Inspection on 11/04/06 for Parkfield House

This inspection was carried out on 11th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Parkfield House 29/10/07

Parkfield House 10/04/07

Parkfield House 12/09/05

Parkfield House 12/04/05

Parkfield House 16/11/04

Parkfield House 14/06/04

Parkfield House 15/12/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Parkfield House Charville Lane West Hillingdon Uxbridge Middlesex UB10 0BY Lead Inspector Robert Bond Unannounced Inspection 11th April 2006 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 Parkfield House DS0000010935.V286815.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. Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Parkfield House Address Charville Lane West Hillingdon Uxbridge Middlesex UB10 0BY 01895 811 199 01895 811 131 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) HALTON SERVICES LIMITED Mrs Gurbachan Kaur Sandhu Care Home 44 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (36) of places Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 36 BED NURSING UNIT Day Shift: 33-36 service users, Two Registered One additional carer for a half day. 31-32 service users, Two Registered 29-31 service users, Two Registered 23-27 service users, Two Registered Assistants. Nocte Shift: 33-36 service 31-32 service 29-31 service 23-27 service users, users, users, users, One One One One Registered Registered Registered Registered Nurses and Five Care Assistants. Nurses and Five Care Assistants. Nurses and Four Care Assistants. Nurses and Three Care Nurse Nurse Nurse Nurse and and and and Two Two Two One Care Care Care Care Assistants. Assistants. Assistants. Assistants. 8 BED DEMENTIA UNIT Staffing levels in the Dementia Unit must at all times be maintained at 1 RMN (or RN with appropriate post qualification training in dementia care) and 1 Care Assistant unless negotiated and agreed with the Commission For Social Care Inspection in advance of any change being made. Date of last inspection 12th September 2005 Brief Description of the Service: Parkfield House Nursing Home is a Georgian building, situated in a residential area in Hillingdon. The building has 3 storeys. It is registered to accommodate 44 service users, 8 of whom are accommodated in a dementia care unit. The building is a listed building, and is a converted mansion. There are 36 single bedrooms (spread over the ground, first and second floor) and four double bedrooms (all situated on the first floor). All bedrooms are en-suite. There are 2 sitting areas on the ground floor and one sitting area on the second floor. There is a dining room on the ground and first floor. The Home is near the local high street, public transport and local amenities. Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) is currently undertaking ‘key inspections’ that measure the outcomes of the key National Minimum Standards (NMS) that have been created by the Department of Health for use in care homes for older people. The Inspector assessed 20 of the NMS and found that the outcomes of 14 were fully met, but 6 were only partly met. The Inspector found that all the requirements and recommendations from the previous inspection had been met. The Inspector made 7 requirements and 4 recommendations at this inspection. The Registered Manager was not present during this inspection, but the inspector interviewed the Senior Nurse, the administrator and the handyman. The Inspector also met other staff, talked to six service users, toured the building and examined a variety of records and files. Three care files were examined in detail (case-tracked). The Inspector left a supply of CSCI addressed envelopes and questionnaires for relatives to complete with their comments about the service, and return to the Inspector. The home had four service user vacancies on the day of the inspection, but was fully staffed. What the service does well: Assessments and care plans are well documented. Staff are adequately trained. Medication procedures are well documented. The food was praised. None of the service users had any complaints to make to the Inspector and no formal complaints have been received in the last six months. The premises are well maintained. Staff were observed to be respectful, polite and caring towards the service users. Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Three hot water outlets produce water that is too hot. Two rooms that have been decorated have not had their pictures or mirror put back. Additional decoration is needed for one bathroom, and along the first floor corridor. Service user’s bedrooms and communal areas have notices on their walls that are for staff to read. The care home can be made more homely by restricting staff notices to staff notice boards. Confidential records on service users should be kept under lock and key when not in use as a way of enhancing the privacy of service users. This applies to old records that are stored, and current records kept in the first floor nurses’ station that does not currently have the facility to lock them away. The date displayed on the clock in the dementia unit was the wrong date, which is not conducive to ‘reality orientation’ of service users. In the light of this, the functioning and staffing of the dementia unit should be reviewed. The home’s policy on requiring the contractor to sign for returned medication has not been implemented. The current complaints procedure leaflet should be displayed in place of the old leaflet. Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 7 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. Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 8 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 Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 9 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 Service users moving into the home have their care needs assessed in advance in a satisfactory way. NMS6 was not assessed as the home does not provide intermediate treatment. EVIDENCE: The Inspector examined the assessments undertaken for the most recent service user to move in. The London Borough of Hillingdon had faxed an assessment to the home, and staff from the home had undertaken their own written assessment. New service users are subject to a ‘trial period’ and a review of their care needs is undertaken subsequently. Parkfield House DS0000010935.V286815.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 The service users’ health and personal care needs are set out in individual plans of care in a satisfactory manner. Service users’ health needs are met in a satisfactory manner. No service user is able to manage their own medication, but service users are protected by the policies and procedures that the care home has in place but one aspect of the procedure has not been implemented. Service users are treated with respect but their privacy is not adequately maintained as confidential records are not kept under lock and key. EVIDENCE: NMS7: The Inspector examined (case-tracked) three service users’ personal care files. He found that each contained the appropriate information, care plan, and risk assessments. These were all subject to review as required. NMS8: The files contained details of the involvement of each service user’s General Practitioner, and details of contact with other health professionals. NMS9: The Inspector examined the medication storage and the medication records on the ground floor and first floor of the home. The storage and Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 11 records were good. Recently new arrangements were made for unused medication to be removed by a contractor. Although the home’s records showed what had been taken, and the record had been signed by the home’s senior nurse, the contractor’s representative had not signed the record. Requirement 1. NMS10: The Inspector found that old confidential care records were stored in an unlocked cupboard in the dementia unit. The Inspector also found that the nurses station on the first floor is not within a lockable office, and that the cupboards within the station that contain confidential records are not lockable. The home must provide adequate and suitable lockable storage facilities and must safeguard the privacy of service users by keeping confidential records under lock and key when not in use. Requirements 2 and 3. Parkfield House DS0000010935.V286815.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. Further consideration of appropriate activities within the dementia care unit is necessary. Religious needs are being met adequately. Service users are enabled to maintain contact with family and the local community to a satisfactory extent. Service users are helped to exercise choice and control over their lives to a satisfactory extent. Service users receive a wholesome diet with adequate choices available. EVIDENCE: NMS12: The Inspector examined the activity plan for the home which showed activities planned for most weekdays that none on Sundays and only hairdressing on Saturdays. Activities include ‘sing-a-longs, quizzes, and arts and crafts. The home has a hairdressing room, and activities room and an activities co-ordinator who is only employed for 20 hours per week. A record is kept of each service user’s involvement in activities. Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 13 The Inspector visited the lounge in the dementia unit and noted that the combined electric clock and calendar displayed the correct time but that the date was showing as February. It transpired that its battery had run out and the incorrect date had probably been displayed ever since. A key aspect of dementia care is ‘reality orientation’ whereby service users who are confused about time and place and the date are made aware of these things. Thus to display the incorrect date continually suggests that staff in the unit have not understood the concept of reality orientation. A review of the operation of the dementia unit, the training that staff have received and the extent and type of activities within the unit are required. Requirement 4. The Inspector will focus on these aspects in more detail at the next inspection. NMS13: The Senior Nurse reported that a Church of England vicar, a Roman Catholic priest and Salvation Army personnel all visit the home frequently, and that service users are able to attend services in the community. The Inspector examined the home’s visitors book and confirmed the extent of visiting that went on, including visits from relatives. The Senior Nurse reported that Age Concern visit to provided advice to service users. The home does not have their own vehicle but occasional outings for a pub lunch are organised. NMS14: Services users views were seen to be obtained at Resident and Relatives meetings. Minutes were seen of a meeting dated 26/10/2005. NMS15: The Inspector examined the current menu which contained suitable choices. The Inspector visited the kitchen and food storage areas. All were clean and tidy. All of the service users spoken to praised the food. Parkfield House DS0000010935.V286815.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): 16 and 18 The home has a satisfactory complaints procedure in place but it is not adequately displayed. Service users are adequately safeguarded. EVIDENCE: NMS16: The home has a suggestion box in the hall. The Inspector examined the home’s complaints record. No complaints had been recorded since before the previous inspection. None of the service users spoken to by the Inspector had any complaints. The Inspector noted that although the home’s policy file contained the a revised complaints procedure that mentioned the CSCI as an organisation that complaints could be addressed to, the complaints leaflet displayed on a downstairs wall of the home was an old leaflet that did not contain the contact details of the CSCI. Requirement 5. NMS18: The Inspector examined the staff training records and saw evidence that staff had been trained in the Protection of Vulnerable Adults (Safeguarding Adults). The Inspector examined financial records concerning the spending of service users’ personal allowance funds. The accounts were well maintained and the expenditure was on appropriate items such as hairdressing and chiropody. Parkfield House DS0000010935.V286815.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 Service users live in an adequately safe and adequately maintained environment but some redecoration is necessary. The home is sufficiently clean and hygienic and can be made more pleasant by removing some of the staff notices from service users’ rooms and communal areas. EVIDENCE: NMS19: The Inspector toured the premises in the company of the Senior Nurse. He found that the home’s design is satisfactory and is adequately furnished and equipped. Overall decoration is adequate but it was noted that corridors and bedroom doors are scuffed by wheelchairs wheels, and a bathroom on the first floor is in need of decoration. Requirement 6 Some rooms have been recently decorated but in one instance a service user’s pictures had not been put back, elsewhere a mirror had not been put back in a bathroom. In many service user’s bedrooms, on their doors, and in communal Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 16 areas such as bathrooms, paper notices for the attention of staff members were found to be affixed. Such notices should only be placed in areas that are used only by staff, or on a central staff notice-board. The home should be made more domestic, homely and attractive by removing notices and putting up pictures and mirrors where these are needed. Recommendations 1 and 2. The Inspector tested the hot water in the en-suite facilities of one bedroom and found the temperature to be 44.9 degrees Centigrade. The temperature should be 42 degrees plus or minus 2 degrees. Requirement 7. The Inspector noted that a small toilet on the ground floor is labelled ‘disabled toilet’. As the room is not sufficiently large to accommodate a wheelchair, it is suggested that the word ‘disabled’ is removed. Recommendation 3. NMS26: The Inspector found the home to be clean and hygienic throughout and he did not notice any unpleasant odours. The home can be made more pleasant by redecoration, and by removing staff notices that are in service users’ personal and communal areas. Parkfield House DS0000010935.V286815.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. Service users’ needs are adequately met by the number and skill mix of staff. Service users are in adequately safe hands because staff are adequately trained. Satisfactory staff recruitment policies and procedures are in place. EVIDENCE: NMS27: The Inspector examined in detail the current staff rota. He ascertained that sufficient and appropriately qualified staff are on duty at all times. In particular the Inspector ascertained that additional laundry staff are now employed so that during mornings as well as afternoons the laundry is staffed (although it was not on the day of the inspection), and the laundry is staffed at weekends now. NMS28: Many of the staff are qualified nurses. However there are 28 care staff employed by the home in addition, and of these only 6 have the NVQ qualification level 2 in care. The NMS require that at least 50 of the care staff must be nursing or NVQ qualified. NMS29: The Inspector checked the recruitment files of the last two employees to be employed. Appropriate references, identification checks, visa checks and CRB checks had been undertaken. NMS30: The Inspector checked the staff training records of the home which clearly showed training received this year to date, and training that had been Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 18 identified as needed, staff member by staff member, for the remainder of the year. Parkfield House DS0000010935.V286815.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, 35 and 38 Service users live in a home that is sufficiently well managed by a person who is registered by the CSCI. The home is run sufficiently in the best interests of the service users. Service users’ financial interests are sufficiently safeguarded. The health, safety and welfare of service users are sufficiently promoted and protected. EVIDENCE: NMS31: The Inspector did not meet the Registered Manager who did not come into the home on the day of the inspection due to suffering a bereavement. The Manager has been registered in that position by the CSCI having passed a Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 20 fit person interview. She is believed to be currently undertaking the Registered Manager’s Award qualification. NMS33: The Senior Nurse reported that quality assurance questionnaires are sent out to relatives on a six monthly basis. Service users’ and relatives’ views are also sought at six monthly meetings. The Inspector examined the minutes of the last meeting held. NMS35: The Inspector examined the records kept of service users’ financial transactions involving money that the home held on their behalf. NMS38: The Inspector examined the records kept in the home of food temperatures, fridge and freezer temperatures, hot water temperatures, fire equipment checks, risk assessments of the premises ,and Legionella water tests. All the records were meticulously kept and showed that all health and safety aspects inspected were in order, except that a few hot water temperatures were slightly too high and must be reduced. See Requirement 7. The hot water supply to the wash-hand basin in the visitor’s toilet is very hot, and has a sign warning users of that fact. It is recommended that the water taps in this toilet have a mixer valve fitted in order to reduce the hot water temperature to near 42 degrees Centigrade to avoid the risk of a service user using this facility and being scalded. Recommendation 4. Parkfield House DS0000010935.V286815.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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? no 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 Standard OP9 OP10 Regulation 13(2) 23(2)(l), 12(4)(a) 23(2)(l), 12(4)(a) 12(1)(b), 18(1)(c)(i ) 22(7) Requirement The home’s policy on the disposal of unused medication must be fully implemented. Old care and health records must be securely stored in order to maintain confidentiality and privacy of service users. Current care and health records must be securely stored in order to maintain confidentiality and privacy of service users. A review of training of staff in dementia care, and the type of activities undertaken in the dementia care unit, is required. Only the updated complaints procedure that refers to the CSCI must be displayed and made available to service users and relatives. The bathroom and corridors identified in the report must be redecorated. The temperature of hot water supplied to service users must be 42 degrees Centigrade plus or minus 2 degrees. Timescale for action 01/05/06 01/05/06 3 OP10 01/06/06 4 OP12 01/06/06 5 OP16 01/05/06 6 7 OP19 OP19 23(2)(d) 13(4)© 01/08/06 01/05/06 Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 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 2 3 4 Refer to Standard OP19 OP19 OP19 OP38 Good Practice Recommendations The care home should be kept as homely or domestic as possible by removing notices that are for staff attention from service users’ bedrooms and communal areas. Pictures and mirrors that have been taken down when rooms are redecorated should be put back as soon as possible afterwards. The word ‘disabled’ should be removed from the sign on a toilet door that says ‘disabled toilet’ as there is insufficient space for anyone in a wheelchair to use the toilet. The hot water temperature for the wash-hand basin in the visitors’ toilet should be reduced. Parkfield House DS0000010935.V286815.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST 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 Parkfield House DS0000010935.V286815.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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