Inspection on 30/10/06 for 1 and 1a Orchard Villas

This inspection was carried out on 30th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 and 1a Orchard Villas 13/03/06

1 and 1a Orchard Villas 25/10/05

1 and 1a Orchard Villas 26/08/04

1 and 1a Orchard Villas 18/03/04

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 08/07/2008.

CARE HOME ADULTS 18-65 1 and 1a Orchard Villas Perry Street South Chard Chard Somerset TA20 2QF Lead Inspector John Hurley Unannounced Inspection 30th October 2006 13.00p 1 and 1a Orchard Villas DS0000016213.V316626.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 1 and 1a Orchard Villas DS0000016213.V316626.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. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 and 1a Orchard Villas Address Perry Street South Chard Chard Somerset TA20 2QF 01460 220747 NA 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) Mr David Edward Wright Mrs Sheila Grace Wright, Mrs Helen Anne Bond Mrs Sheila Grace Wright Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users in ground floor accommodation may have concurrent physical disabilities Date of last inspection Brief Description of the Service: Orchard Villas is a domestic scale residential home, providing care and support for three people who have learning disabilities. One person with significant care and support needs lives in the main house. Two other people live more independently in the adjoining bungalow. The providers, Mr & Mrs Wright live in the main house and provide the bulk of support. The home is located in a rural area south of Chard. Mr & Mrs Wright promote a family based ethos and each of the people living here is included in extended family activities and occasions. Recreational and occupational activities are encouraged on both an individual and group basis. There is a strong focus on outdoor activities including horse riding and stable management. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced key inspection of Orchard Villas of 2006. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. Prior to the visit the proprietorservice completed a pre inspection questionnaire. The views of the service users and people important to them were also sought; where appropriate their comments are included in this report. The inspector toured the building, spoke with the management on duty and spoke privately with service users on both an individual and group basis. They inspected a sample of the service users documentation along with records relating to staff and other documents required by regulation. What the service does well: What has improved since the last inspection? What they could do better: The standard of the recording and availability of all documentation requires to be managed in a more useful way. All staff that administer medication are 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 6 required to be formally trained in the safe administration, recording and disposal of medication. Individual risk assessments must be formally recorded and care plans must be reflective of the individual’s health and social needs and aspirations. They must also be kept under review on a monthly basis and any significant events be formally recorded. All staff files must contain all the information required by legislation, such as 2 written references, health declarations and full employment histories. The management must also ensure that all staff receive the statutory training required such as Health and Safety and basic first aid. 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. 1 and 1a Orchard Villas DS0000016213.V316626.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 1 and 1a Orchard Villas DS0000016213.V316626.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. If followed the stated policies and procedures relating to new admissions will meet the requirements of the National Minimum Standards. EVIDENCE: The management of the home informed the inspector that no new service users had taken up residency since the last inspection. They further informed the inspector that should a prospective service user wish to consider taking up residency they would provide information in the form of the service user guide and statement of purpose. This would also be complemented by visits to the home and meeting the existing service users. They further informed the inspector that they would adopt a multi agency approach with regards to any new placements and use the local authorities single assessment process as a start point for establishing the individuals needs and whether the home could meet these needs or not. Through discussion with the service users and feedback from people important to them the inspector established that there were high levels of satisfaction with regard to the pre admission arrangements made by the home. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 9 The inspector considers that if the stated policies and procedures with regards to admission are followed then the service will met the National Minimum Standards required. 1 and 1a Orchard Villas DS0000016213.V316626.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 adequate This judgement has been made using available evidence including a visit to this service. The care plans that were observed do not fully evidence the changing needs and aspirations of the service user Risk assessments need to be more robust. EVIDENCE: It is clear that the staff group have a clear understanding of the complex needs of the three service users in their care and how these needs are to be met. The inspector observed the management working with an individual who has limited verbal communication. It was clear that they could interrupt movements and mannerisms in order to assist the individual get what the wanted or needed. Service users are encouraged to make as many decisions about their own lives as possible. The service users and people important to them confirmed this. They further informed the inspector of some of the areas they had been 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 11 consulted on such as the choice of decoration for their own rooms and leisure activities. The care plans and associated documents were not readily available on the day of the inspection, some of the key documentation was provided for inspection shortly after the visit. They do contain sufficient detail of how needs are to be met and were not reviewed on a monthly basis for example, the inspector was informed by the management that the reason the hot water temperature was required to be very hot was due to one individual service user incontinence, however this incontinence was not mentioned on their care plan. It was further unclear as to how the service user care plans were being developed in a way that reflected the assessments carried out by care managers. For example one service user has mental health care needs, these needs were not clearly identified in the documentation supplied, similarly it was not clearly recorded how these mental health needs impact on the service user and the planned action to deal with these needs. However through discussion with the manager it was clear that these needs were understood. This lack of recorded evidence will have an impact on the service user should the individual have to move to another home where this knowledge may be lost. It was noted that some details of how a specific need was to be met was not included in the care plan but in the risk assessment. This needs to be crossreferenced to ensure that staff are clear about where the information is held. Service users could not remember care plans being discussed with them but the manager confirmed that that they were. Risk assessments were seen for service users. They were not all dated and there is no indication as to when they have been reviewed. Although they highlight risks they do not necessarily identify what measures have been put into place to minimise the risk. 1 and 1a Orchard Villas DS0000016213.V316626.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): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Formal and leisure activities, links with the community friend and relative relationships are good. The rights of the service user are respected and recognised within the home. The meals in the home offer residents choice and variety. EVIDENCE: Service users confirmed that they are involved in work experience placements and also attend a local day centre. If they wish they also attend evening classes in domestic science and arts and crafts. Service user make use of local facilities such as shops etc. They also confirmed that they attend the local church and two of the service users sing in the choir. Service users are able to invite friends and families to the home and they are also able to go out and about with their own friends as long as this has been 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 13 agreed. Service users told the inspector about inviting friends to the home and about leisure activities. Service users are able to let themselves in and out of the home as they wish. They also confirmed that they open their own post and that they are able to get up and go to bed when they wish although they do get called in the morning if they are going out. Meals are decided on a daily basis and currently the meals are cooked by one of the proprietors in the main part of the home and taken over to the annexe. 1 and 1a Orchard Villas DS0000016213.V316626.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 adequate. This judgement has been made using available evidence including a visit to this service. The service users receive care and support in a way that has been agreed with them. The staff who administer medication must be suitable trained. EVIDENCE: Currently none of the service users require aids or personal support with lifting. The home provides same gender care for the individuals who reside there. All other support is provided to meet individual needs of residents. Individuals are registered with a local GP and also receive regular dental, optical and dental treatment. Additional medical support is provided as required and an example was given of this. Currently none of the service users are administering their own medication. Medication is stored in a locked cupboard and a record is made of when it is given. These records hold all information on one hand drawn up sheet for the service user. This undermines the confidentiality of the individual and so a 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 15 separate record for each individual should be introduced. The management informed the inspector that no one is qualified in the safe administration of medication. There is no documented evidence relating to the use of medication on a per required needs (PRN) basis. The management need to record under what circumstances PRN medication can be given, what balances and checks are in place to ensure that medication is appropriately given and what the management do to evaluate the effectiveness of any intervention undertaken. 1 and 1a Orchard Villas DS0000016213.V316626.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 adequate This judgement has been made using available evidence including a visit to this service. The Service users and people important to them consider that their views are listened too and comments made are acted upon. The management need to update their knowledge and understanding of vulnerable adult issues. EVIDENCE: The inspector was informed that no complaints have been made since the last inspection. The service users and people important to them confirmed to the inspector that they felt confident that they could raise issues with the staff or management and these would be dealt with sensitively and promptly. The home has a comprehensive complaints policy which if required will meet the National Minimum Standards required. The management have not had recent protection of vulnerable adults training, it would be helpful if some consideration were given to undertake training so that they can respond accordingly. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 17 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): 24,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The standard of the environment and facilities within the home is good providing residents with a clean and homely place to live, which they have been able to personalise. EVIDENCE: One service user lives in the main house with the management, the other two service users reside in an annexe attached to the main building. This Annexe has its own entrance, a lounge, equipped kitchen, bathroom and two separate bedrooms. The inspector toured all areas of the annexe and those areas that are used by service user in the main house. They observed that all areas of the home, which was seen, were appropriately decorated and reflected a domestic dwelling well. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 18 Service users have been able to bring their own possessions into the home. The home is furnished in a domestic nature and there is nothing to distinguish the home as a residential home from others in the street. The home was clean and there were no unpleasant odours. Service users said that they have help to clean their own rooms and the communal area. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 19 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): 31,34,36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. No staff files were available to inspect at the time of the inspection, when they were checked they were found to be incomplete with little evidence that the National Minimum Standards had been applied robustly. The home has yet to achieve 50 of staff qualified to NVQ2 level. EVIDENCE: The homes management were not able to produce any staff files on the day of the inspection. The management informed the inspector that these files were kept at the other home owned by the management. These files were checked during a visit to that home. The inspector found that in general employees had not completed an application form, references were not generally taken up and there was no evidence that a robust recruitment process was in place. However all staff had a valid criminal records bureau check but the records available did not contain the necessary documentation that verified the staff members identity. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 20 The inspector was offered little evidence of a structured induction for new staff and the exact employment status of some of the individuals on the rotas was not clear, ie employed or sub contractor. The files that were observed did not contain any reference to formal supervision carried out at 1&1a Orchard Villas. The staff rotas that were shown to the inspector only showed the hours worked that day and not the times that these hours were worked. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 21 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 adequate . This judgement has been made using available evidence including a visit to this service. The management of the home needs to improve its recording and reviewing systems so that it can adequately evidence the work that it carries out. More needs to be done with regards to carrying out comprehensive risk assessments. EVIDENCE: The service is managed on a family centred basis with most of the staff being recruited through the owners extended family or network of friends. The service users feel included in this family and the feedback received from them and people important to them confirm that they contribute to decisions that effect them. As this is a small home the important issue of service user choice is easily achieved and evidenced. All self-monitoring by the management is 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 22 informal and seamless, where even the smallest change to the individuals needs is addressed at the time. Whilst this approach meets the needs of the service user in order to meet all of the requirements of the current regulations more attention is required to evidencing the work that is undertaken at this registered service. All of the service documentation needs to be better collated and the recording of service user needs, aspirations and risk assessments must be kept up to date and readily available. The electrical wiring certificates were seen at the previous inspection where it was recorded that a qualified electrician inspected the system in 2003 , they recommended that the system is rechecked in 2008. The manager informed the inspector that they regularly check the portable electrical equipment for its safety with an industry standard tester. The home has electrical smoke detectors that are wired into the fire system, the management confirmed that these are regularly checked, one service user confirmed that the home has fire drills. The hot water outlets are not currently regulated, the reason given by the management for not controlling the maximum temperature are not based on a robust risk assessment. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 23 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 3 3 x 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 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 1 33 x 34 x 35 x 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 x 3 x x 2 x 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 24 no 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 YA36 Regulation 18(2) Requirement The registered person shall that all persons working at the home are appropriately supervised. This is with specific reference to ensuring that all staff that work at the home have their work formally appraised and have ongoing documented supervision. The registered person shall not employ a person to work at he care home unless full and satisfactory information is available in relation to him in respect of the following matters - each of the matters specified in paraghs1to 6 of schedule 2 and schedule 4 point 6 of the Care Homes for Adults (18-65) National Minimum Standards Care homes regulations. This is with specific reference to ensuring all the above required information is available in relation to the staffs records, such as proof of identity, 2 references etc for all staff who work at the home. 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 25 Timescale for action 01/02/07 2 YA34 19(1)(5) (d)(i) 01/02/07 3 YA20 13(2) The registered person shall make 01/02/07 suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is with specific reference to ensuring all staff that administer medication are suitably trained and that all medicines administered via the PRN route are done so in line with the homes policies and procedures and a rationale for giving medication via this route established. Reasons why the staff gave the medication and the outcome of the intervention must be recorded. The registered person shall ensure that unnecessary risks to health or safety of the service user are identified and so far as possible eliminated. 4 YA9 13(4) (c) 01/02/07 5 YA6 15 (1)(2)(a) (b)(c)(d) This is with specific reference to carrying out full and comprehensive risk assessments relating to the individual service users and the environment of the service. Unless it is impracticable to carry 01/02/07 out such consultation, the registered person shall, after consultation with the service user, our a representative of his, prepare a written plan (“the service users care plan”) as to how the needs in respect of his health and welfare are to be met. The registered person shall – make the service users plan available to the service user; Keep the service user plan under review; DS0000016213.V316626.R01.S.doc Version 5.2 Page 26 1 and 1a Orchard Villas Where appropriate and unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users care plan and notify the service user of any such revision. This is with specific reference to ensuring that any care plan is reflective of the individual’s needs and aspiration and provides details with regards to how these needs are to be met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA42 YA23 Good Practice Recommendations The registered person should consider attending training in relation to risk assessments The registered person should consider updating their training with regards to vulnerable adults procedures 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 1 and 1a Orchard Villas DS0000016213.V316626.R01.S.doc Version 5.2 Page 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!