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Inspection on 26/09/07 for Pendene House Residential Home

Also see our care home review for Pendene House Residential Home for more information

This inspection was carried out on 26th September 2007.

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.

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 is well managed and records necessary for the health and welfare of the residents are maintained. The manager is both supportive and approachable and families and friends are encouraged to be involved in the life of the home. There is a relaxed and friendly atmosphere within the home and staff go about their daily work in an unhurried and professional manner. Privacy and dignity is maintained at all times and it was evident throughout the inspection that residents were well cared for and their care and support needs were met.

What has improved since the last inspection?

Training in first aid and food hygiene has been provided for the majority of staff, those who have not yet completed this training will do so in the near future. The manager and one of the care workers have completed training within adult protection and both are in the process of completing their NVQ (National Vocational Qualification) level 3. A number of areas within the home have been decorated including the first floor corridor and several resident`s rooms and the carpets on the first floor corridor, the stairway and the reception area have been replaced.

What the care home could do better:

Provide appropriate moving and handling training and where necessary arrange for the renewal of this qualification, this will ensure that the care workers are appropriately trained and competent and residents health and safety is not compromised. Provide formal induction training for all new care workers, this would ensure that they were fully aware of their responsibilities as a care worker and competent in their role within the home. Provide more activities for the residents to enjoy. Resident`s benefit from the stimulation and camaraderie that activities provide.

CARE HOMES FOR OLDER PEOPLE Pendene House Residential Home 15 Pendene Road Stoneygate Leicester Leicestershire LE2 3DQ Lead Inspector Diane Butler Unannounced Inspection 26th September 2007 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 DS0000006353.V349904.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. DS0000006353.V349904.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pendene House Residential Home Address 15 Pendene Road Stoneygate Leicester Leicestershire LE2 3DQ 0116 2708911 0116 2708911 jweston5@hotmail.com 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) Pendene House Residential Home Limited Mrs Janice Hill Care Home 12 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (12) DS0000006353.V349904.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User numbers No person falling within categories MD(E) or DE(E) may be admitted to the home when 6 persons in total of these categories/combined categories are already accommodated within the home. 4th May 2006 Date of last inspection Brief Description of the Service: Pendene House is a care home for older persons, providing accommodation and personal care for up to twelve residents. The home can also care for up to six older people with dementia and/or a mental disorder. The home is situated in a quiet cul-de-sac in the Stoneygate area of Leicester and is within walking distance to the local amenities and close to a local bus route. Accommodation is on two floors, which can be accessed by a shaft lift. There is a large dining room and lounge on the ground floor, which are furnished and decorated to a high standard and further seating can be found in the homes entrance hall. There is a large well-maintained garden at the rear of the home accessed by the shaft lift, which goes down to garden level. All rooms in the home are single, some of which are ensuite. Current charges range from £402.00 per week to £505.00 per week. Additional charges are in place for hairdressing, chiropody treatment and transport to appointments. Details of all charges can be found in the homes Statement of Purpose document (a document which provides relevant information about the home), which is given to all prospective and current residents. A copy of the latest Inspection report is available at the home, or it can be accessed via the CSCI website: www.csci.org.uk. Further information about the home is available from the registered manager. DS0000006353.V349904.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit, which took place over a four hour period on Wednesday 26th September 2007. The manager was on duty at the time of the inspection. When undertaking key inspections the Commission for Social Care Inspection (CSCI) focuses upon outcomes for residents and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting two residents and tracking the care they received through looking at their records, speaking with them and discussion with staff on duty at the time of the visit. Observation was also used to evidence whether care needs were being met. Further planning for the site visit included checking the service history and last Inspection report and looking through the AQAA document (Annual Quality Assurance Assessment), which was submitted to the Commission for Social Care Inspection prior to the visit. Questionnaires were also sent to a selection of residents and their relatives to gain their views of Pendene House. Comments received include: “We are always made very welcome by the manager and staff at the home and any concerns on either side are discussed satisfactorily”. “They are adaptable to each individuals needs and accommodate accordingly”. “Higher staffing levels would increase the one to one assistance, although they do manage well at present”. “Bigger jobs than normal cleaning i.e. shampooing carpets have to be asked for but are responded to in time”. “This is a well run home and it is a comfort to know my father is well looked after and you can call any time and find things the same standard”. “They are kind and caring people who appear to be genuinely fond of the residents. Particular attention is paid to adequate nutrition for those who are unable to feed themselves”. What the service does well: DS0000006353.V349904.R01.S.doc Version 5.2 Page 6 The home is well managed and records necessary for the health and welfare of the residents are maintained. The manager is both supportive and approachable and families and friends are encouraged to be involved in the life of the home. There is a relaxed and friendly atmosphere within the home and staff go about their daily work in an unhurried and professional manner. Privacy and dignity is maintained at all times and it was evident throughout the inspection that residents were well cared for and their care and support needs were met. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. DS0000006353.V349904.R01.S.doc Version 5.2 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 DS0000006353.V349904.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All prospective residents have their needs assessed before moving into the home and are assured that these will be met. EVIDENCE: A Statement of Purpose is in place. This document, which contains information about the home, is given to all prospective residents. Information contained in this document includes the aims and objectives of Pendene House, the services that can be provided and details of the complaints procedure should a resident have a concern about anything. Details of the current charges for living at the home are also given. A copy of the Statement of Purpose is also given to all staff members to ensure that they are aware of the aims and objectives of the home. DS0000006353.V349904.R01.S.doc Version 5.2 Page 9 The manager explained that all prospective residents are assessed before they move into the home to ensure that their needs can be met. On checking the paperwork/files belonging to the two most recent residents to move into the home, both included a copy of the needs assessment completed by the manager and a copy of their discharge paperwork on leaving hospital. A confirmation of care was in place for each resident, this statement which was signed by the manager explained that having completed the assessment of need the manager was confident that their needs could be met by the staff working at the home. One of the residents spoken with confirmed that their relatives had had the opportunity to look around before she moved in and both had a signed copy of their terms and conditions in place. Intermediate care is not currently provided at Pendene House. DS0000006353.V349904.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are looked after well in respect of their health and personal care needs. EVIDENCE: The manager ensures that there is a plan of care in place for all residents living in the home. Care plans looked at during this visit were found to be up to date and had been reviewed with the residents themselves. The manager also writes a comprehensive introduction to the residents in their daily record when they first move into the home, this gives the reader a good picture of the residents care and support needs at that time. DS0000006353.V349904.R01.S.doc Version 5.2 Page 11 On checking the daily records kept in the home it was evident that health care services including GP’s, opticians and community nurses are accessed on the residents behalf. One relative questionnaire received stated, “The home is always quick to seek medical help when required, however, sometimes they are frustrated by the slow response by emergency doctors etc”. Staff working at the home are well aware of the individual care needs of the residents and all residents spoken with stated that their individual care needs were currently being met. Residents spoken with also stated that the care workers treated them with respect and throughout the visit both the manager and care worker on duty were seen interacting with the residents in a relaxed and supportive manner. Comments received included: “I’m looked after very well”. “Everyone’s always helpful and pleasant”. “If I’ve got to be anywhere, I’d be here”. A relative questionnaire stated: “The care home has a small number of residents so individual attention and knowledge of each persons needs are taken into account. The manager has high standards in caring for my relative and other residents both in personal care and of the home generally. Staff must meet these standards”. Medication records were checked and were found to be in order, all had been signed into the home appropriately and all had been signed for when administered to the residents. All staff responsible for the administration of medication have received training in the safe handling of medicines. DS0000006353.V349904.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a relaxed atmosphere within the home and visiting is encouraged to enable residents to maintain contact with relatives and friends. EVIDENCE: Choices are offered on a daily basis including what time to get up, what to wear, what time to go to bed and wether to join the other residents in the dining room for meals. Residents spoken with stated that the food served in the home was good and a copy of the day’s menu can be found on the notice board situated outside the dining room. It was noted that an alternative to the main meal was not included on the notice board though it did say that an alternative is available on request. DS0000006353.V349904.R01.S.doc Version 5.2 Page 13 A comment included in a questionnaire received prior to the visit suggested that choices weren’t always provided. The registered manager explained that residents likes and dislikes are always discussed and an alternative is provided when it is a meal that a resident doesn’t like. This was confirmed on talking with residents during the visit. One resident explained “The food is very good, I’ve told her [the manager] that I don’t like one or two things so they give me something else”. Family and friends are encouraged to visit. Residents spoken with and comments included in questionaires received confirmed that visitors were made most welcome and are able to visit at any time. Comments received included: “I visit 3 to 4 times a week and I am always made welcome”. “All staff members are friendly and helpful, they always supply visitors with a cup of tea or coffee and even a meal if appropriate”. “They are kind and caring people who appear to be genuinely fond of the residents. Particular attention is paid to adequate nutrition for those who are unable to feed themselves”. There is currently no structured activities programme within the home, however, music and movement sessions are provided every two weeks and the manager explained that staff provide other activities such as skittles and one to one sessions. A questionnaire received indicated that activities are provided and stated, “They could do with more day time activities as this stimulation is enjoyed by most residents”. The manager stated that this would be looked into. DS0000006353.V349904.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffs awareness of adult protection ensures service users are protected from harm or abuse. EVIDENCE: A complaints procedure is in place. A copy of this can be found on the notice board near the dining room and details are also included in the Statement of Purpose, which is given to all residents and/or their relatives. Both residents spoken with were aware of whom to talk to if they were concerned about anything and both were confident that any issues raised would be dealt with appropriately. One resident explained: “Jan [the manager] is the one I would talk to, she’s very easy to talk to, very pleasant”. The second resident stated: “I would talk to Jan if I wasn’t happy, she’d do her best to sort anything”. Information received prior to the visit stated that no complaints had been received since the last inspection in May last year. This was confirmed on speaking with the manager and on checking the complaints book. DS0000006353.V349904.R01.S.doc Version 5.2 Page 15 The manager is aware of the procedures to follow with regard to the protection of the residents in her care and has recently completed a training course on Referring within Safeguarding Adults. The care worker spoken with during the visit was aware of the actions to take should she suspect any form of abuse and has recently completed a training course on Alerting within Safeguarding Adults. A whistle blowing policy is in place and a copy of this document is given to all staff members when they start work at the home. DS0000006353.V349904.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the accommodation within the home is good, providing residents with a comfortable and homely place to live. EVIDENCE: The areas of the home seen on this occasion were well maintained and suited to the residents needs. Decoration is of a good standard and furnishings in the communal areas are domestic in character and in good condition. A number of improvements have been made to the environment since the last inspection in May last year. The first floor corridor has been redecorated and this now looks bright and Airy. The carpets on the first floor corridor, the stairs and the ground floor reception area have all been replaced and the toilet on the first floor has been completely renovated. DS0000006353.V349904.R01.S.doc Version 5.2 Page 17 A number of resident’s rooms have been redecorated and the owner was in the process of renovating one of the ensuite toilet areas at the time of the visit. The inspector was informed that it was the owner’s intention to redecorate both the dining room and lounge area in the near future. The rooms belonging to two residents were seen. These were clean, appropriately furnished and included the residents personal belongings. A shaft lift serves the garden as well as the two floors in the home enabling the resident’s access to the well maintained garden at the rear of the home. DS0000006353.V349904.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures for the recruitment of staff are in place to ensure residents are not put at risk. EVIDENCE: There are currently two members of staff on duty during the day to meet the needs of the seven residents living in the home. Both the manager and the care worker on duty at the time of the visit stated that they felt that this was sufficient to enable them to care for the residents without feeling rushed and the two residents spoken with stated that they were well cared for. Questionnaires received from relatives prior to the visit confirmed that the residents were being well cared for and on speaking with the care worker on duty it was evident that they were well aware of the residents individual care and support needs. Comments received included: “This is a well run home and it is a comfort to know my father is well looked after and you can call any time and find things the same standard”. DS0000006353.V349904.R01.S.doc Version 5.2 Page 19 “They are adaptable to each individuals needs and accommodate accordingly”. The file belonging to the most recent care worker to be employed was checked and was found to include all the necessary checks including, a POVA 1st (Protection of Vulnerable Adults) check, a CRB (Criminal Records Bureau) check and two references. An informal induction is provided which covers general health and safety, fire safety and the principles of moving and handling and the manager is looking to source some formal induction to ensure that the care workers are competent to carry out their role in the home. A number of training courses have been provided since the last inspection, including first aid training and food hygiene training. It was noted that although the new member of staff had received in house instruction on moving and handling she had yet to complete an accredited training course. This was discussed with the manager who accepted that this was a training course that needed to be offered to all the care workers working at the home and stated that this would be looked into. Four of the five care workers have completed their NVQ (National Vocational Qualification) level 2 and the care worker on duty at the time of the visit was in the process of completing her NVQ level 3. DS0000006353.V349904.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from the overall ethos of the home, which the registered manager provides. EVIDENCE: The manager has many years experience in care and is in the process of completing her NVQ level 3. Evidence was also seen of her completing a number of other training courses to update her knowledge and skills. DS0000006353.V349904.R01.S.doc Version 5.2 Page 21 Both residents spoken with during the visit stated that the manager was approachable and would have no hesitation to talk to her should they need to. One resident explained, “I feel very relaxed here, She’s very understanding [the manager] and she does her very best for you”. The care worker spoken with felt supported by the manager and stated that she was always available to talk to should she need to discuss any issue or concern. Questionnaires received from resident’s relatives also confirmed that the manager was approachable and managed the home well. One questionnaire stated, “The manager is exceptional and I believe that she trains the other staff well”. Through conversation with the manager it was evident that no money or valuables were currently being held on behalf of the residents. Residents and staff are consulted with regard to how the home is run. The manager meets residents on a one to one basis to find out if they are satisfied with the care and support they receive and quality assurance questionnaires are completed enabling the manager to gain the views of the residents in her care. The inspector was informed that staff meetings take place and this was confirmed on speaking with the care worker on duty, though minutes of these meetings weren’t available on the day of the visit. The manager also explained that care workers are consulted on a daily basis to enable them to provide the best possible service to the residents in their care. Policies and procedures required for the safeguarding of residents were in place and all records seen on this occasion were accurate, relevant and up to date. A fire drill and instruction session has been provided as recommended at the last inspection and another is planned for October this year. Training in food hygiene and first aid have been provided since the last inspection and the manager is in the process of obtaining training literature for health and safety training. It was noted that the most recent staff member to be employed had yet to have any accredited moving and handling training though she had had instruction on moving and handling principles from the manager who has completed her manual handling risk assessment and kinetic handling training for trainers course. Moving and handling training for the other care workers was due for renewal. DS0000006353.V349904.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 3 17 X 18 3 3 3 X X 3 3 3 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 3 3 X 3 X 3 3 DS0000006353.V349904.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP12 OP30 OP38 Good Practice Recommendations The registered provider should provide more activities for the residents to enjoy. The registered provider should provide formal induction training for all new care workers. The registered provider should arrange for all staff to complete moving and handling training and/or renew their moving and handling qualification. DS0000006353.V349904.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000006353.V349904.R01.S.doc Version 5.2 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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