Inspection on 19/10/06 for Addlestone Lodge

This inspection was carried out on 19th October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Addlestone Lodge 08/08/05

Addlestone Lodge 05/05/05

Addlestone Lodge 04/08/04

Addlestone Lodge 18/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Addlestone Lodge Addlestone Lodge Ongar Hill Addlestone Surrey KT15 1BS Lead Inspector Deavanand Ramdas Unannounced Inspection 18th October 2006 10:00 X10015.doc Version 1.40 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 Addlestone Lodge DS0000017657.V312342.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 Older People. 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. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Addlestone Lodge Address Addlestone Lodge Ongar Hill Addlestone Surrey KT15 1BS 01932 846268 01932 847197 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) Addlestone Care Home Ltd Mrs Judith Chrisostomou Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing care for elderly people from the age of 60 years Date of last inspection 5th May 2005 Brief Description of the Service: Addlestone Lodge is registered with the CSCI (Commission for Social Care Inspection) as a care home with nursing for twenty five service users. The range of fees charged by the home is £555 - £700 per week. The property is located in Addlestone in Surrey and accommodation is on three floors accessed by stairs or a lift and comprises of a lounge, dining area, kitchen, laundry, office, bathrooms, toilets and shared and single bedrooms. The home has built an extension to increase the number of places at the home and an application for registration will be submitted to the CSCI in due course for approval. The home has a patio area which is accessible, private and secure, and the gardens will be landscaped for the enjoyment of service users. Private parking is available. The registered manager is Judith Chrisostomou. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes key inspection by the Commission for Social Care Inspection henceforth referred to as CSCI and included a partial tour of the premises, interviews with staff and service users, and a review of documents and records. The inspection was carried out by one inspector over a period of 6.30 hrs starting at 10:30 hrs and finishing at 17:00 hrs. Some service users had communication difficulties and judgements were made about them based on their mood, behaviour and information given by staff. The inspector would like to thank the manager, staff, service users and visitors for their contributions to the inspection process. CSCI booklet pertaining to care homes for older people was left at the home for information. What the service does well: What has improved since the last inspection? The home has met the requirements made by the CSCI which has resulted in improvements in management and practice at the home. The Statement of Purpose has been reviewed and updated to ensure prospective service users Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 6 have up to date information on which to make decisions about admission to the home and improvements made to the management of medication to promote health. Care plans have improved and reporting procedures have been strengthened to safeguard the welfare of service users. A cleaner has been recruited to the staff team to ensure the home is in a clean and hygienic state for service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide is good ensuring prospective service users have up to date information on which to make decisions about admission to the home. The arrangements for assessing needs are good ensuring the needs of prospective service users are assessed before admission to the home. EVIDENCE: The home had a Statement of Purpose and Service User Guide which was written in plain English, nicely presented and available for information. The inspector noted the documents were reviewed and updated in October 2006 to ensure prospective service users have up to date information on which to make decisions about admission to the home. The home had a policy on admissions of service users to the home and a standardised assessment to identify the needs of prospective service users to the home. The inspector noted assessment of needs covered physical care, health care needs and social support. Further evidence indicated the manager who had a professional nursing qualification had responsibility for assessing Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 9 the needs of service users to ensure assessments are undertaken by people trained to do so. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9&10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is good ensuring the health, personal and social care needs of service users are recorded in an individual care plan. However, care plans must be reviewed regularly to safeguard the welfare of service users. The arrangements for health care are good promoting the health of service users. Medication management is good and promote health. The arrangements for privacy and dignity are good ensuring service users are treated with dignity and respect. EVIDENCE: The home had individual care plans which sets out in detail actions to be taken by staff with regards to health, personal and social care needs. The inspector sampled care plans which were based on good practice and included risk assessments with attention to mobility and the prevention of falls. Further evidence indicated care plans were in need of regular review and action has been required in respect of this matter to ensure care plans reflect the changing needs of service users. It is recorded ‘‘my relative eating and weight gain has much improved which could be to the care she is receiving’’. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 11 The home had arrangements for meeting the health care needs of service users and input from professionals including the GP, psychiatrist, tissue viability nurse and physiotherapist to meet the health care needs of service users. The inspector noted a service user with behavioural difficulties had input from a community psychiatric nurse and psychiatrist to promote his mental health and the home liaised closely with care management to find a more suitable and appropriate placement. Further evidence indicated the home conducted nutritional screening and monitored weight gain and weight loss and one service user with a medical problem had a special diet to promote health. The home had a policy on medications and a service level agreement with a local chemist. The inspector noted the manager had introduced systems to improve the management of medications and promote health. Further evidence indicated the home had a drug room and adequate storage of medications and medication records sheets had a recent photograph of service users and were dated and signed by staff with no discrepancies. Observations confirmed the home had controlled drugs which were appropriately stored and a controlled drugs register which was up to date and correct. The manager stated the home had a service level agreement with an approved contractor for the disposal of medications and the home kept a record of medications received by and disposed of to prevent mishandling of medications. The home had a policy on the rights of service users and observations confirmed staff addressed service users by their preferred names and knocked on doors before entering service users bedrooms. Further evidence indicated staff had training in privacy and dignity and during discussions a service user stated ‘‘if I say no to something staff respect me’’ Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for activities need strengthening to satisfy the social and recreational needs of service users. Community contact is good promoting family links. The arrangements for autonomy and choice are good enabling service users to exercise choice over their lives. Meals at the home are good and offer variety and choice. EVIDENCE: The manager stated the home promoted social contact and activities and employed a part-time activities co-ordinator who worked 2 days a week to meet the social and recreational interests of service users. Information about activities included an exercise class and reminiscence quiz and a review of records indicated service users went on family outings and to the local church to satisfy their religious needs. It is recorded by a relative ‘‘some activities are organised at Addlestone Lodge but feel a lot more people would benefit from more stimulation’’ and a service user commented ‘‘I read a lot and I have my own television’’. Following discussions a requirement has been made for the manager to review the arrangements for activities to ensure it is adequate to meet the needs of service users. The home had a visitors policy and actively encouraged service users to maintain family links. A review of records indicated the home had contact with volunteers from a charitable organisation Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 13 and the local vicar visited the home for communion on a regular basis. The manager stated service users are entitled to bring personal possessions to the home and the inspector noted the home had information on advocacy services to enable service users to exercise autonomy and choice. A relative stated ‘‘I am involved in managing property and the finances’’ and a review of records indicated service users had advocates and representatives to enable service users to handle their financial affairs. The home had written menu plans and employed a cook to plan and prepare meals at the home. The inspector sampled menu plans which offered variety and choice with healthy options. On the day of the inspection service users had chicken casserole, boiled potatoes, cabbage and carrots for lunch with fresh fruits and custard for dessert. Mealtime was relaxed and staff assisted service users with their meals with hot and cold drinks available. During discussions a member of staff stated ‘‘I have to say the food is pretty good’’ and a service user commented ‘‘I clean my plate so it must be good’’ and ‘‘you have a choice’’. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for complaints are good with complaints information available to staff, service users and relatives. The systems for protection are good safeguarding the welfare of service users. EVIDENCE: The home had a policy on complaints and kept a record of complaints made about the home. The inspector sampled complaint records and noted the last complaint was dated October 2006 with appropriate management action taken. During discussions a member of staff stated ‘‘I am aware of the complaints policy’’ and a service user commented ‘‘staffing is good I have no concerns’’. The home had a policy on safeguarding adults and staff have training in safeguarding adults to protect service users from harm. Further evidence indicated the home had a copy of the local authority (Surrey County Council) procedures on safeguarding adults and a whistle blowing policy. A review of records indicated the home had management guidelines to ensure verbal and physical aggression by service users is understood and dealt with appropriately. During discussions a service user stated ‘‘this place is free and easy’’ and it is recorded by a relative ‘‘staff are cheerful and helpful’’. The inspector noted one incident under safeguarding adult procedures with appropriate action taken by management. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19&26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for the premises are adequate ensuring service users live in a safe and comfortable environment. The systems for hygiene are good ensuring the home is clean and hygienic for service users. EVIDENCE: The provider stated there is a planned programme of development to improve the environment for service users and the inspector noted an extension to the home to increase the number of places to be registered with the CSCI in due course. On the day of the inspection the home was clean, well ventilated and free from mal odour with adequate furniture and fittings. The manager remarked there is a planned programme of renewal and maintenance including painting and decorating the home, replacing carpets and refurbishing bedrooms to make it nice and comfortable for service users. Following discussions a requirement has been made for the manager to produce an action plan outlining the renewal and decoration of the premises to safeguard Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 16 the interests of service users. The home had adequate laundry facilities, a policy on control of infection and staff have training in infection control to prevent the spread of infection in the home. Further evidence indicated the home had a service level agreement with an approved contractor for clinical waste and during discussions a service user commented ‘‘we have a marvellous cleaner who would do everything and anything’’. Observations confirmed the home had gloves and aprons and staff practised infection control measures through regular hand washing to control the spread of infection. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing are good ensuring there are sufficient numbers of staff on duty to meet the needs of service users. The arrangements for qualifications are good ensuring service users are in safe hands at all times. Recruitment and vetting practices must be strengthened to protect service users from harm. The arrangements for staff training are excellent ensuring staff fulfil the aims of the home and meet the needs of service users. EVIDENCE: The manager stated staffing levels are good and the home employed a mix of registered nurses, senior carers and carers, a cleaner, cook, laundry assistant and handyman. On the day of the inspection the home was adequately staffed and the duty roster reflected the numbers of staff on duty. Further evidence indicated the home had waking night staff including one registered nurse and two carers to meet the needs of service users. During discussions a visitor commented ‘‘I have always been made welcome by staff and there is enough of them’’. The inspector noted five registered nurses from abroad are working as senior carers and the home had two staff with the NVQ (National Vocational Qualification) and three staff are working towards the award to ensure service users are in safe hands at all times. The home had a policy on recruitment and retention of staff and staff have recruitment files which were kept securely to promote confidentiality of information. The inspector sampled recruitment Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 18 records and noted staff have CRB (Criminal Record Bureau) disclosure information, completed application forms, interview questions and assessment, statement of terms and conditions, employment declaration and training records. Following discussions with the manager a requirement has been made for employees to have two written references and a recent photograph on recruitment files to protect service users from harm. The home had an induction policy and the company employed a training manager who worked closely with the manager to provide induction and foundation training for staff. The inspector sampled staff induction records based on Skills for Care common induction standards which were dated and signed by the employee and the manager. A review of training records indicated staff have completed mandatory training courses and specialist training including wound care and leg ulcers, and care of the dying to meet the needs of service users. The inspector noted staff have diversity training to support the homes policy on equal opportunity and anti discriminatory practice. Further evidence indicated training was up to date and records provided a clear audit trail of training undertaken by staff to ensure staff are trained to do their jobs. The manager commented new staff have a named supervisor for the duration of their induction and during discussions a member of staff stated ‘‘ all I ever do is training’’ and it is recorded by a relative ‘‘I feel staff do the best to their ability with relevant resources available’’. Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35&38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for the day to day management of the home are good ensuring the home is managed by a person fit to be in charge of the home. The systems for quality assurance are good ensuring the home is run in the best interests of service users. The arrangements for service users’ money are good safeguarding the financial interests of service users. The systems for health and safety are good and safeguard the welfare of staff and service users. EVIDENCE: The home has an experienced registered manager who has the RMA (Registered Manager Award) and a professional nursing qualification to ensure the home is managed by a person fit to be in charge of the home. The inspector noted there are clear lines of communication and accountability in Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 20 the home reflected in an organisational chart in the Statement of Purpose and the manager is aware of her role and responsibilities. During discussions a member of staff stated ‘‘the manager is easy to work for, she has an open door policy and is always prepared to help’’. The assistant operations manager stated quality assurance systems and process are currently being reviewed with input from an external consultant. The inspector noted the company had developed a quality assurance protocol and an annual audit plan to ensure the home is run in the best interest of service users. A review of records and documents indicated the home had Relatives and Residents meetings to ensure participation in the running of the home and used questionnaires to obtain feedback about the home from relatives, service users and other stakeholders. Further evidence indicated the home had Regulation 26 (monitoring visits) with appropriate action taken to promote quality assurance. The home had a policy on service users’ money and the manager stated service users’ money is handled by relatives and advocates to safeguard the financial interest of service users. The home had a policy on health and safety and staff have training in first aid, fire safety, food hygiene and moving and handling. Further evidence indicated the home had a policy on COSHH (Control of Substances Hazardous to Health) and products were appropriately stored to promote safety. Observations confirmed health and safety information was displayed in the home and the kitchen appeared clean and hygienic with fridge and freezer temperatures within normal limits to promote food safety. The home had a gas safety certificate, regular fire drills and a legionella bacteria test to safeguard the welfare of staff and service users. Addlestone Lodge DS0000017657.V312342.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(2)(b) Requirement The registered person must ensure care plans and risk assessments are reviewed at least monthly to reflect the changing needs of service users. The registered person must review the provision of activities at the home to ensure it is adequate to satisfy the social, religious and recreational needs of service users. The registered person must do a plan outlining the renewal, refurbishment and decoration of the premises to safeguard the interests of service users. The registered person must ensure employees have a recent photograph and two written references before commencing employment at the home to safeguard the welfare of service users. Timescale for action 01/11/06 2. OP12 16(2)(m) (n) 01/01/07 3. OP19 13(4) 01/12/06 4. OP29 7,9,19 Schedule 2 01/11/06 Addlestone Lodge DS0000017657.V312342.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. Refer to Standard Good Practice Recommendations Addlestone Lodge DS0000017657.V312342.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Addlestone Lodge DS0000017657.V312342.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!