Inspection on 06/02/07 for Berry Pomeroy

This inspection was carried out on 6th February 2007.

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

Other inspections for this house

Berry Pomeroy 27/11/08

Berry Pomeroy 01/12/05

Berry Pomeroy 21/07/05

Berry Pomeroy 06/12/04

Berry Pomeroy 27/07/04

Berry Pomeroy 17/02/04

Berry Pomeroy 25/11/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Berry Pomeroy 26-28 Compton Street Eastbourne East Sussex BN21 4EN Lead Inspector Robert Pettiford Key Unannounced Inspection 6th February 2007 9:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Berry Pomeroy Address 26-28 Compton Street Eastbourne East Sussex BN21 4EN 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) 01323 720721 01323 639032 info@berrypomeroy.fsbusiness.co.uk Eastbourne Free Church Women’s Council Mrs Nicole Pollard Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of residents to be accommodated is twenty six (26). Residents should be older people aged sixty-five (65) years or over on admission. 1st December 2005 Date of last inspection Brief Description of the Service: Berry Pomeroy is a residential service registered to provide care and accommodation for up to 26 older people. The home is owned by The Eastbourne Free Church Womens Council; a voluntary organisation. The manager is supported by a committee of trustees, who visit the home and produce a monthly report. The home is in Eastbourne, close to the seafront and the town centre. It is close to shops, churches, transport links and other local amenities. The building is a large detached property, which has access to all floors via a passenger lift. All service user’s have a single room, many of which are now en-suite. There is a well-tended garden to the rear of the property. Fees: Range from £380.00 - £450.00 Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on the 6th February 2007. The key inspections for care home services are part of the new methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service user’s and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service user’s and staff were spoken to, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. Service user’s returned several comments cards. During the inspection many service user’s were spoken with and asked to give their views on the home. The inspector joined the service user’s for lunch which gave him a further opportunity to discuss the quality of care within the home and activities they enjoyed. What the service does well: What has improved since the last inspection? Some redecoration has taken place in some of the bedrooms and a few new carpets have been purchase. A business plan has now been prepared and the home has ensured that it is in possession of gas safety certificates. The home now benefits from a manager who is now registered with The Commission for Social Care Inspection. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user’s can feel confident that their needs will be assessed and that they have access to a statement of purpose thus providing them with the information they need to make an informed decision prior to moving into the home. Service user’s also benefit by having a contract that reflects their terms and conditions and rights and responsibilities. EVIDENCE: The home’s statement of purpose viewed provided comprehensive information about the home and it’s aims and objectives. The manager was requested to ensure that it was up to date and included all the information as required of Schedule 1 of The Care Home Regulations. During a tour of the home it was evident that the home’s policy is to provide the service user’s and visitors with a great deal of information on many topics. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 9 Evidence was seen in service user’s files that the home conducts extensive pre-admission assessments to ensure they can meet the new residents needs. Evidence was also seen that residents were issued with legal contracts and terms and condition, which gave details of terms and conditions and rights and responsibilities. The manager confirmed that all residents were offered a trial period of to ensure they are happy to remain and that the home can meet their needs. The home does not offer intermediate care. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user’s benefit from detailed care plans and are supported by staff that treat them dignity and respect. Their health care needs are met however they are not always sufficiently documented. The home’s policy and procedures with regard to the handling and administration of medication need to be reviewed to ensure that the recording of such medication meets with current guidance. EVIDENCE: The inspector viewed and discussed with the manager the care records relating to several service user’s at Berry Pomeroy. In the care plans viewed there were guidelines in respect to support needed. The home undertakes regular reviews. Formal reviews involving significant professionals and relatives where possible are also undertaken. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 11 Evidence was available that service user’s were involved in drawing up personal care plans in the documentation and that they are consulted in reviewing and amending such care plans. The care planning system is currently under review. The manager informed the inspector that the home will start introducing a centred planning approach to care plans which will have a socially lead model as its base. This care planning approach will move away from a healthcare task orientated base to one with includes social and personal goals including hopes and aspirations. The inspector viewed a sample of care records and specific health care records relating to several service user’s. Records viewed confirmed service user’s had access to a range of health care inputs as and when required but not as part of regular health checks. Whilst it was accepted that many of the relatives of service user’s ensure that they have access to Dentists and Opticians etc it was not fully evidenced in the care plans. The home needs to ensure that service user’s have access to their chosen Doctor for medication reviews and health check up’s (if possible), Dentist, Optician in addition to identified specialist health care input. The manager is requested to include within the home’s action plan a provision to ensure that the home complies with standard 8.1 and regulation 12(1)(a) of the Care Home Regulations 2001. It is evident through talking to members of staff at Berry Pomeroy that the emotional health of the service user’s is of a high priority to the home and that staff are pro-active in maintaining and supporting service user’s with their emotional needs in order to maintain their quality of life. The inspector visited the home at 9:15AM. During the inspection the inspector noted that service user’s were seen making choices about their lives and were seen to be part of the decision process. A relaxed atmosphere was noted with the service user’s interacting with staff. The inspector viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of “PRN/As Required” Medication. MAR sheets were seen to be completed correctly and medication was stored appropriately. The manager confirmed that all staff that dispense medication have received appropriate training. PRN or as required medication protocols were not written up. The home could not demonstrate that as required medication is given following an agreed protocol. More specific instructions for staff should be shown on the MAR records rather that “as required” or “as directed”. The home needs to ensure that a signature sheet of known signature’s / initials is kept to ensure that staff giving medication can be clearly identified. To aid identification it was recommended that a photograph be in place within the MAR records prior to that service user’s sheet. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user’s’ social and recreational interest and needs are well provided for with a wide range of activities organised and are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The dietary needs of service user’s are well catered for and their views and opinions are sought regarding the choice of meals served. Service user’s feel confident that they are enabled to exercise choice and control over their lives. EVIDENCE: The home offers a full programme of activities. This included Musical movement, Communion, church services, quizzes, word games, board games, bingo, arts and crafts, reminiscence and many other activities. Organised social activities outside of the home are also arranged. Various other social events are arranged with families being invited. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 13 Service user’s are encouraged to exercise choice and control over their lives where possible, staff were willing to assist if necessary. Service user’s confirmed they could bring personal items on admission and the manager confirmed this was encouraged within the boundaries of health and safety requirements. Family and friends are made to feel welcome within the home are very much seen as priority in maintaining emotional health. The majority of the residents said the food was excellent and that they had a choice. The cook confirmed that where possible fresh produce were always used. Three full meals plus supper and snacks were available every day with drinks readily available. Evidence was seen that the residents were offered a choice at every meal. One new service user was extremely pleased that he could have a cooked breakfast every day if he so wished. Specialist diets could be provided when advised by health care professionals or service user’s. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a clear and effective complaints system in place and service user’s and families are aware of its contents. Service user’s are protected by robust adult protection policies and procedures EVIDENCE: The home had a written complaints procedure, which was seen in the foyer. Service user’s spoken with were aware of the contents and felt free to voice their concerns. The home has received no complaints since the last inspection. The home had also received many compliments from families regarding the level of care offered to their loved ones. The inspector viewed and discussed copies of the Home’s Policy for the Protection of Service user’s and staff “Whistle blowing” procedure. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training is provided in abuse. More courses are planned to ensure all staff receive the training required to protect service user’s from abuse. Criminal Record Bureau Checks (CRB) have been obtained for all staff. Any staff where their CRB has not been received by the home are supervised at all Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 15 times. The Registered Manager is aware of her obligations with regard to ensuring the safety of Service user’s and protecting them from abuse. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26, Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service user’s benefit from living in an excellent well maintained environment which provides a homely warm atmosphere with safe access to comfortable indoor and outdoor communal areas EVIDENCE: The inspector observed that the home is set in well-maintained gardens. The manager stated that the home meets with the requirements of both Fire and Environmental Health Departments. It was apparent that the individual and collective needs are being met in a comfortable environment. The standard of internal decoration and fixtures and fittings are well maintained and of a very high quality. The home benefits from a wide selection of communal area’s thus affording service user’s space should they so wish desire. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 17 The premises are kept exceptionally clean, hygienic throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user’s’ care, social and emotional needs are promoted by the employment of care staff in sufficient numbers to meet their needs and are fully protected by the recruitment procedures within the home. EVIDENCE: The ratios of care staff to service user’s is determined according to the assessed needs of residents. Following discussions with staff, service user’s reviewing the rota and observations sufficient staff were on duty. The home employs a higher than average number of ancillary staff in the view of the inspector who work as cleaners, laundry, cooks, gardener/ maintenance staff. Thus allowing care staff the time to meet the needs of service user’s. The staff training records indicated undertaken training for some of the staff. A number of staff had not received any training according to the evidence seen. Individual and group staff training needs had also not been fully identified. From documentary evidence seen the standard of staff training was good overall with the majority of staff completing basic courses and over 62 achieving a NVQ (National Vocational Qualification) Level 2 or above care Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 19 qualification. The manager confirmed that she would include within the home’s action plan that all staff have completed both adult protection and basic core training. The manager was requested to carry out a training needs analysis and was recommended to complete a training matrix which would clearly identify levels of training for each member of staff. Dementia training was also identified as a need within the home to enable staff to support service user’s further as their needs change. The manager confirmed that the home has a development programme for all new staff, which meets Sector Skill’s council’s workforce training targets and ensures staff fulfill the aims of the home and meet the changing needs of service user’s, and that all members of staff receive induction training to specification within 6 weeks of appointment to their posts, and foundation training within 6 months. The home showed that it undertakes a recruitment practice including submission of an application form detailing all previous work history, requests proof of identity and copies of qualification certificates, seeks two written references, and confirms work status. The home’s recruitment files were seen to include all the information as required under schedule 2 of the Care Home Regulations 2001 on information given. The home was requested however to review it’s staff files to ensure compliance. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user’s benefit from a well run home with an experienced manager in post and is operated in their best interests and their view and opinions are important. Service user’s can be assured that their personal finances are secure, however the standard of record keeping and the need to have a reconcilable audit trail was needed. Service user’s can feel confident that at all times their health and safety is protected EVIDENCE: The Manager held the required qualifications and experience to register with the Commission as Registered manager and was successful in her interview in Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 21 April 2006. Throughout the inspection both the manager and finance manager were open and honest and assisted in the inspection. Both managers were aware of some of the issues raised and were working diligently to address them. Staff confirmed that both were approachable and communicated a clear sense of direction and leadership. Quality assurance was discussed and the views and opinions of many of the service user’s sought. They confirmed a great deal of satisfaction in living within the home and felt confident that their views and opinions were valued by the staff and management. The manager confirmed that the home does undertake quality assurance by means of asking service user’s to complete questionnaires and seeks the views and opinions of relatives, Doctors and other healthcare providers. The Trustee’s of the charity that is the registered provider of the home do regularly visit the home and complete what is known as a Regulation 26 visit. This requires the owner / provider to assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. However the quality of such Regulation 26 visits viewed were seen to be poor. In the view of the inspector too much emphasise was put on how clean the home was and small issues. The inspector stated to the manager that the visits need to focus on outcomes for service user’s with regard to quality of care, staffing, adult protection, audits of policies and procedures and that they are followed, staff training, activities, health and safety etc. along with speaking to staff and service user’s. The home has developed a written business and financial plan for the establishment, which can then be open to inspection and be reviewed annually. Service user’s’ families are encouraged to handle the monies of service user’s who are unable to manage them themselves. The home only deals with relatively small amounts of personal monies on behalf of service user’s. The records for these were viewed and found to be in need of improvement with regard to providing an auditable clear accounting system. The system in place ensured that residents could be confident that the monies were handled securely but records were deemed to be poor. Two accounts were audited and balanced. Monies are kept separately in a safe. A statutory requirement has not been made at this time. The inspector viewed records relating to Health and Safety Procedures, maintenance and servicing, and risk assessments. The inspector viewed the Fire Log book, which was on the whole up-to-date. The inspector was able to evidence that checks and servicing of fire safety equipment / emergency lighting had been undertaken at the required frequency. Not all of the electrical Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 22 cupboards however had a lock. The inspector requested one to be fitted as a priority. Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 2 3 x x 3 Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 26(1) Requirement Whilst it is accepted that regular reg 26 visits occur the provider needs to ensure that such visits to audit the quality of care within the home include, staffing, adult protection, audits of policies and procedures and ensure that they are followed, staff training, activities, health and safety etc. along with speaking to staff and service user’s. Timescale for action 06/08/07 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 OP8 Good Practice Recommendations To ensure that the home is proactive in maintaining health and that medication is reviewed as part of the review process Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 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 © 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 Berry Pomeroy DS0000021050.V324930.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!