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Inspection on 30/01/06 for Parklands Court Nursing Home

Also see our care home review for Parklands Court Nursing Home for more information

This inspection was carried out on 30th January 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides excellent sources of information for prospective and current service users alike and are welcoming to visitors to the site. The assessment process is extensive and completed thoroughly by staff, who use the information derived to develop care plans, which the service users or their representatives are included in their preparation and reviews. The home is well equipped to deliver nursing care and has robust safety procedures to ensure individual frailties are protected from harm. A good range of activities relevant to each client group are provided and staff actively seeks ways to ensure all service users are included by identifying their likes and wishes. The home has provided staff training and NVQ level 2 numbers of staff exceed the requirements of standards in advance of the date for its introduction. Staff training for specific aspects of work such as dementia has been given appropriate priority, preparing staff better for this area of work. TOPPS standard induction and foundation training has been introduced and staff supervision is well established and relevant to guiding staff in their activities of work.

What has improved since the last inspection?

Good progress has been made in implementing the homes decoration and refurbishment programme with a number of areas completed and carpets replaced where required. The assessment processes are reviewed to identifying changes of condition overtime and the care plans expanded to take account of potential complications to certain health conditions giving detailed direction to staff of appropriate responses.

What the care home could do better:

Continued progress is required to fitting of door locks to bedroom doors to provide all service users the choice of added privacy and security in their rooms and the fitting of cold smoke seals will add to the sense of security. The service users medical history provided should be formally checked with the GP to ensure there are no omissions. Medicine storage rooms should have the ambient temperature monitored to ensure the safe storage temperature is not exceeded. As a principal of good practice capillary blood sampling should be undertaken using equipment designed for the purpose.

CARE HOMES FOR OLDER PEOPLE Parklands Court Nursing Home 56 Park Road Bloxwich Walsall West Midlands WS3 3ST Lead Inspector Richard Eaves Unannounced Inspection 30th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Parklands Court Nursing Home DS0000020791.V274821.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. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Parklands Court Nursing Home Address 56 Park Road Bloxwich Walsall West Midlands WS3 3ST 01922 711844 01922 491137 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) Bupa Care Homes (AKW) Ltd, Central and West Mids Regional Office Mrs Diane Karen Bland Care Home 150 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (150) of places Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 90 service users in the category PD(E) may be accommodated at the home aged 50 years and over. No more than nine service users in the category TI(E) aged 50 years and over may be accommodated in Harrison, Samuel and Collins Houses. 60 service users may be accommodated at the home in the category MD(E) who are 50 years and over. Service users not to exceed the maximum number registered for at any one time. 5th September 2005 Date of last inspection Brief Description of the Service: Parklands Court is set in attractive landscaped grounds, close to Bloxwich town centre, shops and public transport. The five small modern detached houses accommodate up to 30 service users in single rooms. Each house being independent of the others for staffing, both care and some ancillary such as house keeping, each having its own facilities such as lounge, kitchenettes and bathrooms.Catering and laundry services are provided centrally from a further building which also accommodates the management and administration services.Each house is dedicated to the needs of different categories of care needs: nursing care for frail elderly people and specialised care for people with Alzheimer’s Disease and other dementia related conditions. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was undertaken by an Inspector from the Commission for Social Care Inspection using the following information: the action plan submitted by the home to the announced inspection during August 2005, reports from the organisation relating to the conduct of the home, the pre-inspection questionnaire and records held at the home. The inspection involved a full tour of each of the bungalow units including, bedrooms, communal rooms, service areas and provided an opportunity to speak with many service users. What the service does well: What has improved since the last inspection? Good progress has been made in implementing the homes decoration and refurbishment programme with a number of areas completed and carpets replaced where required. The assessment processes are reviewed to identifying changes of condition overtime and the care plans expanded to take account of potential Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 6 complications to certain health conditions giving detailed direction to staff of appropriate responses. 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. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1–6 The home provides good sources of information about the home and invites prospective service users to visit and spend time at the home prior to admission to enable them to make an informed decision about entering the home and receive a contract confirming the terms and conditions agreed for their stay at the home. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. Introductory visits and trial stays are encouraged by the home, ensuring that people have time to make decisions, which are right for them. A dedicated team provide intermediate care that prepares service users to return home. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 9 EVIDENCE: Each unit has a copy of the homes statement of purpose available and each includes the units own philosophy, a copy of the service user guide was seen to be issued to each bedroom. All service users receive a contract at the point of admission and a copy is retained. All units use the comprehensive assessment tool, the BUPA Minimum Data Set (MDS) and supplemented with a range of risk assessments that identify needs and interventions required to address and minimise risks. Each of the assessments are subject to regular review. Other assessments seen within the case files were those raised by the care managers at the point of admission and subsequent reviews. All current and future admissions to Samuel unit are assessed using the Walsall Single Assessment process and are admitted for intermediate care, this is supplemented by a range of risk assessments for falls, continence, nutrition and pressure areas. All prospective service users receive confirmation that their assessed needs can be met by the home. Prospective service users are given the opportunity to visit the unit prior to accepting a place at the home and the contract provides for a trial period. A sample of case files were inspected on each unit and show that the preadmission assessment and minimum data set (MDS) were being thoroughly completed and identify needs and risks and these were subject to review by means of a dependency review of the activities of daily living. Parklands Court Nursing Home DS0000020791.V274821.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 – 11 Health care needs of service uses are fully met and care planning in the home is overall of a good standard adequately guiding staff in the delivery of care needs. Medications are well managed at the home, facilitating the promotion of service users health. Service users are treated with respect and their privacy upheld. Staff have been developed to provide care at the time of service users dying with sensitivity and respect. EVIDENCE: Care plans were randomly inspected in each of the units and included a sample of those admitted under the intermediate care arrangements. Overall the care plans were derived from extensive assessments of needs and individually assessed risks were completed well and provided good direction for the delivery of care. Care plans are subject to daily assessment and fully reviewed at least monthly. Contingency planning is generally good although one service Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 11 user on Collins was noted to be receiving an anti seizure medication but with no known history and hence no plan. The unit manager undertook to raise the matter with the GP as a matter of urgency. The units are each responsible for managing their own medications and were all found to be well managed with no problems identified during the inspection. The room temperature on some units was being monitored and requires to be undertaken by all to ensure timely intervention if 25°c is exceeded. On Harrison unit it was observed that unilets for obtaining blood samples was being used manually, it is advised that as a matter of good practice that a mechanism is used. Other than Samuel unit the NOMAD monitored dosage system is used for medicine administration. Samuel intermediate service users receive their medication in individual bottles Staff were observed on each unit to interact well with service users showing respect and using the preferred terms of address, they were seen to be sensitive to protecting the service users dignity in dress, toileting and cleanliness. A limited programme of training is included in the NVQ units and the Nursing staff have experience in care of the dying. Parklands Court Nursing Home DS0000020791.V274821.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 – 15 The home provides a well-organised and appropriately varied social and recreational activity programme that provides interest and pleasure for the service users in each unit. An open visiting policy assists service users to maintain contact with their family and friends. Many aspects of care evidences that service users exercise choice and control over their lives. Meals at the home are wholesome and meet the nutritional needs of service users while reflecting choice and taste. EVIDENCE: The units have an activities programme that is displayed on the main notice board and which forms the basis of routine events which is expanded by more ad-hoc and spontaneous events such as exercises, music and movement, entertainers, individual shopping trips and other one to one sessions. Over the winter trips out have been limited though some visited a garden centre recently. An extensive programme of events were put on in each unit over the Christmas period. Records are maintained of all individual participation in activities completed on a daily basis Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 13 Visitors are made welcome throughout the units accessing various rooms such as lounges, quiet rooms and service users own bedrooms. Families are made welcome on trips and activities arranged for evening times so that they can be included. On the day of inspection a number of families and friends were met by the inspector and were happy to confirm that they are made welcome and encouraged to be involved in the lives of their relatives. Personal preferences are recorded in the care notes regarding the frequency for bathing and their choice of a bath or shower and preferred time of rising and going to bed and take regard of individuals capacity for involvement in activities. The home offers a nutritious menu that includes cooked breakfasts, lighter meal choices at lunch, and two hot choices at the main meal of the day served in the evening. This recent change has come about due to a high proportion of service users enjoying a cooked breakfast and declaring a preference for a light lunch. One visitor whose husband has had to change from normal to liquefied diet expressed the view that the standard of meals for her husband was not good, staff indicated that the service user took a good diet. Other service users who responded in conversation about the meals were all very positive. A further visitor expressed the view that the menus were monotonous and the salads not very interesting. All main meals are prepared in a central kitchen before being transported in hotplates and served in each of the units. Each unit has a small kitchenette where snacks, light meals and drinks are prepared and crockery washed in the dishwasher. All service users have a nutrition assessment undertaken with regular ongoing monitoring and review. Parklands Court Nursing Home DS0000020791.V274821.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 The home complaints policy is robust providing a safe environment in which service users feel they can voice concerns and that these will be listened and responded to. EVIDENCE: The home has an appropriate complaints procedure and maintains a detailed record of the complaint investigation and the outcome, no complaints have been received since the previous inspection. Parklands Court Nursing Home DS0000020791.V274821.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 - 26 The home provides a good standard of décor, furnishings and managed services providing a safe environment and an attractive, comfortable and homely place to live. The home is clean, free from odours and hygienic. EVIDENCE: Parklands Court Nursing Home are a purpose-built premises providing accommodation for up to for 150 persons requiring nursing care in 5 bungalows each of 30 single bedrooms. The home continues to be refurbished, redecorated and repaired on an ongoing basis. The décor, fixtures and furniture are generally completed to high standards. Refurbishment and redecoration is undertaken in a programmed way, Marlborough unit having developed an 8 bed unit and decorated throughout with pastel colours and fixing memory boxes alongside each bedroom door. Clarendon has developed a café stimulation area and a new quiet lounge and the dining area has been decorated and has new furniture. Samuel house is having its bedrooms all decorated as they are vacated this is ongoing. Collins decoration is in good Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 16 order and new carpets were recently fitted. Harrison is planned to have a refurbishment and redecoration next. Each of the units were found to be hygienically clean and free from odour, the fitting of mixing valves to staff hand wash areas such as the sluice rooms is well progressed, each has two sluice disinfectors. The centralised laundry meets all standards for cleaning, sluicing and disinfection by washing machine with facilities and policies to protect staff from infection. The home has extensive grounds with each unit having its own garden area. Ample car parking is provided. Parklands Court Nursing Home DS0000020791.V274821.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 The home has a good mix of staff in sufficient numbers to provide consistency of care that meets service users needs. The home continues to make progress in developing a skilled staff group with understanding of service users needs. EVIDENCE: Staff are appointed and allocated staff to each of the 5 units to provide consistency and in such numbers that reflect the dependency needs of the service users the details of daily allocations are shown under each unit heading. Marlborough staffs with 2 nurses and 4 care for the 18 bed unit and 2 care for the 8 bed unit with 1 nurse and 3 care overnight. Clarendon has 2 nurses by day with 5 or 4 carers and a nurse plus 2 care at night with a twilight shift. Collins has a nurse plus 6 care a.m., a nurse plus 4 care p.m and a nurse plus 2 at night. Samuel staffs with 2 nurses plus 4 care days and 1 nurse and 2 care at night. Harrison 2 nurses and 4 care by day with 1 nurse and 2 care at night. The Home demonstrates a strong commitment to staff training and has achieved a ratio in excess of the 50 of care staff required by standard trained to NVQ level 2. The inspector met with staff on each unit and received positive feedback about working at Parklands Court. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 18 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 – 38 In the absence of a registered manager leadership at the home remains good and staff demonstrate an awareness of their roles and responsibilities to service users benefit. The sound financial management of the home and arrangements for safekeeping of their money safeguards service users interests personal and financial. Staff receive supervision and direction to ensure that the service users receive consistent quality care. The best interests of service users are safeguarded by the homes record keeping, policies and procedures. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 19 EVIDENCE: The home is currently led by an experienced and well qualified nurse manager whose substantive post is as deputy, is supported in this by a stable committed staff group at all levels. On the day of the inspection it was apparent that there was a very good atmosphere amongst the staff. The manager holds frequent staff meetings within each separate unit and maintains a record and actions taken in response to staff inputs. A survey of service users views undertaken during December has not yet been analysed and the survey of March 2005 remains the most recent for which a report and action plan has been implemented. The manager also undertakes regular topic satisfaction surveys and feeds back the findings and actions resulting to the service users meetings. The area manager undertakes monthly regulation 26 visits providing a report for the Commission. The company undertakes regular surveys of service users and relatives views the results of which are published along with an action plan derived from the weakest aspects. Surveys were undertaken during March and May of 2005 the results and action plans were seen. Other quality assurance monitoring includes regular care plan audits, pressure sore audits, accident audits and medication audits. The area manager undertakes monthly inspections and returns a regulation 26 report. The manager agrees a budget for each year to meet the agreed business plan which reflects the findings of the auditing undertaken. The home does not act as appointee for service users, arrangements with full accounting practice is in place for personal allowances held for safekeeping. Supervision is well established and completed fully for 2005 with 2006 planned. An inspection of records required by regulation and listed in the schedules show these to be maintained, up to date, accurate, kept secure and used in accordance with the Data Protection Act. Staff receive training in health and safety at induction with ongoing updates at appropriate intervals. During the tour of the building it was observed that all corridors were clear of obstructions and the premises are kept in a safe condition. Inspection of the health and safety monitoring records show these to be up to date and that very good standards are being maintained consistently. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 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 OP24 Regulation 23(2)(e) Requirement The responsible person will complete the process of fitting suited locks to bedroom doors. Timescale of 2.9.04 not met. The registered person must ensure that the medical history of service users is complete. The registered person must ensure the redecoration programme continues and includes Harrison House. The responsible person must appoint a suitable individual to manage the home and propose that person to be registered. Timescale for action 31/03/06 2 3 OP7 OP19 15(1) 23(2)(d) 31/03/06 30/06/06 4 OP31 8(1) 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The registered person must continue the process of DS0000020791.V274821.R01.S.doc Version 5.1 Page 22 Parklands Court Nursing Home 2 OP9 providing a safe supply of hot water at staff handwash points of sluice, kitchen and laundry to promote good hand-washing practice. The registered person should provide appropriate blood sampling equipment. Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Parklands Court Nursing Home DS0000020791.V274821.R01.S.doc Version 5.1 Page 24 - 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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