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Inspection on 24/03/09 for Benoni Nursing Home Ltd

Also see our care home review for Benoni Nursing Home Ltd for more information

This inspection was carried out on 24th March 2009.

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

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.

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Benoni Nursing Home Ltd Benoni 12 Carrallack Terrace St Just Cornwall TR19 7LW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 2 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Benoni Nursing Home Ltd 12 Carrallack Terrace Benoni St Just Cornwall TR19 7LW 01736788433 01736788433 kernowcare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Benoni Nursing Home Ltd care home 21 Number of places (if applicable): Under 65 Over 65 2 21 2 2 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: 0 0 0 0 Four service users may be accommodated who are aged between 55 to 64 years. Date of last inspection Brief description of the care home Benoni is a detached building situated in a residential area of St Just. The home is registered to provide accommodation and care, with nursing, for a maximum of 25 service users. This can include two service users with a dementia and 2 service users with a physical disability on admission. The home is also registered to accommodate four service users from age 55 years of age to 64 years of age. Bedrooms are situated on the ground floor, first floor, and there are also three bedrooms for service users receiving residential care on the second floor. There are three double rooms. The first and second floors are accessed by a shaft lift. The grounds are modest in size though there are areas for sitting outside. The slope from the road and car parking area to the Care Homes for Older People Page 4 of 28 Brief description of the care home main door is ramped and quite steep, but is negotiable by a person in a wheelchair with assistance. There is a small step and a threshold at the main entrance; these are accessible with a wheelchair with assistance. The home has a strong link with the community and town of St Just. The registered provider is Benoni Nursing Home Ltd. The responsible individual is Mrs Helen Hutson. The registered manager is Mrs Patricia Beesley. Fees range from 550 to 750 pounds per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place over approximately 8 hours. We looked at documentation, toured the premises, met with residents and staff, and discussed our findings with the financial director and the registered manager of the home. Overall, the home largely meets the care needs of the people that live there, and this is confirmed by the positive comments made. Improvements could be made in respect of social/recreational lifestyle, but generally the outcome for residents is good. The requirements and recommendations identified in this report are largely of a managerial/systems nature. The improvements can be assisted with an increase in staffing levels. Care Homes for Older People Page 6 of 28 Subsequent to the inspection the responsible individual (Mrs Hutson) has discussed the findings of this report with the inspector and has already given the homes commitment to addressing the issues identified, and the Commission continue to have confidence in the registered providers ability and commitment to high quality care delivery. What the care home does well: What has improved since the last inspection? What they could do better: Staffing levels should be increased to meet the holistic needs of the people that live there, and to allow the registered manager to manage. The home could do more to meet the social recreational needs of some of its more dependent residents, and do more to demonstrate their ability to make meaningful choices. Documentation should be reviewed and amended as necessary to ensure it provides current and accurate information (e.g. Statement of Purpose and Service User Guide, training records). More could be done to protect residents by ensuring adherence to a robust Care Homes for Older People Page 8 of 28 employment procedure. The home could do more to demonstrate an ongoing commitment to staff training and staff supervision. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More could be done to provide prospective residents and/or their representatives with comprehensive information to enable them to make an informed choice of home. Residents have their needs assessed prior to moving into the home. This is so that the home can assure them the prospective resident that they are able to meet their individual care needs. Evidence: Copies of the Statement of Purpose and Service User Guide (documents that tell a person about the home) are given to relatives, and this includes the homes complaints procedure. Although the home has a number of people with sensory deficits an alternative format is not available. The Statement of Purpose and Service User Guide were last reviewed in 2006 and provide incorrect information. As part of this inspection we looked at the assessments that were carried out prior to a Care Homes for Older People Page 11 of 28 Evidence: person moving to Benoni. The care documentation of a person recently admitted to the home showed that a proper pre-admission assessment had take place. Staff undertake an assessment plus gain the views and opinions of any specialist workers involved with prospective admissions. The home does not provide intermediate care, though respite care is offered. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Many of the people who live at Benoni feel that they are offered a good standard of care. Each resident has a care plan. This is written in plain language, and is easy to understand. Care plans are informative and detailed. The care records also include relevant risk assessments. Evidence: Comments received from the people who live at Benoni were very positive, and included: Excellent, no complaints, and the staff are very kind. Many of the people at Benoni have dementia or mental health needs and are not able to always explain their needs or difficulties. It is therefore important that there are written care plans that detail how needs are to be met to ensure that staff know the nature of the care they are to provide. The care plan forms the basis of the care and support provided. The care plans identify the health care needs of the residents with evidence of health care professional involvement for example chiropody and optician visits. The residents are regularly weighed. Care documentation is written in clear Care Homes for Older People Page 13 of 28 Evidence: language. Each care plan includes a risk assessment. Care plans are detailed and informative about physical care, but could do more regarding likes and dislikes and a social care plan. Care should be taken to ensure the care plans detail the residents holistic care and support needs, including promotion of feelings of well being, with evidence of a regular review including maintenance of strengths and abilities. Care plans should also detail any non-pharmacological means used to modify behaviour. The daily entries were good, detailed and informative. Social and lifestyle statements were included where the residents are perhaps more able or have many visitors. The lifestyle of the more dependent residents was less clear. Supporting documentation showed that clients have access to relevant professional health care agencies as needed. All the people that live at Benoni are registered with a local GP surgery. Clients preferred names are recorded and used. Clients have access to a telephone for private use. Staff were observed to knock before entering residents rooms. We found that medicines were stored securely in locked cupboards and access to the keys was restricted. We found that when people are prescribed medicines with variable doses that the dose actually given is recorded. Medicine Administration Records were seen to be in order, though care should be taken to ensure hand transcribed records show two initials, indicating the entry has been checked as correct. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records do not fully reflect the social/recreational activities available, nor is there sufficient staff to provide in this area, and improvements are needed. Visitors are welcomed to the home at anytime. Choice is not always shown to be available to residents. Evidence: There is an activity record that identifies the activity and the participants, but offers no information as to whether people enjoyed the event, or not. This record shows that organised activities are sparse. We were advised that more is offered, but there was little evidence to support this and the staffing levels are insufficient to offer and provide consistent attention to this important part of peoples lives. The daily entries in the care documentation for the more dependent people do not provide information about how they spent their day. This is in contrast to the daily entries for the more able people and people who have frequent visitors (people who create their own distractions and entertainment). There is little evidence that people are given the opportunity to participate in activities. Some people are fit and active and able to walk to local facilities. There is no Care Homes for Older People Page 15 of 28 Evidence: appointed Activities Organiser. The impression is that there is room for improving the activity opportunities, including one to one engagement. Observation of the interaction between the residents and the staff (including the registered manager) was very positive and contributes to the pleasant environment at the home. Residents and staff confirmed that the registered manager is approachable and pleasant. Residents were seen to have personal possessions, and are free to determine their own lifestyle within the parameters of their care needs. The residents have confidence in the staff. The visitors book, daily records, and comments from residents confirm that contact with loved ones and friends are encouraged. The benefits of the daily entries providing a pen portrait of residents life styles (including times of waking and retiring) was discussed with the registered manager. Rooms are personalised with plenty of evidence of personal possessions being brought in. The menu is displayed at the entrance to the lounge/dining room, and shows the menu for the week. This was discussed with the registered manager as many residents have some degree of confusion, and this may not be the best way to provide clear information that assists people to orientate themselves to time and place. The possible benefit of the menu showing one days meals was discussed. There was no indication of an alternative being available at breakfast and lunch though the record of food provided shows choices being made at tea. We were advised that people were offered alternatives on the basis of their known likes and dislikes, but not actually asked if they would prefer something else. We were told by staff and the registered manager that the weekly menu changes once a month (i.e. the same menu operates for 4-5 weeks). There is a record of food provided, but this does not always show the choices made. Comments from residents included food is pretty good on the whole. We were advised that the cook has achieved the Basic Food Hygiene Certificate. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people that live at Benoni are not fully protected from abuse by staff training and the homes adherence to a robust recruitment procedure. Evidence: There is a complaints procedure displayed near the entrance to the home. A copy of the complaints procedure is available in the Statement of Purpose and Service User Guide. Comments from the people that live at Benoni confirmed that they had confidence in the staff. The registered manager said that the home had received one complaint since the last inspection, which had been resolved. The home does not keep a record of complaints received. One of the responsibilities a care home has is to protect people from abuse, and the Commission expects homes to be proactive in this matter. There is no ongoing safeguarding training taking place. People are not protected by the homes employment procedure. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Benoni benefit from accommodation that for the most part meets their needs. The accommodation is clean and odour free. Evidence: An extension to the property was completed towards the end of 2008. This increased the homes operating capacity from 21 beds to 25 beds (4 new en-suite single rooms). There are 3 double rooms, 5 single en-suite rooms, and 14 single rooms. There are 2 communal bathrooms, and 5 communal lavatories. We looked around the home and the rooms seen were all clean and in good order, there were no unpleasant odours. Some of the people had brought items of their own in to decorate their rooms. All of the rooms are of sufficient size, though room 6 does have limited floor space as a double room. Room 4 has an area to the rear of the room, which is used by staff to store a variety of equipment including a mattress and cushions. This area is adjacent to a wash hand basin and partly separated from the residents room by a curtain. The external fire door in room 7/8 does not close properly (warped?). The carpet under the window in room 10 is badly worn and presents a potential tripping hazard. The home has a sluice facility, but access to this is partly hindered by the storage of Care Homes for Older People Page 18 of 28 Evidence: equipment in this room. Staff were observed to be using protective clothing. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff on duty are not sufficient for all care needs or the efficient management of the service. The recruitment procedures are not robust enough to safeguard residents. Training has not progressed since the last inspection. Evidence: The duty rota and discussion with staff confirms that at the time of the inspection there were 25 people living at Benoni. One client is funded for 1:1 staffing hours, so there are routinely 1 nurse and 3 care staff on duty during the day for 24 residents. The registered manager confirmed that approximately 45 of residents need 2 staff to assist with mobility or transfers around the home or are dependent on wheelchairs. We were advised that approximately 60 have varying degrees of dementia care needs, and 25 present some degree of challenging behaviour (including wandering and occasional aggression). Residents were seen to need the input of two care staff during the inspection, and this clearly has implications for the numbers of staff left available for the other residents. We also received comments from staff about the home being short-staffed. Staff comments and records show that the lifestyle of the residents is not always being afforded the importance it should with existing staff numbers. The home will benefit and improve from increased staffing numbers. A training matrix displayed on a white board on the wall of the office is out of date. Care Homes for Older People Page 20 of 28 Evidence: There are some training certificates in individual personnel files, but not all certificates are collected. The registered manager has introduced a training summary to some personnel files, but the information seen was incomplete (e.g. no dates). There is no system for monitoring staff training needs (e.g. 1st Aid). This is particularly important where staff under the age of 18 are employed to provide personal care. The home must be able to demonstrate induction training, ongoing training relevant to their role, supervision records, shadowing, and a competency assessment. We were advised by the registered manager that in excess of 50 of care staff are qualified to NVQ Level 2 or above. We were advised that new staff undertake a National Training Organisation compliant induction programme, but evidence for this was not seen at the time of the inspection. There was nothing to show the content of the homes own induction for new staff. Two staff personnel files inspected showed no record of them having received induction training. Examination of personnel files showed that the home is not adhering to a robust employment procedure. The two staff personnel files inspected showed no references and only one reference received respectively. The one reference was not from the most recent employer. There was no declaration of physical and mental fitness. The application form asks for period of employment (e.g. May 07 to Dec 08), but the ones seen were completed differently (e.g. 4 months) and therefore did not provide a chronology of employment. The personnel file did not indicate the start date of employment. An up to date photograph is held on file for all members of staff. The use of a checklist at the front of personnel files to readily access core information (such as start date, date crb sent, date crb received, crb reference) was discussed. All encounters seen and heard between staff and residents were appropriate with staff addressing people by their preferred name. Staff were heard to be respectful when talking with service users and seen to be gentle when directing and assisting them. Staff were seen and heard to knock on doors before entering bedrooms. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the required qualifications and experience to run the home. Feedback is sought from residents and/or their relatives regarding the way in which the home is run. Staff are not supervised. Staff training is not monitored. Evidence: There is a registered manager, who is a registered nurse and has also completed the Registered Managers Award. The registered manager has worked at Benoni for approximately 2.5 years as a nurse before becoming the registered manager. There is a formal quality assurance system in place to ascertain the views of those that use the service. This takes the form of quality assurance surveys, but these do not extend to relatives or other stakeholders. Discussion took place with the registered manager about the best way to summarise and publish the findings (including any action taken as a result of these). Care Homes for Older People Page 22 of 28 Evidence: Financial records are supported by receipts. The home has no involvement in the management of individuals finances, though will look after small amounts of money if requested to do so. Care staff are not receiving formal supervision. The premises and equipment within are regularly maintained and checked. There is appropriate insurance in place. Fire training is not being provided at the frequency recommended. The homes records indicate that at least one member of staff has not had fire training for approximately 18 months. The fire training records do not show what the training consisted of, though the fire warden confirmed that it is simply a repeat of the same questionnaire. This was discussed with the registered manager at the time of the inspection. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 19 The registered manager must ensure that the home adheres to a robust employment procedure. Residents must be protected. 01/04/2009 2 27 18 The registered manager 03/08/2009 must ensure that staff receive induction and ongoing training appropriate to their roles. Residents must be protected. 3 30 18 The registered manager 01/04/2009 must ensure there are sufficient, qualified, competent, and experienced staff on duty at all times. The registered manager must ensure there are sufficient staff to meet the residents holistic care and support needs, including promotion of feelings of well being, with evidence of a Care Homes for Older People Page 25 of 28 regular review including maintenance of strengths and abilities. 4 36 18 The registered manager must ensure that staff are appropriately supervised. Residents must be protected, and staff training needs and aspirations identified. 5 38 23 The registered manager must ensure that staff receive appropriate fire training at the frequency recommended by the fire brigade. Residents, staff, and visitors must be protected. 01/04/2009 01/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The registered manager should review and amend the Statement of Purpose and Service User Guide to ensure the documents provide accurate and up-to-date information. The registered provider should consider the benefits of alternative formats for residents. The registered manager should ensure hand transcribed records show two initials, indicating the entry has been checked as correct. This recommendation was made at the last inspection. The registered manager should make arrangements for regular and frequent recreational activities to be offered and available to residents. The registered manager should do more to demonstrate that residents are able to make meaningful choices. The registered manager should review the homes storage facilities to minimise any impact on residents Page 26 of 28 2 9 3 12 4 5 15 26 Care Homes for Older People accommodation and the functioning of facilities such as the sluice. 6 33 The registered manager should extend the use of quality assurance surveys to relatives and other stakeholders, and publish a summary of the findings. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!