Inspection on 14/07/05 for PIA - Barnfield

This inspection was carried out on 14th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

PIA - Barnfield 18/06/07

PIA - Barnfield 04/07/06

PIA - Barnfield 12/01/06

PIA - Barnfield 26/01/05

PIA - Barnfield 22/06/04

PIA - Barnfield 12/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Pia - Barnfield Church Lane Gaydon Warwickshire CV35 0EY Lead Inspector Sheila Briddick Unannounced 14 July 2005 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. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Pia - Barnfield Address Church Lane Gaydon Warwickshire CV35 0EY 01926 640521 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) People in Action Mrs Denise Badger Care home 5 Category(ies) of Learning disability (5) registration, with number of places Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26 January 2005 Brief Description of the Service: The home is a large domestic bungalow in a small village setting, providing accommodation and care for 5 young adults who have severe learning disabilities and/or physical disabilities. South Warwickshire Primary Care Trust owns the property. People in Action manage the home. Two of the five bedrooms have en-suite facilities. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four hours and was unannounced. Service users were at home during the visit and sufficient staff were on duty at that time to meet needs. A tour of the premises took place and care and home records were examined. There is currently no registered manager for the home. An application has been received from the acting manager of the service and the Commission is considering this. What the service does well: What has improved since the last inspection? Care plans are being reviewed regularly and this includes pressure area care, personal care and the associated risks. Service users personal information is recorded only on their care plan rather than staff communication records and stored securely. Written guidance has been provided by specialist services for staff to follow when flushing PEG tubes and administering medication via the PEG tube. All necessary medication information is easily accessible and this includes PRN protocols as required. Staffing levels are appropriate to the needs of the number of people currently living in the home during the day and at nighttime. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 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 Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 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) 2 There is a clear, consistent needs assessment and care planning system in place that adequately provides staff with the information they need to satisfactorily meet prospective service user needs. EVIDENCE: There is currently one vacancy in the home. A prospective service user is visiting the home to enable a positive decision to be made as to whether the home will be able to fully meet their needs. Care Management Assessments have taken place and the staff team are assessing the risks in the environment that may have the potential to affect the well being of the prospective service user. Staff spoken with had met the prospective service user during visits, which included an evening meal and overnight stay. Staff confirmed they had received assessments of the needs of the prospective service user and this had been beneficial to them during the visits. Staff felt that the existing service users in the home would be comfortable and happy with the prospective service user if it was decided the home would meet the assessed needs. Two care plans were examined at this visit and identified that care management assessments are being reviewed regularly. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 9 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 and 9 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service user needs. Carers are keen to develop their knowledge of risk assessment strategies to further promote the health and well-being of the people living in this home. EVIDENCE: Care plans seen at this visit show that care plan programmes and the goals of the people living in this home are reviewed on a regular basis. An agenda is set at care plan meetings and a record made of the review. Actions are identified to meet changing needs although an action plan and how this will be monitored is not always identified. The care plan review format being used is good and further development in action planning to meet change needs will enhance this. Staff spoken with were able to describe the processes in the home of involving service users in the care planning process. This involved observation and ensuring appropriate support. Staff spoken with felt that the communication skills of the staff team played an important part in enabling service users to be involved in the decision-making process. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 10 Staff provided many examples of how communication is used effectively and this included, makaton signing, use of photographs and object referencing. Risks to service users are identified and strategies are in place to minimise risk. Care plans did not evidence that risk assessments are reviewed on a regular basis however and this included manual handling and PEG feeding risks. Care plan programmes in place for the management of specific risks have been agreed with specialist services and this includes psychologists, psychiatrists and dieticians. All records requested by specialist services as part of the monitoring of specialist needs have been completed well. Staff spoken with were aware of the potential risks to the prospective service user and clear in their responsibility to have strategies in place to minimise those risks prior to the new service user coming to live in the home. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 11 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) 16 The people living in this home have opportunities to live an ordinary and meaningful life appropriate to their needs. Lifestyle in the home promotes and respects service user rights and responsibilities. EVIDENCE: The daily routines and preferred activities of service users is clearly identified on their care plan. This includes their preferred form of address, whether they like to spend time alone, or join in with other activities, and in which areas of the home they like to spend their time. Staff were observed to have a positive relationship with all the people living in the home and were keeping them informed of the activities that were happening at the time of the inspection. This included responding appropriately to service users who were asking about people visiting the home, the washing machine repairman and the inspector. On the day of this visit the weather conditions were extreme, (hot weather), and the activities of the day had been planned appropriately and accordingly to ensure that people were comfortable. This included changing activities that were to take place out of doors and providing plenty of cool drinks for people. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 12 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 and 20 The health-care needs of people living in his home are assessed and recognised with evidence of specialist services being readily available to them. The home is eager to improve their current system for medicine management to ensure that robust systems are in place to check all medicine received into the home is administered safely. EVIDENCE: Care plans examined show that the health-care needs of service users are being monitored regularly and reviewed appropriately to meet changing needs. This includes maintenance of epilepsy records, psychology monitoring charts, fluid intake, visits to health care professionals, including GPs for annual healthcare checks. Changes to medication is recorded appropriately however it was evident on some care plans that medication needs of individuals had not been reviewed on an annual basis as part of the care plan reviewing process. Care plans clearly identify the individual’s needs for being moved, supported and the equipment that is necessary for maintaining and promoting independence. People living in the home appeared well and were being supported by a mixed gender care staff team. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 13 Staff spoken with demonstrated a clear understanding of the individual needs of service users and of promoting a healthy lifestyle for people. Staff in this home demonstrated a commitment to developing effective communication skills to ensure that service users remain informed and able to make choices regarding the health-care. One staff member is currently developing a small booklet, which contains pictorial information for individual service users regarding the health services they access and the people they see when there. Physiotherapy, speech therapy and occupational therapy support and guidance has been sought in the care planning process to meet specific needs. This included physiotherapists setting a series of physiotherapy exercises to be carried out with a service user, written guidelines had been left at the home. The member of staff who had been shown by the physiotherapist was to then show other members of staff how to complete the exercises with the service user. The exercises involved some hands on support by staff and this included supporting the service user to move hand, wrist and elbow joints. There was no written evidence in the home to show that the physiotherapist had trained any member of staff in the exercise programme and there were no written guidelines to inform staff that they could only complete the exercises with the service user unless the nominated staff member had trained them. Staff spoken with have been trained in the safe administration of medicines, and this included guidelines for administering medication through a PEG feeding system. Staff confirmed that following this training they are shadowed by a senior member of staff for three observations of practice prior to administering medicine alone. Staff practice in medicine management is not reviewed or audited on a regular basis after this however. A record has not been maintained in the home for the training of staff in the procedure for PEG feeding/administration of medicine and to the responsible person will be to complete the training. Protocols for the administration of Paracetamol to be given as required, (prn) are not robust enough to ensure that the medicine is administered safely. This includes information regarding when the medicine is to be administered, the length of time it can be administered before notifying the GP and any medicine that it cannot be given in conjunction with. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 14 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 and 23 There are systems in place for listening to service user concerns by carers who have a good understanding of the importance of protecting service users from harm. The procedure for notifying the Commission for Social Care Inspection of events that affect the health and well-being of service users is not always actioned. EVIDENCE: There is a clear and effective complaints procedure and information regarding this is available in symbol and written format. Staff demonstrated an understanding of service user needs and this included an understanding of when a service user was not happy or distressed. Service users were observed to be happy and relaxed with staff and comfortable in their environment. The inspector was informed that service users views would be sought during the trial period of the prospective service user visiting the home. Examination of care records showed that all accidents and incidents that affect the well being of service users is recorded well, however these have not always been forwarded to the Commission as required. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 15 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, 27 and 30 The appearance of this home creates a comfortable and homely environment for the people living there. Areas of the home and use of equipment must improve to ensure the health, safety and well-being of the people in the home. EVIDENCE: The premises were comfortable, bright, cheerful and clean on the day of the visit and appropriate to the needs of the people living there. Furnishings and fittings were in general of good quality. The kitchen area however is in need of refurbishment to ensure food safety regulations can be safely met and enable service users to access food preparation areas more safely. This must include re-placement of working surfaces, storage cupboards that can be more accessible to service users and support food hygiene regulations. The bath chair in the bathroom has recently been replaced however a repair to the chair was taking place at the time of the inspection visit. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 16 Service user bedrooms reflect their individual lifestyle and hobbies and were being well maintained. A redecoration programme is planned for one service user bedroom. This does not include a repair to the carpet, which is fraying and badly stained in places. Plasterwork around the wash basin plumbing in one bedroom is in a poor condition and does not promote effective cleaning. Information for staff to follow in meeting service user needs is displayed in service user bedrooms although this is not in a manner that reflects the homely lifestyle of the people living in the home. Staff spoken with had identified areas of the environment that could pose a potential risk of harm to the prospective service user coming to live in the home. This must be addressed prior to the service user coming to live in the home. There is an infection control policy and procedure and staff spoken with demonstrated an understanding of their role in ensuring the home is kept clean. Laundry facilities are situated away from food preparation areas. At the time of the visit the washing machine was out of order and staff had made temporary arrangements for the laundering of linen. Equipment for the repair of the washing machine was expected the following day. There is a large garage adjacent to the bungalow and this was being cleared of unused equipment in order to garage their homes transport. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 17 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) 33 and 35 The people living his home are being supported by staff team who listen to them and understand their individual needs. The training and development programme for staff is good however this could be improved to ensure staff have the skills necessary for maintaining service user’s mobility and the safe use of equipment. EVIDENCE: There were sufficient staff on duty at the time of the inspection to meet the individual and specific needs of the people living in the home. This included providing one-to-one support for activities and the day-to-day running of the home. Staffing records examined showed this to be a consistent practice. Following recent recruitment of staff to the home there is now an appropriate gender mix on duty during the waking day. A ‘trial period’ of staffing levels during night-time has identified that one waking night staff only is sufficient, extra staffing is brought in to meet needs when required and there is an effective on call support system in place to cover the emergencies. The people living in this home are supported at all times by a staff team who communicate well with service users through use of signing, speech and object referencing. Staff spoken with demonstrated the importance of continuing to develop communication processes to meet service user needs. Staff are currently developing information in photographic format for service users as part of informing activities that are being planned. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 18 Team meeting minutes evidence that the staff team work closely with speech and language therapists in developing care plan programmes for service users and developing staff skills. There is a staff training and development programme in place and this includes provision of an active NVQ assessment programme and the Learning Disability Award Framework, (LDAF). Staff spoken with had completed their LDAF and had enrolled on an NVQ at Level 2. Staff confirmed that training needs are discussed regularly during supervision. Staff have written guidelines to follow when supporting service user with physiotherapy exercises and a PEG feeding system. Requirements have been made in this report for the development of a system for ensuring staff have the skills to support people in these activities, who is responsible for their training and how often the competencies of staff in this technique are to be assessed. Staff spoken with confirmed they had regular team meetings and these were open and offered opportunity for discussion on service development. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 19 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) These standards were not assessed on this occasion. EVIDENCE: Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 20 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 3 x x 2 Standard No 11 12 13 14 15 16 17 x x x x x 3 x Standard No 31 32 33 34 35 36 Score x x 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pia - Barnfield Score 2 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 21 No 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. 2. Standard Regulation Requirement Timescale for action October 1, 2005. 9 13.4 3. 18 18.1 4. 18 18.1 Risk assessments included in care plan programmes must be reviewed on a regular basis and a record made of the outcome on the care plan. All staff completing physiotherapy exercise programs with service users must have had training appropriate to the task they are to perform. This can be from a nominated staff member who has had specific training from a qualified physiotherapist to carry out the exercise programme and to be able to train other staff in the procedure. A record must be maintained in the care home of all persons who have received the appropriate training and the lead trainer must have refresher training on an annual basis from qualified physiotherapist. A record must be maintained in the home of all staff who have been trained, and of their ongoing refresher training, in the procedure for the use of PEG equipment. This must include the name of the responsible person E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc August 15, 2005 August 30, 2005 Pia - Barnfield Version 1.40 Page 22 5. 20 13 6. 20 13 7. 23 37.1 8. 9. 24 24 23 23 10. 24 23 11. 12. 24 24 23 13 training staff and an ongoing record of that persons competency to train staff. Staff competency audits must be undertaken to demonstrate their ongoing competence in the administration and recording of medicines All when required medication must have written protocol to support there use which has been endorsed by a clinician and must be reviewed on a regular basis. The Commission shall be informed without delay of the occurrence of any event in the care home which affects the well-being or safety of any service user. Kitchen worktops must be replaced. An action plan, including timescales for completion, must be forwarded to the Commission for the refurbishment of the kitchen area as part of making the facility appropriate to the needs of the people living in the home. Bedroom carpets must be maintained in good condition through cleaning and repair or replacement at all times. Chipped and flaking plaster must be repaired to ensure effective cleaning can take place. The environment must be assessed for risk and strategies put in place to minimise any risk for the prospective service user prior to their coming to live in the home. December 1, 2005 August 15, 2005 August 15, 2005 September 30, 2005 September 30, 2005 September 30, 2005 September 30, 2005 July 15, 2005 Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations It is recommended that an action plan for meeting assessed and changing needs is identified during the review meeting, and this includes the procedure for monitoring progress towards the goal. It is recommended that information to staff being displayed in service user bedrooms reflects the homely environment and this could be on picture pin boards or in photograph frames. 2. 24 3. 4. 5. Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pia - Barnfield E53 S4279 Pia Barnfield V239628 140705 Stage 4.doc Version 1.40 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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