Inspection on 13/06/06 for Manor Park Care Home

This inspection was carried out on 13th June 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Manor Park Care Home 26/04/07

Manor Park Care Home 15/11/05

Manor Park Care Home 04/05/05

Manor Park Care Home 03/11/04

Manor Park Care Home 02/09/04

Manor Park Care Home 31/03/04

Manor Park Care Home 21/01/04

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

CARE HOMES FOR OLDER PEOPLE Manor Park Care Home 3 Ellenborough Park North Weston Super Mare North Somerset BS23 1XH Lead Inspector Juanita Glass Unannounced Inspection 13th and 21st June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Manor Park Care Home Address 3 Ellenborough Park North Weston Super Mare North Somerset BS23 1XH 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) 01934 635432 01934 641045 enquiries@manorparkcare.co.uk Manor Park Care Ltd To be appointed Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. For 38 service users, the minimum staff on duty will be 2 care staff in each unit and a 5th person covering both the units (the 5th person can include the home manager), three care staff on duty at night. May accommodate one person aged 59 years and over. This condition applies to a named individual and will no longer apply if this person leaves the home. May accommodate up to 5 service users, aged 60 years and over, who have dementia. That occupancy remains at 35 until notice of completion is received for the remainder of the building and the Inspector is satisfied with provision in place. That any day care provided does not impact on the National Minimum Standards for the service users resident in Manor Park. 15th & 16th November 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Manor Park Care Home is registered with the Commission for Social Care Inspection to provide non-nursing care for 38 service users aged 65 and over with Dementia or associated conditions. It is approximately 500 yards from the sea and within close proximity of shops and local amenities. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Current fees: £400 to £550 This inspection took place in the presence of the acting manager Aileen Board over two days; a total of 10 hours was spent in the home. During this inspection evidence was gathered by talking to service users, staff and visitors. Also by reviewing documentation, which included care records, staff personnel records and maintenance records; a tour of the premises was also carried out. Service user and relative surveys were sent out however response was poor. Those comments received were complementary and praised staff at the home. One comment made several times was that relatives would have liked to have been informed of the change of manager formerly, rather than having to find out on the grapevine. Residents who could express an opinion said they were happy and staff were nice and respectful. One resident said they had mentioned to kitchen staff how nice the meals were but suggested they could vary the way potatoes were cooked. One resident comment card said they had requested specific food and the home had agreed to provide it. One visitor said he did not know how he would have coped without the help and support he had received from staff and management. During the time spent in the home staff were observed to have a friendly and relaxed rapport with residents. Those residents unable to express an opinion were observed to be happy and relaxed, well groomed and ready to chat freely to staff and visitors. Nine requirements were made; these are discussed in the relevant part of this report. What the service does well: What has improved since the last inspection? Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 6 The home continues to provide support for people with dementia and there has been little change in this area since the last inspection. Since the last inspection all accidents are not recorded in the appropriate format and a generic risk assessment has been carried out for the entire home. 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. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 4 6 does not apply Quality in this outcome group was adequate. Residents with social services contracts are not provided with a statement of terms and conditions. Evidence reviewed confirms prospective residents have a needs assessment carried out before they are admitted to the home. Staff have the necessary skills and ability to care for residents who are admitted. EVIDENCE: Care records reviewed showed that the manager carries out a full preadmission assessment, which identifies specific needs individual to the prospective resident. This assessment forms the basis for the initial care plan on admission to the home. Prospective residents are offered the choice to visit the home however this is usually taken up by relatives on the residents behalf, one visitor spoken to said the visit had been helpful and he had received Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 9 adequate information to make an informed choice on behalf of his relative. One shortfall noted in this outcome was identified by reviewing six sets of residents records selected at random, one of five records contained a contract with the home whilst five of the six only had a contract with the placing authority they did not have a statement of terms and conditions setting out the basic information regarding terms of conditions of occupancy and what residents can expect to receive for the fee they pay. • All residents must have a signed contract or statement of terms and conditions with home. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome group was adequate. Each resident has a care plan; the practice of involving residents in the development and review of the plan is variable. Care plans lacked evidence of regular review, and some risk assessments had been omitted. Residents have access to healthcare services that meet their assessed needs both within the home and in the local community. The home has a medication policy which is accessible to staff, and medication records are up-to-date for each resident. A PRN protocol needs to be implemented by the home. Staff are aware of the need to treat residents with respect and consider dignity when delivering personal care. EVIDENCE: Care plans reviewed showed very clear guidance for staff, they also showed an understanding of the need for individual person centred care. Staff spoken to said that they were able to access care plans and felt they gave adequate Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 11 information. Residents spoken to were unable to express an opinion however one visitor said staff constantly met his relatives needs. Although there was clear guidance to staff the care plans did not show evidence of regular review or of risk assessments being implemented when a risk was identified. One resident identified as at risk of falls,’ due to their physical condition and a high rate of falls identified in the accident book, did not have a clear risk assessment in place. The care records showed that residents were assisted in accessing healthcare services. Records showed that residents had attended outpatients’ appointments, GP, opticians and chiropodist’s; they also showed input from the mental health team. A random audit of the receipt, storage and administration of medication showed there were no errors, it is however recommended that boxes and bottles are dated to enable a clear audit and a requirement was made for the home to develop a protocol for administering PRN (as required) medication. This needs to include identifying triggers for individual residents on PRN medication. Staff were observed through both days, they showed an awareness of residents need for respect and dignity. Residents spoken to said staff are always polite and respectful, one visitor said they felt the way staff dealt with difficult situations was commendable • All care plans must be reviewed monthly. • Residents identified as at risk of falls must have a clear risk assessment. • A clear protocol must be implemented to identify when PRN medication can be used. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome group was good. Sufficient staff resources are provided to allow time for activities and stimulation. Family and friends feel welcome and know they can visit the home at any time. Residents are helped to exercise choice and control over their lives. Residents receive a wholesome appealing balanced diet in pleasing surroundings. EVIDENCE: The home provides a program of meaningful activities for residents and sufficient staff resources are in place to meet these needs. A record of activities carry on the home is maintained they show that residents were accompanied out on walks in the park or to the seafront, they also took part in activities including newspapers to keep up with current affairs, relaxation to music, and quizzes that include reminiscence, board games, musical singManor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 13 along and trips out in the minibus. A recent addition to the activities has been baking cakes, this proved very popular with the residents. They enjoyed mixing the ingredients while staff put the prepared dishes in the oven; they later enjoyed the cakes for tea. Visitors spoken to said they were always made welcome in the home and did not feel they were restricted regarding visiting. Throughout the inspection residents were observed maintaining choice and autonomy. They chose where they spent the day and whether they took part in an activity or not. Residents able to express an opinion said they had a choice. A four weekly menu is provided which gives residents a nutritious and balanced diet. An alternative is available and kitchen staff are aware of residents personal likes and dislikes or medical dietary needs. Residents spoken to said they had enjoyed lunch, while some could not remember lunch they had been observed receiving appropriate assistance in a relaxed and dignified manner. One resident who had been a cook said they had suggested to the homes cook that they present potatoes in a more varied manner, as there were ways other than mashed, boiled and roasted to present them. However he also stated he was satisfied with the overall standard of food in the home. One visitor said his relative had put on weight so the home must be getting it right. A review of care plans showed that all residents had nutritional assessments and the weights of residents over the last six months had been largely maintained. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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 the following standard(s): Quality in this outcome group was adequate. The home has a clear complaints policy and procedure, which includes a time line and record of action taken and outcome. The home has a robust policy and procedure for the protection of vulnerable adults, however their recruitment procedures do not support this. EVIDENCE: The home has a clear complaints policy and procedure which residents who could express an opinion appeared to be aware of. Two residents agreed that they could approach the manager with any concerns, whilst one said they would write to their daughter. One visitor stated that he felt at ease with raising concerns with staff if a problem arose. A record is maintained of complaints raised at the home these showed that appropriate action was taken and a feedback from the complainant was sought. The home has a robust policy and procedure for the protection of vulnerable adults. Staff spoken to said they knew what action to take, they were aware that there was a local authority procedure and where to access the information if they needed to. However the recruitment procedures adopted by the home do not support the homes adult protection policy and puts residents at risk of abuse or harm. This is discussed in the relevant section of this report. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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 the following standard(s): 19 and 26 Quality in this outcome group was adequate. Overall the quality in this outcome was adequate however there were some areas of poor practice noted. The service provides a homely, safe environment with a planned programme of maintenance. The home is generally clean, pleasant and hygienic, with the exception of five identified rooms. EVIDENCE: Manor Park provides a very homely atmosphere for residents to live in. Residents were observed to be relaxed and happy those who could express an opinion said they liked their rooms and could choose where they sat. One resident said that they liked the TV lounge whilst another said they preferred the front lounge where they could watch people walking past. Residents have three lounges and a small area by the office to sit in, and were observed Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 16 through the day settling in one room or another. The dining room is bright and airy and next to the kitchen so food does not have to travel far. A tour of the premises was carried out and although the home was bright, airy and very clean, some identified bedrooms smelt strongly of stale urine, one in particular was very malodorous. This was discussed with the manager, it had also been noted that the relatives of the occupants of two of the rooms identified had raised concerns regarding the smell of stale urine. These odours did not permeate into the rest of the home but they were not pleasant for those entering the rooms. The manager stated that they were in the process of purchasing cleaning fluids, which also contained a ‘urine neutraliser’, which would neutralise the smell. It was agreed that progress in this area would be assessed at the next inspection. • It is recommended that odour neutralisers be used in the identified rooms. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome group was adequate. There are adequate numbers of staff to meet the needs of the resident group. Staff have received training specific to the needs of people with Dementia. The homes recruitment procedure places residents at risk of harm and abuse. Staff have received appropriate training however first aid for all staff needs up dating. EVIDENCE: Staffing levels in the home comply with the conditions of registration set down, residents, visitors and staff all stated that there were generally enough staff on duty at all times. Staff were not observed to be rushing to get jobs completed and residents were taken out for a walk in the park, whilst others chatted with staff over books or newspapers. Staff spoken to said that they had received training specific to dementia care, one visitor said that they could, ‘handle a situation without it blowing out of proportion.’ Staff personnel records were reviewed, they showed that the recruitment procedures in the home continued to be unsafe despite a previous requirement. Staff had commenced work without the appropriate POVA 1st checks being carried out; this places residents at risk of harm and abuse. This was discussed with the manager who made assurances that future recruitment procedures would include a POVA 1st confirmation before they start work in the Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 18 home. It was stated clearly that if the home did not comply following this inspection and staff continued to be hired without the required checks enforcement action would be taken. Staff records showed that mandatory training had been carried out, however the first aid certificates showed that the home did not have a person qualified in first aid on each shift especially at night. Staff are encouraged to attend training relevant to their role in the home. It must be noted that distance learning for manual handling is acceptable as a refresher however manualhandling training must include practical demonstrations and time to practice with an assessor to advise on best practice. • • New staff must not commence work until a POVA 1st confirmation or full enhanced CRB has been received. There must be a qualified first aider on each shift including nights. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 and 38 Quality in this outcome group was adequate. The manager has experience in the care of the elderly and is working towards her Registered Managers Award. The manager and registered providers seek the views of the service users and their relatives/advocates. Records maintained by the home are reviewed and up todate with the exception of the Regulation 26 report. Health and safety in the home is generally satisfactory, however there is a shortfall in staff attendance at fire drills and a lack of qualified first aiders. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 20 EVIDENCE: The acting manager has recently taken on the role and is currently looking at arrears where she can develop her skills further, she has attained the NVQ 4 In Care and has commenced the Registered Managers Award. During the inspection she showed a keen awareness of the needs of the current resident group and the need for staff development and training. The manager and registered providers seek the opinions of residents and their relatives, friends or advocates, responses received were largely complementary and evidence could be seen of the home acting on suggestions. The manager also needs to look at ways of carrying out their own quality audit of how the home meets the national minimum standards other than through relative satisfaction surveys. Progress in this area will benefit the home when they need to complete the self-audit required by CSCI later in the year. The homes records and policies and procedures were well maintained and showed evidence of review. Staff spoken to were aware they could access the files containing the homes policies and procedures at any time. The manager has forwarded regulation 37 notifications to the CSCI as required. However the registered provider must be more consistent in forwarding the monthly visit report required under regulation 26. Health and safety in the home was generally satisfactory, since the last inspection the manager has completed a full generic risk assessment of the home, however it was discussed with the manager that they could be more specific on what the identified risk was and how they could be avoided. The manager was advised to access the HSE website for advise on completing risk assessments. A review of the Fire Log showed that all the relevant checks were being carried out with the exception of regular checks on the emergency lighting, all that staff had received appropriate training. All staff must attend a fire drill this must include night staff, it was noted that very few of the current staff compliment had attended a recent fire drill, although staff spoken to were aware of the action they should take. As previously mentioned the home does not have a qualified first aider on each shift. • The registered provider must forward a monthly report to the CSCI under regulation 26. • All staff including night staff must take part in fire drills. • Emergency lighting must be checked in line with current guidelines. • There must be a qualified first aider on each shift (as previously stated) Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X 2 2 Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 5 Standard OP2 OP7 OP7 OP9 Regulation 5 (1b) (1b) 15 (2b) 13 (4) 13 (2) 19 (1) Requirement All residents must have a signed contract or statement of terms and conditions with home. All care plans must be reviewed monthly. Residents identified as at risk of falls must have a clear risk assessment. A clear protocol must be implemented to identify when PRN medication can be used. The home must obtain a POVA first confirmation before employing new staff. Previous date of 16/11/06 was not met There must be a qualified first aider on each shift including nights. The registered provider must forward a monthly report to the CSCI Previous date of 16/11/06 was not met All staff including night staff must take part in fire drills. Timescale for action 01/08/06 21/06/06 21/06/06 01/08/06 21/06/06 6 7 OP38 OP37 18 (1) 12(1) 13 (4) 26 01/08/06 21/06/06 8 OP38 23 (4) 21/07/06 Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 23 5. OP38 23 (4) Emergency lighting must be checked in line with current guidelines 21/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP26 OP38 Good Practice Recommendations The manager needs to ensure that odour neutralisers are used in identified rooms Generic risk assessments need to be more specific. Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Manor Park Care Home DS0000043913.V294820.R01.S.doc Version 5.1 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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