Inspection on 16/08/05 for 385 Torbay Road

This inspection was carried out on 16th August 2005.

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

The inspector 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

385 Torbay Road 08/05/07

385 Torbay Road 18/10/06

385 Torbay Road 10/01/06

385 Torbay Road 17/02/05

385 Torbay Road 05/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 385 Torbay Road 385 Torbay Road Harrow Middlesex HA2 9QB Lead Inspector Judith Brindle Unannounced 16 August 2005 3.00pm 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. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 385 Torbay Road Address 385 Torbay Road Harrow Middlesex HA2 9QB 020 8868 1025 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) Ms Santa Bapoo Care Home 4 Category(ies) of LD 3, LD(E) 1 registration, with number of places 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Temporary variation agreed for one named individual aged 65 years for the duration of her stay. Date of last inspection 17/2/05 Brief Description of the Service: 385 Torbay Road is a care home providing personal care and accommodation for up to 4 adults with a learning disability. The owner and registered manager is Ms Santa Bapoo. The home opened in 1996. It is located in a quiet residential street in North Harrow. The care home is within a few minutes walk from a variety of shops, restaurants, library, banks and other amenities. Public bus and train facilities are accessible close to the home. The home is a semi-detached house, which is in keeping with other houses in the locality. There is parking for 2-3 cars at the front of the house. All the homes bedrooms are single without en-suite facilities. There is one bedroom on the ground floor. The home has an enclosed accessible maintained garden. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of 385 Torbay Road care home took place during 3.15 hours in the afternoon, and evening of a day in August 2005. There was one vacancy at the time of the inspection. A tour of the premises took place. A variety of records including care records, and some policies and procedures were among a variety of records inspected. The inspector was pleased to meet, and talk to all the residents, and staff on duty, during the inspection. There was a Gujerathi speaking interpreter present for part of the inspection to assist the inspector with communication with the residents who spoke little English. The inspector also observed interaction between staff and residents, and interaction between residents during the inspection. The registered manager was not on duty in the care home during the unannounced inspection, but did spend half an hour talking with the inspector towards the end of the inspection. The shift leader who was on duty kindly accessed documentation, and information requested by the inspector during the inspection. A requirement from a previous inspection was met. Key National Minimum Standards for Adults were inspected. What the service does well: What has improved since the last inspection? The home has continued to provide a quality service. Recruitment of staff has led to a consistent staff team. The registered manager has completed NVQ level 4 in management. Staff have reviewed and developed documentation including care records and some policies/procedures. Most communal areas of the care home have been redecorated. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 6 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. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Arrangements are in place to ensure that all residents have their needs assessed prior to moving into the care home, and during the trial period to ensure that the service can meet prospective resident’s needs. EVIDENCE: There have been no new admissions to the home since 1996. The home has an admission policy. The admission criteria for the home are recorded in the statement of purpose. The admission process includes a referral and social service assessment summary from the local authority social services. There are systems in place for assessment of prospective resident’s needs by the provider. There has been a resident vacancy within the care home for sometime. The registered manager spoke and gave examples of the importance of assessment of prospective residents and ensuring that they are compatible with the residents living in the care home. The three care plans that were inspected recorded evidence of assessment of individual service users needs, social, health, welfare and spiritual needs. Records and staff confirmed that the assessment process and assessment review continues during prospective service users’ visits to the home, prior to admission, and following their admission. The service user plans that were inspected recorded evidence of having been reviewed. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and 9 Arrangements are in place to ensure that residents’ individual needs are identified, recorded, and reviewed. Arrangements are in place to ensure that staff respect residents’ right to make decisions. Residents are supported to take risks as part of encouraging an independent as possible lifestyle. EVIDENCE: All the residents have an individual care plan. The three care plans were inspected. These care plans contained assessment information and documentation. Individual resident’s goals and action plans to meet these goals were recorded. Resident’s individual profiles were recorded. Records confirmed that residents are involved in their care plans. A resident who kindly spoke with the inspector had an awareness of her care plan. These care plans recorded evidence of having been regularly comprehensively reviewed. The registered manager informed the inspector that she was in the process of organising a multidisciplinary, (and resident and family) review meeting in regard to the review of a resident’s care plan. A resident kindly informed the inspector of whom their key worker was, and was positive in regard to the support that she received from the key worker. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 10 Staff were observed to encourage residents to make choices. A resident informed the inspector of the variety of choices that she made. These included choosing her clothes, and the activities that she wished to participate in. During the inspection residents made the decision as to what to have for supper. The registered manager informed the inspector that she was supporting a resident to obtain an advocate. Information in regard to service users finances is recorded in their care plans. The home has a policy in regard to the management of resident’s money, and financial affairs. Records of the three resident’s income and expenditure were inspected. These were up to date, and the balance of a resident’s money confirmed that the records were accurate. A resident reported that she has knowledge, and understanding of her finances, and had access to her money. Records confirmed that residents had a financial risk assessment. The home has a missing persons’ policy, and a risk assessment policy. The three care plans inspected recorded evidence of risk assessment, which included finance, public transport, medication, and community access. Risk assessments included house safety assessments, such as using the cooker, and knives, swimming, and accessing public transport. There were also individual key risk assessments. These risk assessments showed evidence of having been reviewed. Records informed the inspector that there was staff guidance in regard to staff action to meet resident’s needs that might challenge the service. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 11 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 16 and 17 Arrangements are in place to ensure that residents have the opportunity to participate in a variety of leisure activities, which include accessing community, based facilities. Residents are supported in maintaining, and developing contact with family and friends. Meals provided for residents are varied and wholesome, and meet their cultural needs. EVIDENCE: Residents kindly informed the inspector of the variety of activities, and leisure pursuits that they participated in. These included activities within the day resource centres that they attend. Some activities include educational and training activities, which include computer skills. A resident spoke positively of developing her skills. One resident kindly informed the inspector of two part time jobs that she had recently obtained. These involved attending an interview. From speaking with the resident it was evident that she had gained confidence from developing a variety of skills. Residents all confirmed that staff were supportive and had an understanding of their needs. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 12 Residents informed the inspector of the community activities that they participated in. These included going to the cinema to watch Asian films, shopping, and eating in restaurants. A resident said that she particularly enjoyed regularly food shopping with the registered manager. Other activities included listening to music, sewing, and attending places of worship. Staff and records informed the inspector that staff were flexibly provided to meet residents needs, such as when going on an outing. Residents, and staff spoke of plans being in progress in regard to a holiday for the residents. The care home has a visitors’ policy/procedure. Records confirmed that visiting times were flexible. The care home has a visitor’s recording book. It is recommended that visitors be reminded to record their visit. The last record of a visitor to the home was 19/5/05, when other records confirmed that there had been visitors to the care home more recently. Residents, staff and records confirmed that residents maintained links with family/friends and significant others. A resident spoke of two family gatherings that she had recently attended. There is a telephone within the care home that resident’s spoke of using. Records and residents informed the inspector that family members sometimes attend care plan review meetings. Residents were observed to move freely within the care home. Staff were observed to interact in a positive, and respectful manner with service users. Staff were observed to interact with service users, and not exclusively with each other. The home has a smoking and alcohol policy. Residents informed the inspector of the various daily household duties that they participated in. These included tidying their bedrooms, and helping with cooking. Residents were observed to participate in the planning of their meals. Meals eaten were recorded. The residents confirmed that meals provided meet their cultural needs, and preferences. A variety of dried, fresh and frozen foods were stored. All the residents informed the inspector that they enjoyed the meals provided. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 13 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) 18,19, and 20 Resident’s choice in regard to the provision of personal support is respected. Arrangements are in place to assess and meet the personal care, and the individual health and welfare needs of residents. Medication is stored and administered safely. EVIDENCE: The three care plans inspected recorded evidence that residents’ were supported by staff to access healthcare services, which include specialist services. These include dental services, optician services, chiropody services, specialist healthcare services, and psychiatric services. Residents spoke of attending healthcare appointments. Records confirmed that all the residents are registered with a GP. The registered manager spoke of having regular contact with the local authority learning disability team. Residents have a routine during the week of attending their resource centres, and other planned activities, so need to get up fairly early, but a resident confirmed that at weekends there is flexibility and choice in regard to when residents choose to get up. The care home has a medication policy, which has recently been reviewed. Medication was stored securely and records confirmed that the medication was administered appropriately. The pharmacist dispenses medication into dossette medication containers. A staff member spoke of medication training that she had received. The registered manager and records informed the inspector of planned medication training for staff, and that all medication is 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 14 checked by staff when received from the pharmacist. This was confirmed during the inspection. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 15 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 and 23 Arrangements are in place for handling complaints objectively. There is awareness among residents of how to complain and confidence that a complaint would be listened too. Arrangements are in place in regard to policies and procedures to ensure appropriate response by staff to any suspicion of abuse. EVIDENCE: The care home has a complaints policy/procedure. The home has appropriate recording systems in place in regard to recording complaints. There were no complaints recorded. Residents who kindly spoke with the inspector had an understanding of how to make a complaint and spoke of confidence that a ‘concern’/complaint would be taken seriously. The care home has appropriate policies and procedures in regard to responding to any suspicion or allegation of abuse. There is an accessible recorded whistle blowing and a counter bullying policy. The registered manager/proprietor informed the inspector that staff had received abuse awareness training. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 16 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 and 30 Arrangements are in place to ensure that the care home is well maintained. The residents are provided with clean and comfortable surroundings. EVIDENCE: The home is a semi- detached house located in a quiet residential street in Rayners Lane, North Harrow. The home is in keeping with the other houses in the area. The home is close to a variety of amenities that include shops, restaurants, cafes and banks. Local transport facilities that include train and bus services are within a few minutes walk from the home. A tour of the premises took place. The home is furnished in a homely manner, with quality furniture and fittings, and was very clean, and free from offensive odours at the time of the inspection. The home had been redecorated in some communal areas since the last inspection. The care home has a well maintained enclosed garden. The residents are provided with clean and comfortable surroundings. Laundry facilities, which include a washing machine and electric clothes dryer, are located away from the food preparation areas. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 and 35 The home has appropriate staff recruitment policies and procedures. There needs to be some action taken by the registered person to ensure that residents are not at risk from newly employed staff. Staff receive appropriate training to be able to meet residents’ assessed needs, which include changing needs. EVIDENCE: The care home has a staff recruitment policy/procedure. This includes the need for required disclosure checks. The staff personnel documentation of two recently employed staff were inspected. One file included a Criminal Records Bureau check completed during the recruitment process. The other staff member had a Criminal Records Bureau check that had been completed during their previous employment. Individuals working in the care sector who work with vulnerable adults need to obtain a new protection of vulnerable adults check. This is performed by having a new disclosure being processed. This was discussed with the registered manager. Both staff files contained required information and documentation. Records and staff confirmed that staff receive appropriate training. This includes ‘in house’ training using videos and questionnaires. This includes COSHH, manual handling training, and health and safety training. Records informed the inspector that a new staff member had completed an induction programme. The registered manager, and records informed the inspector that 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 18 most staff were in the process of completing LDAF (Learning Disability Award Framework) accredited training. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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) 37, 39 and 42 Resident’s benefit from a well run home. Some quality assurance monitoring systems need further development to ensure that there are effective systems in place to monitor the quality of the service, and to continue to improve the service for residents. Arrangements are in place to ensure that the welfare, and health and safety needs of residents, staff and others are met by the service. EVIDENCE: The registered manager/provider has worked with adults with learning disabilities for several years. She is also a trained nurse, and has managed the home for many years. The registered manager informed the inspector that she had recently completed NVQ level 4 in management. She reported that this had assisted her in making improvements to the service. The registered manager develops her skills, she spoke of appropriate training in regard to the service that she was presently undertaking. The care home has comprehensive quality assurance systems in place, but these processes and documentation need to be actioned and recorded by the registered person. There needs to be a recorded annual development plan. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 20 The registered manager spoke of being in the process of collating questionnaire information about the service that had recently been received. There was some recorded evidence that systems in regard to the service were being monitored. These included regular maintenance and environmental checks and of care plans being reviewed. All opened foods stored in the fridge need to be dated as to when the packaging was opened and/or when the food was stored. This was discussed with the shift leader. The light fitting located in the upstairs bathroom needs to have an appropriate cover or be replaced, to ensure that there is no risk to residents, visitors, and staff. Fridge and freezer temperatures, and also hot water temperatures were monitored. Certificates of worthiness in regard to electrical checks were up to date. Records informed the inspector that required fire safety checks are carried out. The employers liability insurance certificate was displayed and expires 21/1/06 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 385 Torbay Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 22 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 34 Regulation 13(6) Requirement There needs to be a new protection of vulnerable adults check (CRB/POVA) for a recently employed staff member. There needs to be a recorded annual development plan. All opened foods stored in the fridge need to be dated as to when the packaging was opened and/or when the food was stored. The electric light fitting in the upstairs bathroom needs to be appropriately covered or replaced. Timescale for action 1/10/05 2. 3. 39 42 24(2) 13(4) 1/11/05 1/9/05 4. 42 13(4) 1/11/05 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. 2. Refer to Standard 15 Good Practice Recommendations It is recommended that visitors are reminded to record their visit. 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 4TH Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 385 Torbay Road G62-G11 S17564 385 Torbay Rd v234222 160805 Stage 4.doc Version 1.40 Page 24 - 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!