Inspection on 28/10/08 for Elizabeth House

This is the latest available inspection report for this service, carried out on 28th October 2008.

CSCI 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

Elizabeth House 20/06/06

Elizabeth House 15/12/05

Elizabeth House 27/04/05

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elizabeth House 35 Queens Road Oldham Lancashire OL8 2BA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Steve Chick     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Elizabeth House 35 Queens Road Oldham Lancashire OL8 2BA 01616266435 01612878191 philipleicester@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Susan Leach Type of registration: Number of places registered: Elizabeth House (Oldham) Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: No more than two service users may be admitted into the home between 55 and 64 years of age. The home is registered for a maximum of 30 service users to include: *up to 5 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age). *up to 19 service users in the category of DE(E) (Dementia over 65 years of age). *up to 2 service users in the category of DE (Dementia under 65 years of age). *up to 30 service users in the category of OP (Old age not falling into any other category). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Care Homes for Older People Page 4 of 28 Over 65 19 5 30 2 0 0 Brief description of the care home Elizabeth House is a large detached property situated close to Oldham town centre. Accommodation is presently 22 single en-suite rooms and four shared en-suite rooms. There are four lounges with dining areas and a large dining room. Adapted bathing facilities are provided with communal toilets being situated close to lounge areas. Outside of the property consists of a large garden and patio area to the front and enclosed patio to the rear, including a small parking area. Fees charged by the home range from 350 pounds - 360 pounds per week. Care Homes for Older People Page 5 of 28 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: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. We (the Commission for Social Care Inspection) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Elizabeth House knew that the visit was going to take place. For the purpose of this inspection five service users were interviewed in private, as were two relatives of service users. Additionally discussions took place with the manager and three staff members were interviewed. Care Homes for Older People Page 6 of 28 We also looked at information we have about how the service has managed any complaints, what the service has told us about things that have happened in the service, these are called notifications and any relevant information from other organisations. Before the site visit, we asked for surveys to be sent out to residents, and staff, asking what they thought about the care at the home. Ten residents, and five staff returned their surveys to us. Some of the information from these surveys is included in the report. We also asked the management of the home to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, some of these comments have been included in the report, however the AQAA did not give us as good quality information as would have been helpful. We undertook a tour of the building and looked at a selection of service user and staff records as well as other documentation, including staff rotas, medication records and the complaints log. We had received one complaint about the service since our last Key Inspection which was passed to the provider to investigate. We were aware of no safeguarding issues at Elizabeth House. What the care home does well: What has improved since the last inspection? What they could do better: Care planning records should be in more detail to give clear guidance to staff about how best to provide care for the specific individual. Daily records should more consistently record significant events or observations relating to individual service users. Records of the food provided should be in more detail. This would enable the manager to better demonstrate that a nutritionally balanced diet is offered to all service users. Quality audit and self assessment processes and records should be maintained more thoroughly to demonstrate how the manager has improved the service and how they Care Homes for Older People Page 8 of 28 intend to continue improvements to the way in which service users care needs are met. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 10 of 28 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. Service users needs are appropriately assessed and they, or their representatives, are able to visit before a decision is made that the home is appropriate for them. Evidence: The manager told us that prospective residents are given information about the home through their statement of purpose and service user guide. All people who answered this question in the service user survey said that they had received a contract and all but one said they had received enough information about the home before they moved in. The manager told us that all prospective service users are assessed before moving into the home. She also told us that a place would not be offered if she did not feel that the staff team was able to meet that persons needs. A selection of service users files was looked at. All had a copy of an assessment which had been undertaken before Care Homes for Older People Page 11 of 28 Evidence: admission to Elizabeth House. Elizabeth House does not offer intermediate care. Care Homes for Older People Page 12 of 28 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. The arrangements in place ensure that the health, personal and social needs of service users are met. Staff practices also serve to promote the dignity of the service users. Evidence: A selection of service users files was looked at. All had a written care plan which had been reviewed at regular intervals. There was evidence on most files looked at, that the service user had signed the care plan to indicate their agreement with it. The manager told us that service users are involved in their care planing, at a level dictated by their capacity to understand. Not all the care plans were in sufficient detail to give clear guidance to staff about how best to provide care to the specific individual concerned. Similarly there was inconsistency in the daily records. Good examples were seen of records including both relevant observations and subsequent actions. However other examples were seen where there was less clarity about what action had been taken to address an identified need. Observation, together with discussion with visitors, service users and staff all Care Homes for Older People Page 13 of 28 Evidence: indicated that these were weaknesses of the administrative practice, not the care practice of staff. Staff who were asked, described a system which included detailed verbal information being passed on at each change of shift. They reported to us that they had appropriate up to date information about each persons needs to ensure that those needs could be met. Staff who returned surveys to us were positive about the communication system in use and comments included - senior staff always ensure we are kept updated on residents conditions and inform us of any changes throughout the day so we can give the best possible care.; ... information is passed over on handovers throughout the day; ... I feel the residents needs are met and the level of care given is at a high standard. and I feel that service users are cared for very well. Service users who completed our survey all said they receive the care and support they needed either always (7), or usually (3). All said that staff listened and acted on what they said and that the staff were available when needed either always (5) or usually (5). There was clear documentary evidence that service users had access to the full range of medical support available in the community. At the time of this unannounced visit one more carer than usual was on duty as a service user was being escorted, by them, to a hospital appointment. Another service user told us that once, when they had fallen and hurt their shoulder, I went to the hospital and staff came with me. Service users who completed our survey all said that they received the medical support they needed either always (9) or usually (1). Relatives who were spoken to confirmed that communication from staff was good, saying they ring us all the time ... keep us informed. The home has a written policy and procedure in respect of the control, storage, disposal, recording and administration of medicines. This was not looked at on this visit, but has been found to be appropriate at previous visits. Medication was seen to be stored securely. A sample of medication administration records was looked at and presented as being predominantly well maintained. There was evidence that the manager periodically audited the records and took appropriate action if errors were noted. Discussion with service users, visitors and staff, as well as observation during the visit indicated that service users were treated with respect and had their dignity maintained. Care Homes for Older People Page 14 of 28 Care Homes for Older People Page 15 of 28 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. Appropriate social contacts and activities are facilitated within the home to give service users the opportunity for social fulfilment. The provision of food to maintain service users health and well-being is good and service users are able to maximise their autonomy within the context of communal living. Evidence: The manager told us that daily social interaction between staff and service users was good, although they acknowledged that some service users would benefit from more outings and trips. Most service users who completed our survey said that activities were either always (3) or usually (6) arranged by the home. Service users who were asked, confirmed that they had freedom of choice about how they spent their time. For example they could chose when they got up or went to bed and whether they went to their rooms or spent time in any of the communal lounges. The owner reported that he had purchased a bain marie specifically so that meal times could be flexible to meet the needs of the service users. Care Homes for Older People Page 16 of 28 Evidence: A record is kept of activities organised for service users to participate in if they wish. This was looked at and indicated that there was a variety of activities available. One meal was sampled during the visit which was pleasantly presented and tasty. People were observed being offered a choice at this meal time. Service users who completed our survey all said they liked the food either always (9) or usually (1). Service users who were asked at our visit were also positive about the food. One person discussed how they found large portions off putting and after mentioning that to the staff they just bring enough to suit me. As with several other aspects of administration there was a failure, acknowledged by the manager, to keep effective records of the menus. This record is necessary so that the manager can demonstrate that Elizabeth House is providing a suitably nutritious and varied diet for the people living there. Care Homes for Older People Page 17 of 28 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. Service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaint they may have would be dealt with appropriately. Evidence: Elizabeth House has a written complaints procedure which has been found to be appropriate on previous inspections and was not looked at again at this visit. Staff who returned surveys reported that they knew what to do if they had concerns about any service user. Similarly all service users who returned the survey said that they knew how to make a complaint and all said that they knew who to speak to if they were not happy either always (6), or usually (4). Service users and visitors who were asked were confident that staff would respond appropriately to any complaint. One visitor said when you point out little things, they deal with it, theyre on the ball. The manager maintained a record of complaints received which presented as being predominantly appropriately maintained. One complaint made on behalf of a service user was in the process of being investigated by the manager at the time of this visit. The manager reported that staff had received POVA (protection of vulnerable adults) Care Homes for Older People Page 18 of 28 Evidence: training. This was confirmed by discussion with staff and looking at a sample of training records. Staff who were asked demonstrated an understanding of the importance of being aware of the possibility of abuse or exploitation of the vulnerable adults in their care. Similarly they understood the process for whistleblowing. Service users who were asked expressed the view that they were safe at Elizabeth House. One service user said nobody is ever sarcastic ... I feel safe ... I just feel comfortable. Another said I feel safe, they talk to me, I talked to them, we have a laugh .... Visitors who were spoken to said that they had never come across any staff who are awkward and that they had no concerns [ about their relatives care] none at all. We are not aware of any safeguarding issues at Elizabeth House since the previous inspection. Care Homes for Older People Page 19 of 28 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. The home is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. Evidence: The manager told us before our visit that they tried to make sure that all furniture was kept in good condition and that all fixtures and fittings were refurbished regularly. One staff member said, in their returned survey, I find the workplace in which I work provides a safe, secure environment to both the service users and staff members. A tour of the building was undertaken at this unannounced visit. The tour included communal areas and a selection of service users bedrooms. There was clear evidence of service users ability to personalise their own rooms. The home presented as clean, tidy and well maintained throughout, with no unpleasant smells being apparent. The owner reported that he believed this to be the usual state of the building. The laundry facilities are located in the basement. The owner reported that the washing machines were suitable for the demands made on them. At the time of visit service users were observed to be wearing clean and appropriate clothing. The manager told us that there were policies and procedures in place which addressed Care Homes for Older People Page 20 of 28 Evidence: infection-control, and that staff received training in health and safety matters. The owner reported that disposable gloves and aprons, to minimise the risk of cross infection, were always available for staff. These items were seen in bathroom cupboards during the tour. Service users reported in the surveys returned to us that the home was fresh and clean either always (9) or usually (1). One visitor commented that the home had looked tired but had improved. Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and vetting procedures are effectively applied to minimise the risk to service users of inappropriate staff being employed. The numbers and skills mix of staff on duty promotes the independence and well-being of service users. Evidence: At the time of this unannounced visit six care staff were on duty. It was reported by the manager that this was one more than usual as a service user had a planned hospital appointment so a member of staff had come in to escort them. Usual staffing levels were reported by the manager as being five care staff between 08:00 -- 15:00; four care staff between 15:00 -- 20 2:00 and three between 22:00 and 08:00. Other staff employed at the home included a cook, domestic and manager. A copy of the staff rota for the week beginning the 27th of October 2008 was looked at to confirm these staffing levels. All service users who completed our survey all said that staff are available when they were needed either always (5) or usually (5). The manager told us that 15 of the 23 permanent care workers employed held National Vocational Qualifications (NVQ) level 2 or above. A small selection of staff files was looked at and copies of the NVQ certificates were seen. There was good documentary evidence on staff files that a wide range of training Care Homes for Older People Page 22 of 28 Evidence: opportunities was made available for the staff team. Staff who were spoken to confirmed that they had access to appropriate training and that they were encouraged to take up those opportunities. One member of staff said that training was brilliant, I have never known anywhere to prompt training like here. Another member of staff said I mentioned NVQ three when I first started ... I was really pleased that it was signed up for in a couple of weeks. Another reported in their returned survey I am provided with the opportunity to improve my knowledge and physical performance by regular training. Staff who were asked, said that they did receive supervision from a member of the management team. They also reported that the manager and senior staff were approachable and supportive. The manager told us that all staff had been subject to the necessary pre-employment checks. All staff who returned a survey to us said the pre-employment checks were undertaken. All staff who were asked during the visit said that a criminal records bureau disclosure and references had been obtained for them. A small selection of files relating to recently appointed staff was looked at. These gave written evidence that the required pre-employment checks had been undertaken by the manager. There was also evidence that the manager investigated potential queries raised in references and satisfied herself that the applicant was suitable to work with vulnerable adults. All service users who completed our survey said that staff listened to them and acted on what they said. Service users and visitors spoken to were all positive about the attitude of the staff team. Comments from service users included: -- staff are good in every way, I cant fault them.; I like the older staff; staff always come to help me when they say they will, ... they apologise if they are late and explain why ... some staff know what you want before you ask. Care Homes for Older People Page 23 of 28 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 manager is competent to run the home and implement the health and safety procedures for the benefit of the service users and staff. Evidence: The manager has many years experience of managing this care home. The manager told us that she had recently completed the RMA (the required professional qualification for managers of care homes) but as yet the certificate had not been sent to her. There was documentary evidence that satisfaction surveys sent out by the manager had been received in September and October of this year, from various professionals with contact with Elizabeth House. At the time of this visit the information in these surveys had not been fully assessed by the manager nor had a report been produced identifying how the home plans to improve over the next 12 months. The manager acknowledged that administration and the maintenance of effective documentation Care Homes for Older People Page 24 of 28 Evidence: was not her greatest strength. A selection of records relating to money held on behalf of service users was looked at. These presented as being appropriately maintained to protect the interests of the service users. Findings at previous inspections have indicated that the health and safety issues are effectively addressed and that regular safety checks on equipment in the home are undertaken. A small sample of records was looked at to confirm this good practice was continuing. Records which were seen, presented as being appropriately maintained. Staff who were interviewed confirmed that induction and training included issues around health and safety, moving and handling and fire procedures. Ample supplies of personal protective equipment -- such as disposable gloves and aprons -- to minimise the risk of cross infection were seen during this visit. Care Homes for Older People Page 25 of 28 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 26 of 28 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 The manager should ensure that staff accurately record any observations or actions relevent to meeting the assessed needs of each service user. This is to ensure that people with an interest in the service users, can be confident about how the service users care needs are being met. The Manager should ensure that records are maintained of the food provided for the people living in the home, to demonstrate that Elizabeth House is providing a suitably nutritious and varied diet for the people living there. The Manager should ensure that sufficient time is prioritised to complete any documentation which is required to provide evidence of a management team which is seeking to improve the service offered to service users. This specifically applies to information provided in the AQAA and internal quality reports. This will enable service users and their representatives to see if their views are taken into account. 2 15 3 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!