Inspection on 01/08/07 for 28 Medina Road

This inspection was carried out on 1st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

28 Medina Road 02/08/06

28 Medina Road 02/02/06

28 Medina Road 26/10/05

28 Medina Road 01/03/05

28 Medina Road 26/10/04

28 Medina Road 26/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 28 Medina Road 28 Medina Road Grays Essex RM17 6AQ Lead Inspector Mr Trevor Davey Unannounced Inspection 1st August 2007 13:30 28 Medina Road DS0000018084.V346242.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 28 Medina Road DS0000018084.V346242.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. 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 28 Medina Road Address 28 Medina Road Grays Essex RM17 6AQ 01375 380366 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) Family Mosaic Martin John Turner Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Personal care may be provided for up to four (4) service users of either sex who are aged between 18-65 years of age. Personal care and accommodation may be provided for no more than four (4) service users who have a learning disability. 2nd.August 2006 Date of last inspection Brief Description of the Service: The home is a converted bungalow and its situated in a quiet residential cul-desac in Grays. The service currently caters for four adults with a learning disability. The home is within walking distance from local amenities and a bus route is available which is a short distance from the town centre. The home offers single bedroom accommodation with separate communal bathroom and toilet facilities. A large lounge with patio doors open out on to an extensive garden area. Information about the home is made available to prospective residents in the Statement of Purpose and Service User’s Guide. The current service charge paid by residents is £63.95 to £95.00 per week plus £1781.00, which is contributed by funding authorities. Additional charges are made for chiropody treatment, hairdressing and toiletries. 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection site visit covered a period of 3.50 hours and covered all Key standards. The Registered manager together with other staff and residents, were spoken with during the site visit. Their comments and contributions received were helpful in assisting the Inspector to prepare this report. As part of the site visit, a tour of the premises took place and some of the personal care records and other official records within the home were also assessed. The management of the home had conducted their own survey and quality assurance exercise but the results of surveys completed were not available for inspection. It is understood that these had been completed and returned to the Registered Provider at their head office. As part of the inspection process, the Inspector provided survey forms at the home for completion. This is to find out what people think of the home, the standard of service provided and to assist the management in making improvements. The information included in the annual quality assurance assessment form (AQAA) which had been submitted to the Commission for Social Care Inspection, was also used in compiling the inspection report. This form gives homes the opportunity of recording what they do well, what they could do better, what has improved in the previous twelve months as well as future plans for improving the service. What the service does well: The home has been successful in demonstrating its pro-active approach by developing communication skills with residents to find out what they enjoy which has resulted in further improvements in their lifestyle. Care plans are person centred, detailed and reflect changes with regular reviews taking place. Potential risks have been identified and the action to manage these is clearly documented. Staff have developed a good and positive working relationship with residents where there are difficulties with verbal communication. Staff commented in the C.S.C.I. survey forms that the home is good at putting the interests and general wellbeing of the residents first at all times. Staff recruitment records were complete and available for inspection. Positive comments were made by staff in the survey forms returned to the Inspector regarding induction and training provided. The home is good at identifying specific training needs and appropriate courses are arranged. 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 6 The home and residents benefit from good and positive management with staff working well as a team. 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. 28 Medina Road DS0000018084.V346242.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 28 Medina Road DS0000018084.V346242.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 People who use the service experience good quality outcomes in this area. Pre-admission assessment details for care/health needs gave staff enough information to assure potential residents that their needs could be met. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Pre-admission assessment information was detailed and included a record of visits made by the manager to prospective residents prior to admission. Prospective residents had also visited and stayed in the home for short periods prior to being admitted. A case summary was provided which included family history, past psychological history, current medication and behaviour. Likes and dislikes had also been taken into account. Useful information had been provided by previous residential environments including general guidelines for the management of challenging behaviour. Where sign language is needed to assist in communication, staff had developed these skills with the aid of a guidebook and training. Some of the relatives are supportive and residents are able to maintain regular contact including visits to the family home. The manager advised the Inspector that the existing Service Users Guide is currently being updated which will include additional symbols and photographs 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 9 of staff. A copy of this latest document is to be sent to the C.S.C.I. shortly. Positive comments by residents were made in survey forms returned to the Commission for Social Care Inspection to confirm that consultation took place with them prior to moving into the home and sufficient information was made available. 28 Medina Road DS0000018084.V346242.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 People who use the service experience excellent quality outcomes in this area. Residents can expect to have a detailed and comprehensive plan of care drawn up by the home that reflects their wishes and details their needs. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Care plans sampled, were tailored to the individual and included a photograph of the resident concerned. The support plan was indexed and easy to follow. Plans included information relating to personal hygiene, health action plan, issues relating to aggressive behaviour, skill development and daily activities planned. Information was clear and set out the wishes of residents as well as the support to be provided by support workers. The format of the care plan included activities needed as a result of the assessment, which included shortterm goals, as well as the timescale for reviews. The layout and details of the 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 11 information provided enabled continuity in providing support, irrespective of which members of staff were on duty. Staff spoken with confirmed that they are fully involved in preparing and updating care plans. Risk assessments had also been included which clearly identified the potential hazards and the measures needed to minimise these risks. Four weekly reviews of residents take place, which had been recorded. Staff have successfully been able to develop their communication skills, which includes “speaking hands”, and good interaction between members of the staff team with residents was observed during the inspection. The management acknowledge in the AQAA form submitted to the CSCI, that further communication training would be of benefit to enable staff to understand clearer when choices have been expressed. Since the last inspection, staff have become more skilled in listening to residents as well as developing their communication techniques which has resulted in less challenging behaviour. It was noted that one resident who had been admitted to the home in 1997, was last reviewed by the funding authority in August 2003. The manager of the home has sent reminders to the local authority concerned and has also sent a copy of the internal house review but no acknowledgement has been received. The home should continue to pursue this matter further as there is a statutory obligation for these reviews to be undertaken. 28 Medina Road DS0000018084.V346242.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 People who use the service experience good quality outcomes in this area. People living at the home are able to take part in a range of activities which meet their individual, social and cultural needs. Residents living in the home benefit from healthy and well presented meals. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Residents are encouraged to take part in a variety of recreational and leisure activities which include visits to country parks, farms, pubs, the gymnasium and cinema. Residents have also been taken on holiday by the staff team. Pictures and photographs were also in the home of these events. The staff are sensitive to the preferences and wishes of residents where individuals may prefer to be taken out on a one-to-one basis in less crowded areas. Some 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 13 family contacts and visits are made on a weekly basis. Some activities are arranged jointly between several other local homes. Menus were available and records of meals provided. Meals are prepared in accordance with individual resident choice. The kitchen was clean and hygienic with daily records showing fridge and freezer temperatures. To assist in communication throughout the home, symbols and pictures are used which are displayed on doors as well as explaining the use of emergency and security systems. The management acknowledged that they need to develop a wider range of activities and during the past twelve months, some residents have been successfully integrated into friendship clubs. There is a lack of resources in the local community of social activities and the home have tried to reduce the impact of these by creating more of their own activities such as arranging walks and sensory facilities within the home. 28 Medina Road DS0000018084.V346242.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 People who use the service experience good quality outcomes in this area. The personal, physical and emotional health needs of residents were being met appropriately taking account of preferred support required. Medication and administrative procedures were not always being followed to ensure the safety and protection of residents. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Care plans and other personal health records inspected included detailed information of holistic needs and how they should be met. Health screening checklists had been introduced using colour picture symbols to assist communication and understanding with residents. Records of appointments with health care professionals and treatment provided was available including visits to diabetes clinics. Additional support has been given to the home by community nurses in providing catheter care. 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 15 Overall, medication and administrative records (M.A.R.) had been recorded in accordance with accepted procedures and sample checks showed that medication had been provided to residents in accordance with prescribed details. It was noted, however, that transcribing on the M.A.R. sheets had not been accompanied by two staff signatures. Some other prescription details only included to be taken as directed which means that without specific dosage instructions from the doctor, residents could be placed at risk. The administration of temazepam must also be recorded in the controlled drugs register. Protocols were in place for P.R.N. (to be taken as required) medication. The Inspector was advised that workbooks for staff are going to be introduced for further medication training. 28 Medina Road DS0000018084.V346242.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 People who use the service experience good quality outcomes in this area. Residents can expect to have their complaints taken seriously and be protected by the home’s ‘safeguarding adults from harm‘ procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: An effective complaints procedure is in place and since the last inspection no complaints had been recorded. The complaints procedure is appropriately illustrated with pictures and symbols, which is suitable for the resident group. Cards from relatives expressing appreciation of the service provided were also available. Staff were aware of the reporting procedures to be followed for cases of abuse or suspected abuse as laid down in the prevention of vulnerable adults policy. Ongoing training is being provided by the manager using training materials provided by the local authority. 28 Medina Road DS0000018084.V346242.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 People who use the service experience good quality outcomes in this area. The premises are well maintained to enable people who use the service to live in a safe, comfortable environment. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The premises were clean and hygienic with regular maintenance taking place of services and equipment. Residents have been able to personalise their rooms with their own belongings. Staff have enabled residents to adapt their rooms to suit their individual needs and lifestyles. Sensory equipment and appropriate colour schemes have been introduced to assist some residents to relax and to relieve tension. The Inspector took the opportunity of observing a house meeting, which took place with residents and staff. Redecoration in the home is to take place shortly as well as providing new carpet. Records were available of regular maintenance and servicing checks. From the AQAA form 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 18 submitted, the home has acknowledged that the existing windows will need replacing and their plans for improvement in the next twelve months, include redecorating parts of the home. Staff have received training in infection control and the control of substances hazardous to health (C.O.S.H.H.). Disposable gloves and appropriate waste disposal arrangements were in place to minimise the spread of infection. One member of staff had been delegated the task of keeping these procedures upto-date. Work place risk assessments for a safe working environment were also available for inspection and have been updated. 28 Medina Road DS0000018084.V346242.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): 32,33,34 & 35 People who use the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support people who use the service. Recruitment policies and practices are in place to ensure residents are properly supported and protected. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Registered Manager leads the staff team. The rotas, which were available at the inspection, reflected the staff on duty. Four or five support workers are normally available each day depending on the support required and activities, which have been arranged. There is always a minimum of three staff on duty throughout the day. Night-time cover includes one member of staff who is on awake duty and another person sleeps on the premises and is available to give assistance if required. 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 20 Staff recruitment records were available which included copies and evidence of Criminal Record Bureau checks, application forms, written references and proof of identification. Evidence of recruitment checks carried out for agency staff was also available. At the time of inspection, there was one staff vacancy and all other members of the staff team had been employed in the home for at least two years. All staff have individual training files where records of courses and training completed had been maintained. Certificates were also available which included Fire awareness, first aid, food hygiene and managing aggressive behaviour. The home has commented on their AQAA form, that the staff team is well established and experienced. From conversation, observation and records examined, the staff group work well as a team and are confident as to their roles and responsibilities. One member of staff has completed the N.V.Q. Level 3 care and four others are waiting to begin their training. 28 Medina Road DS0000018084.V346242.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 People who use the service experience good quality outcomes in this area. The management and administration of the home is based on openness, respect and has effective quality assurance systems in place. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Registered Manager is experienced, competent and is currently undertaking training for the Registered Manager’s Award. Other staff have responsibilities within the home and it is planned to increase delegation of duties in the next twelve months. Staff confirmed that the manager is approachable with support and advice being given through supervision and appraisals. Records are kept of these sessions. 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 22 A house meeting took place on the day of inspection and it was observed by the Inspector that these were open and gave staff opportunities to discuss issues relating to staff monitoring of residents and the importance of recording specific information. Other items were discussed including the arrangements for a party and an outing for residents. These meetings take place on a regular basis. The personal allowances are managed and safeguarded on behalf of residents and the manager is the appointee as approved by the Department of Social Security. Records of transactions and receipts were made available for inspection. These accounts are audited every month on behalf of the Registered Provider. All residents have their own individual bank accounts but these do not attract interest. To enable residents to receive interest on the money they have in savings, it is recommended that consideration be given for interest-bearing accounts to be opened on behalf of individual residents. Regular monthly monitoring visits take place on behalf of the Registered Provider and reports were made available for inspection. Residents are regularly consulted regarding their views and opinions of the service and recent surveys had been completed and returned to the Registered Provider. The outcomes of these surveys are notified to all homes but only include the overall results, which have been collated and do not identify the outcomes for individual services. Whilst the home has demonstrated that it is listening to users of the service to promote higher standards and improvements of care, it would be helpful for the Registered provider to give feedback, which relates to specific individual homes. 28 Medina Road DS0000018084.V346242.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 1 2 3 4 5 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 x 32 3 33 4 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x 3 x x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 x 4 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 3 3 2 x 4 x 3 x x 3 x 28 Medina Road DS0000018084.V346242.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 YA20 Regulation 13(2) Requirement Timescale for action 30/09/07 The Registered Person shall make arrangements for the 17(sched3) recording, handling, safekeeping & safe administration of medicines received into the care home. This refers to clear prescription details & confirmation of changes by G.P.to minimise the risk of medication being given in error. 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. YA39 3. Refer to Standard YA39 YA39 Good Practice Recommendations The views of residents should be obtained regarding placing their savings in interest bearing accounts. Risk assessments for residents should take into account whether window restraints are necessary to minimise risk of potential injury. The outcomes of quality assurance surveys undertaken in the home should be fed back to residents & staff together with the action plan agreed. 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 28 Medina Road DS0000018084.V346242.R01.S.doc Version 5.2 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!