Inspection on 11/09/06 for Matlock Close 4

This inspection was carried out on 11th September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Matlock Close 4 16/03/09

Matlock Close 4 24/04/08

Matlock Close 4 04/12/07

Matlock Close 4 20/06/07

Matlock Close 4 06/02/06

Matlock Close 4 21/07/05

Matlock Close 4 17/01/05

Matlock Close 4 17/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Matlock Close 4 Barnet Hertfordshire EN5 2RS Lead Inspector Anthony Lewis Key Unannounced Inspection 11th September 2006 09:00 Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Matlock Close 4 Address Barnet Hertfordshire EN5 2RS 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) 020 8449 9055 020 8449 9055 spower@pentahact.org.uk www.Adepta.org.uk Adepta Miss Sandra Power Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 8 adults who have a learning disability (LD), and who may also have a physical disability (PD). 6th February 2006 Date of last inspection Brief Description of the Service: 4 Matlock Close is a large purpose built detached bungalow for eight adults with learning and physical disabilities and has been designed for residents who use wheelchairs. The home has a substantial plot with gardens to the sides and rear. There is off street parking to the front of the home for several vehicles. The home was opened in May 1995 and is managed by Adepta who provides care and support to people with special needs and maintained by Notting Hill Housing. It is situated on a relatively new housing estate in High Barnet, a short walk from local bus routes and local shops and a short bus journey to Barnet Town Centre. Barnet General Hospital is within a short walk of the home. The fee for residents living in the home is £1,382.00 per week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on Monday 11th September 2006 at 9am and was completed at 3.30pm. The manager, who is temporary until the end of September 2006 and the deputy manager were available throughout the inspection process and were very helpful and accommodating. The operations manager visited the home in the afternoon to carry out a monthly service quality audit and participated in the inspection process. To gather evidence for this inspection, three residents were spoken to informally, although this was rather difficult due to all of the residents having some form of communication difficulty. One of the residents and his father were spoken to together and one resident was spoken to in the presence of a member of staff. Five members of staff were spoken to three individually in private and two together. Evidence was also gathered by viewing all of the residents’ files, seven staff files and various other files, certificates and documents. An extensive internal and external tour of the home was conducted with the registered manager. What the service does well: What has improved since the last inspection? What they could do better: Six requirements have been made at this inspection, of these two have been restated. Further information about unmet requirements can be found in the relevant standard. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 6 If staff are to support residents to achieve their full potential, they must ensure that they identify residents goals and ambitions with the support of the resident’s representatives. To ensure that residents can access all communal areas of the home, the ceiling glass in the conservatory must be replaced. All bathrooms must be fitted with appropriate equipment so that all residents can use the facilities. To ensure that robust recruitment procedures are being followed and that residents are safe, all staff must have a recent photograph in their file. Staff must receive the required training to ensure that they have the skills and experience to meet all of the needs of the residents. Safety tests must be carried out regularly and inspection certificates must be available in the home to ensure that everyone in the home is safe at all times. 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. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 and 2. Qualities in these outcome areas are good. This judgement has been made from evidence gathered during the visit to this service. Prospective residents to the home have the information to make an informed choice and robust assessments ensure that they are eligible to live in the home and that the home can meet their needs. EVIDENCE: At the previous inspection, a requirement was made that the service users’ guide and statement of purpose must be revised. Both were viewed and the revisions have been made. The service users’ guide has been developed in written and pictorial format for easier understanding of the information. All of the residents have lived in the home for many years and although their assessments have been archived, the organisation has policies and procedures on assessing potential residents to the home. The statement of purpose also contains some information about the assessment process. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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, 7 and 9 Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. Although residents are being supported to take manageable risks and make decisions about their lives, they are not achieving their goals because staff are not ensuring that goals are identified and recorded. EVIDENCE: Although it was made a requirement at the previous inspection, on looking through all of the residents’ care plans, there was a lack of information about their goals or ambitions. There was also no evidence that the resident, their family or representative was involved in drawing up their care plan. This was discussed with the manager and the operations manager and a revised and restated requirement was made. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 10 All of the residents have some form of communication difficulties. However, evidence in their personal file show that the services of a speech and language therapist has been sought. There was also evidence that two of the residents have an advocate who also support them to make decisions. Care plans contained information on the way residents communicate verbally through distinct facial expressions and through certain gestures. When spoken to, the staff were able to describe how they understand and support the residents to make decisions. Each resident’s care plan contains information on individually assessed everyday risks to them, compiled by staff in consultation with the resident or their representative. The home is using Adepta’s risk assessment format, which includes information on the risk and benefits to the resident, others and the organisation. The staff have been ensuring that the risk assessments are reviewed regularly. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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): 12, 13, 14, 15, 16 and 17. Qualities in these outcome areas are good. This judgement has been made from evidence gathered during the visit to this service. The staff are ensuring that residents access the community and take part in appropriate activities. They are also ensuring that residents maintain family links where possible and that their nutritional health care is well managed. EVIDENCE: The manager stated that none of the residents are in paid or voluntary employment. Certificates on residents’ bedroom walls and in their personal file shows that some of them have attended various courses at college. All of the residents also attend a day centre at least once a week and are supported by the staff there to develop their physical and mental skills. According to the deputy manager and evidence in their care plans, four of the residents are active in their church and attend every Sunday. The manager stated that the residents are active in their community and have a good relationship with the neighbours. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 12 Throughout the day, residents were observed entering and leaving the home with staff support. Three staff went out for lunch with two residents and the father of another resident came to take him out for the day. Residents’ daily diaries show that they have been accessing activities in the community such as the cinema, eating out or shopping. Information contained in residents’ care plans show that they are active in their community and are able to access all activities and facilities. A resident spoken to said, “I like going to football matches”. When asked what his favourite football team was he shouted the name out and smiled. The manager stated that none of the residents have close relationships with people other than their family. She went on to say that two of the residents who have minimal contact with their family, have an advocate who will support them when required, such as at various meetings and reviews. One residents father said, “I come here once a week and take my son out, I also attend meetings and talk to the staff about how he’s doing.” Throughout the day, staff were observed and overheard interacting with the residents in a courteous, supportive and professional manner. Residents seemed relaxed by the way they responded to staff support. Staff were also observed knocking on residents’ bedroom door prior to entering. The menu for the past four weeks was seen and contained sensible nutritious and varied meals such as casseroles, salads and vegetable dishes. When asked if she like the meals prepared in the home, one resident said quickly, with a smile on her face, “Yes, I do.” Another resident said, “I like the food and I help cook.” The father of a resident said that his son has never complained about the food to him. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 and 20. Qualities in these outcome areas are good. This judgement has been made from evidence gathered during the visit to this service. The staff team are ensuring that they support residents according to the residents’ preferences. They are also ensuring that residents’ health and health care needs are robustly monitored and met. EVIDENCE: Recorded on each residents care plan is information on how staff should support them with their personal care. Contained within the care plans is information on how the resident should be supported in getting up in the morning and going to bed at night. There is also information on supporting the resident with hygiene, dressing, doing their nails and hair. When spoken to a resident’s father said, “I’ve been coming here to see my son since the home opened and I’ve never had a problem with the way in which the staff look after my son.” He went on to say, “My son always looks clean and well cared for when I come here.” Each resident has a “Record of visits to a medical service”, in their file. Staff ensure that when residents visit their: GP, chiropodist or, dentist, that the advice/treatment and follow-up arrangements are recorded. The records show that the residents have regular health care checks to ensure that their health is monitored and maintained. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 14 The manager said that none of the residents administer their own medication. When looked at, the Medication Administration Records (MAR) charts for all of the residents show that staff have been filling them in correctly. All medication in the home is stored correctly. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 and 23. Qualities in these outcome areas are good. This judgement has been made from evidence gathered during the visit to this service. The home is ensuring that all complaints are taken seriously and that people have the necessary information if anyone wishes to make a complaint or if they suspect that someone is being abused. EVIDENCE: The home has comprehensive information available if residents or others wish to make a complaint. There is information in the service users’ guide along with Adepta’s complaints policy and procedure. The home also has complaint forms, which have sections for the complaints, the investigation and the outcome and any further action that should be taken. The home’s operations manager is, appropriately investigating a recent complaint made by the father of a resident. The home has the London Borough of Barnet’s Multi-Agency Protection Policy and Procedure and Adepta’s adult protection policies and procedures, which contains information on how to recognise signs of potential abuse and steps that the staff member should take if they have any suspicions. Staff spoken to had a good understanding of how residents should be protected from abuse. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 the following standard(s): 24, 29 and 30. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. Although the staff have ensured that the home is comfortable and is kept clean and hygienic, residents do not have sufficient or appropriate facilities to maximise their independence and ensure their freedom of movement and robust maintenance repairs are not occurring. EVIDENCE: An extensive tour of the home was conducted with the manager. The door to the conservatory was blocked. When spoken to, the manager stated that the door was blocked to prevent people entering the conservatory because one of the glass ceiling panels came away and fell to the floor. A temporary wooden panel has been put in its place. The manager went on to say that residents are being prevented from using the conservatory. A requirement is made that the glass panel must be replaced and made safe so that residents can use the room. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 17 A requirement was made at the previous inspection that an assessment is carried out to ensure the all baths are appropriate to meet the personal care needs of all of the residents. The manager and deputy manager stated that one assessment has been carried out but no decision has made as to what will be done about the bath. A requirement is made that a review of the identified bathroom takes place to ensure that an appropriate bath is fitted and that all residents are able to use the bath. The home has a part-time cleaner who ensures that all areas of the home are kept clean, tidy and hygienic. There is also a dedicated laundry room with washing and sluicing facilities. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 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): 32, 34 and 35. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. A competent staff team is supporting residents. However, residents are being put at risk and some of their needs may be overlooked due to recruitment and training procedures not being adhered to. EVIDENCE: Some of the staff files viewed contained a copy of their certificate in moving and handling and an introduction to learning disabilities. Many of the staff have worked in the home for many years and when spoken to all had a good understanding of the needs of the residents. The personal files of seven staff were viewed and contained information such as a Criminal Records Bureau Record (CRB) check, two references and an application form and other information such as a passport or documents from the Home Office regarding permission to stay or work in the UK. Five of the seven files however, did not contain a photograph of the member of staff. A requirement is made regarding this. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 19 The file containing staffs’ training certificates was viewed and although the staff have been continually receiving training, there was a lack of evidence to show that all of the staff have received the statutory training such has health and safety, protection of vulnerable adults, food hygiene, health and safety and moving and handling. A requirement is made that a review of staff training is undertaken to ensure that all staff are receiving statutory training. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 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, 39 and 42. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. The temporary manager is running the home reasonably and the quality of the service is being assessed. However, people are at risk due to inadequate safety monitoring. EVIDENCE: The manager stated that she has worked in the home since March 2006 on a temporary contract. She went on to say they she has a City & Guild in advanced management in care and has been in management since 1991, in various services. Adepta has a quality assurance manager, whose role is to co-ordinate reviews of the quality of service provided, through sending out questionnaires to residents, staff and other stakeholders. The information from the questionnaires received back are forwarded to operations managers and registered managers who will structure their development plan according to the views and comments from the questionnaires based on their overall findings. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 21 The staff are not ensuring that all health and safety checks are carried out regularly. Fire tests should occur weekly but when checked, there had been gaps where at times tests have not occurred for up to two or three weeks. Safety certificates such as gas, Portable Appliances Test (PAT) and the water test were seen and were up to date and in order. However, the London Fire and Emergency Planning Authority (LFEPA) certificate could not be found. A requirement is made that fire safety checks are carried out weekly and when found; a copy of the (LFEPA) certificate is forward to the Commission. Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 X 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 2 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 x LIFESTYLES Standard No Score 11 X 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 x 3 X 3 X X 2 x Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 (3) 16(n) Requirement Timescale for action 29/12/06 2. YA24 23 (2) (b) 3. YA29 23 (2) (n) 4. YA34 5. YA35 19 (1) (b) (i) Schedule 2 18 (1) (i) The registered persons must ensure that residents’ personal goals are identified and recorded and that their family or representative are involved in drawing up their care plan. (Timescale of 10/03/06 not met). This requirement is revised and restated. The registered persons must 20/10/06 ensure that the glass conservatory ceiling panel is replaced. The registered persons must 27/10/06 ensure that a review of the identified bathroom takes place to ensure that an appropriate bath is fitted to enable all residents to use it. (Timescale of 10/03/06 not met). This requirement is revised and restated. The registered persons must 20/10/06 ensure that all staff has a recent photograph in their file. The registered persons must ensure that a review of staff training is undertaken to ensure that all staff are receiving DS0000010536.V311191.R01.S.doc 26/01/07 Matlock Close 4 Version 5.2 Page 24 statutory training. 6. YA42 23 (4) (a) (c) (v) The registered persons must 20/10/06 ensure that fire safety checks are carried out weekly and that a copy of the (LFEPA) certificate is forward to the Commission. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Matlock Close 4 DS0000010536.V311191.R01.S.doc Version 5.2 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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