Inspection on 28/01/10 for Ailsa House Residential Care Home

This is the latest available inspection report for this service, carried out on 28th January 2010.

CQC found this care home to be providing an Good service.

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

Ailsa House Residential Care Home 28/06/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Ailsa House Residential Care Home 64-66 Genesta Road Westcliff On Sea Essex SS0 8DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carolyn Delaney     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Ailsa House Residential Care Home 64-66 Genesta Road Westcliff On Sea Essex SS0 8DB 01702346473 01702349313 ellisbarbara13@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Ram Kishore Tandon care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ailsa House is an established private care home that provides personal care and accommodation for 18 older people. It caters for people with low to moderate dependency needs and although it does not routinely provide care for people suffering with dementia, it has been registered for three places for people who have dementia. Ailsa House is a large traditional house, in keeping with other properties in the area, and is located in a residential area of Westcliff on Sea. It is close to public transport, sea front and local amenities. The home has twelve single bedrooms and three shared rooms situated on the ground and first floor, many with private en-suite facilities, and each with a call bell facility and a TV point. The home has a passenger shaft lift between the ground and first floor. Staff facilities and offices are on the second floor. The home is nicely decorated and has a homely atmosphere. There is a garden to the rear of the house with a separate patio area. Residents living at the home are able to Care Homes for Older People Page 4 of 25 Over 65 3 18 0 0 1 8 1 2 2 0 0 8 Brief description of the care home access facilities in the local community and leisure interests are encouraged with support from staff and relatives. A conservatory built to the side of the property is used as a day care facility for up to ten clients. This is not a registered facility and is run separately to the home, although residents in the home can join in activities with the day care clients and day care clients are able to mingle with the residents when they are invited. The most recent inspection report was available in the entrance hall of the home, with copies of the homes Statement of Purpose and Service User Guide. The current fees for the home range between £397.00 and £544.00 pounds per week. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a routine unannounced inspection which included a visit made to the home. As part of the inspection process we reviewed information we had received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment, which the registered provider or owner is required by law to complete and tell us what they do well, how they evidence this and the improvements made within the previous twelve months. We also looked at the improvement plan that we asked the manager to send us following the last inspection. This plan described how the manager was to address the issues as identified at the last inspection. We sent surveys to the home to distribute to residents and staff and to complete and Care Homes for Older People Page 6 of 25 tell us what they think about the home. At the time of writing this report we had received surveys from seven residents living in the home. We received six surveys from staff members. During the inspection we spoke with two residents, two relatives, two members of staff and the manager. When we visited the home we looked at residents care plans and information available to staff to help them support residents. We looked at how staff were recruited to work in the home and how they were trained to support residents. We looked at how the home was managed and how residents were involved in this. We also observed how staff interacted with residents when supporting them with activities such as meals and providing recreation and stimulation. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that the home will be suitable for them because the assessment process identifies their needs and takes their wishes into account. Evidence: The manager told us in the Annual Quality Assurance Assessment that all people had a detailed assessment of their needs carried out before they were offered a place in the home and that there was a welcome pack with information to help people decide if the home will be suitable for them. We received surveys from seven people living in the home. Six people told us that they received enough information to help them decide if the home was the right place for them. They also told us that they had been given written information about the homes terms and conditions (sometimes called a contract). The other person indicated that they were not sure. Care Homes for Older People Page 10 of 25 Evidence: When we visited the home we looked at the arrangements for assessing the needs of people before they were offered a placement. We looked at the assessments, which had been carried out for two people who had moved into the home since the last inspection. We saw that the manager or deputy manager had visited both people to assess their needs before offering them a place in the home. Both assessments identified areas where each individual required assistance or support around health, personal care, maintaining safety and daily and social activities. On the basis of the information obtained at the assessment and other information provided by the placing commissioners (such as social services who purchase care placements from the home) the manager determined that the home would be able to support individuals for their assessed needs. We saw that when a person moved into the home that they were provided with a contract of terms and conditions. This set out the cost of the place in the home and what services the fees covered. We spoke with one residents relative during the inspection. They told us that they were extremely happy with the care provided by the home. They said Since moving into the home (resident) is walking and eating better. They told us that their relative was happy and settled. We saw from looking at the care plans for the other person who had moved into the home that their overall physical wellbeing and mobility had improved since moving into the home. Since the last inspection there have been no breakdowns in placement (This is where a person would have to move out because the service was unable to meet their needs). Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported for their assessed health and personal in the way they choose. Evidence: The manager told us in the Annual Quality Assurance Assessment that each person had a care plan tailored to their needs. They told us that most residents were capable of tending to their personal care needs and were encouraged to remain as independent as possible for these. They told us that residents were encouraged to be mobile to minimise risks of developing pressure sores. The manager said that where there were risks to an individual then assessments were completed and appropriate action was taken including the provision of pressure relieving equipment. They told us that medicines were stored securely and administered by trained staff. Seven people completed surveys and they told us that they always the care, support and medical attention that they need and that staff were always available when they needed them. Care Homes for Older People Page 12 of 25 Evidence: When we visited the home we looked at how the manager and staff supported people who live there for their assessed health, personal and social care needs. We looked at the care plans for three people. Care plans were in a pre-printed format and staff added extra information to make them somewhat more person centred. However information recorded did not always accurately describe individuals needs and capabilities. We saw however that staff supported residents and encouraged them to be as independent as possible for their personal care and mobility. Care plans were reviewed regularly by staff and amendments made to the plan when there were changes to the needs of the individual. We looked at how staff identified and minimised risks to residents health and safety and how they supported people to enjoy good health. We looked at the arrangements for assessing areas of risks such as injuries, falls and developing pressure sores. We saw that where risks were identified that there were plans in place to minimise these. Staff encouraged and supported residents to be as mobile as possible and at the time of the inspection none of the people living in the home had pressure sores. Relatives we spoke with said that they had seen an improvement in residents since they moved into the home. They told us She (resident) is eating better now and walking, we are very pleased. We saw that residents were registered with the g.p. of their choice and that staff acted promptly to ensure that residents saw their doctor if they felt unwell. We looked at the arrangements for receiving, handling and administering medicines. We saw that all staff who had responsibilities for administering medicines undertook training. The manager carried out regular audits so as to ensure that staff completed records correctly and administered medicines safely. We looked at medication administration records and saw that these were completed correctly. Medicines were stored safely and there were separate arrangements for storing and keeping records for controlled medicines such as Morphine. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can experience a lifestyle which suits their abilities and reflects their choices and preferences. Evidence: The manager told us in the Annual Quality Assurance Assessment that there were activities planned both in and outside of the home and that residents views were obtained regularly so as to ensure that these activities suited peoples wishes. They told us that there was an activities coordinator employed to provide opportunities for residents. The manager told us that meals were served from a four week menu and residents were asked what they want to eat each day. They told us that snacks and drinks were available throughout the day. We received surveys from seven residents. Each of the seven told us that staff always listened to them and acted on what they say. Six people told us that the home always arranged activities, which they could participate in and the other person said that there usually were. When we visited the home we looked at the arrangements in place for providing suitable opportunities for residents to be stimulated and occupied. When we arrived at the home the activities coordinator was was involving a residents in a quiz, which they most were participating in and appeared to be enjoying. Residents Care Homes for Older People Page 14 of 25 Evidence: who chose not to be involved in group activities were provided with the opportunity to have some one to one time with staff if they wished to do so. During the inspection we saw that there was a wide range of activities available for residents to participate in including games, music, exercises with ball and arts and crafts. An activities coordinator was employed to work between two and three days per week and outside entertainers visited the home usually twice a week. Residents told us that they have dancing lessons every Friday night and they Really enjoyed this. Those residents who were more mobile and who chose to were supported to go out with staff or their family. Three residents regularly attended local church services and there was a mini bus available to take residents out to local amenities. Two residents we spoke with commented that residents were stimulated and occupied. One resident told us that they would like to go out more in the mini bus. The majority of residents told us that they always enjoyed the meals in the home. They told us The food is very good and The chef makes very tasty meals. On the day of the inspection we observed the chef asking residents which option from that days menu they would like for lunch. Menus were displayed on dining room tables so that residents could choose their meal. One resident told us If we dont like what is on the menu the chef will always cook something else for you. During the inspection we saw staff serve lunch to residents. The meal looked hot and appetising. Residents had drinks and a selection of condiments to accompany their meal. Residents were given ample time to eat and appeared to be enjoying their meals. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are confident that their complaints and concerns will be taken seriously and that they will be safeguarded from harm. Evidence: The manager told us in the Annual Quality Assurance Assessment that the complaints procedure was available for people to access. They told us that there had been no complaints made within the previous twelve months and that all staff had received safeguarding training. Each of the seven residents who completed surveys told that there was always someone to speak with informally if they were unhappy and that they knew how to make a complaint. Each of the six members of staff who completed surveys told us that they knew what to do if someone had concerns about the home. When we visited the home we looked at the arrangements for receiving and dealing with complaints and how people living in the home were safeguarded from harm. The manager told us that there had been no complaints made about the home. We saw that the complaints policy and procedure was accessible in communal parts of the home and there were suggestion boxes where people could make comments anonymously should they wish to. Regular residents meetings were held where people were encouraged to make comments and suggestions about anything they felt could be improved. Care Homes for Older People Page 16 of 25 Evidence: We spoke with three residents and two relatives. All said that they were very happy with the home and that they had no complaints. One person told us We have no complaints, staff and manager are so kind and caring. Another person said Any little issues are resolved quickly, we are very happy with the home. We looked at how people who may be vulnerable were safeguarded from harm. We saw that all staff working in the home undertook training around safeguarding people from harm, recognising and reporting poor practice. We saw that there were robust procedures in place for recruiting staff to work in the home, including obtaining references from previous employers and satisfactory Criminal Records Bureau disclosures. During the inspection we observed how staff engaged and interacted with residents when supporting them. We saw that staff were caring and respectful and spoke to people politely. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Ailsa House enjoy safe, comfortable and homely surroundings, which meets their needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home was safe, clean and well maintained. They told us that there was hand washing facilities where clinical waste was handled and there were policies and procedures in place for infection control. They told us that equipment was checked and maintained in good working order. Each of the seven residents who completed surveys told us that the home was always fresh and clean. People we spoke with during the inspection commented positively about the home. One person said It is a cosy little place, she (relative) loves it here. During the inspection we took a brief tour of the premises. All areas we saw were clean and free from unpleasant odours. Communal areas were comfortably furnished. We looked at records for maintenance and saw that equipment such as lifting hoists, fire detecting systems, gas and electrical equipment and installations were regularly checked and maintained in good working order. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their needs will be met because they are supported by staff who are recruited robustly and trained appropriately. Evidence: The manager told us in the Annual Quality Assurance Assessment that staff were trained to meet the needs of residents. They told us that 70 of staff had National Vocational Qualification training and that staff recruited from overseas were trained nurses. The manager told us that all appropriate checks were carried out for staff before they commenced work in the home. Each of the six members of staff who completed surveys told us that checks such as references and Criminal Records Bureau disclosures were obtained before they started work. They told us that they received training, which was relevant to their roles, helped them understand the needs of the people they cared for and kept them up to date with new ways of working. Staff told us that they regularly met with the manager to discuss how they were working. When we visited the home we looked at the arrangements for recruiting and training staff. We looked at the recruitment files for two people who had been employed to work in the home since the last inspection. We saw that all of the appropriate checks including references from candidates previous employers, Criminal Records Bureau Care Homes for Older People Page 19 of 25 Evidence: disclosures and Independent Safeguards Authority checks had been obtained before a person was offered employment. Each person was interviewed to further determine their fitness to work with older people. We saw that once a person commenced work in the home they completed an induction, which covered the homes policies and procedures. Following on from this staff commenced Skills for Care Common Induction Standards. These help to ensure that staff deliver care and support in a standard and consistent manner. The manager told us that the staffing levels for the home were four in the morning, three in the afternoon. The night duty was covered by one waking member of staff and one sleep in person (who would be called upon if needed). We looked at duty rotas and these confirmed this. Residents we spoke with and those who completed surveys told us that staff were available to support them when needed. We saw that there was an ongoing training and development for staff, which covered topics including safe moving and handling, infection control, handling and administering medication and caring for people with dementia. We saw that staff met regularly with the manager to discuss work and any training needs. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the interests of the people who live there and they are regularly consulted with to obtain their views so as to maintain and improve the service. Evidence: The manager told us in the Annual Quality Assurance Assessment that there were policies and procedures in place for the effective management of the service. They told us that they had recently carried out a quality assurance process involving residents and that the responses from this were positive. As part of obtaining the views of people who live in the home we asked them in surveys what they felt the home did well and what, if anything could be done better. All of the people who completed surveys told us that they were happy living in Ailsa House. One person said Staff deal with any health problems and the chef is very good. Others told us Everything is to my satisfaction. Staff are always very helpful. One person said that they would like more trips out in the mini bus. Care Homes for Older People Page 21 of 25 Evidence: We saw that regular residents meetings were held and that they were asked about the things they would like to change. Residents commented that they were happy. They made suggestions about menus and activities and these were acted upon by the manager and staff. We saw that the home was well maintained and all the equipment, installations and devices needed for the effective running of the home and supporting residents were kept in good working order. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans could be more individualised and person centred so that they reflect the wishes and choices for how they are supported for their health and personal care needs. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!