Inspection on 13/12/07 for Oak House

This is the latest available inspection report for this service, carried out on 13th December 2007.

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 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

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Oak House 193 Weald Drive Furnace Green Crawley West Sussex RH10 6NZ Lead Inspector Nigel Thompson Key Unannounced Inspection 13 December 2007 10:30 Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak House Address 193 Weald Drive Furnace Green Crawley West Sussex RH10 6NZ 01293 885469 01293 885469 oakhouse@evesleighcaregroup.co.uk 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) Evesleigh Care Homes Ltd (ILIACE Group) Mrs Janet Warburton Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 2006 Brief Description of the Service: Oak House is a care home registered to accommodate up to four service users with learning disabilities. The Registered Provider is Independent Living Group (ILG) and the Registered Manager is Ms Janet Warburton. The home is a semi-detached property, situated on the outskirts of Crawley town, and therefore has access to all community facilities and is within easy reach of local rail and bus stations. Accommodation is provided over two floors. Each service user has their own bedroom, with one bedroom located on the ground floor, and the remaining three rooms on the first floor. On the ground floor there is a living room, an activity room and a large kitchen that includes a dining area. In addition the home has a garden with lawn and decking to the rear of the property. Information about the service, including the Statement of Purpose, Service User’s Guide and CSCI reports is made available to prospective service users or their relatives, on request, as part of the admission process. The current range of fees, as of 13 December 2007, is from £1,092 to £1,909 per week. Additional charges are made for personal items, such as; toiletries, chiropody, hairdressing, activities, transport and holidays. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over five hours in December 2007. It found that the majority of the key National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was satisfactory. There have been significant changes, regarding the ownership of the service since the previous inspection. The registered provider at that time was Evesleigh Care Homes. They were superseded by ILIACE, which soon afterwards was itself taken over, in April 2007, by the Independent Living Group (ILG). The purpose of this inspection was to assess compliance with the requirements of the previous inspection and to generally monitor care practices at the home. Service users observed and spoken with during the inspection expressed satisfaction with the home, the staff and the service provided. On the day of the inspection there were four service users living at the home. The inspection process involved a tour of the premises, observation of working practices, examination of records and documentation and discussion with three service users, one relative, one member of staff and the registered manager. The focus of the inspection was on the quality of life for people who live at the home. What the service does well: The relaxed, very homely and welcoming environment at Oak House has evolved over many years and reflects the commitment within the staff team and the open and inclusive management style. Service users are encouraged, enabled and supported to make decisions about their lives. They are involved and regularly consulted on many aspects of daily living, including menu planning and activities. It is evident that service users at the home benefit from having a competent and experienced manager and a dedicated staff team, who are clearly committed to providing a consistent and high quality level of care. Staff work closely with service users and have developed a sound understanding of their individual care and support needs. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 6 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The thorough admission policy and procedure ensures that service users are admitted only on the basis of a full needs assessment, undertaken by people competent to do so. Prospective service users know that the home is able to meet their individual care and support needs. EVIDENCE: Comprehensive information relating to the service is made available to all prospective service users, their relatives and associated care managers. Relevant documentation including an updated ‘Statement of Purpose’ and ‘Service User Guide’ was examined and found to be satisfactory. An admission policy made available for inspection contained details of the assessment process, undertaken to identify an individual’s care and support needs. Following a referral to the home, representatives from the organisation’s Placement Team will visit the prospective service user and carry out a full preOak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 9 admission assessment, including any personal and emotional care and support needs, mobility issues, social and cultural needs and family involvement. The manager confirmed that, prior to moving into the home, a prospective service user would be invited to visit the home to look around and get a feel for the place. During these visits the individual would also have the opportunity to meet with members of staff and existing service users. On moving in, a flexible trial period is provided to establish whether the individual’s assessed needs are able to be met and decide on their suitability for the home and their compatibility with existing service users. In contracts that were examined it was evident that individual agreements had been signed and dated by the service user themselves or a relative or representative on their behalf, the manager and the service manager. There have been no service users admitted to Oak House since before the previous inspection. With the four service users evidently very settled and content in their home, the manager confirmed that there is little likelihood of this situation changing in the foreseeable future. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users’ care plans enable staff to meet assessed needs in a structured and consistent manner and individual plans, including risk assessments reflect changing support needs. Systems for consultation and participation remain effective and service users are treated with respect and encouraged and enabled to make decisions about their day-to-day living. EVIDENCE: Comprehensive care plans, ‘Essential lifestyle Plans’ have been developed for each service user. Written in the first person, the plans were found to contain useful information including: ‘Who I am’; ‘Daily Routine’; ‘Ways in which I communicate my feelings’; ‘Who is in my life’ and ‘Likes and dislikes’. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 11 Plans that were examined also contained personal risk assessments and details of the individual’s physical, psychological and emotional support needs and were found to be accurate, up to date and generally well maintained. Regular care plan reviews are recorded in the ‘Service user monthly report’ and plans are amended appropriately to reflect any changing needs or circumstances. The report contains a summary of the previous month and any agreed actions for the following month. In one file examined, this section included: ‘To watch less television – as I’m a bit of a television addict’. It was noted that each monthly report is routinely signed by the service user, their key worker and the manager. The manager confirmed that individual service users and, where appropriate, a relative or representative continue to be directly involved in annual placement reviews. Independence and individuality continues to be encouraged and promoted within the home and is reflected in the personalising of service users’ rooms, the choice of bedclothes and colour schemes and individual preferences for occupational and leisure activities. Staff, spoken with during the inspection, confirmed that service users are encouraged, enabled and supported to make decisions regarding many aspects of their daily living, including menu planning, what clothes they wear and how they spend their day: The manager emphasised the importance of staff developing close working relationships with individual residents. Despite the variable and limited verbal communication of some service users, the manager confirmed that effective and regular interaction and consultation takes place constantly throughout the home. This was evident from direct observation of service users being supported in a professional, sensitive and respectful manner. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are enabled and supported to maintain contact with family and friends as they wish and effective links with the community enrich their social and educational opportunities. Service users benefit from appropriate recreational and leisure activities and menus that are balanced and nutritious, reflecting their individual likes and preferences. EVIDENCE: The recreational and leisure interests of service users are identified and recorded in their individual care plan and they continue to be supported to access activities and facilities, reflecting their individual needs, preferences and abilities. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 13 A weekly activities programme has been developed and implemented for each service user, a copy of which is displayed in the office. Community participation remains a focus in the home and service users are evidently enabled and supported to visit the cinema, theatre, shops and other local amenities. On the day of the inspection, one service user was evidently enjoying her weekly reflexology session. Menus examined were found to be varied and balanced and are evidently based on service users’ identified likes and preferences. An alternative to the main meal is always available. Service users spoken with during the inspection expressed satisfaction with the standard and variety of meals provided. The manager confirmed that, where appropriate, service users’ family links are encouraged and supported, however not all service users have regular family contact. Visiting to the home is largely unrestricted and relatives and friends are made welcome at any reasonable time. During the inspection one service user enjoyed a visit from her brother who spoke very positively about the home and the care that his sister was receiving: ‘This is the best place she has been in. We can’t fault the manager or staff – they’re brilliant and so kind. It gives us all peace of mind knowing that she is so happy here and being so well cared for’. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff have developed close and positive relationships with service users and demonstrate an awareness and sound understanding of their individual care and support needs. Service users are protected by clear and comprehensive policies and procedures in place for the control and safe administration of medication. EVIDENCE: In accordance with their personal care plan, service users are fully supported and enabled, as far as practicable, to exercise control over their lives and maintain maximum levels of independence and individuality. The manager emphasised the importance of staff developing close working relationships with individual service users and being aware of any changes in mood or behaviour. As previously documented, during the inspection, service Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 15 users were observed being supported in a sensitive, professional and respectful manner. Documentary evidence was in place to demonstrate that the health and emotional care needs of service users continue to be met within the home. All service users are registered with local GPs and have access to other health care professionals, including district nurses, physiotherapists and dentists, as required. It was noted, in care plans that were examined, that all appointments with, or visits by, health care professionals are recorded. Up to date and detailed policies and procedures relating to the control, storage, administration and recording of medication are in place. Medicines are stored and recorded appropriately. All staff responsible for administering medication have received training and are individually assessed and authorised to do so. This was supported through discussions with staff and evidenced by training records examined. The manager confirmed that, following risk assessments, no service user currently self-administers their own medication. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home’s complaints procedure ensures that service users, staff and visitors feel able to express any concerns, confident that they will be listened to and acted upon. Service users are protected, through updated policies and procedures relating to abuse and safeguarding vulnerable adults. EVIDENCE: A clear, simple and concise complaints procedure is in place. The manager confirmed that close working relationships and effective communication and consultation within the home hopefully provides adequate opportunities for any concerns to be raised and discussed before they become complaints. Service users, relatives and members of staff confirmed that they would have no hesitation in speaking to the manager or making a complaint if necessary and each person was confident that they would be listened to. It was noted that there have been no concerns or complaints recorded by the home since the last inspection. The home has produced detailed policies and procedures, relating to adult protection and abuse, including a whistle blowing policy. These documents are evidently to be revised shortly in accordance with the recently implemented Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 17 multi agency guidelines for the safeguarding of vulnerable adults. The manager confirmed that all care staff have undertaken appropriate training regarding abuse and will be receiving further updated training relating to the new policy and procedures. This was supported through discussions with members of staff during the inspection and evidenced through individual training records. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The service is accessible, safe and clean and remains clearly suitable for it’s stated purpose. Service users benefit from pleasant accommodation that is comfortable, generally well maintained and decorated to a satisfactory standard. EVIDENCE: During my ‘guided tour’ of the premises it was evident that the generally well maintained décor and good quality furniture and furnishings continue to provide a comfortable, pleasant and very homely environment for service users. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 19 The manager confirmed that independence and individuality continue to be promoted within the home and, as previously documented, this is evident from the personalising of service users’ rooms, reflecting individual preference and interests. Infection control policies and procedures are in place and clearly adhered to. Service users, with staff support as necessary, are evidently responsible for keeping bedrooms clean and tidy and on the day of the inspection, levels of cleanliness and hygiene throughout the home were found to be generally satisfactory. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users benefit from there always being sufficient trained and competent staff on duty to meet their assessed needs. Robust staff recruitment policies, procedures and documentation help to ensure the protection of service users. EVIDENCE: Care staff at Oak House are evidently deployed in sufficient numbers to meet the assessed care and support needs of service users. The manager confirmed that staffing levels within the home are maintained and regularly monitored to ensure that current individual needs can continue to be met in a consistent manner. This was further evidenced by the current rota, viewed during the inspection, that details which staff are on duty at any given time and includes their designation. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 21 Service users and members of staff, spoken with during the inspection, confirmed that staffing levels within the home are adequate to meet all identified support needs. In addition to the comprehensive induction programme undertaken by all newly appointed staff, the manager confirmed that appropriate core skills training is provided, including first aid, moving and handling, food hygiene and fire safety. This was confirmed through discussions with staff and supported by training records examined. In accordance with company policy, the manager confirmed that formal supervision is provided for all care staff on a regular basis. This was evidenced by supervision records examined and through discussions with staff, spoken with during the inspection, who acknowledged the benefits of effective supervision and confirmed feeling valued and supported by the manager: ‘I find supervision very useful. The manager is always very approachable and she has been so kind and supportive to me during a very difficult time’. The manager is clearly aware of the need for thorough and robust recruitment procedures, to ensure the protection of service users. Individual files that were examined, relating to recently appointed members of staff, were found to be well maintained, containing all relevant and necessary information, including two satisfactory references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) disclosures. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users benefit from a competent management structure. They are protected by satisfactory health and safety procedures and their best interests are safeguarded by effective quality monitoring systems. EVIDENCE: The experienced and competent manager has been in her current position for over four years. She has achieved the Registered Manager’s Award (RMA) and also holds the NVQ level 4 in management and care. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 23 From the open and inclusive atmosphere within the home and through observation and discussions with service users, relatives and members of staff, it is evident that the manager is held in high regard. She is ‘kind and helpful’, ‘very approachable’ and operates an ‘open door’ policy, with people feeling confident and able to discuss any issues with her at anytime. The manager confirmed that the health, safety and welfare of service users and staff remain of paramount importance within the home. She added that training is provided in many aspects of safe working practices, including moving and handling; food hygiene; fire safety and first aid. COSHH assessments and guidelines are in place. Regular fire drills are undertaken and recorded. Temperature regulators are fitted to all hot water outlets, accessible to service users. All accidents, incidents and injuries are recorded and reported, as required. Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 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 © 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 Oak House DS0000066064.V356740.R01.S.doc Version 5.2 Page 27 - 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!