Inspection on 16/08/05 for Bhajan Kaur Rai Hall

This inspection was carried out on 16th August 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

Bhajan Kaur Rai Hall 17/05/07

Bhajan Kaur Rai Hall 10/05/06

Bhajan Kaur Rai Hall 31/05/05

Bhajan Kaur Rai Hall 02/02/05

Bhajan Kaur Rai Hall 15/09/04

Bhajan Kaur Rai Hall 19/03/04

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Applegarth

Trevayler Residential Care Home

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St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

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

CARE HOMES FOR OLDER PEOPLE Bhajan Kaur Rai Hall Epinal Way Care Centre Hospital Way Loughborough, Leicestershire LE11 3GD Lead Inspector Mrs Carole Burgess Unannounced 16 August 2005 09:30 am th 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. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bhajan Kaur Rai Hall Address Epinal Way Care Centre Hospital Way Loughborough, Leicestershire LE11 3GD 01509 216616 01509 262710 surjit@rushcliffecare.co.uk karen@rushcliffecare.co.uk Rushcliffe Care Limited 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) Vacant Care Home (CRH) 43 Category(ies) of Physical disability over 65 years of age (PD(E)) registration, with number 43 both, Old age, not falling within any other of places category (OP) 43 both, Physical disability (PD) 43 both, Sensory impairment over 65 years of age (SI(E)) 6 both, Mental disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) 12 both, Dementia over 65 years of age (DE(E)) 12 both. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. No person under the age of 55 years may be admitted to the home under catgory PD. 2. No one falling within category SI(E) may be admitted to the home where there are 6 persons SI(E) already accommodated within the home. 3. Service Users: No person to be admitted to the home in catagories MD(E) or DE(E) when 12 persons in total of these catagories/combined catagories are already accommodated in the home. Date of last inspection 31st May 2005 Brief Description of the Service: Bhajan Kaur Rai Hall is one of three units owned by Rushcliffe Care Limited within the Epinal Way Care Centre in Loughborough, Leicestershire. It is purpose built with all the necessary adaptations to support the specific needs of the residents. The home is situated on two floors with a lift servicing the first floor, and is fully accessible to wheelchair users. The first floor is seperated into two zones - one being a safe environment for residents with dementia. It has a high standard of décor throughout. All rooms have en-suite shower facilities. The home has spacious dining rooms, and comfortable and well-appointed sitting rooms with televisions, videos and books on both floors. There is an on site laundry and industrial kitchen which services all three units. Situated adjacent to the Loughborough Hospital, and approximately one mile from the centre of Loughborough, it is accessible by public transport or car. There is ample parking for visitors. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they receive through review of their records, discussion with them (where possible), and the care staff and observation of care practices. An opportunity was taken to look around the home, view records, policies and care plans and to talk to staff and residents. Many of the residents were seen during the inspection and three residents gave the Inspector their impressions of the home. Prior to this inspection the CSCI received a complaint regarding the level of care provided for a former resident. This inspection took into account the complaints made against the home and inspected the standards relating to the issues raised by the complainant. The following are a summary of the issues brought to the attention of the CSCI: 1. The home failed to ensure that a room was hygienic and free from offensive odours. 2. The home, on a specified date, failed to ensure that the delivery of care was adequately resourced and supervised by suitably trained and experienced staff putting residents at risk. 3. The home failed to treat a resident and his family with dignity, sensitivity and respect. 4. The home failed to deliver their Philosophy of Care contained in the home’s Statement of Purpose. Complaints 1, 2 & 4 were upheld and requirements made. Complaint 3 was unresolved as some staff were not available and staff felt that their actions and comments may have been misinterpreted by the complainant. The Company Manager will write to the complainant to address these concerns. Outcomes for the issues raised are recorded in the main body of this report. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Staffing cover, at the time of the inspection, once again, appeared ‘thin’ when compared with the Department of Health Residential Forum Guidelines, and management must revisit staffing levels to ensure that residents receive a satisfactory standard of care, particularly as the home now has a separate zone on the first floor for twelve residents who have dementia, thereby increasing the workload and responsibility for the staff. Low staffing levels have been identified during two previous inspections as a cause for concern. Both staff and residents commented on low staffing levels and the adverse impact on care. It was noted that staffing was low on the day relating to the complaint and may have been a contributory factor but this does not excuse poor care practice. The acting manager stated that she is included in the care-staffing compliment most of the time – at least three or four days out of five. This does not allow sufficient time for her to effectively manage the home. N.B. The acting manager has since informed the CSCI that, since that inspection, additional staffing hours has ensured that she now has sufficient administration and management time. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 7 Care plans must be completed in a ‘timely’ manner to ensure that the health, welfare and personal needs of the residents are fully documented, particularly in relation to healthcare professionals’ instructions. Specific risks and risk assessment, associated with the care of a resident, must be written in care plans and should contain relatives contact details, and evidence resident and or relative/representative involvement, where appropriate, to ensure that the resident’s needs are fully met. Whilst the home is generally very clean it was noted that a specific room had a particularly offensive odour and the carpet required cleaning or replacing. Where it is company policy to weigh and record residents’ weights monthly, and where this is not done, the reason why should be recorded in the resident’s care plan. This was identified in the previous inspection report. 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. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 8 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 Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 9 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) 3 The admission process is generally well managed but requires attention to detail to ensure that the residents’ health and welfare needs are fully met. EVIDENCE: Pre assessment documentation was satisfactory but in some cases lacked detail and did not fully encompass all of the areas identified in the National Minimum Standards. Health and Social Services Care Management plans were available. The remaining standards were inspected during the previous inspection in May 2005 and found to be satisfactory. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 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, 8, 10 & 11. Residents are generally well looked after in respect of their health but care plans must be completed in a ‘timely manner’ to ensure that resident’s health and personal care is fully met. EVIDENCE: Residents are generally well looked after in respect of their health and personal care as detailed in residents care plans. However, the complainant’s relative, who had been in the home for 10 days, did not have an individual care plan or risk assessments to ensure that the resident’s specific health and personal care needs, as identified in the preassessment documentation, were met. Specific care needs, as identified in a hospital discharge form, had not been acknowledged or addressed. The Company Manager and Senior Manager agreed that this was not acceptable and not in line with Rushcliffe Care’s general good practice and would be addressed. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 11 The complainant felt that his relative and family had not been treated with ‘dignity, sensitivity and respect’ during a difficult and distressing time. The resident’s room had been left open and dirty cups not cleared after the resident had been taken to hospital. The Company Manager acknowledged that when a resident is in hospital or has passed away, either in the home or in hospital, the resident’s room should be left in a clean state and secured. This had not occurred on this occasion and the Company Manager will personally address these concerns. Nevertheless, on the day of inspection residents said that they were well cared for and that staff were polite and respectful. Residents who are near to the end of their life can remain in the home, where this is appropriate, in consultation with their GP and their relatives. The remaining standards were inspected during the previous inspection in May 2005 and found to be satisfactory. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 14. The staff work hard to ensure that residents experience a safe and homely life style but attention to detail within the care plans would ensure that all care needs are met. EVIDENCE: The complainant’s relative’s admission form did not contain all next-of-kin or relatives contact details. This resulted in the family not being contacted in a ‘timely’ manner or being informed when the resident was ill. This was noted in another residents file although others contained contact details. Residents said that their wishes and personal preference were adhered to and supported by the care staff. The remaining standards were inspected during the previous inspection in May 2005 and found to be satisfactory. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 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, 17 & 18. Arrangements for receiving and responding to complaints are sound. EVIDENCE: The home’s complaints process reflects the government’s adult protection guidelines, set out in the No Secrets’ publication. Staff are aware of these procedures and receive relevant training. Complaints and concerns made to the home are dealt with appropriately. The CSCI has received one complaint about the home, investigated during the course of this inspection. The CSCI will write to the complainant regarding the specific outcomes relating to the complaint, detailed within the body of the inspection report. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 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) 26. The home generally provides a comfortable, homely, clean and safe standard of accommodation for the residents. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 15 EVIDENCE: The home was clean and hygienic in all communal areas and in all but one of 10 rooms inspected. The acting manager acknowledged that the complainant’s relative’s room was odorous on the day the resident moved to the home but was ‘rug doctored’ prior to the arrival of the resident. This room was not odorous on the day of inspection. The carpet of an identified room, odorous on the day of inspection, requires cleaning or replacing. Rooms should smell clean and fresh, even when doors and windows are closed. Odorous rooms affect a resident’s dignity and are distressing for both the resident and their visitors. The remaining standards were inspected during the previous inspection in May 2005 and found to be satisfactory. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 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, 29 & 30. Staff at the home are well trained and caring but staffing is insufficient for the numbers and dependency of the residents, particularly as there are two floors and three zones, one of which is separate and cares for people with dementia. EVIDENCE: The Senior Manager and Acting Manager maintain direct responsibility for the home. Staffing hours, as proposed by the Senior Manager in May 2005, are below those provided at present. Staffing levels, at the point of inspection, were low when compared with the Department of Health Residential Forum Guidelines. At the point of inspection there were four care staff on early shift, three care staff on the afternoon shift, with an additional smaller half shift, and three on night duty to cover two floors and 33 residents (at the point of inspection), 11 of whom were highly dependent. People with dementia are cared for in a separate, safe area within the home. Staffing is, therefore, ‘thin’ and could result in inadequate care thereby not meeting the identified needs of the residents. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 17 The level of staffing appears to have compromised the care provision for a resident on at least one occasion as identified in the complaint investigation. The acting manager stated that she is not supernumerary for the majority of her shifts; in consequence has little management time. Both staff and residents identified that there were insufficient staff, but that staff worked very hard and were very caring. (The acting manger has since informed the CSCI that staffing levels had improved enabling her to spend more time on managerial duties). The complainant identified a day when care was not of the required standard for his relative. Staffing on that day was below the usual staffing levels with senior staff helping out with breakfasts. Nevertheless, the staff on duty were under pressure and, although experienced and well trained, failed to identify that a resident required medical help and failed to inform the resident’s relatives that he was sick, as they had been requested to do (this had not been recorded in the resident’s admission notes). The home had failed to deliver their Philosophy of Care contained in the home’s Statement of Purpose on this occasion. Extensive ‘in house’ training, and additional course such as 4-day First Aid at Work Courses are undertaken, and good care practice supports staff in meeting the residents’ health and welfare needs. However, inadequate staffing appears to have compromised the usually high standard of care provided throughout Rushcliffe Care Limited, for at least one resident and his family, and must be urgently reviewed. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 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, 32, 33 & 38. The acting manager, who is applying for Registered Manager status, manages the home well and ensures that the residents’ rights are protected within her managerial time constraints. EVIDENCE: There is no Registered Manager at present but the acting manager has applied for Registered Manager status. She is currently undertaking NVQ Level 3 and will be applying to undertake the Registered Managers Award. The acting manager stated that she is included in the care staffing rota for approximately four out of five of her working days. She requires more time and support in her management, supervisory and administrative role in order to ensure that sufficient staff provide a good standards of care for the residents in their care. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 19 Good interaction between staff and residents ensures that there is an ethos of openness in the home. Staff support the residents to make decisions in their everyday life, which promotes their independence as far as is possible. The acting manager is in the process of introducing supervision (a regular review of staff performance and training needs) to ensure that staff maintain the standards of care expected throughout Rushcliffe Care Limited. The remaining standards were inspected during the previous inspection in May 2005 and found to be satisfactory. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 2 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 1 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 2 x x x x 2 Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 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 7.1, 7.6 & 13. Regulation 15.1 Requirement Timescale for action 16.09.05 2. 8 13(1)(b) 3. 4. 26 27 & 28 16(2) (k) 18(1)(a) The Registered Person(s) are required to ensure that unless it is impracticable to carry out such consultation, the registered person(s) shall, after consultation with the resident, or a representative of his, prepare a written plan as to how the residents needs in respect of his health and welfare are to be met. The Registered Person(s) are 16.09.05 required to ensure that residents receive where necessary, treatment, advice and other services from health care professional (in a timely manner). The Registered Person(s) are 16.09.05 required to keep the care home free from offensive odours. The Registered Person(s) are 16.09.05 required to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the residents. Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 22 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 8.9 Good Practice Recommendations The Registered Providers are recommended to ensure that where residents are not weighed, as per care plan, the reason why this is not done is recorded, as identified at the previous inspection. The Registered Person(s) are recommended to be make staff aware that residents privacy and dignity should be maintained at all times and that company policies and procedures regarding residents personal rooms and effects are adhered to following the death of a resident. The Registered Person(s) are recommended to ensure that next-of-kin and relatives contact details are recorded and adhered to. The Registered Person(s) are recommended to ensure that the acting manager has sufficient competent and experienced care staff to ensure that the home is run in the best interest of the residents and in that staff are sufficient in number to ensure the health, safety and welfare of the residents. 2. 10 3. 4. 13 33 & 38 Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Pavilions 5 Smith Way, Grove Park Enderby, Leicestershire LE19 1SX 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 Bhajan Kaur Rai Hall C51 C01 S1655 Bhajan Kaur Rai Hall V242994 160805 Stage 4.doc Version 1.40 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. You have been warned!