Inspection on 18/04/05 for Bakers Court Nursing Centre

This inspection was carried out on 18th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bakers Court Nursing Centre 25/03/10

Bakers Court Nursing Centre 07/05/09

Bakers Court Nursing Centre 23/07/08

Bakers Court Nursing Centre 28/02/08

Bakers Court Nursing Centre 25/04/06

Bakers Court Nursing Centre 19/01/06

Bakers Court Nursing Centre 06/09/04

Bakers Court Nursing Centre 13/04/04

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

CARE HOMES FOR OLDER PEOPLE Bakers Court Nursing Centre 138-140 Little Ilford Lane Manor Park London E12 5PJ Lead Inspector Seka Graovac Announced Inspection 18th and 19th April 2005 at 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Bakers Court Nursing Centre Version 1.10 Page 3 SERVICE INFORMATION Name of service Bakers Court Nursing Centre Address 138-140 Little Ilford Lane, Manor Park, London, E12 5PJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8514 3638 020 8553 2603 enquiries@bakerscourt.ansplc.co.uk ANS Homes Limited Mr Christopher Stringer Care Home 78 Category(ies) of Dementia (0), Mental Disorder, excluding registration, with number learning disability (0), Old age, not falling within of places any other category (0), Physical disability (0) Bakers Court Nursing Centre Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1) minimum staffing levels 2) admitting service users above 60 years of age Date of last inspection 6th September 2004 Brief Description of the Service: Bakers Court Nursing Centre is operated by ANS plc. The organisations motto is: Leading the way in nursing care. It has over 50 care centres throughout England and Scotland and provides professional nursing care and a wide range of services within a hotel atmosphere to well over 3000 clients. Bakers Court Nursing Care Centre is registered with the Commission for Social Care Inspection to provide care to up to 78 people with general nursing needs, physical disability, dementia or/and a mental health diagnosis who are over 60 years old. The centre is situated in Manor Park area of Newham and is easy to access by public transport. There is ample parking available for visitors within the grounds of the centre as well as on the surrounding roads. The premises are purposly built and all the bedrooms are single with en-suite facilities, equipped with the nurse-call sytem, television and telephone point. The ground, first and second floor are connected via 2 lifts and the staircases. Each floor is run as a seperate unit. The ground floor caters for people with general nursing needs, physical disability and mild to moderate dementia. The first floor is for people with a mental health diagnosis (including dementia), while the second floor unit provides continuing care. The premises are fully wheelchair accessible. The designated catering team provides three meals a day and also tray service for people who prefer to eat in their own bedrooms or are unable to leave their beds. A Renault People Carrier is also available. Bakers Court Nursing Centre Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was conducted over two days and lasted approximately 13 hours. The inspector had the opportunity to discuss care provision with seven service users and also met and had short conversations with many other service users. The inspector ate her lunch on both days with the service users. The inspector also received verbal feedback about the service from three relatives and a friend of the service users. The friend had also forwarded a written feedback to the inspector. The inspector had a tour around the home that included all the communal areas, some bedrooms, catering and laundry facilities. The inspection methodology used, included viewing three service users’ files and staff files for three staff that recently joined, as well as reading other documentation. The individual discussions were held with the registered manager, deputy manager, two registered nurses and one care assistant. The inspector also met and had short conversations with the catering manager, two cleaners that were responsible for the laundry at the time of the inspection and a number of care staff and nurses. The deployed inspection methodology enabled the inspector to collate the evidence and make the judgements regarding the standard of care in the Bakers Court Care Centre as determined by the National Minimum Standards. What the service does well: The promotional information about the ANS plc and the Bakers Court Nursing Centre was clear, well written and presented. The centre carried comprehensive assessment of care and support needs of prospective service users. Both the centre and the prospective service users or their representatives had sufficient information available before agreeing the contract for the service provision. The care planning process was good and the individual care plans were regularly reviewed. Service users enjoyed their daily life that included regular meals, social activities, spiritual contact and visits from relatives and friends in accordance with their wishes and the life situations. The service users were complementary about the service and specifically about the day-staff. They also felt free to raise the concerns with the inspector, the staff and the management. The centre was appropriately dealing with the complaints and the concerns raised. The centre was compliant with the condition of registration regarding the minimum staffing levels. The employers underwent a rigorous recruitment Bakers Court Nursing Centre Version 1.10 Page 6 procedure. The organisation promoted nursing as a profession overseas and in this country. The staff were positive about their employer and the management of the home. Both the management and the staff team at the Bakers Court Nursing Centre were committed to work to a high standard and strived to improve the service provision. This has been recognised in the company accreditation to “ISO 9001:2000” quality standard and also in the “Investors in People” award. The environment was fit for its purpose, well maintained and comfortable. The service users and the staff benefited from the competent and motivated management. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bakers Court Nursing Centre Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Bakers Court Nursing Centre Version 1.10 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 standard(s) 1, 3 and 4. (Standard 6 not applicable.) The centre’s admission procedure supported prospective users, their relatives and other representatives, as well as the staff of the Bakers Court Nursing Centre to make fully informed choice regarding the placement prior to its commencement. EVIDENCE: The ANS plc and the Bakers Court Nursing Centre promotional literature as well as the Guide for Service Users were well presented and contained all the information as required by the National Minimum Standards and the Care Homes Regulations. The Guide has been reviewed and amended since the previous inspection in accordance with the requirements made at that time. The viewed service users’ individual files contained comprehensive individual care and support needs assessments carried out by the centre. The service users gave mainly positive feedback to the inspector about living in the Bakers Court Care Centre. One person replied to the inspector’s question: “What is the best thing about living in the Bakers Court Care Centre” by saying: “Everything is the best thing, here.” Some service users expressed feeling sad about having to live in the care setting rather then in their own Bakers Court Nursing Centre Version 1.10 Page 9 homes. The issues that they and their representatives raised with the inspector were discussed with the management and the inspector was satisfied with the centre’s already taken or proposed actions. The inspector was made aware that the Bakers Court Nursing Centre terminated the contract for one service user due to being unable to meet this service user’s family’s needs and was liaising with the Primary Care Trust and the Social Services regarding this lady’s move to live with her family. The deployed inspection methodology indicated that the centre had a capacity to meet the needs of the admitted service users. Bakers Court Nursing Centre Version 1.10 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 standard(s) 7 and 9. The home’s care planning process was very good, but the appropriate medication procedure was not always followed thus potentially putting service users at risk. EVIDENCE: The inspector viewed individual care plans for three service users. All of them were comprehensive and in date. In the discussions with the inspector, the staff demonstrated their understanding of the care planning process. They used the care plans in a proactive way, continually monitoring and evaluating the service users’ health and wellbeing. The inspector also viewed the home’s medication administration records and was concerned that they contained a number of gaps. The registered nurse stated that it was most likely that the service users had their medicines as prescribed but the staff forgot to sign for it. Two visitors also expressed their concerns about the home’s dealing with the service users’ medication. The issues were discussed with the management of the home who agreed that the gaps in the medication administration records were not acceptable and promised firm actions to ensure that the appropriate medication procedure (including recording) is implemented at all times. Bakers Court Nursing Centre Version 1.10 Page 11 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 standard(s) 12, 13 and 15. Service users enjoyed their daily life that included regular meals, social activities, spiritual contact and visits from their relatives and friends in accordance with their wishes and life situations. EVIDENCE: The centre had a welcoming atmosphere and the inspector met three relatives and a friend who were visiting the service users at the time of the inspection. The service users also spoke to the inspector about their regular visitors that included ministers of religions. One service user had family members with her at all times (including nights) and the centre was doing its best to accommodate this arrangement until this service user is able to join her family outside of the residential care setting. All the bedrooms had a television point and many service users who spend most of their time in their bedrooms told the inspector how much it meant to them. Each room also had a telephone point and there was a mobile (on the trolley) pay-phone available for service users to make and receive private phone calls. The centre employed an activities organiser. The weekly activities plan was displayed on the notice board and the service users’ interests and preferences were included in their files. The inspector observed two staff members interacting with the service users. She also saw a cat and a fish-tank at the centre. The service users enjoyed a clothes-show that happened a week before Bakers Court Nursing Centre Version 1.10 Page 12 the inspection. One service user was proud to point out the certificates for communication skills, IT skills and aromatherapy that she achieved and that were displayed on the wall in her bedroom. The inspector was also informed that young people from “Trident”, an organisation that provides work-experience, visited the home on a regular basis. The inspector ate her meals with the service users. The food was tasty. Some service users told the inspector that food in the home was very good, while one person said: “It’s never going to be as good as when you cook it yourself”. They all agreed that there was always plenty of food available and that they are asked to choose what they would like to eat. The menus were displayed showing two options for the main meal. In addition to that, the service users could order different things as well. The specific dietary requirements were catered for. The main kitchen was well organised and hygienic at the time of the inspection. The required records were kept. The inspector was informed that the catering manager had certificate in advanced food hygiene. The rest of the catering team was enrolled on a three months distance-learning programme. Each floor had its own servery. The inspector was informed that the hot-trolleys with the more accurate temperature controls and better heatretention have been obtained since the previous inspection. Bakers Court Nursing Centre Version 1.10 Page 13 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 standard(s) 16. The centre deals appropriately with complaints. EVIDENCE: The complaints procedure included in the Service User’s Guide has been reviewed and amended since the previous inspection and it is fully compliant with the specification of the standard and related regulation. The inspector viewed the centre’s complaints log that evidenced that the management was taking the complaints seriously and was committed to improve its service provision. Visitors and service users were open in their discussions with the inspector and shared their concerns about the service as well as the compliments. It indicated that the customer care was high on the agenda in the centre and people felt free to speak when their expectations were not fulfilled. One service user told the inspector how a staff nurse protected this service user’s rights in the situation when a care assistant was not helpful. Although there were a number of complaints raised with the centre in the last 12 months (as expected in a large establishment) and the issues were raised at the inspection as well, the inspector was satisfied with the actions that the management had already taken or was planning to take in order to resolve the issues and improve the service provision. No formal complaints have been raised with the Commission for Social Care Inspection since the previous inspection. Bakers Court Nursing Centre Version 1.10 Page 14 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The environment was fit for its purpose, clean, well maintained and comfortable. EVIDENCE: The Bakers Court Nursing Centre benefits from many communal areas and single occupancy bedrooms with en-suite facilities. A number of additional facilities such as a smoking lounge, hairdressing saloon, bathrooms fitted with the appropriate equipment and a garden were also available. One room has been turned into a library since the previous inspection. Also, seating facilities for the garden have been purchased and the carpets have been changed in some bedrooms. The centre manager stated that the budget was approved for changing the carpet in one of the lounges on the ground floor in the current financial year. The service users told the inspector that they liked their bedrooms, although they missed their own homes. The bedrooms that the inspector saw were of adequate size, appropriately furnished and individualised in accordance with the service users’ wishes. The environment was clean and Bakers Court Nursing Centre Version 1.10 Page 15 well maintained. The inspector viewed the maintenance records that included evidence of regular servicing of the lifting equipment. One service user was eagerly awaiting a new mattress that would make her more comfortable. She also raised with the inspector an issue about the staff not always responding to the nurse-call, usually night-time. When the inspector activated a nurse-call point in one of the bedrooms on behalf of the service user who needed help, a care-assistant responded within 30 seconds. The centre manager stated that he was in process of purchasing a print-off device that would record the time of the activation of the particular nurse-call point and the time of the response. This would enable continuous monitoring of the time it took staff to respond. Laundry facilities were adequate. Bakers Court Nursing Centre Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, and 29. The service users’ needs were met by the staff team. The staff were appropriately recruited and competent in their roles. EVIDENCE: The first thing all the service users said in their discussions about the home was how wonderful the day-staff were. The words they used to describe the staff: “excellent”, “marvellous”, “caring”, “really nice”, “wonderful”, “it’s like a family”. However, some issues were raised about the night-staff behaviour, such as talking loudly among themselves in the language not understood by the service users and using their personal mobile phones inappropriately. The management was aware of the issues and was dealing with them. There were four qualified nurses and thirteen care assistants on duty at the time of the inspection. The inspector was told that at night there were always three registered nurses and six carers, one of whom was flexibly deployed across the units, in accordance with the need. According to the information provided in the pre-inspection questionnaire, the centre employed twenty-three registered nurses, fifty-four care staff and twenty-three ancillary staff. Sixteen care staff have obtained a National Vocational Qualification (NVQ) and the inspector was informed that additional sixteen staff were due to complete NVQ level 2 and two staff to complete level 3 in the current calendar year. The inspector viewed staff files for three staff that have been most recently employed. The records seen indicated a thorough recruitment procedure that included POVA (Protection of Vulnerable Adults) check. The organisation Bakers Court Nursing Centre Version 1.10 Page 17 carried out the overseas recruitment campaigns and was also actively involved in the promotion of the nursing profession in this country. Bakers Court Nursing Centre Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36, and 38. Service users benefit from the well-managed nursing care service. However, the management must fully implement formal supervision of all staff and further minimize the fire safety risks. EVIDENCE: The registered manager has a post-graduate diploma in management and is also a registered general nurse. Prior to his current role, he worked in acute surgical nursing for twelve years. He is supported by a deputy manager, who is also an experienced qualified nurse. The centre was well run and the service users and the staff expressed their trust in the management of the centre, in their discussions with the inspector. Both the management and the staff expressed their commitment to provision of a high standard of care and the improvement of the service. The company has external quality assurance accreditations such as: “ISO 9001:2000” and “Investors in People”. Bakers Court Nursing Centre Version 1.10 Page 19 The service users and their representatives’ meetings were not held on a regular basis, but the centre demonstrated that their views were solicited and taken in the account in different ways. The Bakers Court Nursing Centre conducted a customer satisfaction survey in December 2004 that included visiting health and social care professionals as well as service users and their visitors and next of kin. The findings were published in the Service User’s Guide and were used in a proactive way to address the identified areas that the participants wanted to see improved. However, despite a related requirement being made at the previous inspection, the provider did not undertake the monitoring visits to the centre in the frequency determined by the Care Homes Regulations. The Commission also did not receive any reports. Another outstanding requirement was regarding formal supervision for all the staff that included minuted one-to-one meetings at least bimonthly. The inspector was informed that the centre’s supervision programme has commenced, but was not fully implemented at the time of the inspection. The staff who spoke to the inspector were looking forward to it. They commented positively about written daily tasks-allocations that have been introduced since the previous inspection and the improved lines of communication. The heath and safety in the home was generally well managed. The centre was visited by the Fire Authority in February this year, and no requirements or recommendations were made at that time. However, the inspector was concerned to see many fire doors (mainly service users’ bedrooms) left propped open with the wedges. The list of the doors that were kept wedged open was available in the reception area. The centre manager stated that the staff were instructed to go around their areas and close all the fire-doors in a case of a fire-alarm being triggered. The inspector felt that this could put the staff and the service users at risk. The risk could be easily minimised by the installation of the fire-safety approved devises that would keep the doors open if the service users wished so, but would automatically respond to the firealarm being triggered. After sharing her concerns with the management and the Fire Authority, the inspector decided to make a requirement in this respect. The examined fire records indicated regular weekly tests and drills twice a year. Bakers Court Nursing Centre Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 4 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 2 x x 2 x 2 Bakers Court Nursing Centre Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement The registered person(s) must ensure that the appropriate procedures for dealing with medication (including records) are implemented at all times. The registered person(s) must ensure that the registered provider conducts unannounced monthly monitoring visits to the centre, and that the subcequently produced reports are made available to the registered manager and the Commission for social Care Inspection. (The previously set target for the regular visits expired on 31/12/04.) The registered person(s) must ensure that all staff receive formal supervision at least bimonthly and that those one-toone meetings are minuted. (The previously set target expired on 31/01/05.) The registered person(s) must ensure that all the fire-doors that need to be kept open so as not to contribute to isolation of the vulnerable service users are fitted with the approved devises that would automatically close Version 1.10 Timescale for action 30/04/05 2. 33 26 31/05/05 3. 36 18 30/06/05 4. 38 23 31/10/05 Bakers Court Nursing Centre Page 22 them, if the fire-alarm was triggered. 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 33 Good Practice Recommendations Hold service users and/or their representatives meetings on a regular basis. Bakers Court Nursing Centre Version 1.10 Page 23 Commission for Social Care Inspection 4th Floor, Gredley House 1-11 Broadway, Stratford London E15 4BQ 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 Bakers Court Nursing Centre Version 1.10 Page 24 - 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. 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