Inspection on 30/10/06 for Shaftesbury Court

This inspection was carried out on 30th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Shaftesbury Court Manor Close Trowbridge Wiltshire BA14 9HN Lead Inspector Karen Mandle Unannounced Inspection 3rd October 2006 09:40 Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 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 Shaftesbury Court DS0000067490.V308878.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 Adults 18-65. 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. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shaftesbury Court Address Manor Close Trowbridge Wiltshire BA14 9HN 01905 338602 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) www.sanctuary-care.co.uk Sanctuary Care Ltd Mr Steven Coare Care Home 18 Category(ies) of Learning disability (1), Physical disability (17) registration, with number of places Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: Shaftesbury Court is registered to provide personal care for 18 younger people with a physical disability. The focus of the home is to support service users to lead an independent life style. The home is purpose built to support wheelchair users. All the bedrooms are single. The home is divided into four wings with four rooms on each wing. Each wing has an assisted bathroom and a kitchen/dining room. There is also a registered bungalow which house two residents. The main communal area is situated in the centre of the home linking the three units. Shaftesbury Court is situated in the town of Trowbridge, Wilts within walking distance of all local amenities. Sanctuary Care owns the home and the registered manager is Mr Steve Coare. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection commenced the 3rd October 2006 at 9.40am. The inspector returned to the home the 10th October 2006 to complete the inspection. The inspector spent the majority of the first day with four of the service users who were happy to participate with the inspection process by showing the inspector around the home, visiting bedrooms and discussing daily life in the home. The inspector gave 6 service users surveys to complete on the first day of the inspection, 3 were returned to the inspector on the second visit. The service users had positive opinions about the service provided at the home. The inspector was able to freely speak with and observe the staff interacting with service users. A number of records were reviewed such as care plans, medication records and health and safety records. The requirements and good practice recommendations had all been met from the previous inspection. Only 2 requirements were made following this inspection. The fees commence at £680.00 per week. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Nutritional risk assessments are now being implemented ensuring that all nutritional needs are being met. Pressure relieving equipment is now provided in line with the individual assessment. Service users are engaging in more college courses. The Head of Care is working towards implementing workshops Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 6 within the home relating to health care needs with the aim of providing service users an opportunity to take more responsibility for their own health. The three kitchens used by the service users had all been replaced. The assisted Parker bath had been replaced. Infection control practices had improved. 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. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 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 the following standard(s): 2 An admission policy and procedure is in place. Documented records of the pre admission assessment were in place. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to the home. EVIDENCE: The majority of service users had lived at Shaftesbury Court for many years with admissions rarely taking place. However a service user had recently been admitted. The admission procedure was assessed. A documented pre admission assessment was seen, providing information of the service users’ physical needs and social needs. A home visit to the service user had taken place as part of the admission procedure conducted by the Manager and Head of Care. The prospective service user had also been able to visit Shaftesbury Court prior to admission to meet with other service users, view the accommodation and meet with the care staff. A trial period of six weeks is offered before the service user makes a final decision to live at Shaftesbury Court permanently. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, 8 and 9 The care records are comprehensive and service users are fully involved in all aspects of developing their personal plan. Service users are supported to make their own decisions about their lives. Service users are consulted and contribute to all aspects of life within the home. The home continues to support service users to live an independent life style. Quality in this outcome area is judged to be good. This judgment has been made using the available evidence including a visit to this home. . EVIDENCE: Each service user is provided with a comprehensive care plan. The service users are fully involved with the development of their care plan and participate with all care plan reviews. The care records of four service users were closely reviewed following visit with the service users. The service users had signed in agreement to the care plans. The care plans provided the care staff with clear directions on how to meet the individual care needs of the service users. A record is maintained of all GP visits and other health care professionals who are requested to support the care needs of the service users. Pressure area Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 10 risk assessments are in place for all service users and nutritional risk assessment are currently being implemented. Detailed epilepsy profiles are in place, again giving clear direction for staff on how to support those service users with epilepsy. Risk assessments are in place for all activities of daily living and are reviewed 3 to 6 monthly depending on the level of risk. Shaftesbury Court aims to support service users to be independent and to make their own decisions and choices. Through observation of the care staff interacting with the service users it was evident that the staff do support them with decision-making. Three service users who spent much of the morning assisting the inspector confirmed that they do make their own decisions about their daily lives. The care plans also addressed decision-making and identified when service users needed more assistance with this. The service users continue to hold regular meetings chaired by one of the service users’. The meetings provide an opportunity for service users to voice concerns or changes they would like to make within the home. The minutes of the meetings are displayed on the notice board for all service users to read. Once the service users agree any issues that need to be addressed, they inform the manager by e-mail or in person. The home continues to support service users to live an active and independent life style as far possible. Risk assessments are in place to support service users in an independent life style such as going out alone which service users are encouraged to do. Service users are also encouraged to be independent within the home by being responsible for cleaning and tidying their own bedrooms, doing their own laundry and ensuring their own food stock for breakfast and lunch is maintained. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 and 17 Appropriate activities are provided. Service users are encouraged to participate in local community events and are supported to maintain relationships with family and friends. The staff respect the rights of the service users and interact respectfully with them. The service users are provided with a well balanced diet, which they were complimentary of. Quality in this outcome area is judged to be good. This judgment is made using the available evidence including a visit to the home. EVIDENCE: The service users generally choose what activities they wish to participate in or do. During the week many of service users are out of the home attending appointments or college. Cinema and local theatre trips are frequently arranged. Arts and crafts groups take place. Many of the service users have their own computer with Internet access, providing opportunity for them to contact family and friends and to research any interests. The majority of service users have their own TV and music system in their rooms. A notice board in the communal room provides information of activities taking place within the home. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 12 Service users are supported and encouraged by the home to participate in local community events such as music concerts and theatre productions. Many of the service users attend a local community college and a service user has a weekend job in a local café. Service users enjoy shopping in the town’s shopping centre. Community events are displayed on the notice board. Service users are supported to maintain links with family and friends. Several service users take regular weekend trips to visit with parents. Friendships are made within the home. Service users are able to receive visitors at any time within the privacy of their own room. During the tour of the home staff were observed respecting the rights and privacy of the service users by not entering the service users rooms without knocking or gaining permission from the service user prior to entering their bedroom. Service users are provided with a key to their room, and many of which lock their room when leaving the home. A system is place for service users to receive their mail unopened. Staff were observed interacting very well with service users in an open but respectful manner. The main hot meal of the day is provided in the evening, which is cooked by the chef in the main kitchen and then transported the individual wings where service users are able to have the meal together in their dining room. A choice is provided each evening, which the service users can choose from the day before. Service users were very complimentary of the standard and choice of meals provided. The service user or the carer makes breakfast and lunch at the time the service user wishes. These two meals are flexible to suit the service user. Each service user has their own fridge and is responsible for buying their own food for breakfast and lunch. Service users weights are monitored. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 18, 19, and 20 Service users are supported with personal care. Health care needs are closely monitored and appropriate action taken when health care needs change. The medication procedure is safe. Quality in this outcome area is judged to be good. This judgement is made using the available evidence including a visit to the home. EVIDENCE: The care records provide clear instructions to staff on how each service user prefers to be supported with personal care. Manual handling assessments are in place, again with clear instructions how to meet the manual handling needs of the service users. Personal care is provided in the privacy of the service users bedroom or bathroom, this was observed taking place. Service users are encouraged to be independent with personal care as much as possible. Service users get up and go to bed when they wish. Service users are encouraged and supported by the staff to buy and choose their own clothes. The health care needs of the service users are closely monitored and appropriate action taken when health care needs changed. Any changes in health care needs are documented in the care records. The home is not Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 14 registered to provide nursing care, therefore the community nursing team addresses the nursing needs of the service users. All service users are registered with a local GP. Service users are encouraged to visit the GP at the practice and be independent with making appointments. The Head of Care is currently working on providing workshops for service users in relation to their health care needs to try and promote service users to take more responsibility for their own health care. The medication procedure was assessed and was safe. All medication was stored correctly. The medication administration records were up to date. The home chooses not to have a homely remedy policy, as the home was unable to gain consent to use the homely remedy medications from a GP. A service user was self-medicating with a completed risk assessment in place. As safe practice the staff checked with the service user that all medications were correct on a weekly basis. The staff had been provided with medication training. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 22 and 23 A complaints procedure and policy is in place. Service users confirmed that they would not hesitate to raise any concerns or complaints with the homes management team. The recruitment procedures and the staff training provided supported the protection of service users from abuse. Quality in this outcome area is judged to be good. This judgment has been made by using the available evidence including a visit to this home. EVIDENCE: A complaints policy and procedure is in place, a copy of which is displayed in the entrance hall of the home. Each service user is also provided with a copy of the complaints procedure. Service users are clearly encouraged by the care team to voice opinions or any concerns regarding the service provided by the home. Four service users confirmed that if they had a complaint or concern that they would talk to “Steve” the manager or “Eleanor” the head of care. The home has not recently received any formal complaints. An Abuse policy and procedure is in place supported by a Whistle Blowing policy. All staff had received training in abuse awareness and the local vulnerable adults procedure. Recruitment procedures are robust and protect service users from abuse as far as possible. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 24 and 30 The home provides comfortable and spacious accommodation for service users to live in and is generally well maintained, apart from several floor surfaces. Infection control practices continue to improve. The home was clean throughout. Quality in this out come area is judged to be adequate. This judgement has been made using available evidence including a visit to this home. EVIDENCE: Shaftesbury Court is a purpose built home, which is suitable for the physical needs of the service user group. The home is generally well maintained. The home is spacious and promotes an independent lifestyle for the service users. The home has three wings with six single bedrooms on each wing, an assisted bathroom and toilet and a kitchen/dining room. The three wings are linked together by the large communal lounge area. A main kitchen is also provided. The communal room has been decorated, however the carpet is worn and stained. The manager informed the inspector that a refurbishment programme is in place to address the communal area and corridors. The main kitchen which was clean but needed to be painted as paint was flaking off areas of the Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 17 wall near to where food was being prepared. Several floor surfaces will need to be replaced as they are in poor condition and difficult to clean. The home was clean throughout. Infection control practices continue to improve. The Head of Care will be providing infection control training to all staff. Clinical waste was being dealt with appropriately. The laundry facility was clean and organised. Adequate hand-washing facilities for the staff are provided. The service users kitchens had all been replaced as required from the previous inspection. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Competent staff support the service users. Recruitment procedures are robust and protect the service users as much as possible. The staff had been provided with mandatory training. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this home. EVIDENCE: Shaftesbury Court benefits from having several staff members who have worked at the home for many years, providing a stable core team for the service users. This includes the Manager and Head of Care. The Head of Care role has only recently be clarified but is considered as a beneficial role for the home. The Head of Care is responsible for overseeing all aspects of care delivered to the service users. The service users the inspector spoke with were complimentary of the staff and the support they provided. The staff were observed listening and interacting well with the service user during the course of the inspection. Currently 67 of the staff had obtained NVQ level 2 or above. The recruitment files of four members of staff were reviewed all contained two references, application form, contract of employment, terms and conditions and appropriate police checks. Photographs of the employees were not on file. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 19 Interviews take place with two members of staff. Recruitment procedures are robust and protect the service users. New staff are given a 6 month probation period. All staff had been provided with mandatory training. A member of staff was due to attend manual handling co-ordinators training the week following the inspection. On completion of the course the manual handling co-ordinator can provide on going training within the home and to new staff at the commencement of employment, ensuring that safe manual handling practices are provided to service users. The staff had recently received tissue viability training, which the Head of Care reported as very informative. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The manager has much experience caring and managing a home for this client group and has good leadership skills. Quality assurance systems are in place, which fully involve the service users. The home is generally well maintained with health and safety issues addressed. Quality in this outcome area is judged to be good. This judgment has been made using the available evidence including a visit to the home. EVIDENCE: The Manager Mr Steve Coare has been in post at Shaftesbury Court for approximately fourteens years. Mr Coare has a clear understanding of the aims and objectives of the home. Three members of staff the inspector spoke with reported that they found Mr Coare very approachable. Four service users were also asked how they found the manager, all of which reported that “Steve” was always helpful and listened to them. Mr Coare projects good leaderships skills. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 21 Quality assurance systems are in place enabling service users to voice their opinions regarding the service provided by the home. Residents meetings regularly take place without staff present. A service user chairs the meeting. Any concerns or issues are then passed to the manager. Minutes are taken of the meeting and openly displayed for service users. Surveys are sent annually to the service users and family members. Sanctuary Care also hold a residents forum called SHIRE every 2 months at a designated venue away from the home for service users from Shaftesbury Court and other Sanctuary Care homes’ in the area. The service users decide who will attend the SHIRE group. Health and safety issues are generally well addressed providing a safe environment for service users to live in. Comprehensive risk assessments are in place for daily activities that take place in the home relating to service users. General risk assessments for the premises are in place. All accidents are recorded and what action was taken following the accident. The accident record is audited monthly identifying any pattern to the accidents. The electrical equipment is tested annually. Hoists had been serviced by, an outside contractor. The home is generally well maintained. Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 4 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 x Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 23 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 YA24 YA24 Regulation 23(2,d) 23(2,b) Timescale for action The kitchen will be painted. 15/12/06 The registered person will ensure 15/12/06 that all flooring in the home is maintained to a standard that can be kept clean and safe. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Shaftesbury Court DS0000067490.V308878.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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