Inspection on 02/12/05 for Meadow View Care Centre

This inspection was carried out on 2nd December 2005.

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

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

Other inspections for this house

Meadow View Care Centre 13/05/08

Meadow View Care Centre 20/06/07

Meadow View Care Centre 14/12/06

Meadow View Care Centre 20/06/05

Meadow View Care Centre 09/03/05

Meadow View Care Centre 15/09/04

Meadow View Care Centre 03/02/04

Meadow View Care Centre 16/07/03

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

CARE HOMES FOR OLDER PEOPLE Meadow View Care Centre Wharrage Road Alcester Warwickshire B49 6QY Lead Inspector Jackie Howe Unannounced Inspection 2nd December 2005 10:00 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 Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Meadow View Care Centre Address Wharrage Road Alcester Warwickshire B49 6QY 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) 01789 766739 01789 763440 Prime Life Limited Mrs Melanie Oliver Care Home 42 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (42) of places Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users Service users placed in the bungalows must be assessed by social services and the Registered Manager as suitable for the bungalow style of living and not have primary diagnosis of dementia. Service users in the bungalows must have one member of staff available at all times, this member of staff clearly identified on the staff duty rota. 20th June 2005 2. Date of last inspection Brief Description of the Service: Meadow View is a purpose built care home, situated in the town of Alcester. Meadow View Care Home can accommodate up to 42 older people including 25 older people in the dementia care category. The service provider offers long and short-term accommodation and services associated with meeting the personal care needs of service users in the above categories. The accommodation is on one level in two wings. The complex also includes several privately owned bungalows and a separate annex called “Poppies”. All clients are offered single bedroom accommodation with en-suite facilities. Meadow View is spacious with a long wide corridor leading from the entrance to the communal and accommodation areas. The communal areas consist of a large lounge dining room with smaller sitting rooms off the main room. The gardens are landscaped and very attractive. The care home is registered to provide personal care services only. The visiting district nurses treat service users needing nursing care. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Inspectors have made three inspection visits to the home since the last unannounced inspection report. Two of these visits have been in relation to vulnerable adults matters. These reports are available on request. The inspection took place from 10am to 4pm and was unannounced. There were thirty-six residents at the home during the inspection. Two inspectors conducted the inspection; the inspection included the investigation of a complaint, progress on meeting requirements, standards not covered at earlier inspections and the inspection of the domiciliary care service. A separate report is available for the domiciliary care service. What the service does well: What has improved since the last inspection? There is now a controlled drug book in use. Residents who are nutritionally at risk are now being weighed and plans are in place to meet these needs. The manager is now keeping The Commission informed of events that affect the well being of residents. Accidents are now being recorded in the accident book. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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 Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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): 3, 4 Pre admission assessment information is insufficient to determine whether individual care and support needs can be met. The dementia care skills and knowledge of the staff group are not sufficient to satisfactorily meet the needs of the residents with dementia who live at the home. The skills and knowledge base of the staff group ensure that the needs of the older people without complex dementias are met. EVIDENCE: The manager stated that she receives the Care Management documentation from health and social services and if able to visit a potential service user prior to admission, she takes paperwork from the care plan to complete. Whilst the current system fulfils the requirements related to elements of physical care, nutrition, continence, mobility and falls, there is little evidence of an assessment related to the needs of someone with dementia. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 9 As the paperwork used is part of the care plan, there was no dated evidence of review and it was not clear what information had been gathered at assessment stage and what has been added at a later date. Staff had little understanding of how to problem solve, be creative, keep people occupied and be person centred in the ways in which they work with individuals who have dementia. For example at breakfast time there was not a choice of breakfast offered to residents and breakfast was already prepared so residents did not have the opportunity to butter toast etc. Residents waited for things to happen and they were not encouraged to participate in daily living activities. Further evidence to support this is reflected throughout the report. Further training in dementia care must be provided. During a discussion with the manager she said 30 of the 36 residents at the home showed signs of having some memory loss and confusion. The manager should ensure that staff can meet the needs of any prospective residents who may have short term memory loss and or confusion but do not have a diagnosis of dementia. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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 Care plan programmes and risk management strategies are not sufficient to meet the assessed and changing needs of service users particularly those with dementia. These shortfalls could place service users at risk. The shortfalls in the recording of administration of medication leave the residents at risk. EVIDENCE: In the care plans seen there was no completed life history or ‘getting to know you’ component in the personal profile section. This information is essential for staff to be able to adequately provide the care and support that residents need. There was no dated evidence of reviews in the care plans seen, so it is difficult to assess where changes to care needs have been made. Language used in some risk assessments does not give clear guidance to staff on to how to deal with a situation which they may find challenging and therefore minimise risk. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 11 Examples are that risk assessments state that ‘diversional techniques’ are to be used to try and prevent a particular behaviour, without direction to staff of which ‘diversional techniques’ are considered to work best for a particular service user. Further evidence gained from the complaint investigation indicates that ‘diversional techniques’ were not sufficient as an instruction to minimise risk. Risk assessments must include a description of any action to be taken. There are good assessments for health care. Nutritional screening had improved in one care plan, and the manager said that she was able to access good support from local health care professionals, including accessing appropriate equipment to provide pressure area care. Medication errors or practices have been the subject of requirements at the previous five inspections. There were a number of gaps in the administration of medication records. So there is not an accurate record of whether residents have been administered the correct medication. Staff must sign the medication administration records to demonstrate whether medication has been refused, administered or the resident was absent. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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 The opportunity for service users to enjoy a varied and valued lifestyle is limited and does not offer sufficient chances for stimulation. Little opportunity is offered to exercise choice. EVIDENCE: During the time spent in the home, there was little evidence of stimulation or activity taking place. Music was put on mid way through the morning but generally activities were limited. Residents were observed sitting or walking and were not occupied in any meaningful activity. When asked what was going on today the reply from one service user was ‘ nothing as usual’. One gentleman who was looking rather down, when asked what would make him happier replied, ‘To be more involved, I have jobs but they are insulting, for example to clean up. I’m not a cleaner I’m a … I get up, have breakfast – nothing.’ Breakfast was observed. Everyone received cornflakes, toast which was already buttered and with marmalade, and a cup of tea. The tables were unlaid, so there were no prompts to show it was a mealtime. One gentleman pushed his away and said he did not want it, his breakfast was cleared away and nothing was offered as an alternative. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 13 When questioned about what he did not like he said he was fed up, would have been able to butter his own toast, and then with a big smile said ‘egg and bacon would start off my day’. After breakfast there were more staff available. Some good interaction with two members of staff and residents was noted. One lady said she had not received her breakfast, everyone was aware that she had, but another one was given without question, which she ate with relish. The manager stated that the home promotes community links by church visitors, and local school children visits especially at Christmas. Visitors to residents are welcomed and can visit at any time. One gentleman was visiting his mother to take her out for the day as he does each Friday. He said that his mother had moved from a home, which had sadly closed down. He said that he was ‘quite happy’ with the Meadow View, but that he ‘did not know the staff’s names… not like at the other place…it’s not personal here…it’s a big place, and people are everywhere’. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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): 16, 18 Complaints procedures are in place and written complaints are investigated by the organisation. However, there are no effective complaints processes in the home to demonstrate that residents and their relatives’ complaints and concerns are listened to and acted upon. The policies and practices for the protection of vulnerable people at the home do not always keep them safe. EVIDENCE: It was difficult to assess the systems of dealing with complaints within the home, as there are only the copies of the response letters from the responsible individual kept in a file. Written complaints are investigated by the organisation. However, no systems are in place at the home to monitor the outcomes of complaints. From discussion with the manager and from observation, she actively problem solves concerns from both residents and relatives but does not record this. Staff have been given information about recognition and the reporting of abuse. However, they have not been provided with adequate training. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 15 The lack of detail in risk assessments seen does not keep residents safe particularly when the resident is vulnerable to abuse. Again the lack of dementia care skills of the staff group does not afford the residents any protection. This was evident in the care records and the care practices looked at as part of the complaint investigation. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 16 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): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not specifically assessed at the inspection, a tour of the home, and conversations held with service users in personal bedrooms, did allow the inspector an opportunity to observe the home and people living in it. One service user’s bedroom whilst furnished to a high standard did not hold any personal belongings. He was feeling particularly low in mood and said, ‘It’s an empty room and it gets to me when I go to bed – I feel so empty’. There are few homely touches in the communal areas. Service users cannot access their bedrooms during the day if they cannot manage their own door key, as the doors lock automatically. This was quite distressing for some people who called out for someone to let them into their rooms. To prevent the doors from shutting, doors had been propped open with footstools. These are difficult to see as they are the same colour as the carpet and this practice is a significant hazard to service users. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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, 29, 30 Staffing rotas do not accurately record hours worked by staff. They do not demonstrate whether there are sufficient staff on duty to ensure that the needs of the residents are met. The procedures for the recruitment of staff are not robust and lack appropriate pre employment checks. This potentially leaves residents at risk. There is a training and development programme in place that provides staff with a basic level of training to complete their induction and to be able to care for older people. Staff still do not have skills base needed to meet all of the dementia care needs of the residents. EVIDENCE: On the day of the inspection there were nine care staff on duty. This is not a normal shift pattern but one member of staff was being reintroduced from sick leave and another had an appointment, this is good practice. Staff on duty stated that they felt there are insufficient staff at times when they are really needed, especially early morning. It was difficult to substantiate this one way or the other due to the design of the staff rotas. Staff rotas showed that there are seven staff on duty between 8am and 2pm and between six or seven between 2pm and 8pm. On discussion with the manager this is not the case and often there are staff starting at 9 or 9.30 or staff only working from 5pm – 8pm. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 18 The actual hours worked by individual staff was not accurately recorded nor was the member of staff for the domiciliary care agency identified on the rota, as specified in the condition of registration. On occasions the manager was a rota’d as a member of care staff. In one week this was for 4 long days followed by two shifts at the weekend. The staff files of two recently appointed staff members showed that the manager had not completed all the necessary recruitment checks to ensure the protection of residents. Only one reference was seen for both staff members, there was not any employment history for one member of staff and a reference was not sought from the last employer. The organisation’s personnel departments develop the mandatory training programme. Staff should complete fire safety, food safety, COSHH, moving and handling and first aid training as part of their induction training. The recognition of abuse is covered during the induction. However, more specific training is required due to the vulnerability of people with dementia. Staff still have not had adequate dementia care training to enable them to meet the needs of the residents. According to the training chart provided by the manager there are at least 13 staff that have not completed the training that forms part of the induction. The training chart also shows that a majority of staff have not completed the organisation’s induction programme. This training chart includes training dates up to 18th November 2005. Only 4 staff including the manager have completed any medication training. Action must be taken to ensure that staff complete their induction training and provided with training to be able to safely meet the needs of the residents. Further training charts provided by the organisation at a later date did not include any induction, foundation or any other training completed between the dates of 18th November and 2nd December 2005. The training plan did indicate that dementia care training is booked for January 2006. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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): 33, 35 The lack of any working quality assurance system means that residents’ and their family’s views are not actively taken into consideration in the running of the home. Service users’ financial interests are safeguarded by the systems in place at the home. EVIDENCE: Quality assurance is referred to in the statement of purpose. Evidence of a recent Quality Assurance exercise was not available. Resident’s finances are managed by their families. Advocacy Alliance are appointee for two residents and they manage their finances. The manager keeps records of financial transactions for these two residents. Advocacy Alliance checks the records on a monthly basis. Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 20 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 x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x x Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 21 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 Standard OP4 Regulation 18 Requirement All care staff must be provided with the minimum of one days accredited dementia care training. The training must provide staff with information and skills on person centred practices, problem solving communication and keeping people occupied. The training must also include the issues of sexuality in dementia. 2 OP3OP2 12,14,15 Life histories for residents must be completed as part of the assessment and care planning process to ensure that residents’ needs can be met. Care plans and risk assessments must be reviewed and updated to reflect each resident’s current needs and situation. Include a current photograph of each resident in their care plan. Each review should be dated. 01/03/06 Timescale for action 01/02/06 3 OP7 15 01/01/06 Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 22 4 OP7 13,15 5 OP9 13 6 OP12 12 7 OP16 22 8 OP19 13 9 OP19 13, 23 10 OP27 17 11 OP29 19 The manager must ensure that each individual service user’s risk assessment includes a description of any actions to be taken. Accurate records of the administration of medication must be kept. Records must show whether medication has been administered/not administered, refused or the resident was absent. The registered manager must provide items of interest, things to do and ensure staff involve residents in daily living tasks to ensure that residents are occupied and stimulated. The complaints system must include a summary of complaints made and the action that was taken. Risk assessments must be completed for the use of footstools and other means of propping open doors. The registered manager must seek advice from the fire officer about the status of the bedroom doors and the use of wedges or footstools. Complete a fire risk assessment. The registered manager must ensure that staffing rotas accurately reflect the hours worked by staff. Two written references must be obtained for staff prior to them starting work at the home. The registered provider and manager must ensure that staff complete their induction training and are provided with training to be able to safely meet the needs of the residents. DS0000043254.V268059.R01.S.doc 01/01/06 01/01/06 01/02/06 01/04/06 01/01/06 01/01/06 01/01/06 01/01/06 12 OP30 18 01/03/06 Meadow View Care Centre Version 5.0 Page 23 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 OP3 Good Practice Recommendations The manager should ensure that staff can meet the needs of any prospective residents who may have short term memory loss and or confusion but do not have a diagnosis of dementia. The manager should produce an assessment and care planning format that considers all of the needs of a person with dementia and whether the home can meet their needs. Staff should use the information in resident’s life histories to provide things for people to do and to keep residents occupied. Staff should have access to information about good practices in dementia care. Any review of a service user’s care with other professionals and families should prompt a full review of the service users’ care plans and risk assessments. Visual or photographic choices of food and drinks should be given to people with dementia. The menu board should be completed on daily basis. The manager should develop a system for recording comments and concerns that are dealt with. The complaints system should include a summary of complaints made and the action that was taken. The Adult Protection training should specifically consider the needs of people with dementia. The registered manager should not be included in the care staffing numbers except in the case of emergencies. The manager should ensure that a full employment history is obtained from staff and that a reference is taken from the last employer. A dementia care mapping exercise should be undertaken as part of the quality assurance system. The quality assurance system should be developed further and be repeated on an annual basis. 2 OP3 3 OP4 4 OP7 5 OP15 6 OP16 7 8 9 10 11 OP18 OP27 OP29 OP33 OP33 Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Meadow View Care Centre DS0000043254.V268059.R01.S.doc Version 5.0 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. 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