Inspection on 01/06/05 for Perryn Road 23

This inspection was carried out on 1st June 2005.

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

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

Other inspections for this house

Perryn Road 23 01/02/07

Perryn Road 23 05/12/05

Perryn Road 23 10/01/05

Perryn Road 23 17/05/04

Perryn Road 23 01/07/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Perryn Road, 23 Acton London W3 7LS Lead Inspector Gavin Thomas Unannounced 1 June 2005 at 12.35pm 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 23 Perryn Road Address Acton, London W3 7LS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 749 8273 0208 944 8900 info@cmg-corporate.com Care Management Group Limited Care Home 8 Category(ies) of Learning Disability (8) registration, with number of places Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th December 2004 & 10th January 2005 Brief Description of the Service: 23 Perryn Road has operated under the Care Management Group (CMG), as a care home for adults with learning disabilities since 1998. Some of the service users have assoicated needs including a mental health diagnosis and exibiting challenging behaviours. The building is a large double fronted detached property in a residential area close to Acton High Street with shopping and public transport facilities. External features inlcudes an enclosed rear garden, most of which is laid to lawn. Off road parking is provided for up to two vehicles. The age range of the service users is between 20 and 50 years. At the time of this inspection, there were seven service users accommodated. All service users are accommdated in single bedrooms. Bedrooms are situated on the ground, first and second floors. Because of the age and design of the building, the size of the bedrooms vary greatly. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The service does not have a computer or any form of typing equipment. The service is currently required to submit handwritten documentation to the organisation’s head office for typing and printing. The time lapse between documents being sent to the organisation’s head office and being returned to Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 6 the home is too long. Similarly, it was identified on this inspection that repairs to a bedroom door lock were outstanding for a period of nine days. These practices require urgent review to ensure that the running of the home is not obstructed through organisational practices. 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. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 5 The home’s Statement of Purpose and Service User Guide were well written providing service users and prospective service users with details of the services the home provides. Thorough assessment procedures are well maintained. EVIDENCE: An up to date Statement of Purpose and Service User Guide were in place. Both documents were accessible to visitors. Service users have also been issued a copy of the Service User Guide. The Manager Designate said that the Statement of Purpose has recently been requested by a number of Placing Officers. A dedicated team within the organisation carries out pre admission assessments and matching processes. The Placement’s Officer manages this team. The Manager Designate and/or a member of the staff team carries out subsequent assessments with prospective service users. There was no evidence to indicate that the organisation confirms in writing to the service user that having regard to the assessment, the care home is suitable for the purpose of meeting the service user’s needs in respect of their health and welfare. The Manager Designate was advised to consult with the Placing Officer regarding this. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 9 Contracts were in place between the home and service users. Where possible, service users sign their contracts. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 & 9 Care plans and reviews were of good quality. However, the process in having these documents typed centrally must improve to ensure that they are returned to the home in a more reasonable timescale. The systems for service user consultation are good with sufficient evidence that service user views are sought and acted upon. EVIDENCE: Care plans were in place for all service users. Care plans examined were detailed and tailored in accordance with service users individual needs. Care planning reviews are held six monthly and at other times when necessary. Informal care plan reviews are held monthly and recorded. This is evidenced. Details for one review was not available at the time of this inspection. Care plans and reviews are submitted to the organisation’s head office for vetting and typing. The Inspector was informed that this process could take between three and four months before documents are returned to the home. This process must be reviewed. Service users are encouraged to participate in the day-to-day running of the home. Consultation processes include monthly house meetings, informal Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 11 discussions, feedback from relatives and representatives and request letters written by service users. Risk assessments were in place for all service users. Risk assessments are reviewed and updated frequently. Where possible, service users are involved in devising their risk assessments. The risk assessments examined were detailed and well written. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12 , 13 , 14 & 15 Good support levels are in place for enabling service users to re-establish relationships with significant others. Equally maximum support is provided to enable service users to maintain relationships with relatives and significant others. Links with the community are good with opportunities to enrich service users’ social and educational opportunities. EVIDENCE: Service users are supported to uphold their religious beliefs and faith. Some service users do attend church services. The Catholic Priest visited service users at the time of this inspection. Three service users were engaged in structured daytime activities. This included a college placement, a day centre placement and a work placement. One service user said they attended an interview for voluntary employment on the day of this inspection. The Manager Designate was in the process of exploring opportunities for three service users to engage in structured daytime activities. The three service users were engaged in activities arranged by the home. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 13 The home was still in the process of exploring further opportunities for service users to engage in a wider range of community-based activities. All service users have a freedom pass for using public transport. The home has a car. Service users also make use of a bus, which is owned by Care Management Group. Three service users are now accessing the community independently. The three service users are monitored via a Community Access Programme. This programme has been designed with assistance from a Psychologist. The Manager Designate said the programmes are proving successful and positive for the three service users. Service users access a range of community resources and amenities. These include the gym, Internet café, bowling, and clubs. Service users also eat out at local restaurants. All service users have an annual holiday. Service users have the option of taking a holiday abroad. The home continues to support service users in maintaining contact with relatives and significant others. Visiting arrangements are flexible. Visiting arrangements are agreed with individual service users. Service users continue to maintain contact and friendships with service users from other establishments owned by Care Management Group in West London and people outside of the organisation. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 The health needs of service users are well met with evidence of good multi disciplinary working taking place when required. The systems for the storage and administration of medication are good with clear and comprehensive arrangements being in place to ensure service users medication needs are met. EVIDENCE: Service users personal support requirements were set out in their care plans. Service users health needs were also set out in their care plans. The Community Team for People with Learning Disabilities (CTPLD) continues to provide professional support and assistance. In particular, the Psychologist who works closely with the home and service users. Service users have access to health care specialists and service. These include, Psychiatry, sexual health and well woman clinic. All service users are offered routine health checks. Primary health services include chiropody, dentistry and opticians. A medication policy was in place. The Manager Designate said there were no changes to this policy. Routine Pharmaceutical audits are carried out. Reports for these visits confirmed this. All staff had attended in – house training on medication. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 15 Accredited training must be arranged for the staff team. A record for the disposal of medication was in place. The Medication Administration Records examined were satisfactory. All medications were kept in a locked cupboard. The medications were stored appropriately. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home has a satisfactory complaints system although the record of complaints needs to be developed for the reasons as set out below. Systems were in place to protect service users from exploitation and abuse. EVIDENCE: A complaints policy and procedure was in place. A visitor’s complaints procedure is now displayed in the home. The home had received one complaint since the last inspection. This complaint was unfounded. Although the complaints record has been revised, the format of this document must be revised to include details of action taken in respect of any such complaint and the outcome. An adult protection policy and procedure was in place. The home was also in receipt of the Department of Health guidance - No Secrets. The majority of staff had attended training on the protection of vulnerable adults. The Manager Designate said that two staff were due to attend this training. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26 & 27 Recent investment has significantly improved some of the appearance of this home, creating a more comfortable and safe environment for those living there and visiting. The Manager Designate has a good understanding of the areas in which the home needs to improve. Planning was in place and set out how this improvement was going to be resourced and managed. Care Management Group must ensure however, that maintenance requests are addressed more promptly for the reason as set out below. EVIDENCE: There has been good progress in improving the physical standards of the home since the last inspection. Progress made up to the time of this inspection were as follows: • Replacement flooring in the shower room on the ground floor. • Replacement carpet in the hallway and lounge on the ground floor. • Replacement carpet commenced on the staircase. This is still to be completed. • Replacement carpet and redecorating in some of the bedrooms. • Replacement furniture and curtains in some of the bedrooms where required. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 18 One bedroom was in the process of being redecorated at the time of this inspection. A programme of routine maintenance was in place. All service users are accommodated in single bedrooms. All bedrooms inspected were very well presented, personalised and clean. Two service users said they chose their own colours. The Manager Designate said that all service users were involved in selecting colour schemes and replacement furniture. All bedroom doors are lockable. However, it was of concern that the lock on one bedroom door had been broken since 23rd May 2005. Although the Manager Designate had communicated with Care Management Group about this, the lack of response resulted in the service user not being able to lock or open the door properly from the inside. A small towel was being used at night to stop the door from shutting to. The service user told the Inspector they did not like the lock being broken and was frightened of being trapped in their bedroom. This practice is unacceptable. All defaults to the property must be addressed promptly to ensure service users safety and in this case, their privacy at all times. Subsequent to this inspection, the Manager Designate informed the Inspector that the lock was repaired on 2nd June 2005. The home has four toilets, two baths and two shower cubicles. The ratio of toilets, baths and showers are in keeping with the criteria as set out in Standard 27 of the National Minimum Standards for Adults (18-65). All toilets and bathrooms were well presented and clean. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 & 36 There is no clear or consistent system in place to evidence staff training including foundation training, which has been absent from the training modules since the last inspection. The home has a satisfactory system in place for formal one to one supervisions and annual appraisals with the staff team. EVIDENCE: A training programme for the home was not in place. The Manager Designate explained that Care Management Group issues monthly training schedules. Training request forms are then completed for individual staff. Given that the monthly training schedules were not consistent, a training and development programme must be devised and implemented. Evidence of foundation training was not available. The immediate requirement issued at the previous inspection has not been met. One to one supervision meetings are held with staff every six weeks. The Manager Designate confirmed that annual appraisal systems were in place. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 & 42 The Manager Designate has a clear vision for the home, which he effectively communicates to service users, staff and relatives. Although the organisation seeks the views of service users and significant others, a full quality and monitoring system was not in place. EVIDENCE: The Manager Designate has been in his current post since July 2003. The Manager Designate has a Bsc in Psychology and Health studies, a Post Graduate – Integrative certificate in Counselling and Psychology, a Post Graduate Diploma in Counselling and a NCFE in Counselling. The Manager Designate said he keeps abreast of current practice through research. He has also undertaken training in adult protection, fire safety, budgeting, food hygiene, First Aid, grievance procedures and quality systems. As stated under Standard 37.2 ii, the Manager Designate is required to achieve a qualification at Level 4 NVQ in both management and care by 2005. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 21 The Manager Designate and the staff team are making on going progress in providing an environment, which provides service users with opportunities to develop their potential. There was also evidence, which indicated that the service is transparent and the types of support provided, enables service users to express their emotions and wishes. Although the requirement to produce a quality assurance system within the previous timescale set has not been met, the Manager Designate confirmed that this project is underway and should be completed within the next two months. The quality assurance model is being devised at organisational level. Care Management Group has issued surveys to service users and relatives. The results of surveys will be published once responses have been received. There was no evidence to demonstrate that all washing, bathing and showering appliances are thermostatically controlled. This requirement was made at the previous inspection and not met within the timescale set. Therefore an immediate requirement was issued on this inspection to provide the evidence required within the revised timescale set. Records of hot water temperatures were satisfactory. These records now include the actual appliances tested. Staff had undertaken training in food hygiene, fire safety and First Aid. The contents of the First Aid box were very scant. The Manager Designate said he had requested a new First Aid box via Care Management Group. Documentation seen confirmed this. Fire drills are held every three months. Records of fire drills were very well written. The Manager Designate confirmed that night staff are included in fire drills. A fire risk assessment was in place. This document was last updated in December 2004. The fire route planner was displayed in the entrance hall on the ground floor. Records examined confirmed that an approved contractor tests fire appliances routinely. The home also carries out weekly tests on the emergency lighting and fire alarm system. Health and safety risk assessments were in place. These assessments were last updated in May 2005. Freestanding wet floor signs must be provided to maximise safety in the home when floors have been cleaned. Records examined confirmed that approved contractors routinely test gas and electrical appliances. The kitchen was clean. Food storage areas were satisfactory. The washing facilities have now been relocated from the basement to a small utility room on the ground floor. The Manager Designate said that work would be carried out in due course where damp is present on the basement walls. Progress towards this will be monitored at the next inspection. Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score x x x x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Perryn Road, 23 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 2 x G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15 (2) (a) Requirement The CMG Head Office must ensure that care plans and associated records are returned to the home within a more reasonable timescale. The record of complaints must include details of action taken in respect of any such complaint and the outcome. All defaults to the property must be addressed promptly to ensure service users safety and where applicable, their privacy. An up to date training programme must be devised and implemented. (Timescale of 28/2/05 not met). Evidence of foundation training must be available in the home. (Timescale for immediate requirement of 10/2/05 not met). Evidence must be obtained and supplied to the CSCI to demonstrate that all washing , bathing and showering appliances are theromostaically controlled. (Timescale of 28/2/05 not met). Freestanding wet floor signs must be provided to maximise Timescale for action 3/7/05 2. 22 22(3) 31/7/05 3. 24 23(2)(b) 31/7/05 4. 35 18(1)(a) (c)(i) 18(1)(a) (c) (i) 31/7/05 5. 35 31/7/05 6. 42 13(4)(c ) 22/6/05 7. 42 13(4)(c ) 31/7/05 Page 24 Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 service users safety when floors have been cleaned. 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 Good Practice Recommendations Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ground Floor 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 Perryn Road, 23 G61 G10 s27747 Perryn Road v214211 010605 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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