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Inspection on 17/11/09 for Aberdeen House Residential Home

Also see our care home review for Aberdeen House Residential Home for more information

This inspection was carried out on 17th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We received feedback from a visiting health-care professional who told us that he always found the staff to be very helpful. Residents spoken with praised the staff employed.

What has improved since the last inspection?

One of the lounges was in the process of being redecorated and refurbished during this inspection. The registered manager and deputy manager had completed a National Vocational Qualification in team leading.

What the care home could do better:

During this inspection we identified that staffing numbers at night time were not sufficient to meet peoples needs or to provide people with choice about how to spend their day. Since this inspection the provider has already taken action to address the shortfalls identified and has increased staffing levels at night. Staff training regarding moving and handling had not been updated for some time for some staff. Some manual handling practices were potentially unsafe, again the provider has already taken action to address this. Care plans were not in place for all assessed needs and risk assessments were not always in place or had not been reviewed for some time, this is required in order to ensure that risks are identified and appropriate action is taken. Care plans that reflect the changing needs of people must be in place if staff are to meet their needs. One room was found to have an unpleasant odor, this must be eradicated in order to provide a pleasant and comfortable environment in all areas of the home. Communal bathrooms were institutional in appearance, the provider told us these had just been re decorated and were not yet finished.

Key inspection report Care homes for older people Name: Address: Aberdeen House Residential Home 20 Stockerston Road Uppingham Rutland LE15 9UD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Debbie Williams     Date: 1 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Aberdeen House Residential Home 20 Stockerston Road Uppingham Rutland LE15 9UD 01572823308 F/P01572823308 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Linda-Jane Thornalley care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: No additional conditions of registration. Date of last inspection Brief description of the care home Aberdeen House is an 18-bedded residential care home for older people. The home, which is a converted farmhouse, is situated in Uppingham, close to the centre of this rural village. Service Users rooms are located on two floors with a shaft lift and a stair lift providing access to upstairs facilities. Service Users have access to a communal lounge / dining room, a conservatory and a quiet lounge. There is a well-maintained patio garden outside. Details about the weekly fees can be obtained from the Registered Manager or provider, there are additional costs for hairdressing, toiletries, transport, chiropody and dry cleaning. 0 0 Over 65 18 1 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. We visited the home on the 17th and 19th of November 2009. The main method of inspection used was case tracking which meant selecting four residents and tracking the quality of their care by checking records, discussion with them and with staff and observation of care practices. We checked all the standards which the Care Quality Commission have decided are key standards during this inspection. In some sections we have also checked additional standards, these will be detailed in the main report. Since the last key inspection there have been concerns raised about staffing levels, medication procedures and meal times. There was also a safeguarding investigation undertaken by social services. Care Homes for Older People Page 5 of 26 A separate pharmacy inspection was carried out shortly after this inspection. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they require to make an informed decision about moving into Aberdeen House. Evidence: The provider has a Statement of Purpose which is available to all prospective residents. This document sets out the services and facilities provided. People have their needs assessed before moving into Aberdeen house, this is to ensure that the service can meet peoples needs. We looked at assessment records and found that basic assessment information was available. A form know as getting to know you is used, this is to gather information about peoples individual needs, life history and preferences, we found two instances of this form not being filled in. This information is needed if staff are to provide individualized care and is of particular importance to people who may have communication difficulties. Care Homes for Older People Page 9 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Aberdeen House, mostly, had there health and personal care needs met but improvement was required in care planning, risk assessment, medication procedures and maintaining peoples dignity. Evidence: We case tracked four people and this involved speaking with them and looking at care plans and other care records. While care plans were in place these did not address all assessed or recorded needs. Where applicable social services care plans and care reviews were also in place. Risk assessments were in place for nutritional risk but these were not always updated. There were no weighing scales available for people with mobility problems and therefore not everyone had a record of their weight or any subsequent weight gain or loss. A requirement was made regarding the assessment of nutritional risk, it is imperative that any risk is identified and appropriate action taken. There were no risk assessments in place for the risk of developing pressure sores, this Care Homes for Older People Page 10 of 26 Evidence: is required so that appropriate action can be taken where risk is identified, such as referral to community nursing services. We spoke with people living at Aberdeen House about staff attitudes, people told us that staff were very good and maintained their privacy and dignity. We observed staff using a commode chair to transfer people with mobility problems, this did not promote dignity for the people being moved in this way. Care records seen provided evidence that people had access to health-care services such as GPs, community nurses and hospital appointments. People spoken with told us they could see their GP when they wished to. There was a community psychiatric nurse visiting the home at the time of this inspection who gave positive feedback about Aberdeen House and said that staff were very helpful. We looked at medication administration records and storage areas. There was a separate pharmacy inspection on the 16th of September 2009 and a pharmacy compliance visit on the 2nd of December 2009. Requirements had not been met and were re issued regarding the storage and accounting of controlled medications, the provider said she would order the required equipment for this on the day of the pharmacy inspection. Care Homes for Older People Page 11 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The day to day running of the home did not always promote choice and autonomy for people living at Aberdeen House. Evidence: People spoken with told us they could spend their day as they pleased and that there were no restrictions on visitors coming to the home. We had concerns about staffing levels and whether these were sufficient to enable people to make choices about routines of daily living. The registered manager told us that on a usual day, half of the residents chose to go to bed before 8 pm. One person spoken with told us they got ready for bed at 5 in the afternoon and that she did not come out of her room as she needed to be hoisted and this was a lot of work for the staff. Other people spoken with told us they felt staffing numbers were sufficient to meet their needs and they were never left waiting for staff to attend to them. At least four people living at Aberdeen house had high dependency needs which meant they required two staff to attend to them for some daily living activities. Because there was only one member of staff on at night, this limited choice for some people and potentially put them at risk. We held a meeting with the providers shortly after this inspection, the providers told us that night time staffing levels had been increased. Care Homes for Older People Page 12 of 26 Evidence: We observed the lunch time meal during this inspection. People were served their meal on small tables in the lounge. The providers told us that people did not always choose to use the dining room. The lunch time meal seen appeared appetizing and nutritious. We looked at menu records which were varied, menu records stated that an alternative was always available. People spoken with told us they enjoyed the meals provided and could have a snack or drink at anytime. Social and recreational activities provided included entertainers coming into the home, hand massage, games and quizzes. An activities organizer works at the home for two afternoons a week. Young adults from the local school come into the home once a month to spend time with residents. Care Homes for Older People Page 13 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Aberdeen House were mostly protected by the providers policies and procedures regarding complaints and safeguarding. More staff training is required to ensure all policies and procedures are adhered to. Evidence: People spoken with told us they would feel confident making a complaint to staff members or to the management team. Staff spoken with were aware of the correct procedures for safeguarding adults. We looked at staff recruitment files and found that all relevant checks and references had been carried out before staff commenced employment, this ensures that staff working at the home are fit and suitable to do so and people are protected from harm. Some staff Criminal Records Bureau checks were more than three years old, we made a recommendation that checks be re done every three years. Not all volunteers visiting the service had been checked with the Criminal Records Bureau or Protection of Vulnerable Adults list. The provider made the decision to ensure that these volunteers would not be alone with residents unsupervised and therefore people living at Aberdeen House would be protected. Care Homes for Older People Page 14 of 26 Evidence: The policy for management of falls had recently been changed to ensure that whenever a resident falls they would be attended to by two staff members. However, we found one instance where a resident had fallen during the night and the staff member on duty had not followed this policy and had not contacted the on call staff member. Since this inspection staffing levels have been increased and therefore there will always be at least two staff in the building. The Registered Manager and Deputy Manager were due to attend the local authorities safeguarding adults alerters training and would cascade this information to other staff. Care Homes for Older People Page 15 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe well maintained environment. Not all areas of the home were pleasant and hygienic. Evidence: At the time of this inspection the front lounge was being decorated and refurbished so was not in use. The home provides accommodation over two floors, there are two lounges and a dining room/conservatory. We undertook a partial tour of the premises including the private rooms of people we case tracked. Peoples private rooms were personalized and appeared homely and comfortable. On the first day of this inspection we identified three rooms which had unpleasant odours, on the second day of this inspection, the odour had been eradicated in two of the rooms but remained in one persons room. Care records seen confirmed that this issue had also been raised previously. Communal bathrooms were institutional in appearance, the provider told us that the bathrooms had just been re decorated and finishing touches were not yet complete, these would make the bathrooms feel more homely and attractive. Staff had received training in infection control and this minimized the risk of cross infection for people living at Aberdeen House. Care Homes for Older People Page 16 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At the time of this inspection staffing numbers were not always sufficient to meet peoples needs and staff had not received all the training they required to do their jobs. Evidence: We spoke with people living at Aberdeen House and staff working there. People said that staffing levels were sufficient. However, due to the dependency levels of people living at Aberdeen House and day to day routines of daily living, we did not feel that night time staffing levels were sufficient to meet peoples needs or to offer them choice and flexibility. We required that staffing levels between 8 pm and 7 am be increased. The provider told us that this requirement has now been met and that two staff are on duty from 8 pm until 7 am. A programme of staff training and development was ongoing, all new staff complete induction training. We found that some staff members had not had their moving and handling training updated for some time. Some staff had achieved National Vocational Qualifications in care and some staff were working towards this qualification. We looked at staff recruitment files and found that all relevant checks and references Care Homes for Older People Page 17 of 26 Evidence: had been carried out before staff commenced employment, this ensures that staff working at the home are fit and suitable to do so and people are protected from harm. Some staff Criminal Records Bureau checks were more than three years old, we made a recommendation that checks be re done every three years. Not all volunteers visiting the service had been checked with the Criminal Records Bureau or Protection of Vulnerable Adults list. The provider made the decision to ensure that these volunteers would not be alone with residents unsupervised and therefore people living at Aberdeen House would be protected. Care Homes for Older People Page 18 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some care practices at the service meant that the health, safety and wellbeing of residents was not always promoted or protected and the home was not always run in the best interests of people living there. Evidence: The registered manager had the relevant experience and skills to manage the service and people spoken with said she was approachable and would listen to their concerns. A quality assurance programme was in place and this included seeking the views of people who use the service and their relatives. However, considering the problems we identified in moving and handling, staffing levels and staff training, the providers should consider the effectiveness of their quality assurance programme. Staff supervision records were seen, staff receive formal supervision every two months. Care Homes for Older People Page 19 of 26 Evidence: Not all staff had up to date training in moving and handling people and we found instances of practice which was potentially unsafe, since this inspection, the provider has increased staffing levels and changed some of the practices used to move people with mobility problems. There were no risk assessments for the use of bed-rails, we made a requirement regarding this. systems in place for the management of peoples personal money protected people from financial abuse. Care Homes for Older People Page 20 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Controlled drugs must be stored in a cupboard that complies with the Misuse of Drugs (safe custody) regulations for security reasons and to meet legal requirements This has not been fully complied with but a cupboard has been ordered. This requirement has been reissued. 22/01/2010 2 9 13 There must be a clear audit 22/01/2010 trail for the use and disposal of controlled drugs for security reasons and to meet legal requirements. This has not been fully complied with and a new due date is issued Care Homes for Older People Page 21 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 27 18 Staffing numbers between 8 pm and 7 am must be increased. This is so that people have their needs met and are protected from harm 19/11/2009 2 38 13 Equipment used for moving people must only be used in accordance with the manufacturers requirements This is to avoid injury to people living at Aberdeen House and staff working there. 19/11/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be in place for all needs. This is to ensure that staff are aware of the actions they must take to meet peoples health and social care needs. 23/12/2009 2 8 12 Nutritional screening must be undertaken on admission and subsequently on a periodic basis, including weight gain or loss. 23/12/2009 Care Homes for Older People Page 22 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is so that nutritional risk is identified and appropriate action can be taken. 3 8 13 Risk assessments must be 23/12/2009 completed for all potential risks such as nutritional risk and risk of developing pressure sores, these should be updated at least on a monthly basis to reflect peoples changing needs. This is to ensure that risks are identified and minimized. 4 10 12 Staff must not use a commode chair without a seat for transfering people with mobility problems. This is to maintain peoples dignity. 5 14 13 The provider must refer any management of care that results in a potential deprivation of liberty to the Leicestershire and Rutland Deprivation of Liberty to team to obtain consent for such actions. This includes the use of a mattress at floor level to prevent falls. 24/12/2009 15/12/2009 Care Homes for Older People Page 23 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that people have choice and control over their lives while also being protected from harm 6 26 16 All areas of the home must be kept free from offensive odours. This is to ensure that people live in a comfortable and pleasant environment. 7 30 38 Staff must receive training 29/01/2010 regarding the providers policies and procedures and all systems for safe moving and handling and health and safety procedures. This is to promote safety for people living and working at the home. 8 38 13 Where bed rails are used this should be after consultation with the community nursing team and risk assessed for risk of entrapment. This is to minimize the risk of harm for people living at Aberdeen House. 9 38 13 Staff must receive training in safe working practices regarding moving and handling and use of 23/12/2009 24/12/2009 31/12/2009 Care Homes for Older People Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action techniques for moving people. This is to avoid injury to people living at Aberdeen House and staff working there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 Information regarding peoples individual needs and preferences, social and life history should be recorded where possible. This helps staff to understand and therefore, meet peoples needs and expectations. Criminal Record Bureau checks should be applied for at least every three years. This is to ensure that people working at the home are suitable to do so. 2 18 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 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!