth certificate should be obtained by the Registered Providers. The Registered Providers must ensure that they review the quality of care provided by the home regularly. Records set out in Schedule 3 and 4 must be kept in the care home. The fire alarm system and emergency lighting must be checked/serviced by a specialist at appropriate intervals. Staff must receive regular fire training from a competent person. 01.08.05 15.07.05 01.09.05 01.08.05 15.07.05 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 6 Good Practice Recommendations There should be a clear record made of the service users goals and aspirations and how the home is to help to meet these. Care Plans should be developed in a format suitable to the needs of service users. There should be a clear record kept, and made available to staff, of the service users personal care needs and their preferences to how they would like to be guided. The Registered Providers should ensure that all staff have at least an NVQ 2 qaualification in care or are working D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 25 2. 3. 18 35 Lewis House 4. 5. 6. 39 41 42 towards one. The Registered Providers need to ensure staff have training in autism, challenging behaviour and communicating with service users who have a learning disbaility. The home should have an annual development plan, reflecting the aims and outcomes for service users. Individual records and home records should be well organised and in good order. A fire drill /evacuation should take place at night or the early morning. Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF 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 Lewis House D55 S26836 Lewis House V229014 080605 Stage 4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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