Inspection on 15/08/06 for Portland House

This inspection was carried out on 15th August 2006.

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

Portland House 23/10/08

Portland House 01/11/07

Portland House 04/12/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Portland House Belvidere Road Shrewsbury Shropshire SY2 5LS Lead Inspector Pat Scott Key Unannounced Inspection 15th August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Portland House DS0000067189.V296979.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. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Portland House Address Belvidere Road Shrewsbury Shropshire SY2 5LS 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) 01743 235 215 None Kelly Residential Limited Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (3) of places Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels for 43 service users: 8am - 2 pm 2pm - 8pm 8pm - 8am 2 RN`s 1 RN 1 RN 6 care assistants 5 care assistants 3 care assistants These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependancy nursing needs. Additional staff must be on duty when high dependancy service users are accomodated. These minimum levels are for direct nursing and personal care only. They do not include ancilliary staff. They are exclusive of the manager`s time. The home must provide the following minimum staffing levels for 3033 service users: 8am - 2 pm 2pm - 8pm 8pm - 8am 2 RN`s 1 RN 1 RN 6 care assistants 5 care assistants 3 care assistants These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependancy nursing needs. Additional staff must be on duty when high dependancy service users are accomodated. These minimum levels are for direct nursing and personal care only. They do not inlcude ancilliary staff. They are exclusive of the Manager`s time. The home can accommodate a maximum of 43 (forty-three) service users requiring nursing care which includes a maximum of 3 service users with PD (Physi cal Disability). 2. 3. Date of last inspection Brief Description of the Service: Portland House is situated in a residential area of Shrewsbury. Kelly residential Ltd were registered as the provider in May 2006 with Mrs M Rai as the responsible individual. The home comprises of an older building with a modern extension situated within large grounds. Portland House is classed as a new service and has not developed a statement of purpose or service user guide. The inspection reports are not yet available Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 5 for viewing in the home. The care home rates have been set but are not yet available within the service user guide. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the owner, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? What they could do better: The links between the style of home, its philosophy of care and its size, design and layout should be made quite clear in the home’s statement of purpose. The provider needs to make clear in its statement of purpose which clientele their home is aimed at and to make sure the changes to the physical environment matches their requirements. The manager needs to be aware of the content and philosophy of the statement of purpose so that it can be discussed in supervision and training. The provider needs to produce a service users guide and reflect in this the changes within the regulations (as from September 1st 2006) to include greater detail relating to the standard package of services provided, the terms and conditions which apply to key services and fee levels and payment arrangements. The guide is also required to state whether the terms and conditions (including fees) would be different in circumstances where a service user’s care is funded, in whole or in part, by someone other than the service Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 7 user. One service user said that they had not been provided with information but that also it had not been by choice that they entered the home. Full assessments of need must be conducted before and when the service user moves into the home. Care plans should be written in a way that reflects the wishes of each individual and their diverse needs e.g. dietary needs, activity/social/emotional support and spiritual and religious views. A record of improvements to the premises should be maintained. Service users were complimentary about the refurbishment that had taken place. The requirements for numbers and skill mix of staff in the home must be met at all times. Key national minimum standards regarding staff recruitment, induction, training and management were not met. Recruitment is not robust as not all checks are returned prior to appointment. Staff said they had received training but files were disorganised and no evidence of a plan in place. Robust recruitment is imperative to ensure that only suitable people are employed to work with vulnerable service users. The induction standards should be amended to meet those for ‘Skills for Care’. Overall service users may not be safe as a result of how the service delivers these outcome areas. Some service users are assessed as needing bed rails. A robust risk assessment should be conducted and recorded and agreement sought from relatives/GP/supporter prior to using them. 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. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives do not have the information needed to choose a home which will meet their needs. Service users move into the home without having had all his/her needs assessed and so they are not assured that these will be met. EVIDENCE: The home does not have a statement of purpose or service user guide. One service user spoken with stated that they had not been given any choice in being admitted to Portland House and that this had been made by their social worker. One service user could not remember having been assessed by staff prior to admission. Care plans viewed contained assessments of need carried out by the home which in some cases were incomplete regarding medication details, funeral arrangements, diet, G.P., attitudes, sleep pattern, consent for bed rails, activities, terminal illness/palliative care and spirituality. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 10 However, a new type of care plan is being introduced. One seen of a new service user had an assessment of need recorded. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plan recording does not provide staff with the information they need to satisfactorily meet service users needs. The health needs of service users are met with evidence of some multi disciplinary working taking place. Personal support in this home is not consistently offered in such a way as to promote and protect service users dignity and independence. EVIDENCE: Poor recording of assessments does not enable staff to plan and deliver effective care. Current care plans were up to date with the reviews but did not reflect total care to be provided. For example, one service user admitted for end of life care did not have his holistic needs assessed and addressed. Staff had omitted to address important needs such as spirituality and religious care. The quality of Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 12 the care plan recording is such that people who are not familiar with its content could not use it in an emergency. The care of another service user who was very frail and in bed was discussed with staff. It was stated that this person preferred to eat her breakfast in bed. She had not been assisted to sit up and therefore could not have her drinks or eat her jam sandwich. Two beakers of fluid were left on her table. This service user was again visited and had been assisted to eat her food but was still not sitting up and had food down her nightdress which had not been changed. The bed rail bumpers had dribbles of dried fluid down the sides of them which had gone onto the bed’s valance. Care staff should assist individuals to eat in as sensitive and dignified a way as possible. A service user who had recently suffered a stroke and was being cared for in bed had no turn chart in her room. Medication records were up to date and the Boots MDS system has been implemented. Service users said that they had settled well and that staff did treat them well. Those that had been assisted up during the morning looked well groomed and dressed in their own clothes. One service user who shares a bedroom said that staff always close his curtains when being assisted with his personal care. A relative spoken with said that “nothing was too much trouble for staff when I ask”. It is considered that health and personal care provision is satisfactory for some individuals requiring less intervention, but there are those frailer individuals who require more attention than they were getting. Staff meet needs in a reactive manner rather than understanding individuals diverse needs and proactively delivering the service. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in social activity and keep in contact with family and friends. Residents receive a healthy diet but not always according to an assessed requirement. EVIDENCE: The menus are in the process of being reviewed with more emphasis on choice. Service users spoken with did not know what the main meal of the day was going to be but they were complimentary about the food provided. The dining room is undergoing refurbishment. The home has an activity co-ordinator for 20hrs a week. Various events are organised and displayed within the entrance hall. The co-ordinator stated that she tells people what is on for the day. There is a lack of recording of preferred social activity/hobbies etc in the assessments. There is little evidence of service user consultation or involvement in the planning of meaningful pastimes. There is little evidence that the home facilitates individual choice. It is stated that one to one time is given to frail service users who are unable to participate in group activities. Service users are encouraged to keep in contact with family and friends and visitors were seen to come and go during the inspection. Portland House DS0000067189.V296979.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not have access to a complaints procedure that enables them or their supporters views to be listened to and acted upon. Established staff have been provided with training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: The CSCI has not received any complaints about the home since the registration of the new provider. Nor have their been any adult protection issues. There is no statement of purpose or service users guide which should detail procedures of how to complain. There was no other means in the home of service users having the opportunity to make comments or suggestions about the service. A complaint log/record was not available for inspection. The inspection of 27/2/06 under the previous providers identified that the manager provided training in adult protection to the staff team. The lack of a training plan does not allow for identifying when established staff are to receive updates in this area. Staff files seen for new starters did not provide evidence of adult protection training having been planned. Service users were seen to speak easily to staff and were comfortable in their company. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Areas of the home already refurbished provide a safe, comfortable environment for service users. However, there are still areas requiring improvement. EVIDENCE: A programme of refurbishment is underway to improve the appearance and safety of the bedrooms and communal areas in the home. Records are not currently kept of improvements that have taken place and the Proprietor agreed to do so. Shared rooms are being reduced which will reduce the overall numbers registered. The outside areas have greatly improved to provide better access. Waste bins are stored out of site, but clinical waste bins must be secured. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 16 An infection control audit took place by the Shropshire PCT April 2006 which identified a shortfall in the management of this area. The Proprietors have agreed to implement the salient points from this audit. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of adherence to minimum staffing requirements puts service users at risk of harm. Lack of induction, training provision, monitoring and supervision of staff does not ensure that service users are in safe hands. The registered person fails to demonstrate good employment practice which does not protect vulnerable service users in the home. EVIDENCE: At the time of inspection the home was providing care and accommodation for 33 service users. The conditions of registration regarding staffing states that 2 qualified nurses and six care staff should have been on duty during the 8-2pm shift. There was one qualified staff and seven care assistants on duty. The home provided the correct numbers but not staff skill mix. Three staff files were seen, one of a long term member of staff and two new recruits. The new staff lacked criminal record bureau check results prior to starting. They had one reference returned, one of which should have been explored further but with no written evidence of this. POVA first checks were on file. Staff may start employment pending a criminal record bureau clearance, if a POVA first check has been received and two written references, and only if the home is experiencing staffing difficulties which would have a Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 18 detrimental impact on service user care. The Proprietor stated that the staffing establishment in the home had been satisfactory. This evidence does not demonstrate that good employment practice has been followed. A requirement regarding the same issue was made at the last inspection of 27/2/06 under the previous owner but same manager. There was no evidence of induction for the new staff or planned training. There was no evidence on staff files of completed and signed off induction standards or of mentors being allocated to support staff in completing these documents. Regular supervision following adult protection issues had not been recorded for one member of staff. Staff need to be adequately trained in order to carry out the care to meet services users needs. They need to be able to assess, plan, provide and monitor the outcomes of care for service users. Supervision is an important element which brings together all these practices and ensures that staff are competent to do their job and that competency is maintained. There was no evidence produced of a training plan for the year or any record of training having been conducted. It was suggested that a training matrix would enable management to see what training is up to date and what needs to be repeated. This can then provide a useful planning tool for management as well as a record of the home’s position regarding training provision. The training attended should then be recorded upon individuals personal training profiles. A staff member did comment that staff were attending NVQ programmes and training opportunities had improved. She felt staff were more motivated under the new ownership and were optimistic that care would improve. The staff member in the laundry confirmed she had achieved relevant NVQ training in her area. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management and leadership of the home is lacking which does not benefit service user care. Record keeping in the home is variable in quality so that service user’s rights and best interests are not safeguarded. EVIDENCE: The manager has been in post since November 2005. There has been a failure to evidence that the employment policies and procedures, induction, training and supervision arrangements have been put into practice. This does not enable staff to develop and be aware of good practice. Records required by regulation for the protection of service users and for the effective and efficient running of the home were not in good order, with the exception of the fire Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 20 records. There has been a recent concern from the fire authority regarding management and staff competence in dealing with a fire at the home. The owners have implemented robust recording with regard to the fire system. They are also reviewing the recording for hot water outlet testing and legionella risk. Although improvement in the internal premises is gathering pace slow progress has been made regarding the leadership, training, development and supervision of staff who are directly involved in service user care. The lack of a statement of purpose for the home makes it difficult for the manager and staff to be familiar with the aims and objectives of the new owners. Risk assessments were not complete regarding the use of bed rails. There is a failure to record consent to their use from service user, family or G.P. The owners stated that quality surveys will be conducted when the improvements to the environment are complete. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 X 3 1 1 2 Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? New service 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 OP1 OP1 Regulation 4 5 Requirement The registered person shall produce a statement of purpose for the home. The registered person shall produce a service user guide to comply with the amended statutory instrument 2006 No. 1493. The registered person shall not provide accommodation to a service user at the care home unless a full assessment has been conducted. The registered person shall prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall ensure that service users are treated with respect and their dignity protected. The registered person shall ensure that service users can exercise choice in relation to routines of daily living, leisure activities and meals. The registered person shall ensure that a complaints DS0000067189.V296979.R01.S.doc Timescale for action 15/11/06 15/11/06 3 OP3 14(1)(2) 15/09/06 4 OP7 15(1) 15/11/06 5 OP10 12(4)(a) 12(1)(b) 12(1)(2)( 3) 16/08/06 6 OP12 16/08/06 7 OP16 22 15/09/06 Portland House Version 5.2 Page 23 8 OP27 OP28 OP30 18(1)(2) 9 OP29 19(1) 10 OP32 OP33 OP36 24(1)(3) 11 OP38 13(8) procedure is available to service users and/or their representatives. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home. The registered person must establish open management systems which support and promote a sense of direction and leadership, through written documentation, supervision of staff and quality assurance based on clearly stated objectives. The registered person shall ensure that risk assessments are carried out for all safe working practices including the use of bed rails. 15/09/06 15/09/06 15/09/06 15/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP30 Good Practice Recommendations The registered provider should amend the induction standards to comply with the changes in ‘Skills for Care’. DS0000067189.V296979.R01.S.doc Version 5.2 Page 24 Portland House 2 OP19 A record of improvements to the home should be maintained. Portland House DS0000067189.V296979.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Portland House DS0000067189.V296979.R01.S.doc Version 5.2 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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