Inspection on 29/08/06 for Uphill Grange

This inspection was carried out on 29th August 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Uphill Grange 18/06/08

Uphill Grange 09/01/08

Uphill Grange 25/07/07

Uphill Grange 28/11/05

Uphill Grange 23/05/05

Uphill Grange 16/09/04

Uphill Grange 20/07/04

Uphill Grange 27/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Uphill Grange Uphill Road South Weston Super Mare North Somerset BS23 4TX Lead Inspector Barbara Ludlow Key Unannounced Inspection 29th 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 Uphill Grange DS0000020290.V310075.R02.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. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uphill Grange Address Uphill Road South Weston Super Mare North Somerset BS23 4TX 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) 01934 635422 01934 419384 Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) Ms Emma Stevenson Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. May accommodate up to 26 persons aged 50 years and over requiring nursing care May accommodate up to 18 persons aged 65 years and over requiring personal care Manager must be a RN on parts 1 or 12 of the NMC register. Staffing Notice dated 03/12/2001 applies Ms Stevenson successfully completes Level 4 NVQ in Care and Management by 30th September 2006. 28th November 2005 Date of last inspection Brief Description of the Service: Uphill Grange is registered to provide personal care for up to 18 residents and nursing care for 26 residents. The home is a converted older property in the small village of Uphill, on the outskirts of Weston Super Mare. Accommodation is provided in single and two double rooms. The majority of these have en suite facilities. A large dining room, with a small lounge area, is situated on the lower ground floor. The two main lounges are on the ground floor, and overlook the large garden and surrounding countryside. A passenger lift ensures level access throughout the home. Acegold limited, a wholly owned subsidiary of Four Seasons Health Care, owns Uphill Grange. Miss Emma Stevenson was appointed home manager in November 2004 and has since become the homes Registered Manager after the CSCI Fit process was successfully completed. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key standards inspection was carried by B.Ludlow and K McCluskey for CSCI over a five hour period. The Registered Manager Ms Emma Stephenson was on duty and was available throughout the inspection day. The inspection was well received by the manager, her staff and service users. The last inspection report and progress made was discussed at the start of the inspection. There were twenty two service users with residence at this inspection (this included one person in hospital). Sixteen were identified in the nursing care category and six in personal care only category of the home. A tour of the premises was made. Service users and staff were seen during this time. Service users were seen both in the communal areas and in private in their rooms. Service users with dementia care needs were seen and were observed during this inspection. Lunchtime meal was served in the dining room, this was observed. Records were sampled, these included service user care plans, staff recruitment files and maintenance and servicing records. Feedback was given to Ms Stephenson at the end of the inspection visit. A letter was sent to the home after the inspection to make regulatory requirements of the management, which needed to be met within 28days, and before the draft stage report was issued. Written feedback was sought from service users and visiting professionals. Extra time was allowed for the return of any forms after the inspection site visit and prior to the inspection being closed. What the service does well: Uphill Grange is a very grand house set in pleasant gardens with open countryside views. As part of a large corporate organisation the home benefits from the back up support of the organisation, corporate literature and company systems for managing the home. Service users confirmed that they are well looked after and the home has a comfortable and relaxed atmosphere. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 6 Staff are settled and the manager reported little turnover of staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 7 contacting your local CSCI office. Uphill Grange DS0000020290.V310075.R02.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 Uphill Grange DS0000020290.V310075.R02.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): 1,2,3,4,5 NMS 6 does not apply. The outcome for this area was good. The home has a range of corporate information available for prospective service users ands their families. Service users are assessed prior admission to ensure that their identified care needs can be met. Contracts are issued. EVIDENCE: There is a range of useful literature available in the homes entrance hall for prospective service users and their families. Pre admission assessments are carried out by the Manager to ensure that care needs can be met at the home. Examples were seen in the care plans chosen for sampling. Two contracts were requested, one for a privately funded person and one for a person with public funding. These indicated a clear breakdown of the fees paid by the service user and social services and how this is made up. The Registered Nurse Care Contribution is separate; paid direct to the home this is in addition to the fee charged in the range £495.00 to £550.00. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The outcome for this area was good overall. Service users reflected that ‘its alright here’. Care plans were sampled and care was observed throughout the day. Care plans could be more person centred. More care should be taken to ensure that care needs are accurately reflected in the care plan documents. A requirement made at the last inspection is restated. EVIDENCE: Discussion took place with the Manager, who stated that the home has a good rapport with Community Health Care services; the present level of service delivery is good. Examples were given of service users having access to community physiotherapy services and the ease of referral to the community health care services which is at present very good. Changes to be made by the PCT may affect the referral for specialist services at some stage in the near future. Medication Administration Records (MAR’S) were seen. There were signatures for hand transcribed entries and no administration gaps were seen. There was photographic identification for each service user. This was good practice. Pots of skin creams were not labelled with the date of opening nor discard by date. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 11 This must be done to ensure that out of date skin creams cannot be easily left in use. A total of six care plans were seen. Four care plans were chosen for case tracking and two where the service users were identified as having pressure sores (one on admission to the care home). The care plans are a company generic style. These were not completed in a ‘person centred’ way. More detail could be added and it could be recorded in a more meaningful way. Examples included the following, One plan seen where psychological needs were not clearly expressed into the care plan. A person prone to falls has a pressure mat, which is used to alert staff when this person is up and about their room. The use of the pressure mat was not documented in the care plan. The identification of a ‘High risk’ Waterlow score and action taken warrants a recorded care planning intervention. The use of pressure relieving equipment was seen in place but there was no care plan for this intervention. This was a requirement also made at the last inspection. One care plan was sampled where the level of mobility and problems identified with mobility were not clearly documented. Three different statements were made in the care plan about this service users mobility aid in use and their support needs. These anomalies were discussed with the Manager at the inspection feedback. The care and attention given by staff to the service users was observed during the inspection, this was at all times thoughtful and caring. Service users asked felt that their care needs are met. Service users who were not able to comment looked well cared for and those who needed help with their personal care were well dressed and looked well kempt. Drinks were served during the morning and cold drinks were presented on the dining tables at lunchtime. Fluid balance charts were seen in use. Call bells were seen to be accessible to the service users who remained in their bedrooms. One service user reflected on their stay saying ‘it’s alright here’. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The outcome for this area is good. Service users were happy with their care at Uphill Grange. Friends and family are welcome. A range of activities is offered each week. Meals are nicely presented and there is a choice. One service user commented that ‘the foods all right’. EVIDENCE: Service users are able to choose how they spend their time. The home has an activities organiser who works 20 hours per week. There is an awareness of the need for more 1:1 care for the more dependent service users and those with dementia. The home has a number of service users with dementia and staff are undertaking distance learning to improve their understanding of this specialised area of caring. The home fund raises throughout the year with raffles and a fete to support the activities budget. A fete was held in August. Trips out are charged at cost to the service users. Lunch was observed. A spacious dining room is on the ground floor. This room was nicely presented; the tables were attractively laid and had condiments and fruit squash drinks. The inspectors noticed that the vinegar in containers on Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 13 two tables was stale; these were removed. The Manager and chef replaced all the containers after the inspection. The chef served lunch from a hot servery to staff with trays. This was nicely done; staff knew the service users and special aids such as plate guards were used where needed. The meals looked and smelled appetising. There was no rush and service users were able to enjoy their three-course lunch as a pleasant social occasion. The meal of mushroom soup was followed by lamb hotpot, carrots, broccoli, potatoes and a fruit pudding dessert. The dining room has doors out to the garden; these were open as this was a warm day allowing a pleasant airy atmosphere. Uphill Grange DS0000020290.V310075.R02.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 The outcome for his area is good. Appropriate measures are in place to protect service users from harm. One service user asked felt they would be able to ‘raise any concerns with Emma’ (the homes Registered Manager). EVIDENCE: The home has company policies and procedures to protect service users from harm and to enable complaints to be dealt with effectively. The home has improved its recruitment practices since the last inspection. CRB checking is a legal requirement for all care home staff and is the responsibility of the registered persons. Staff files were examined and CRB checks are now in place for staff including the most recent overseas employees identified at the last inspection. The inspector was informed that the company (head office) is addressing its practice with regard to the recruitment of staff from overseas and in particular the checking of the authenticity of references. Uphill Grange DS0000020290.V310075.R02.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): 19,20,21,22,23,24,25,26 The outcome for this area was adequate. There were some health and safety requirements identified for attention within 28 days of the inspection site visit. These included protection from hot surfaces and removal of bedroom door deadlocking devices. A satisfactory written response to these requirements was received on 2.10.06. The upgrading of the environment continues. Regular fire alarm checks are made and fire safety had improved. EVIDENCE: Uphill Grange provides a suitably adapted environment for service users to receive nursing and personal care. Corridors are spacious and have handrails and there are assisted bathing facilities, walk in showers and adapted toilet facilities. The communal lounges look out onto the gardens. A recommendation for a first floor bathroom is continued, as this would improve the location of accessible bathing facilities. The bathroom on the top floor where there are empty bedrooms is used. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 16 Bedrooms can be personalised and this was seen during the tour of the premises when bedrooms were sampled for viewing. The home was clean and no unpleasant odours were detected. Redecoration and upgrading work continues. Since the last inspection two en suite baths have been converted into shower facilities. This improvement will make these en suite facilities more useful. There were some health and safety requirements identified for attention within 28 days of the inspection site visit. These included risk assessments and action planning for protection from hot surfaces, the removal of bedroom door deadlocking devices and the securing of wardrobes. Also one ground floor fire door was seen to be wedged open. A satisfactory written confirmation of the action taken was sent to CSCI on 2nd October 2006. A fire door has been put into the ground floor corridor to improve fire protection. There was no drying laundry evident and the manager confirmed that this corridor is no longer used for hanging laundry to dry. It was noted that hot taps on baths that are not used are not run regularly to reduce any risk of Legionella. This should be done. All water safety tests at the home were recorded to have been satisfactory. Infection control was reasonably well managed. Bar soaps were seen in communal facilities and one catheter bag was stored with no cap applied to the end. This is poor and staff must be reminded of best practice. Uphill Grange DS0000020290.V310075.R02.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 The outcome for this area is good. Interactions were observed to be friendly and helpful, service user comment described staff as being ‘kind’. Staff training is given and is there is a focus on it the meeting the needs of the service users. There were no new starters at Uphill Grange. Outstanding CRB’s from the last inspection were completed. EVIDENCE: The home has a sufficient staff team that is skill mixed. The number of care staff with an NVQ is low at 1 of 18 but there are 5 staff identified who are keen to take up NVQ Level 2 training. The home employs 6 Registered nurses and there is a registered nurse on duty at all times. Staff receive in house training and updating. A range of topics have been covered from statutory induction, manual handling and fire training to care planning, team leading, communication and specific illness topics such as Parkinson’s disease. The inspectors were informed that a distance-learning package of training on dementia care is due to be started. Staff supervision was not examined at this inspection. There have been no new starters since the last inspection at Uphill Grange. Staff are offered work shifts at another home in the company group. One staff member who normally works 48 hours or more each week was identified as working at both two homes. Care must be taken to ensure that staff who Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 18 volunteer to work for such long periods without a day off, do not become overtired. Staff recruitment files were sampled to assess practice. CRB checks were on file for overseas staff recruited earlier this year and which were identified at the last inspection. References for these staff had not been checked for their authenticity. The Area Manager informed the inspector that this is with the company head office where the recruitment of overseas staff is managed. Discussion is taking place at a senior level regarding the company recruitment policy and practice. Staff were observed to be knowledgeable about the service users and interactions were observed to be friendly and caring. Service users asked described staff as being ‘kind’. Uphill Grange DS0000020290.V310075.R02.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 The outcome for this area was poor at the time of the inspection. In light of the immediate action taken and the response received on 2.10.2006, the outcome for this area is now adequate. Environmental improvements are in progress. There were areas of Health and safety where improvements were required within 28days; these were made by letter after the inspection. A response was made to CSCI and was received on 2.10.06. Service users commented that they liked their rooms. Redecoration of nine bedrooms and a corridor plus the addition of two en suite showers shows continuing investment in the home. The maintenance of fire safety equipment and all other safety checks were satisfactory. Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 20 EVIDENCE: A response was made to CSCI and was received on 2.10.06, an action plan was included. Potentially hot, unguarded surfaces had been identified in en suites where remedial action had been taken in the bedrooms. Also wardrobes were identified that had not been secured to prevent them from toppling forward and causing accidental injury to the service user. Redecoration of nine bedrooms and a corridor plus the addition of two en suite showers shows continuing investment in the home. The maintenance of fire safety equipment was satisfactory. One double electrical socket was seen in close proximity to a bath in a top floor bathroom, which is seldom used. A requirement was made to assess the safety of this and take appropriate action to prevent the risk of electrocution. Service users told the inspectors that they liked their rooms, bedrooms seen were personalised. Records inspected included: Fire alarms, emergency lighting, fire doors and exits, weekly records of the checks were seen. Fire extinguisher servicing had been carried out in February 2006. The fire alarm system and the nurse call were serviced in April 2006. The last fire drill was held in April 2006. The home has lift servicing under contract, these were seen. Gas safety check was carried out in January 2006. The home has a waste disposal contract with regular collections. Uphill Grange DS0000020290.V310075.R02.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 3 3 1 Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP29 OP8 Regulation 19(4)(b) (i) and (c) 13(8) Requirement In future staff references must be checked for their authenticity. The use of monitoring equipment (pressure pad) must be recorded in the care records. The use of pressure relief equipment must be recorded in the care records. This requirement was also made at the last inspection with action by 6.12.05 Risk assessments must be 06/12/06 undertaken and guards must be fitted to hot surfaces such as uncovered radiators in bedrooms and en suite facilities. This was required at the last inspection by 28.02.06 Catheter bags must be managed 28/11/06 hygienically as possible. Caps must be replaced to cover open tube end on reusable night bags, when left in the bathroom during the day. Bar soaps must not be left for use in communal facilities such as Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 23 Timescale for action 06/11/06 06/11/06 12(1) 3. OP25 13 (4) (c) 4. OP26 13(3) showers and baths. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP21 OP28 OP15 OP38 Good Practice Recommendations An accessible communal bathroom should be provided on the first floor. Staff should be encouraged to enrol on NVQ training courses. The daily Menu should be displayed. Unused basins/ baths / showers should be run regularly to prevent the development of Legionella in the ‘dead leg’. (Reference: see HSE guidance for Care Homes) Uphill Grange DS0000020290.V310075.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Uphill Grange DS0000020290.V310075.R02.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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