Inspection on 21/04/05 for 807 Pershore Road

This inspection was carried out on 21st April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

807 Pershore Road 19/05/08

807 Pershore Road 21/06/07

807 Pershore Road 04/10/05

807 Pershore Road 07/12/04

807 Pershore Road 14/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Pershore Road, 807 Selly Park Birmingham West Midlands B29 7LR Lead Inspector Brenda ONeill Unannounced 21st April 2005 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. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Pershore Road Address 807 Pershore Road Selly Park Birmingham B29 7LR 0121 415 5684 0121 415 5684 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) Mind in Birmingham vacant Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65. 2. Two named people, who are over sixty five years of age can be accommodated and cared for in this Home. Date of last inspection 07/12/04 Brief Description of the Service: 807 Pershore Road is a large detached double fronted three storey, Victorian style property in Selly Park. The home is well placed in terms of access to the local community, being close to a number of shops, pubs, park, Stirchley village and local bus and rail services. The front of the house has a well-maintained walled garden, which provides parking for some cars, the rear garden is large and very private and is utilised by residents in the summer. The decor of the home is of a good standard, and the house feels spacious and homely, it appears to be a well established home with a clear philosophy of care that clearly suits the service user group. The home provides care and support for up to ten people with mental health needs and describes itself as a rehabilitation unit. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over five hours on April 21st 2005. This was the first of the statutory inspections for this home for 2005/2006. During this visit a tour of the premises was made, however not all the bedrooms were inspected, two residents files and other documentation was sampled. Six of the ten residents were spoken to and they were all happy with the service they were receiving. All the care and management staff that were on duty at the time were also spoken to. What the service does well: All the residents spoken with were very positive about their relationships with staff and friendly interactions were seen throughout the inspection. Involving residents in deciding how their care needs were to be met was of high importance in this home and residents had been involved in drawing up their own care plans and risk assessments. The inspector saw residents making a variety of choices for example, coming and going from the home, whether they cooked for themselves, where they spent their time and managing their own finances. Residents living at the home were encouraged to develop and maintain independent living skills such as laundry, cooking, travelling on public transport. All residents had keys to the home and their bedrooms. The home generally had a very ‘easy going’ atmosphere that appeared to make the residents comfortable. Staff had a very good understanding of the needs of the residents and made sure their health care was taken care of. There were good systems in place to ensure residents received the right medication at the right time. The staffing levels appeared to meet the needs of the residents. Staff turnover at the home remained quite low which was very good for continuity of care. The management of the home was good and it appeared to run smoothly. Any complaints raised by the residents were taken seriously by staff and addressed. Residents commented that the home was comfortable and that they were happy with their rooms. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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 Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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) 2,3 and 4 The arrangements for the assessments of prospective residents were good and took into account the individual’s aims and aspirations and the home meets the needs of the residents. Staff had a very good knowledge of the residents needs prior to admission ensuring that their needs are known and met. EVIDENCE: There had been no new residents admitted to the home since the last inspection therefore the initial assessment process was not inspected. The inspector was aware from the previous inspection that prior to admission to Pershore Road a thorough assessment of prospective residents’ needs took place that involved a variety of professionals. There was evidence on the residents’ files sampled of visits to the home prior to admission. As a minimum prospective residents had at least one overnight stay before making a decision whether to move there or not. One of the residents commented on how his life had improved since moving to the home and how he was encouraged by staff to maintain and improve his life skills. Throughout discussions with staff it was evident they were very knowledgeable about the needs of the residents and the areas where they required support. The residents support needs were very clearly detailed in their care plans which included their aims and goals and also a section entitled ‘what others need to know to support me’. Staff were able to tell the inspector about the input the residents received when their mental health was causing concern, Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 9 which involved psychologists, social workers and psychiatrists. Other individual needs cited to the inspector included foot care and monitoring of diabetes. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9. There was a good system in place for care planning and assessing risks that involved consultation with the residents however the system for reviewing care plans needed to be consistent. Residents made decisions about their everyday lives wherever possible. EVIDENCE: Two residents’ files were sampled during this inspection. Both included very detailed care plans which had been drawn up in consultation with the individual residents. The care plans included the aims/goals of the individual, their needs and also any concerns they had. There was also a separate section that included all the details that support staff needed to know to enable them to care appropriately for each resident. This was an improvement since the last inspection as at that time one of the care plans had little detail of the support being offered to the resident as he had not wanted to contribute fully. All the residents had key workers and they were able identify who they were. Part of care planning process was that a monthly evaluation of the care plan was carried out by the key worker in consultation with the resident as well as a formal review every six months. One of the files sampled did not have any evaluations since December 2004 and no documented review within the last six months. It was important to ensure that reviews were carried out and Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 11 documented to ensure the individual’s current needs were reflected in the care plan. Observations made during the course of the inspection evidenced that residents were able to make decisions as far as possible, for example, coming and going from the home, whether they cooked for themselves, where they spent their time and managing their own finances. The two files sampled included several risk assessments that had been written from the service users perspective and the actions to be taken had been agreed with them. There were risk assessments for such things as, suicide, self-neglect, aggression and medication. These were being reviewed on a regular basis. It was recommended that there were read and sign sheets attached to risk assessments indicating that staff had read and agreed to follow risk assessments. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 15 and 16. Residents had the opportunity to develop and maintain life skills both within and outside the home and contact with family and friends was encouraged. Staff had a very good understanding of the residents support needs and this was evident from the friendly relationships and the comments from residents. EVIDENCE: Observations made and discussions with residents evidenced that they were able to develop and maintain independent living skills and that personal development was encouraged. Residents were being supported by staff to do their own laundry, keep their rooms clean, ensure personal hygiene was maintained and cook their own meals. There were opportunities in the home for residents, who were able with support from staff, to self cater managing their own budget using the facilities provided in the home. All the residents were able to go out independently, some were able to travel on public transport unsupported at all times others needed support from staff on some occasions. Residents spoke to the inspector about going to structured external placements such as colleges, gardening projects and drop in centres. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 13 One of the residents informed the inspector that he continued to go church every week and preferred to go by taxi. Several of the residents were also attending a ‘Sunday club’ which they seemed to enjoy. At the time of the inspection discussions were taking place with the residents about their choice of holiday for this year and this was evidenced in the minutes of the last residents meeting. The bedrooms seen during the inspection evidenced their choices for leisure whilst in the home, for example, music systems, musical instruments and computers. The staff at the home were very proactive in encouraging and maintaining family contact wherever possible for the residents. The residents spoke about visiting their family members and about family members and friends being able to visit the home. The only routines in place at the home were the ones agreed with the residents and detailed on their weekly planners or in care plans. All residents had keys to the door of the home as well as their bedrooms and were seen to come and go as they pleased throughout the inspection. Residents were positive in their comments about staff and friendly relationships were evident. The residents also commented that despite the vast age range of the resident group and the differing personalities they all got on quite well. The home generally had a very ‘easy going’ atmosphere that appeared to make the residents comfortable. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, and 20. Staff had a very good understanding of the resident’s support needs and ensured that personal and health care needs were met whilst maximising the resident’s independence and control over their lives. The medication system was well managed ensuring residents receive their prescribed medication appropriately. EVIDENCE: Residents at the home were independent in terms of personal care and only needed prompting from staff. As at the last inspection there was only one female resident at the home. She assured the inspector she did not feel isolated as she had very good relationships with the female staff at the home and also had the opportunity to mix with women outside the home. The appearances of the residents appropriately reflected their different personalities and age groups. There was clear evidence on resident’s files that they were supported where necessary to attend health care appointments. One of the residents confirmed he received visits from the district nurses to administer his insulin twice daily and that they monitored his blood sugar levels. One of the residents discussed with the inspector how staff were supporting him to try and lose some weight and improve his fitness as his weight gain had been of some concern. There was evidence on individual files of the appropriate input from mental health Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 15 care professionals including psychologists, community psychiatric nurses and psychiatrists. During the inspection staff demonstrated how they were supporting a resident who was unwell due to his mental health. Residents were encouraged to self-administer their medication wherever possible and all had lockable facilities in their bedrooms. The medication system in the home was well managed with evidence of the required checks and risk assessments being in place. The manager needed to ensure that copies were kept of any prescriptions in case of any queries. All staff who were handling medication had had accredited training. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The home had a robust system for complaints that evidenced any complaints received were taken seriously and acted upon. EVIDENCE: The home had a robust complaints procedure which had been amended to ensure it made it clear to complainants that they could go directly to the CSCI with a complaint and did not have to refer to the home or organisation first. There was a record kept of any complaints received in the home and of the investigation and any outcomes. No complaints had been lodged with the CSCI in relation to the home. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28 and 30. The home was comfortable, generally well maintained and met the needs of the residents however it could be further improved with some replacement furnishings to the communal areas and a new kitchen. EVIDENCE: There had been no changes to the layout of the home since the last inspection which was suitable for its stated purpose. There was ample communal space for all residents with designated dining and smoking areas. The redecoration of the dining room and replacement furniture in the lounges remained outstanding from the last inspection. The kitchen and laundry were domestic in size and accessible to residents. Four bedrooms were viewed during the inspection and the occupants were satisfied that they met their needs. There was evidence on the residents’ files that the furnishings and fittings in the bedrooms had been discussed with them. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 18 There were adequate toilets and bathrooms, no more than three residents shared each bathroom and toilet. It is an outstanding recommendation that a shower be installed on the top floor of the home to offer choice to the residents. The home was clean and odour free with the laundry being appropriately located. The COSHH substances that were stored in the laundry were not being stored securely and presented a risk for residents. The main kitchen, which was used by the residents, was in need of refurbishment, many of the units were worn and the grouting between the tiles needed attention and was not conducive to good infection control. It was also noted by the inspector that there opened foods in the fridge that had not been dated on opening and posed a risk as a source of infection. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Appropriate staffing levels were being maintained to meet residents needs. Staff demonstrated a very clear understanding of the needs of the residents which contributed to ensuring that residents receive appropriate support and assistance. EVIDENCE: Throughout the inspection staff demonstrated a very clear understanding of the needs of the residents and the support they needed. There were very positive interactions between staff and residents and without exception the resident’s comments about staff were very positive. The staffing levels appeared to meet the needs of the residents. Staff turnover at the home remained relatively low, which was very good for the continuity of care. There were two support worker vacancies these had been frozen pending the closure of another home however they were being covered by agency and bank staff. The home also employed a cook and domestic assistant. Recruitment procedures and training were not inspected during this visit therefore the requirements made following the last inspection have been brought forward to this report. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 and 42. The home was well managed with an open and inclusive atmosphere where the health and safety of the staff and residents were promoted and protected. EVIDENCE: The registered manager had left since the last inspection however another of the organisation’s managers was managing the home. During discussion it was evident he was very experienced in the running of a care home and had a lot of experience caring for people with mental health needs. Relationships between him, staff and residents appeared to be good. Residents expressed the view that they would not hesitate to approach the manager or any of the other staff with any issues that arose and seemed confident that these would be resolved. Regular residents meetings took place where a variety of topics were discussed. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 21 Health and safety at the home were well managed. There was evidence on site of the servicing of all equipment and fire training for staff was up to date. The issues that arose during this inspection were relatively minor. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 3 x 2 Standard No Pershore Road, 807 Standard No 31 32 Score x x Version 1.20 Page 22 X00023.Pershore Road 807.UI.280405.stage 4.doc 11 12 13 14 15 16 17 3 3 x x 3 3 x 33 34 35 36 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 x x x 2 x Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 17(2) schedule 1 Requirement The manager must ensure all the information detailed in schedule 1 of the care homes regulations is included in the statement of purpose. (Previous time scale of 01/02/05 not assessed for complaince.) Care plans must be reviewed at least six monthly and updated as necessary. Copies of all prescriptions must be kept. The dining room is in need of decoration. (Previous time scale of 01/03/05 not met.) The furniture in the lounges must be replaced. (Previous time scale of 01/02/05 not met.) The main kitchen must be refurbished. (Previous time scale of 01/04/05 not met.) All opened foods in fridges must be dated when opened. All COSHH substances must be locked away when not in use. 50 of care staff mus be qualified to NVQ level 2 or equivalent by 2005. (Not assessed for complaince at this inspection.) The registered person must Timescale for action 01/06/05 2. 3. 4. 5. 6. 7. 8. 9. 6 20 24 24 30 30 30 32 15(2)(b) (c) 13(2) 23(2)(d) 16(2)(c) 23(2)(b) 13(3) 13(3) 13(3) 18(1)(a) 01/06/05 22/04/05 01/07/05 01/07/05 01/06/05 22/04/05 22/04/05 December 2005 10. 34 19(1)(a) 01/06/05 Page 24 Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 schedule 2 11. 35 18(1)(a) 12. 37 8(1)(a)(b) ensure that all documenation in relation to staff as detailed in schedule 2 of the Care Homes regulations is available for inspection. (Previous time scale of 01/02/05 not assessed for complaince.) The manager must ensure that records are maintained of the induction training undertaken by staff. (Previous time scale of 01/02/05 not assessed for complaince.) An appliaction for registration of the manager must be forwarded to the CSCI. 01/06/05 01/07/05 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 9 27 Good Practice Recommendations It is recommended that there were read and sign sheets attached to risk assessments indicating that staff had read and agreed to follow risk assessments. The home should consider installing a second shower on the top floor of the building to provide residents on that floor with a choice in terms of bathing facilities. Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Ladywood House 45-46 Stepehnson Street. Birmingham B2 4UZ 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 Pershore Road, 807 X00023.Pershore Road 807.UI.280405.stage 4.doc Version 1.20 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!