CARE HOME ADULTS 18-65
Pentire 15 Pentire Crescent East Pentire Newquay Cornwall TR7 1PU Lead Inspector
Lowenna Harty Unannounced 20 September 2005 09:30 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 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 Stationary 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. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Pentire Address 15 Pentire Crescent East Pentire Newquay Cornwall TR7 1PU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Spectrum Acting Manager - Mrs Lesley Potter Care Home 3 Category(ies) of Learning Disiability (3) registration, with number of places Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration to those stated above. Date of last inspection 13 January 2005 Brief Description of the Service: 15 Pentire Crescent is a home providing accommodation and personal care for up to 3 adults with a learning disability. The home is opperated by Spectrum, an organisation that provides care for people with autistic spectrum disorders. Spectrum empolys a manager and a team of care staff to provide care to service users on a day-to-day basis. The aim is to provide them with the support they need in a homely, domestic-style environment. The home is located in Newquay and as such service users are able to access all the facilities of a small town with the added advantage of ready access to several local beaches. The house is a detached, two-storey building, with a large garden. Service users are provided with their own bedrooms, one of which, has an en-suite bathroom. There are two additional bathrooms. All the bedrooms are on the ground floor of the house. The home has an office and a separate sleeping in room for staff. There is a domestic-style kitchen with open plan dining room and conservatory, a separate laundry/store room downstairs. There is also a workshop that service users are able to make use of. On the first floor of the building there is a large, comfortable lounge, with TV, Video, music centre and a computer with internet access for serivce users to make use of. The home does not specifically provide accommodation for people with physical or sensory disabilities, but could readily adapted to meet special needs, if required.
Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on 20 September 2005 and was unannounced. It lasted for approximately five and a half hours. Two of the service users were at home and the inspector met with both of them, one of them in private, at their request. The third service user was returning from a family visit later that day. The inspection consisted of an inspection of records and documents relating to the management of the home and the care and services provided to the service users individually. This included a selection of key written policies and procedures to guide staff and assessment, care planning, health care and daily care records relating to each of the service users. Part of the inspection focused on an inspection of the home’s premises and observation of daily life for service users. One of the service users kindly led the inspection of the premises. The inspection also consisted of an interview with a staff member who was on duty at the time and discussion with the person currently in charge of the home. Overall the home provides the service users living there with a good standard of care and service users interviewed at the time of the inspection said that they are satisfied with the services provided to them. The inspector would like to thank the service users, the home’s acting manager and staff for their kind assistance in the conduct of this inspection. What the service does well:
There have been no new admissions to the home since the previous inspection and service users currently living there are very familiar with the services on offer to them. A copy of the home’s statement of purpose is kept on a notice board outside the main office for the benefit of service users and their visitors. Each service user has a service users’ guide, which they have signed, which provides them with information on their rights and obligations whilst they are resident at the home. There is adequate assessment and background information available to staff working with service users, to keep them informed of their needs. Each service user has an individual care plan, which is written for and with them and sets out their health and social care needs, including their likes, dislikes, preferences and religious/ cultural needs. Service users contribute to
Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 6 daily care records, which show how their care plans are carried out on a dayto-day basis. Service user take part in a wide range of activities in and out of the home, which reflect their individual preferences and abilities. This includes voluntary work and college placements and membership of clubs outside of the home. Staff help them to make choices to develop their skills and independence. They are able to make telephone calls in private, receive visitors and have access to the Internet via a computer in one of the lounges. They are assisted to access local community facilities, either with staff or independently, depending on their individual needs and levels of confidence. Service users are assisted and encouraged to maintain contact with their families and develop appropriate friendships with people from outside of the home. At the time of the inspection one of the service users was due to return from a family visit. Spectrum’s senior managers are available to provide additional support and advice on service users’ developing friendships and relationships. Service users’ healthcare needs are appropriately met and they are assisted to access local NHS service providers, including GPs and dentists, when they need them. They are encouraged to maintain active and healthy lifestyles in accordance with their written care plans. Service users’ views are listened to through regular care planning reviews, which they contribute to; attendance at regular formal house meetings, where they can discuss household concerns and individual sessions with their key workers. Service users have completed written feedback forms on their views of the care and services provided to them at the home, which contribute to the plans for ongoing improvements. One of the service users contributes to the development of policies and procedures across the Spectrum organisation. The home is comfortable, homely clean and hygienic. It is well located for access to the local town and provides service users with opportunities to develop their skills in a domestic-style setting, with support from staff. It is well maintained and comfortably furnished throughout. What has improved since the last inspection?
The home’s service users’ guide now contains a summary of the home’s statement of purpose, information on service users’ views of the home and information on the fees and charges they are expected to pay so that they can be clearer about their rights and obligations. Spectrum has invested in the provision of a computerised system, which now contains all staff recruitment records in a secure format. This provides good evidence that staff are recruited in a way that is fair and safe for service users.
Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 7 All staff now have access to the General Social Care Council’s handbook, which provides guidance on the standards of conduct expected of all staff working in the social care field, to inform their practice. What they could do better:
The home’s statement of purpose needs to be updated on the current management arrangements and staff working in the home so that service users and their representatives have accurate information. Whilst service users are provided with opportunities to exercise choice and control in many aspects of their lives, they do not currently have lockable bedroom doors. One of the service users said that they would like to have the option to lock their bedroom door and they should be able to do so, unless there are clearly stated risks around this. Whilst all the service users have detailed risk assessments and behavioural management plans, they were not suitably individualised, up-to-date or appropriate for all of them. Where possible service users and/or their independent representatives should sign their agreement of their risk assessments to demonstrate their agreement to the imposition of any restrictions deemed necessary for their protection and welfare. Service users do not take medication on a regular basis and the home has adequate storage facilities for medicines. Spectrum has recently updated its policies and procedures for the management of service users’ medicines and these need to be introduced to this home. Current records of medication were not up-to-date and there needs to be accurate recording in place to protect service users from medication errors. Service users wishes should they become seriously ill or in the event of their unexpected deaths should be included in their written care plans, so that staff can ensure they take appropriate action should this be necessary. The home’s fire safety risk assessment needs to be fully completed and there must be regular fire evacuation drills to ensure that service users are better protected from risks due to fire in the home. There needs to be improved evidence that staff have undergone the training they need to undertake the work they perform, kept in the home. This could be in the form of copies of their training certificates and a staff training plan showing what training they have done and what is planned. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 8 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. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 5 Prospective service users have good information about the home although further improvements are needed so that they can be fully informed. Admission to the home is on the basis of a detailed assessment process to ensure it will be suitable for new service users. All service users have been provided with written statements of the terms and conditions of their occupancy in the home so that they are informed of their rights and obligations. EVIDENCE: No new service users have been admitted to the home since the previous inspection and current service users are very familiar with the services provided to them there. The home has a detailed statement of purpose, which is kept pinned to the home’s notice board so that service users can readily access it. Most of the information is accurate and up-to-date, with the exception of staffing and management arrangements. The statement of purpose contains information on the home’s admission procedures. The home does not admit people on an emergency basis. There is background/ initial assessment information on all the service users on their personal files. The home’s service users’ guide functions as a statement of terms and conditions for service users and copies of these, signed by service users were on their personal files. They have been provided to service users in formats that are suitable for them. Service users’ guides now contain copies of feedback questionnaires completed by service users with their comments on the care and services provided to them and adequate information on fees charged.
Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 11 Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Service users help staff to draw up individual care plans for themselves. They are assisted to make decisions about their lives, but would benefit from having increased opportunities in this respect. Service users are able to take risks to develop their independence but written risk assessments need to accurately reflect this. EVIDENCE: Service users have detailed written care plans that address all aspects of their health and social care needs, including religious and cultural issues. Their care plans are personalised and signed by service users. Service users contribute to detailed daily care records, which demonstrate how their care plans are followed up in their daily lives. Service users care plans consider their likes and dislikes and decision-making skills. They all contribute to menu planning and are encouraged to plan their own time, with staff support. This was observed at the time of the inspection. Service users do not currently have the option of locking their bedroom doors and one of the service users said that they would like to be able to. Service users’ individual risk assessments are detailed and address specific activities they are engaged in although one service user’s written risk assessment needs to be updated to fully reflect their current situation in an appropriate way.
Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 13 Service users should be invited to sign their risk assessments as evidence of their participation in their formulation and agreement with the contents. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Service users benefit from participating in a wide range of activities in and out of the home. They are supported to access a variety of community resources to develop their skills and independence. Service users maintain relationships with their families and have opportunities to develop social lives outside the home. EVIDENCE: Daily care records, written by service users, and their care plans provide evidence that service users take part in a wide range of activities, which meet their individual needs. They are encouraged to pursue their individual interests and develop their skills. Both the service users interviewed at the time of the inspection stated that they are satisfied with the activities provided for them. The home has a computer with Internet access, which service users make use of. Service users are assisted to attend a local college, clubs in the community outside of the home and voluntary work placements. The home provides transport and staff to accompany service users when they are in the community if they require this. There are opportunities for service users to access the local community independently, depending on their individual circumstances and risk assessments. At the time of the inspection, one service
Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 15 user was returning from a home visit. There are records of service users’ contact with their families and the home has suitable facilities for service users to make telephone calls in private. Spectrum’s senior managers are available to provide specialist input and advice with regard to service users developing friendships and relationships, where this is necessary. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 & 21 Service users’ physical and emotional health needs are met appropriately. Further improvements are needed in the way medication is managed to protect service users from medication errors. Service users’ wishes in respect of their ageing, illness and death need to be ascertained so that they can be followed, if necessary. EVIDENCE: Service users’ care plans consider their physical and emotional health needs, including health promotion. There are records to show that they are assisted to access local NHS healthcare providers such as GP surgeries and dentists. None of the service users take medication on a regular basis. The home has suitable storage facilities for medicines. Spectrum has updated its policies and procedures in respect of medication but the home does not yet have a copy of the revised written guidance for staff. Medication records reviewed were not correctly signed. They need to be signed contemporaneously and countersigned in respect of transcribed administration records. Service users and/or their representatives have not been consulted on their wishes in the event of their unexpected death or serious illness. This should be done so that staff can ensure their wishes are carried out. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users’ views are sought on a regular basis and acted upon appropriately. EVIDENCE: The home has a formal written complaints procedure, which has been provided to service users in the home’s statement of purpose and service users’ guides. Service users have completed internal quality assurance questionnaires and their comments have been incorporated into their ongoing care plans. There are regular house meetings and service users have individual sessions with their key workers to discuss their plans and concerns. Service users interviewed at the time of the inspection stated that they are satisfied with the care and services provided to them at the home. One service user contributes to the development of policies and procedures across the organisation. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The home’s environment is comfortable and homely so that service users can benefit from living in a domestic-style setting. The home is clean and hygienic although some improvements are needed to make it safer for them. EVIDENCE: The home is situated in a local community setting, within easy reach of all the facilities of the local town. It is well maintained inside and out, tastefully decorated and comfortably furnished. The exterior of the building was being redecorated at the time of the inspection. There is sufficient private and communal space for service users. It was clean and tidy throughout at the time of the unannounced inspection. The home’s environmental risk assessment is complete although the fire safety risk assessment is not. There are records of weekly tests of alarms and fire safety equipment but there has not been a recent evacuation and these should be undertaken monthly. There is an up-to-date electrical hardwiring test certificate and a log of tests to electrical appliances, which is up-to-date. There are records of staff training in the home’s fire safety procedures. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 35 The home operates fair, safe and effective recruitment practices. Improvements are needed to demonstrate that staff are appropriately trained to meet service users’ needs. EVIDENCE: Spectrum has introduced a computerised record system across its service to provide evidence that staff are employed on the basis of a written application form with full employment history, formal interview according to a set format, the provision of two satisfactory references and checks with the Criminal Records Bureau. There is a lack of evidence that staff have completed training they need in the form of copies of their certificates, which should be kept in the home, alongside a staff training plan. There is evidence that new staff are provided with copies of the General Social Care Council handbooks for staff working in care homes, to guide and inform their practice. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 Service users’ views are appropriately considered in the ongoing management of the home. There are systems in place to protect their health, safety and welfare although improvements are needed. EVIDENCE: Service users contribute to the running of the home through their individual care plans and reviews and feedback questionnaires on their views of the services provided to them. There are regular house meetings with service users, with minutes kept, during which they can discuss household issues and they have regular, formal opportunities to discuss any concerns they have with their individual key workers. One of the service users contributes to the development of policies and procedures across the Spectrum organisation. Service users are protected by individual risk assessments, which address specific activities they take part in. There are policies, procedures and written risk assessments to maintain a safe environment for them to live in, although improvements are needed to fully protect service users from fire risks.
Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 21 Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Pentire Score x 3 2 2 Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 23 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 1 Regulation 4(1) Requirement The homes statement of purpose must contain up-to-date information on the management and staff working at the home. The homes written medication policy must be updated to reflect best practice in accordance with the Royal Pharmaceutical Guidelines. There must be satisfactory records maintained in respect of medicines administered to service users. The homes fire safety risk assessment must be completed. Fire evacuations must take place in accordance with the homes written safety procedures. There must be documentary evidence kept in the home that staff are suitably trained. Timescale for action 01/12/05 2. 20 13(2) 01/12/05 3. 24 & 42 23(4)(a) 23(4)(c) 01/12/05 4. 35 18(1)(a) 01/12/05 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.
Pentire Refer to Standard 7 Good Practice Recommendations Service users should be provided with lockable bedroom
D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 24 2. 9 3. 21 doors unless records indicate that it is unsafe for them or they do not wish to have them. Service users written risk assessments should be up-todate, in suitable individual formats for them. Service users and /or their independent representatives should sign them as evidence of their agreement with the contents. The wishes of serivce users in the event of their death or serious illness should be ascertained and included in their care plans. Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 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 Pentire D52-D04 S28263 Pentire Crescent V245591 200905 Stage 4.doc Version 1.40 Page 26 - 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!
