Inspection on 19/05/08 for Stoneybridge Cottage

This is the latest available inspection report for this service, carried out on 19th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stoneybridge Cottage 27/09/05

Stoneybridge Cottage 02/06/05

Stoneybridge Cottage 15/03/05

Stoneybridge Cottage 05/01/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Stoneybridge Cottage Pengover Liskeard Cornwall PL14 3NH Lead Inspector Helen Tworkowski Unannounced Inspection 19th May 2008 09:00 Stoneybridge Cottage DS0000060821.V362990.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 Stoneybridge Cottage DS0000060821.V362990.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. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoneybridge Cottage Address Pengover Liskeard Cornwall PL14 3NH 01579 348774 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) stoneybridgecottage@hotmail.co.uk Mr Nigel Bruce Troke Mr Nicholas Simon Troke Simon Giles King Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 2. Date of last inspection 1st June 2006 Brief Description of the Service: Stoneybridge Cottage is registered to provide care and accommodation for two people with a learning disability. It is in a rural location on the outskirts of Liskeard in Cornwall. It was selected for its quietness and general situation away from people. Although only one mile from the nearest houses in Liskeard it is not practical to walk there, as there is no footpath and traffic - although light - is quite fast. There are however plenty of other areas accessible by car where people can walk. On the first floor the home offers two bedrooms for service users and a bathroom. There is also sleeping accommodation for two staff and an office. The ground floor consists of a large sitting room, separate dining room, kitchen and utility room with a shower and WC. There is a garden that is secure plus some outhouses. Parking is available. The fees for this service are based on the assessment of the support that each person will need. The fees do not include items such as personal toiletries and clothing. A copy of the Statement of Purpose and Service User Guide, documents that provide information about the home, are available in the office. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that the people who use this service experience good quality outcomes. This inspection included a visit to Stoneybridge Cottage. The visit started at 9.00 am and finished at 3.30pm. This visit included a tour of the house, time was spent talking to the Manager, Simon King, to two of the care staff, and with one of the people who live at Stoneybridge Cottage. We looked at some of the paperwork that details the care provided, and at the systems for managing medication. We also looked at records relating to staff recruitment and health and safety. In addition to visiting the home we also talked to two of the Social Workers who are involved with people who live at Stoneybridge Cottage, and one of the relatives. We have received an Annual Quality Assurance Assessment form, this is a self-assessment form completed by the Manager of Stoneybridge Cottage, dated 6th May 08. What the service does well: Stoneybridge Cottage offers a service that is focused and built around the people who live there. One Social Worker commented on how much happier one person was since he had moved, and that Stoneybridge Cottage was more than meeting his needs. One relative commented that he/she was “very happy with the care” and that his/her relative was “well looked after”. We spoke with one of the people who lived at Stoneybridge about what they thought about the place and he said that he thought that the food, the staff and his bedroom were all “good”. The people who live at Stoneybridge Cottage had the opportunity to go out and do things they enjoy. Where appropriate they are involved in tasks around the house and garden. Staff at Stoneybridge Cottage have a good understanding of physical and emotional needs, and where they have identified needs they have worked to ensure that these are met. The house is small and the people who live at Stoneybridge seem at ease and comfortable, there is a terrace to the back of the house and this seemed a well used area. The bedrooms were furnished to reflect the individual tastes and preferences. The house is well staffed with people who feel that they are well trained, able to communicate with their manager and each other. Staff have good working relationships with the people who live at Stoneybridge. Stoneybridge Cottage DS0000060821.V362990.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. Stoneybridge Cottage DS0000060821.V362990.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 Stoneybridge Cottage DS0000060821.V362990.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are thinking about moving to Stoneybridge Cottage can be confident that their needs will be known prior to a move. EVIDENCE: One person has moved to the Stoneybridge since the last inspection. We talked with the Manager about the process of assessment and getting to know this individual. He explained that the move had been at short notice, but he had met with the individual and with staff from the previous placement to get an understanding of needs. The Manager had also obtained information from the Social Worker. There was historical information and information provided by the previous placement. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in making day-to-day decisions about their lives and receive the help and support that they need. EVIDENCE: Individuals are involved in making day-to-day decisions about their lives and receive the help and support that they need. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 10 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, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices about how they spend their time and are encouraged to take part in a range of social and occupational activities. EVIDENCE: We spoke to staff about how the people at Stoneybridge Cottage spend their time. It was clear that they supported the two individuals in different ways, and understood what their needs were. When the inspection started one person was involved in gardening, and was clearly enjoying working with staff. We were told that they had opportunities to go out and there was a photo album to show some of the ways one person had spent time in previous months. The information on the pre Inspection questionnaire said that the service was trying out activities to see if the individual enjoyed them and found them meaningful. The questionnaire also noted that whilst one person found interactions with the public difficult they were trying to reduce this aversion. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 11 We spoke with the Manager about how staff supported the people who live at Stoneybridge Cottage to keep in contact with their families. We were told that staff provide transport for home visits, and help individuals to telephone. We spoke to the family of one person who lives at Stoneybridge and was told that they were satisfied that their relative had enough to do, and had the opportunity to go out on a regular and frequent basis. We were told that both of the people who live at Stoneybridge Cottage had the opportunity to use a vehicle, as the house is in a rural area with limited access to public transport. We ate lunch at Stoneybridge Cottage, and the people who lived their were involved in choosing what they ate. We were told in the Pre Inspection Questionnaire that there is a 4 week menu, and that food is monitored to see if each person enjoys what is on offer. We asked one of the people about the food and he said that it was good. When we looked at the health records, there were records of weights, and changes in weight were monitored. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 12 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. The health and personal care needs of the people who live at Stoneybridge Cottage are well met. EVIDENCE: As part of this inspection we talked to one of the Social Workers for a person at Stonebridge Cottage. The Social Worker had commented that the individual was happy at the home, and that difficult behaviours had been reduced. Where there had been difficult behaviours these had been dealt with appropriately. The Social Worker commented that one of the things that he/she felt the home did well was to take an individual focus. We looked at the way incidents of difficult behaviour are managed, for one person there was clear guidance on how difficult situations were to be managed, for the other person there was no separate specific guidance. We looked at the incident reports, and were told that these were discussed at staff meetings and reviews. We discussed with the manager the need to ensure that any discussions about the individual are recorded with the information about that individual. We were told that there had been one incident where an individual had needed to have a member of staff guide his hands. This, though Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 13 minor, is a form of restraint, and needs to be recorded as such. Guidance on this is provided by the Department of Health in “Guidance for Restrictive Physical Interventions- How to provide safe services for people with Learning Disabilities and Autistic Spectrum Disorder”. The Manager said he was not aware of this guidance. We looked at the health care needs of the individuals, and there was a record of health care needs being met. Staff had identified where additional support was needed and had provided this support. One person had needed support and encouragement to wear hearing aides, this had been provided. The home was awaiting guidance from a speech and language professional before developing their work on communication further. As part of this inspection we looked at the system for the management of medication. There was a record of medication being administered and where medication had been sent for a relative to administer there was a record of this. The Manager audited this medication. One of the Social Workers commented that the home had worked to reduce the need for “as required medication”. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 14 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have their rights protected and are able to complain. EVIDENCE: The information provided in the Pre- Inspection Questionnaire was that no complaints had been received by the home. The complaints record seen during the visit to the home was empty. We asked one of the relatives if he/she would be happy to complain, and he/she said that they felt they could do this but would go via the Social Services Department. We were also told that if there were any small concerns then staff were happy to try and put things right. We looked at the policy on Safeguarding (Adult Protection), this document contained information about where to take concerns within the organisation, but not who might be contacted outside the organisation, this should be included. We asked the Manager about training and he said that he had received training in relation to the Protection of Vulnerable Adults in Plymouth. We suggested that it would be useful to be aware of the contacts in Cornwall who operate within the same procedures. All three of the staff who responded to surveys sent in September 07 said that they knew who to speak to if they had concerns. We looked at the systems for managing finances, and there were systems in place to ensure that all money held was accounted for. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 15 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, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Stoneybridge Cottage benefit from a well-maintained and comfortable house, which they see as their home. EVIDENCE: As part of this visit we looked around the house. The accommodation was clean and the two people who live at Stoneybridge Cottage seemed comfortable in their surroundings. The weather was fine on the day of the visit and the patio and garden were being well used. The two bedrooms reflected the preferences of the two people who live at the cottage. One person prefers a “minimalist” bedroom, with the furniture securely attached to the floor. We discussed with the Manager whether the accommodation could be reorganised so that the people who live at Stoneybridge Cottage have better use of the facilities. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 16 One of the people at Stoneybridge was very happy to show us that he had a key to his room, and that he regarded this space as his own. We discussed with the manager that one of the individuals had no wardrobe or space to hang clothes. We asked to see the risk assessments for the environment. The Manager said that he had recently become aware that he needed to complete separate risk assessments in relation to the building and would be completing these in the near future. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 17 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, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff at Stoneybridge are trained, skilled and in sufficient numbers to support the people living in the home. Recruitment procedures are not robust and the necessary pre-employment checks are not always carried out, to ensure that only people suited to the work live at Stoneybridge Cottage. EVIDENCE: As part of this inspection we looked at how staff who had recently started work in the home had been recruited. We looked at the records of checks made before employment. We found that the individuals had been interviewed and references taken, however references had not always been received prior to starting work in the home, or were not available for inspection. We also found that not every applicant had a complete work history, with all gaps in employment accounted for. We asked to see copies of “POVA First Checks”, which is a check that must be completed prior to an individual starting work in the home, pending completion of a full Criminal Records Bureau check. We were told that these had been done, however we could not be shown any evidence that this was the case. Pre-employment checks are important as they help ensure that people who are not suited do not work with vulnerable people. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 18 We talked with two of the staff who had recently started work in the home. One of the individuals explained that he/she was receiving an induction, and that this seemed to cover what he needed to know. The individual had been told the person he was working with and knew what to do and what not to do. The individual said that he/she thought that the manager was very approachable, though as he/she was not able to judge the level of supervision and support. The questionnaire completed by the Manager, Simon King, indicates that regular supervision and staff training meetings are held. One of the staff commented how impressed he/she was with the discussions at Handovers, and that issues concerning service users were handled in a sensitive and professional manner. We talked with staff on duty about the training they had received and as both staff were relatively new they had received only limited training whilst at Stoneybridge. However the training three surveys from staff returned in September 07 indicate that staff felt that they received training to do their role and were kept up to date with new ways of working. The Manager said that staff received training in how to “break away” from people who held them, and there was a record on file. We talked to the Manager about training in relation to “learning disability awards framework”, and it’s value in providing staff with a specific understanding of the needs of people with a learning disability. We were told that there are three staff on duty during the day time, and two care staff sleep in the house at night. This was the case during the inspection. The house was clean and tidy, and the people in the house appeared satisfied with this level of staffing. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 19 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect. The records of systems for ensuring that risks to people are minimised are lacking, such records help ensure that things are not missed. EVIDENCE: Mr Simon King is the Registered Manager for Stoneybridge Cottage. He confirmed in the questionnaire for the Commission that he was intending to complete his Registered Managers Award. One of the staff completing a survey commented “My manager always makes himself accessible for any support and listens with a willing ear” and “We have an excellent line of communication and often “bounce” ideas off each other”. Another person said what the service did well was “team work”. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 20 We asked staff about whether they thought living at Stoneybridge Cottage was like- they said that it was “a good place to live”. We talked with the Manager about how he made sure that the service was of a good quality and he said that they sent questionnaires to people who are involved in the service. The questionnaire received by the Commission states that these quality assurance questionnaires are carried out by someone outside the home. We discussed with the manager the need to show that any issues raised in such questionnaires are dealt with. As has already been noted whilst there are risk assessments in place these have focused on the people who live in the home rather than the environment. The Manager stated that he had recently attended training in this area and was about to remedy the situation. We looked at checks of the fire system, and these were being made, however there was no Fire Risk Assessment, which should determine the nature and frequency of any measures taken to lower the risk of a fire. Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 4 3 X 3 X 3 X X 2 X Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13(8) Requirement All physical interventions (holding or restrain people) must be recorded as per the guidance provided by the Department of Health in Guidance for Restrictive Physical Interventions- How to provide safe services for people with Learning Disabilities and Autistic Spectrum Disorder. Pre-employment checks must be made for all staff before they start work. This must include taking two relevant references, provision of a full employment history, and a “POVA First Check” pending completion of a full Criminal Records Bureau check. Risk assessments must be in place to ensure that the people who live and work at Stoneybridge are safe. This must include a Fire Risk Assessment. Timescale for action 01/07/08 2 YA34 19 01/07/08 3 YA42 13(4) 01/07/08 Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 23 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 Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Stoneybridge Cottage DS0000060821.V362990.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!