Inspection on 30/10/06 for 8 Piggy Lane

This inspection was carried out on 30th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

8 Piggy Lane 23/05/07

8 Piggy Lane 14/02/06

8 Piggy Lane 13/12/05

8 Piggy Lane 11/01/05

8 Piggy Lane 06/08/04

8 Piggy Lane 17/03/04

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

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

CARE HOME ADULTS 18-65 8 Piggy Lane Bicester Oxfordshire OX26 7HT Lead Inspector Kate Harrison Unannounced Inspection 30th October 2006 09:00 8 Piggy Lane DS0000013125.V318216.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 8 Piggy Lane DS0000013125.V318216.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. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Piggy Lane Address Bicester Oxfordshire OX26 7HT 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) 01869 249533 jacki.berry@oldt.nhs.uk Oxfordshire Learning Disability NHS Trust Ms Jacqueline Berry Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5), Physical disability (5), of places Physical disability over 65 years of age (5) 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 5 14th February 2006 Date of last inspection Brief Description of the Service: 8 Piggy Lane is a modern bungalow that is part of a purpose built complex situated close to local amenities in Bicester, North Oxfordshire. A housing association owns the property and the Oxfordshire Learning Disability NHS Trust manages the home. The Trust plans to change its name to Ridgeway Partnership NHS Trust soon. The home is registered for five people with learning and physical disabilities, and a staff team, led by the nurse team leader, provides 24-hour support. The fees are £308 per week. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 9am and was in the service for 5½ hours. The inspection was a thorough look at how well the service is doing. It took into account detailed written information provided by the home’s manager, and any information that the CSCI has received about the home since the last inspection. The registered manager (team leader) and the assistant team leader were both away from the home on the day of the inspection visit and the inspector discussed issues with other managers available on the site, and with the care staff available in the home. Access to information was not readily available as the team leader works part time and the assistant team leader was not at the home. The inspector talked to the residents seen during the inspection and two relatives responded to questionnaires that the Commission had sent out, as did one general practitioner from the surgery where all the residents are registered. The inspector looked at how well the home was meeting the standards set by the government and has, in this report, made judgements about the standard of the service. From the evidence seen the inspector considers that this home would be able to provide a service to meet the needs of individuals of different religious, racial or cultural backgrounds, because the residents’ views are considered to be central to the care provided at the home. However, this report shows that the Trust has not responded appropriately to the disability needs of some individuals on the grounds of cost, and so it is not certain that equality and diversity issues are well managed. The NHS Trust providing the service is moving towards a different model of supporting the residents, so that the residents have more control over their affairs. In the meantime the home is still subject to the Care Homes Regulations, and needs to be managed according to the legislation. This report finds that the Trust is not meeting the regulation, and makes four requirements that need to be met, and several recommendations for good practice. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The residents’ lifestyle plans should be reviewed every six months. The complaints procedure needs to include the Commission’s address and telephone number. The broken furniture in one bedroom needs to be mended or replaced. The corridor carpet looked shabby and has not been shampooed for several months, and this needs to be carried out regularly. All complaints, whether verbal or written, need to be recorded, and the manager needs to make sure that those relatives and other representatives of the residents’ are aware of the home’s complaints procedure. An annual quality review of the service needs to be arranged, to include the views of relatives, residents and other interested people, so that the home can learn what needs to be done to improve the home. The Trust needs to provide a better bedroom for one particular resident, so that the health and safety risks to the resident and the staff members are taken into account. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 7 The Trust needs to provide, in rooms occupied by residents, adequate furniture, bedding and other furnishings, including curtains and floor coverings and equipment suitable to the needs of the residents. The Trust should consider how the costs incurred to residents who have been required to buy bedroom furniture and flooring can be reimbursed. A named responsible person should be in charge of the home when neither the manager nor the assistant team leader is available. 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. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 8 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 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four of the residents have been at the home for a long time, and one new resident was admitted several months ago. The resident actively chose the home when the previous arrangements were no longer possible, and visited several times before moving in. The resident is encouraged to help in developing the individual lifestyle plans, and the process is expected to be complete in the near future. 8 Piggy Lane DS0000013125.V318216.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The essential lifestyle plans of two residents were seen. Both contained personal information on individual choices made by the residents, as well as information for staff on how best to meet the needs of the individuals. Guidance was included for staff members on interpreting the communication methods of all the residents, so that all staff members have a shared understanding for each resident. Risk assessments are conducted where necessary on topics affecting the residents, such as outings and activities. Although the daily record shows changes in needs, both the plans were last reviewed in December 2005 and should be reviewed every six months. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ individual plans show that what is most important to them is respected. This includes their relationships with the most important people in their lives and their favourite activities. It also includes what traits their carers should foster in themselves so that they are able to best meet the needs of the individual residents. Some residents enjoy trips out with friends and family, and others go out as part of their day, with a carer. On the day of the inspection visit one resident was at a day centre, and was able to independently decide how to spend the rest of the week. One resident had recently returned from a holiday, and had brought back souvenirs. Staff members prepare meals, and a record is kept of the menus. Residents’ nutritional needs have been assessed since the last inspection visit. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 12 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ essential lifestyle plans show attention to the detail of how the residents want to be treated in matters of personal care. All but one of the residents have been at the home for several years, and staff members have an understanding of each resident’s needs, supported by documentation. All the residents are registered with a local GP practice, and the records show that full medical checkups are organised appropriately. Medication is supplied by a local pharmacy, and residents’ medication is appropriately recorded and administered. One doctor from the GP practice used by the home replied to the CSCI comment card, and had no concerns about health issues at the home. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 13 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 and 23. Quality in this outcome area is poor. Staff members are unaware of the recording procedures, concerns are not effectively communicated or addressed and the regulation about the Commission’s details is not met. Relatives are not aware of the home’s complaints procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is displayed in the hallway and gives information about how to complain and to whom in the organization to address any complaints to. By regulation the procedure must include the Commission’s address and telephone number, and the procedure must be amended to include these details, so that relatives and representatives know how to refer a complaint outside the home. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection, and both the relatives who replied to the Commission’s comment cards said that they were not aware of the home’s complaint procedure. The registered manager should make sure that relatives and representatives are aware of the home’s complaints procedure. Staff members are experienced in understanding the residents’ needs, and have a history of acting on their behalf when necessary. One relative, through the Commission’s comment cards, said that he/she had asked repeatedly for a change of wheelchair for the resident, and this has not been addressed appropriately. The registered manager was not aware of the request, and this may be due to lack of communication between shifts. The registered manager 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 14 should address the communication difficulties between shifts, address the concern of the relative and refer to the appropriate authorities for help if necessary. Staff members were not aware of a record of complaints being kept at the home, and the registered manager should make sure that all staff are aware that all complaints, verbal and written, should be recorded. The home’s policy on safeguarding vulnerable adults was reviewed recently, and all members of staff have had training on how to protect vulnerable adults. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 15 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, 26 and 30. Quality in this outcome area is poor. The Trust is not addressing the accommodation needs of one of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well situated so that residents are able to access local facilities easily. It is part of a complex including another home and office facilities. The garden has been adapted to meet the special needs of one resident and has space and equipment to suit the other residents. All the facilities are on the ground floor. The living/dining area is bright and clean, and the sensory room is used regularly. The inspector saw some residents’ rooms, with the resident’s permission, and saw all the communal areas of the home. Some of the bedrooms are decorated to the residents’ wishes, but one bedroom was sparsely furnished. The inspector was told that the resident could not afford more furniture as the resident had to buy a new adjustable bed recently. The linen basket in the bedroom was broken and knobs were missing from the drawers, and the registered manager should take effective action to address these issues. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 16 Several residents have been required by the Trust to buy their adjustable beds and, in one instance, one resident has had to fund the new flooring required in the bedroom. The Trust must provide in rooms occupied by residents, adequate furniture, bedding and other furnishings, including curtains and floor coverings and equipment suitable to the needs of residents. The Trust should consider how the costs incurred to residents who have been required to buy bedroom furniture and flooring can be reimbursed. A recommendation was made at the inspection visit on 13th December 2005 that the manager should assess whether the size of the one bedroom meets the individual resident’s needs. This report will refer to that resident as Resident A. In July 2006 Resident A’s physiotherapist wrote a letter to the manager stating that the small size of the room presented health and safety risks for the resident and for the staff members, and the inspector understood that the manager informed the Trust. The inspector understands that the manager has not been allocated any funds to address this issue, and does not expect any. The Trust must ensure that the size and layout of Resident A’s bedroom is suitable for his/her needs, and that the bedroom provides a safe environment. The maintenance of the home is shared between the home’s staff and the Housing Association who owns the building. The Housing Association is responsible for service contracts for gas and electricity, and these have been carried out recently. The corridor carpet looked shabby and had not been shampooed for several months, and the registered manager should arrange for this to be carried out regularly. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. As the registered manager works part time, she should designate an appropriate person to be in charge when neither she nor the assistant team leader is available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The part time registered manager has gained NVQ Level 4 in Management and manages the home with the help of the full time assistant team leader. Although only four of the thirteen care staff members have achieved NVQ Level 2, five more are in the process of taking the course and, when they complete, the home will meet the national minimum standard of 50 trained staff. On the day of the inspection visit, staff were not clear who was in charge of the home, and the registered manager should designate an appropriate person, with NVQ Level 2 if possible, to be in charge when neither herself nor the assistant team leader are available. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 18 Staff members were seen to be interacting well with the residents, and it was clear that the residents trusted and liked the staff on duty. The comment cards received said that there were always sufficient numbers of staff on duty and on the day of the inspection visit staff on duty were able to manage the residents’ needs. Three staff files were seen to check the home’s recruitment policy. Recruitment is managed from the human resources department away from the home, and some information such as criminal record bureau clearances, proof of identity and photographs are also held there. Each staff file contained confirmation that the information was available, and other information such as application forms and references were seen on file. The annual staff training on moving and handling residents was overdue at the time of the inspection visit, due to the lack of a trainer. The manager has confirmed that the training has since taken place. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Quality in this outcome area is poor. Annual quality monitoring is not carried out, safety training for staff is not arranged in a timely way, and residents’ personal information has not been stored securely. The Trust has been informed of the risks to the health and safety of a resident and staff members and has not effectively addressed the issue. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The part time registered manager is a registered nurse, has gained NVQ Level 4 in Management and manages the home with the help of the full time deputy. Residents’ files containing sensitive personal information were kept in an unlocked cupboard in the dining room, and these were removed to a locked location during the inspection visit. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 20 There is no formal annual quality assurance system in place. Monthly quality monitoring visits by a senior member of the Trust have not been happening for some time and are expected to restart this month. The registered manager must arrange for annual quality reviews of the service, to include the views of stakeholders, to be undertaken. The Trust has a health and safety policy but has not effectively responded to written concerns about the health and safety risks to one resident due to the small size of the bedroom. Although the Trust provides equipment for staff to safely carry out their caring tasks, it is not clear that training for staff is organised in a timely way, such as the moving and handling of residents, as this mandatory training was overdue. 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 X 3 X 2 X 2 1 X 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 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 YA22 Regulation 22 Requirement The home’s complaints procedure must be amended to include the Commission’s address and telephone number. The registered manager must arrange for an annual quality review of the service, to include the views of stakeholders, to be undertaken. The Trust must ensure that the size and layout of Resident A’s bedroom are suitable for his/her needs and that the bedroom provides a safe environment. The Trust must provide in rooms occupied by residents, adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of residents. Timescale for action 30/11/06 2 YA39 24 31/01/07 3 YA24 23 31/01/07 4 YA26 16 31/01/07 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 23 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 YA6 YA26 Good Practice Recommendations The essential lifestyle plans should be reviewed every six months. The Trust should consider how the costs incurred by residents who have been required to buy bedroom furniture and flooring can be reimbursed. The registered manager should take effective action to either replace or mend the broken furniture in a resident’s room. The registered manager should arrange for the corridor carpet to be shampooed regularly. The registered manager should address the complaint mentioned in the report, and refer to the appropriate authorities for help if necessary. The registered manager should make sure that all staff are aware that all complaints, verbal and written, should be recorded. The registered manager should make sure that relatives and representatives are aware of the home’s complaints procedure. The registered manager should designate an appropriate person to be in charge when neither she nor the assistant team leader is available. The registered manager should address the communication difficulties between shifts. 3 YA26 4 5 YA24 YA22 6 YA22 7 YA22 8 YA32 9 YA32 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 8 Piggy Lane DS0000013125.V318216.R01.S.doc Version 5.2 Page 25 - 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!