Inspection on 29/05/07 for 3 Gerard Road

This inspection was carried out on 29th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

3 Gerard Road 22/12/05

3 Gerard Road 03/06/05

3 Gerard Road 02/09/04

3 Gerard Road 06/05/04

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 3 Gerard Road Weston Super Mare North Somerset BS23 2RE Lead Inspector Catherine Hill Unannounced Inspection 29th May 2007 10:00 3 Gerard Road DS0000008084.V337277.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 3 Gerard Road DS0000008084.V337277.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. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 3 Gerard Road Address Weston Super Mare North Somerset BS23 2RE 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) 01934 641038 0117 9699000 www.brandontrust.org The Brandon Trust Mr Terry Cook Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged 18 years and over with learning disabilities 22nd December 2005 Date of last inspection Brief Description of the Service: 3 Gerard Road is a smaller home in a residential area close to the centre of Weston-super-Mare. The resident group is aged between mid-40s and late 60s. Most residents have day care but the home also arranges regular activities, particularly for those who do not want to attend day centres. Each bedroom is single and one is on the ground floor. There is a choice of lounge and dining facilities. The attractive back garden has a patio area with outdoor seating and a raised, sloping lawn area that is accessed by a short flight of steps. Current fee levels are between £824.95 and £996.62. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of two visits to the home, both of which were unannounced. The first visit was during the day, when the inspector spent most of the time talking with the manager and staff, and looking at some of the homes records. The second visit began at 6.30 one evening, and the inspector spent most of the time with residents and with one of the staff on duty. Before and after these visits, the inspector spoke with several residents relatives and some of the health- and social- care professionals who work with them to get their views on the quality of service. Two residents were case-tracked, which included spending time with the person themselves, discussing their care with staff, looking in-depth at the persons care records, medications records, and finances. The inspector saw all the communal areas in the home, and two of the residents showed her their bedrooms. She also looked at a number of records, including: • the homes Statement of Purpose and Service User Guide • some other residents care records • medications • residents work timetables and leisure activities • the staff rota • staff recruitment and training • some of the homes written policies and procedures • records of the homes own health and safety checks. What the service does well: The staff team at 3 Gerard Road is particularly good at adopting an adult-toadult approach to residents, offering them a broad range of meaningful choices, and giving them effective support to take control of their own lives as far as possible. This achievement is even more significant, given the difficulty that many of the residents have in expressing themselves, and their level of dependence. Residents looked very relaxed and interacted easily with staff. Staff spoke about the residents in positive terms, and involved the person themselves as much as possible. There is a strong awareness of how peoples dignity should be promoted. Many of the relatives and health- and social- care professionals the inspector spoke with before and after this inspection visit commented on the unusually good range of activities the home provides. Several people gave examples of 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 6 how this has broadened residents horizons, and greatly improved their quality of life. Residents own records and conversation with staff during this inspection visit reinforced this. Records were succinct but clear and informative. Essential information was easy to access. Many documents have been produced in formats that the residents are likely to understand with support from staff. Staff and visitors to the home felt that the very open, consultative management style of the home creates a pleasant atmosphere. The manager and other staff are seen as approachable and open to discussion. 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. 3 Gerard Road DS0000008084.V337277.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 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents get useful information before deciding to move into the home. The home gathers a good level of information about prospective residents to ensure that it will be able to offer them a suitable service. EVIDENCE: The homes Statement of Purpose was put onto a DVD for the person who moved in most recently. The house manager is currently working on putting the Service Users Guide onto DVD. The hard copy of the Service Users Guide has been updated with new photographs that show the changes to the environment. No new residents have been admitted since the last inspection. Previously admitted residents had informative assessments on their files, and care plans had been based on identified needs. Discussion with staff showed that the team has a lot of knowledge about individual residents needs and how they should be met. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 9 The existing resident group is able to meet prospective residents before they move in. Prospective residents may visit as often as they need to before deciding to move in for a trial period. Residents contracts were in the form of a pictorial agreement, supported by brief and clear written information. 3 Gerard Road DS0000008084.V337277.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, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each persons care needs - and their preferences for how these are met - are thoroughly documented. Protection and freedom are carefully balanced so that residents are safe but not unnecessarily restricted. Residents are given good opportunities to exercise choice. EVIDENCE: Each persons care records are in a clear order so that essential information is easily accessible. A personal profile has been drawn up on each person, which summarizes their needs and what is most important to the person themselves. These include information on their preferred daily routines, what staff can do to enable the person to make decisions for themselves, the persons preferred style of communication, and clear guidelines about how staff can support socially acceptable behaviour. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 11 Each resident has a person-centred plan, which gives clear and useful information on what the person needs from staff. This information is phrased positively to promote a respectful approach. Difficult issues are tackled with honesty and tact. The actions that staff should carry out to meet each identified need are clearly listed. It is clear from reading these documents what is important to the residents themselves. The staff team plan to work on making residents care documents even more accessible to them. There is already written guidance on how residents can be involved in some aspects of the running of the home, but the team plans to look at ways of expanding this further. Risk assessments show how the need for protection has been balanced against the right to freedom, and how each risk can be minimized. Discussion with staff and observation of practice revealed that staff understand the risk assessments and are applying them consistently. Confidential information is kept securely. Staff were careful to discuss confidential issues in private, and their comments to residents were made in a way that promoted the persons dignity. 3 Gerard Road DS0000008084.V337277.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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each person has a wide range of social and vocational opportunities. The home actively supports residents relationships with family and friends. Menus are based on residents preferences and nutritional needs. EVIDENCE: Some of the older residents choose not to attend day centres but staff ensure that each person is offered some sort of interesting activity every day. Residents have regular outings and holidays, either in small groups or one-to3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 13 one with staff. The home has produced a pictorial version of the day centre’s timetable for those people who attend. The staff team has built effective relationships with residents’ families and other significant people. One relative reported that staff regularly take the resident to visit family, and that the family is always made very welcome if they visit the home. Staff tell other carers promptly about anything significant, and are keen to work co-operatively. Relatives and other carers also commented that staff treat residents with warmth and respect. One person commented that the resident always seems very happy at the home. Professional staff commented on how proactive the staff team is with residents: staff work out a timetable that will suit each persons individual tastes. They also felt that the regular one-to-one support opens up good social opportunities for the residents. Part of each persons care plan addresses how they can be involved in the daily life of the home. Each person helps out with some aspect of household chores, and residents are invited to give their views on a variety of subjects. Some effective strategies have been identified for discovering residents opinions. A magnetic board with photographs of residents doing different tasks is used as the household chores rota. Another board with photographs of staff is used as the residents version of the staff rota. Menus are varied, interesting, and well-suited to the needs of this resident group. Residents get a take-away one night a week. Observations and residents financial records showed that people regularly eat out in local cafes or restaurants, often as part of their one-to-one day with staff. 3 Gerard Road DS0000008084.V337277.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, 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Support with personal care is tailored to individual needs and preferences, which are thoroughly documented. Health Action Plans are being introduced, which will further improve how residents health care needs are monitored and met. Staff get clear guidance about how to handle medications, and these are thoroughly recorded and regularly reviewed. Support is promptly adapted to meet residents changing needs. EVIDENCE: Health care is already covered very thoroughly as part of residents’ care plans but two staff are currently doing training in Health Action Planning. Residents care needs will be reassessed when this training has been completed. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 15 Reasons for residents not accessing particular types of health care are clearly documented in their care plans, and these entries are cross-referenced to other documents. Each physical support need is clearly outlined, with a note of the actions needed by staff to meet this need. Residents have routine access to health screening. One persons physical care needs had recently and suddenly changed, and their care records clearly reflected this. Daily notes showed that professional support had been sought promptly and that staff had increased their input. 3 Gerard Road DS0000008084.V337277.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents well-being and rights are well protected. EVIDENCE: No complaints have been received by CSCI or the home. Staff advocate on residents behalf to ensure that their views are taken into account. Staff also consult families in an effort to gauge residents feelings and wishes. Staff told the inspector about the training they receive, and discussion with them showed that they are well aware of residents rights. All staff have had training in safeguarding adults, and this training is repeated every year. Staff the inspector met demonstrated a clear understanding of the potential for abuse and the need to report any concerns. It was evident that the team takes this aspect of their work very seriously and regularly discusses its own practice. 3 Gerard Road DS0000008084.V337277.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, 25, 26, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is decorated, furnished and maintained to a good standard, and is well suited to this resident groups needs and lifestyle. EVIDENCE: Much of the communal areas of the home have been redecorated over the past year or so, and some new furniture has been provided in the hallway. The overall impression is of a pleasant, comfortable and homely place. Residents were evidently very pleased with their bedrooms and seemed to be relaxed in the communal rooms. A lot of work has been done to the garden, which has a newly laid patio with plenty of seating and parasols, a greenhouse, a small pond, and a lawned area reached by a short flight of steps. The garden looks particularly attractive and is now a much safer and more pleasant space for residents. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 18 There is a large lounge at the front of the house with plenty of comfortable seating and a table for meals or activities. The kitchen is also large enough to allow several people to eat their meals in there. There is a quiet lounge at the back of the house, which has comfortable seating and a small dining table. This range of communal rooms allows residents a choice of where they sit to relax or to eat. It also allows people to spend time in smaller groups. All bedrooms are single and at least 10 m squared. The two residents who showed the inspector their bedrooms evidently feel that this is their own space to use as they wish. Staff had helped them to personalise their rooms. The two rooms were very different and reflected the tastes of their occupant. Two bedrooms have been redecorated and recarpeted since the last inspection, and two more are being refurbished in the near future. None of the bedrooms has an ensuite facility. There is a bathroom and separate toilet upstairs and a shower room with toilet downstairs. The upstairs bathroom is being refurbished soon. All areas of the home looked and smelled clean and fresh. 3 Gerard Road DS0000008084.V337277.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, 32, 33, 34, 35, 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff have clear roles and responsibilities. Residents are supported by an effective staff team. They benefit from well supported and supervised staff. EVIDENCE: Staff recruitment practices are thorough, and the required checks are carried out on each person before they start work. The home is planning to look at ways of increasing resident participation in staff selection. Staff have detailed, clear job descriptions and effective guidance about the standards that are expected of them. There are at least two staff on duty throughout the day, often more. One member of staff is on sleeping-in duty at night. Staff training records showed that each staff member has good opportunities to attend relevant training. Most staff had training in safeguarding adults late last year, and the two newer staff members have been booked onto the next course. Training has also been booked to raise staff awareness of the new 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 20 Mental Capacity Act. Recent training includes first aid, manual handling, safe handling of chemicals and risk assessments, food hygiene, fire safety, Makaton, person-centred planning, advocacy, and LDAF (Learning Disabilities Award Framework) foundation courses. One member of staff has NVQ 3, and two other staff are currently doing this qualification. Two staff hold NVQ 2. The recorded dates of staff one-to-one supervision sessions show that staff have this type of support from the manager every four to six weeks. Staff met at this inspection found these formal supervision sessions very useful but also commented that they can discuss issues with the manager any time. 3 Gerard Road DS0000008084.V337277.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, 38, 39, 40, 41, 42, 43 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-run home which puts their interests at the heart of decision-making. EVIDENCE: The manager has been in this post for some years. He is a registered nurse (RMNH), holds the Registered Manager’s Award and is an NVQ Assessor. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 22 Everyone the inspector spoke with described a relaxed and open management style. Peoples views are actively sought and listened to with respect. Many people commented on how approachable the manager is, and it is evident that he inspires confidence in the homes staff team and among the other professionals who have contact with the home. Staff felt encouraged to contribute their ideas to the running of the home. Each staff member has their own delegated area of responsibility, and several people said this gives them room to be creative. Staff also felt well supported, and are actively encouraged to work to the best of their ability. Some creative strategies are in place for enabling residents to have their say in how the home is run, and for ensuring residents know what is happening in their own home. Brandon Trust has its own quality assurance system, and the home draws up a yearly business plan to address areas where it feels improvements could be achieved. The whole team is involved in this exercise, and residents interests are very much at the heart of the process. There is a good range of policies and procedures, which are regularly reviewed and which emphasize residents rights. The ones the inspector sampled were very informative. The inspector looked at one resident’s finances in depth. Very detailed records are kept, and savings are invested in individual residents’ interest-paying accounts. These records reflected the variety of interesting activities that are offered to residents, and indicated that they are supported to spend their money in ways that will enhance their lives. Staff carry out a routine health and safety check of the premises every month. Any problems are recorded, and repairs are requested promptly. All seven of the staff hold a current first aid certificate. The staff team has formal fire instruction once a year, and fire safety is discussed every six months in staff meetings. As the staff also cover night-time duties, they should have fire refresher training every three months. Either a senior manager or the manager of another Brandon Trust home visits unannounced once a month to carry out an audit of the home. A written report is left on site, and a copy is also sent to CSCI. These reports show that the visitor spends time with residents and staff, and checks a range of aspects of the homes running. 3 Gerard Road DS0000008084.V337277.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 4 2 3 3 4 4 3 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 3 3 4 4 3 3 3 3 3 Gerard Road DS0000008084.V337277.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA42 Good Practice Recommendations Staff covering night-time duties should have fire instruction every three months. 3 Gerard Road DS0000008084.V337277.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Taunton Local Office 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 3 Gerard Road DS0000008084.V337277.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!