Inspection on 14/03/06 for Aldergrove Manor Nursing Home

This inspection was carried out on 14th March 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

Aldergrove Manor Nursing Home 07/04/10

Aldergrove Manor Nursing Home 14/01/10

Aldergrove Manor Nursing Home 18/08/09

Aldergrove Manor Nursing Home 18/09/07

Aldergrove Manor Nursing Home 25/07/06

Aldergrove Manor Nursing Home 24/08/05

Aldergrove Manor Nursing Home 18/01/05

Aldergrove Manor Nursing Home 18/08/04

Aldergrove Manor Nursing Home 15/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Aldergrove Manor Nursing Home 280a Penn Road Penn Wolverhampton West Midlands WV4 4AD Lead Inspector Rosalind Dennis Unannounced Inspection 14th March 2006 10:30 X10029.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 Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Aldergrove Manor Nursing Home Address 280a Penn Road Penn Wolverhampton West Midlands WV4 4AD 01902 621840 01902 621841 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) Southern Cross Healthcare Services Limited Mrs Debbie Rowley Care Home 70 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (27), of places Physical disability (17), Terminally ill (7) Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate up to 34 elderly persons requiring nursing care of which up to 7 persons may require palliative care. Ground Floor Nursing/Palliative Care Unit (34 beds) Unit Manager with 10 supernumerary hours per week Service Users 21-25 26-30 31-34 08:00-14:00 1 RGN 4 CA 2 RGN 4 CA 2 RGN 5 CA 14:00-20:00 1 RGN 3 CA 1 RGN 4 CA 2 RGN 4 CA 20:00-08:00 1 RGN 1 CA 1 RGN 2 CA 1 RGN 3 CA First Floor Residential EMI Unit (19 beds) Residential Supervisor with 6 hours supernumerary per week Service Users 1-9 10-12 13-15 16-19 Date of last inspection 08:00-14:00 1 Senior CA 1 CA 1 Senior CA 1 CA 1 Senior CA 2 CA 1 Senior CA 3 CA 14:00-20:00 1 Senior CA 1 CA 1 Senior CA 1 CA 1 Senior CA 2 CA 1 Senior CA 3 CA 20:00-08:00 1 Senior CA 1 Senior CA 1 CA 1 Senior CA 1 CA 1 Senior CA 1 CA 24th August 2005 Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 5 Brief Description of the Service: Aldergrove Manor is owned and managed by Southern Cross Healthcare Ltd. The manager is Mrs Debbie Rowley. It is a purpose built, two storey building, standing in it’s own grounds and is situated on the outskirts of the city of Wolverhampton. The home is set back off the main road on one of the main routes into Wolverhampton. It is on a main bus route, close to the cities railway system and within easy access to local shops and community facilities. All 71 bedrooms are single with en-suite, some of which have interconnecting doors for couples. Since the inspection in January 2005 the structure within the home has changed and the home now consists of a 19 bedded unit for older people with dementia, a 17 bedded unit for younger adults that have physical disabilities and a 34 bedded nursing unit which includes allocation of 7 beds for palliative care. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by one inspector over a period of six hours and included observing activity within the home, speaking with residents and staff and observing documents such as residents care files. The manager was not present on the day of inspection, however the inspector found the home functioning well, the atmosphere calm and residents appeared content and well cared for. Staff were observed to be attentive to resident’s needs. A full tour of the premises was not undertaken at this inspection and the inspection focussed on the dementia unit and the unit for young physically disabled adults (YPD). What the service does well: What has improved since the last inspection? What they could do better: Shortfalls at this inspection were few. Two residents had identified that there should be more consultation with residents; therefore it is recommended that systems are put in place to increase resident consultation and involvement in the day to day running of the YPD unit Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 7 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. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6 is not applicable to this home EVIDENCE: The intended outcomes for Standard 3 were assessed at the previous inspection of this service and were not reviewed on this occasion. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 and 10. There is clear and consistent care planning in place, which provides staff with the information they require to meet residents’ needs. The systems for the administration of medication are satisfactory and ensure medication needs are met. EVIDENCE: Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 11 A range of care plans and risk assessments were examined from a random selection of residents care files from the dementia and younger persons unit. All files observed contained an extensive range of care plans relevant for each individual case tracked during the inspection. Care plans detailed action that is required to address the residents identified problem, any improvements and all showed evidence of regular review. Daily entries made by staff into residents care records describe the actual care given, which corresponded to the residents care plan. Risk assessments and wound care records were complete and also regularly reviewed. Each file documented regular communication between staff, residents and their significant others, additionally records to confirm staff contact with and visits by healthcare professionals were well maintained. Residents on the Dementia unit were observed being treated with great respect and individuality by staff and appeared well looked after. The medication room on the Dementia Care Unit was well organised and Medication Administration Record (MAR) sheets were observed to be complete. Staff that administer medication have attended the required medication training. A comprehensive medication audit is undertaken for each of the three units and to ensure non-bias a staff member that works on a different unit will complete the audit. It has been identified that the medication room on the dementia unit requires an air-cooling system although the temperature on the day of inspection did not exceed the required limit. Residents that were spoken with confirmed that their privacy is maintained. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15. The home provides meals that offer variety and cater for different nutritional needs. Staff at Aldergrove Manor assist residents to exercise choice as far as possible and according to their differing capabilities. EVIDENCE: The home employs an activities co-ordinator and a range of activities are provided in-house for residents to take part in if they choose. Observations of the dementia unit, care records and discussion with staff confirms that a variety of activities are offered. The lounge and dining area on the dementia Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 13 unit incorporates a “reminiscence” notice board where photographs of residents before their illness are displayed. Throughout the inspection residents on this unit appeared content listening and singing to music with staff and the staff were observed to interact well with residents. Discussion with five residents on the younger persons unit was generally positive although two residents commented that they felt the home could offer more to do on a daily basis, with increased resident consultation and involvement in the day to day running of the unit. These comments were passed to the deputy manager and YPD unit manager for action. Observation of menus demonstrates that a varied and satisfactory diet is offered. The meal served on the dementia unit during the inspection appeared and smelled appetising and residents seemed to enjoy their meal. Staff were observed to be attentive in assisting residents to eat. Staff working on the dementia unit have developed systems to identify residents’ likes, dislikes and immediate needs. Two residents on the YPD unit commented that although the meals were usually nice, occasionally food could be bland and the quality variable. Observation of responses to a recent resident questionnaire identifies some areas for improvement regarding meals and a discussion with the deputy manager confirmed that the home does act on the responses. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The arrangements for the protection of residents from abuse is satisfactory. EVIDENCE: The manager and deputy manager have demonstrated that they have a good knowledge of adult protection processes and procedures and evidence was available to demonstrate that staff have attended adult protection training. Staff that were spoken with during the inspection confirmed their attendance and could describe the relevant procedures. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed on this occasion. EVIDENCE: The intended outcomes for Standards 19 and 26 were assessed at the previous inspection of this service and were not reviewed on this occasion. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 The home has a robust recruitment procedure in place that protects residents from the employment of inappropriate staff. Staff are appropriately skilled and competent to carry out the duties for which they are employed. EVIDENCE: The last inspection identified deficits in the homes recruitment procedure. The manager has audited staff files to ensure they contain required information and a staff file checked confirmed that all required pre-employment checks had been completed. The home provides an induction programme that meets the required level and a staff member recently employed by the home spoke positively of her induction. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 17 The last inspection report makes reference to the new structure of the home and that relatives and residents had reported that the structure had impacted on residents care. The two units observed during this inspection appeared to be functioning well and staffing levels appeared satisfactory. One individual did comment that they did not feel staffing levels were always sufficient on the YPD Unit, therefore staffing levels will be revisited at the next inspection. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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 and 38. The home is continually monitoring and reviewing processes to ensure that residents receive a good range of quality services. The home is well maintained and the staff group appropriately skilled to ensure that the health, safety and welfare of residents is promoted. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 19 The manager has the skills and knowledge to lead the staff team and manage the home. EVIDENCE: CSCI are aware that the manager has a good range of supporting qualifications, skills and experience. The deputy manager provides continuity for the home in the absence of the manager. One individual commented that they had not been introduced to the manager on their admission to the home and felt that it would have been useful to enable them to “put a face to a name”. Observation of quality assurance processes show that the home is continually auditing the service it provides. Questionnaires are sent out randomly on a monthly basis to residents, relatives and staff and the results are collated and actioned. The home operates a comprehensive process of auditing quality and practice, which includes catering, health and safety, recruitment and medication. Senior management conduct monthly, unannounced visits of the home and a copy of this report is sent through to CSCI. Observation of records demonstrates that resident’s financial interests are safeguarded and the home maintains accurate records of all financial transactions. A full range of servicing, maintenance and regular monitoring of services is undertaken and observation of documents showed all to be up to date. The maintenance person undertakes weekly checks of bed rails and evidence was available to confirm that training in the safe use of bed rails has been undertaken by senior staff which is due to be cascaded to all staff. The home has had a recent inspection by the local fire officer and information was available to confirm that the work is in hand. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 20 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 X 2 X 3 X 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 ENVIRONMENT Standard No Score 19 X 20 X 21 X 22 X 23 X 24 X 25 X 26 X STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA16 Good Practice Recommendations It is recommended that systems are put in place to increase resident consultation and involvement in the day to day running of the YPD unit. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE 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. Aldergrove Manor Nursing Home DS0000017175.V286916.R01.S.doc Version 5.1 Page 23 - 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!