Inspection on 30/12/06 for Braeside

This inspection was carried out on 30th December 2006.

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

Braeside 30/08/07

Braeside 15/02/06

Braeside 10/08/05

Braeside 11/01/05

Braeside 30/11/04

Braeside 03/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Braeside Stanhill Lane Oswaldtwistle Accrington Lancashire BB5 4QF Lead Inspector Mrs Lynn Mitton Unannounced Inspection 15th December 2006 10:00 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 Braeside DS0000009500.V314656.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. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Braeside Address Stanhill Lane Oswaldtwistle Accrington Lancashire BB5 4QF 01254 398099 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) Mr George Anthony Hitchen Mrs Christine Philomena Hitchen Mrs Jennifer Mavis Brimlow Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 Brief Description of the Service: Braeside is a detached property situated on the main road in Oswaldtwistle within easy reach of local amenities. There was a parking area for visitors and staff. The service is registered to provide personal care and accommodation to 24 people aged over 65 years. The accommodation provided for residents is mainly in single bedrooms, sixteen of which have an en-suite toilet and washbasin. There are three lounges and a dining room. Fees for the cost of a weeks care at Braeside ranges from £324.50 – £366.00. There was information available to potential service users and their families advising them of the home and giving them details about the type of service they could expect. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted on 13th December 2006. The registered manager of the home completed a pre inspection questionnaire. The inspector spoke to residents in receipt of a service, visitors to the home and to the care staff on duty at the time of the inspection. Throughout the report there are references to the “tracking process”, this is a method whereby the inspector focuses on a small representative group of residents. Records regarding these people were inspected. Two residents were case tracked, their files examined in detail and two care staff member’s files were also case tracked. 5 of the Commissions resident’s questionnaires were returned, and 7 visitors questionnaires were also returned. Comments and findings of these surveys are referred to throughout this report. The inspector conducted the inspection with the registered person and senior carer on duty at the time of the inspection. During the inspection a number of records, policies and procedures were also viewed. What the service does well: One residents’ relative wrote: “It’s a lovely place, mum has always been happy and content. All members of the family call at anytime and are made welcome. Mum is always clean. We check her room and can speak to the matron. They always accommodate our wishes and are very helpful. They communicate very well with us”. Another residents’ relative told the inspector; “I’d talk to the manager if I had any concerns – she’s a lovely lady – the carers are very good and I am made very welcome here”. Contracts were issued to each resident when they moved into the home, ensuring that they were aware of the terms and conditions of their stay at the home. The admission procedure for new residents ensured that information about their care needs was obtained before they arrived. This enabled staff to have a clear understanding of what they needed to do for them. Visitors to residents at Braeside were made welcome. Meals were varied and provided a social occasion on a daily basis. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 6 Complaints had been dealt with in a satisfactory manner. The general layout and décor of the home provided comfortable surroundings, and was warm, tidy and clean. Resident’s finances were dealt with in a satisfactory manner. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Braeside DS0000009500.V314656.R01.S.doc Version 5.2 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 the following standard(s): OP2 OP3 & OP6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A contract was being issued to each resident when they moved into the home. The admission procedure for new residents ensured that information about their care needs was obtained before they arrived. This enabled staff to have a clear understanding of what they needed to do for them. EVIDENCE: One residents’ resident wrote: “We were invited to choose a room for our relative from 3 available and were able to move some furniture and belongings in from home”. Contracts and an “Agreement of Residence” explaining the terms and conditions of residents stay at Braeside were in place for the two residents case tracked. However, some details had not been completed on one, for example, date of admission, fees and payment details. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 10 The inspector saw two assessments of need, which had been completed prior to new residents being admitted. Letters were sent to residents advising them that Braeside was able to meet their needs. Intermediate care is not offered at Braeside. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 11 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 the following standard(s): OP7, OP8 OP9 & OP10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans did not contain sufficient detail to ensure that all care and health needs were identified and interventions documented. Medication was not being stored or administered in a way that ensured resident’s safety was maintained. Residents were cared for in a way that promoted choice, dignity respect and fulfilment. EVIDENCE: The inspector looked at two residents care plans. Some information was available identifying residents care and health needs and how these should be met. The quality of the information was considered basic by the inspector, who discussed the information that should be included in each care plan at length with the senior carer on duty and the registered person, as this issue has been outstanding at previous inspections. The inspector advised that care plans should contain detailed clear and concise identification of each persons needs and a description of how these needs are to be met by the care staff team. They should also demonstrate residents and or next of kin involvement, and be reviewed regularly. The content of and the use of language and phraseology in Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 12 the daily records were also discussed. On one residents care plan case tracked there were no records completed regarding this residents health needs, this despite this person being an unstable diabetic, there were also no nutritional assessment or weight records on the care plan. The inspector and senior carer discussed one resident’s hand nails which were in need of attention. Resident’s medication was not administered by a monitored dose system. Drug administration records seen were accurate and up to date. Some medication seen was out of date, and some medication seen had been put in the wrong storage box. The inspector was advised that all the care staff team had completed mediation awareness training. Accredited medication administration training was ongoing for all care staff and was due to be completed in January 2007. From observations, the inspector felt that staff knew residents needs well, and they were observed to treat them with dignity and respect. One residents relative wrote; “Some of the carers are excellent to others its just a job”. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 13 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 the following standard(s): OP12, OP13, OP14 & OP15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A regular programme of planned activities would ensure that residents had opportunities to engage in activities as well as having enjoyment, mental and physical stimulation. Residents were given opportunities to exercise choice and control in their day to day living. Visitors to residents at Braeside were made welcome. Meals were varied and provided a social occasion on a daily basis. EVIDENCE: Records had not been kept of any residents’ recreational activities undertaken since November. The inspector was advised that a Christmas Party for residents and their families on the 15th December. One resident spoke to the inspector about how he helped out at his son’s garage. The inspector was advised that clergy from the local Catholic Church visit residents weekly and clergy from the Church of England visit on an ad hoc basis. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 14 There were a number of visitors to the home on the day of the inspection. One said she was “made very welcome”. The visitor went on to say she could talk to the registered manager about any concerns she had about her relative – “she’s a lovely lady”. Another visitor said; “this is a very homely home, the care staff are very helpful – it’s very nice here”. The inspector ate lunch with the residents, and noted that this was a pleasant social occasion. Varied meals were offered to residents with different dietary needs. Choices of food were available for breakfast and at suppertime. One resident told the inspector that the food was very good. Some residents chose to eat in their own room. One residents’ relative wrote; “the standard of home cooking is very good, mum has gained weight and is very satisfied”. The inspector noted that fridge freezer and hot food temperatures were not always being recorded, and one fridge had temperatures recorded of 11 degrees centigrade. Specialised cutlery and plate guards were seen to be in use. The inspector spoke to the cook who advised that 5 residents were diabetics and they discussed how these residents’ needs were met. The inspector observed resident’s exercising choice and control over day-today elements of their lives. Care staff were seen to respect residents choices and opinions. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 15 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 the following standard(s): OP16 & OP18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints were dealt with in a satisfactory manner. Current protection from abuse policies and procedures do not ensure the safety of the residents, nor do they give care staff clear guidelines. EVIDENCE: One residents relative wrote; “Mum is quite placid, but will not suffer in silence. There hasn’t been any cause for complaint”. Another residents’ relative wrote: “On occasions our parent has had injuries to her leg and we have had to make enquiries as to how this happened, especially when she needed hospital treatment and no one seemed to know. Things have been better in recent months”. There had been one complaint to the Commission since the previous inspection. This had been dealt with by the home. There was evidence of the complaints procedure on residents files case tracked, however, there was no evidence of a policy or procedure in the homes communal areas. This was rectified during the inspection. The inspector advised that the complaint policy and procedure should be in clear evidence in communal areas of the home. The inspector noted there was a policy entitled “Protection of Vulnerable Adults” – this needed reviewing as it made reference to the NCSC. The inspector was advised that all care staff had not yet completed prevention of Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 16 abuse training. The inspector advised that this matter should be given high priority. Comments made (as above) by a residents’ relative were discussed with the senior carer on duty. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 17 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 the following standard(s): OP19 & OP26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The general layout and décor of the home provided comfortable surroundings, and was warm, tidy and clean. Some areas of the home were malodorous. The practice of drying clothing on the boiler is a fire hazard and compromises the safety of residents at the home.. EVIDENCE: One residents’ relative wrote; “The lift has been out of action of action for 4-5 weeks”. The inspector noted that the homes lift had last been serviced in December 2006. The inspector conducted a tour of the communal areas, and the home was clean, tidy warm and the standard of cleanliness and hygiene was satisfactory. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 18 However, there continued to be localised areas of odour detected in the home. The inspector was advised that a carpet cleaner was regularly employed and that there were 28 hours per week cleaning hours. The registered person and inspector discussed how this ongoing issue was being managed. The inspector was advised that the layout of the home had been changed, making two bedrooms en-suite. Laundry facilities were seen and industrial facilities were in place. The inspector noted that clothing had been placed on top of the boiler, despite a notice on the wall instructing otherwise. The inspector advised that these items must be removed as a matter of urgency, and this prctice cease immediately, as they posed a significant fire hazard. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP27, OP28 OP29 & OP30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were sufficient staff on duty to meet service users needs. 66 of care staff were trained to NVQ level 2 standard. Staff training ensures that the care staff team are able to competently care for the service users. Recruitment and selection procedures do not fully protect residents. EVIDENCE: One residents relative wrote; “they are very accommodating and pleasant”. The staff rota was seen and this demonstrated which staff were on duty at any time during the day or night. The inspector was advised that 10 out of 13 care staff had now obtained NVQ 2 care qualification. The inspector observed residents being supported by competent and caring staff. Two staff recruitment files were case tracked and both were found to have shortfalls in the documentation required by legislation. The inspector advised that evidence of staff training should be available on care staff’s file, and ensuring that gaps in employment are fully accounted for and recorded. For example, there was no evidence that one staff member Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 20 case tracked had completed induction training, or any other training, or had received 1:1 supervision. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP31, OP33, OP35 & OP38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The attitude of the staff and management is to run the home around the needs and choices of the residents. The views of residents and visitors about the running of the home were being sought. Resident’s finances were dealt with in a satisfactory manner. EVIDENCE: The registered person visits the home daily and his role includes ensuring the maintenance and upkeep of the property. The registered person and inspector again discussed better time management of the registered manager. A relatives and residents survey had been developed and issued by the home. The results had been collated and published. The inspector advised that this Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 22 document should be dated and put on display for residents and visitors to the home. The registered manager was not appointee for any resident; the inspector was advised that personal financial affairs were dealt with by the residents themselves, their next of kin or families. The inspector noted that the fire system had been independently checked in April/May 2006. The last fire drill had been conducted in June 2006, and the last test on 12th December 2006. The inspector advised that a new fire record book was needed. The inspector was advised that care staff had received prevention of fire training, but the date was not recorded. There had been a Gas Safety check completed in November 2006. A portable appliance test had been completed in March 2006, and the 5-year electrical wiring certificate had been completed in September 2003. The homes lift had last been service in December 2006. The inspector was advised that care staff had received training regarding food hygiene, moving and handling and fire, however, there was no evidence of this on the care staff files case tracked. The inspector noted that a fire door into the dining room was being wedged open. The inspector advised that this practice must cease immediately. The inspector and senior carer discussed the practice of staff holding one residents cigarettes as a means of monitoring their intake. The inspector advised that a risk assessment must be completed for this practice and evidence that this practice is in accordance with the resident and their next of kin. There was an assessment of risk seen on both care plan case tracked, but no actual risk assessments seen. Braeside DS0000009500.V314656.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 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Braeside DS0000009500.V314656.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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(1)(b) Requirement Timescale for action 30/04/07 2. OP7 15 Schedule 3 3. OP8 15 Schedule 3 The registered person must produce terms and conditions of the service, in respect of accommodation, amount and method of payment of fees, and the provision of facilities and services provided to service users. 30/04/07 The registered person must ensure the service users plan sets out in detail the action which needs to be taken by care staff to ensure all aspects of health, personal and social care needs of the service user are met. Information as identified in the Care Home Regulations must be kept for each person. This requirement has been outstanding since 10th August 2005 The registered person must 30/04/07 ensure the service users plan sets out in detail the action which needs to be taken by care staff to ensure all aspects of health, personal and social care needs of the service user are DS0000009500.V314656.R01.S.doc Version 5.2 Braeside Page 25 4. OP9 13(2) 5. OP15 16(2)(g) 6. OP18 13(6) 7. 8. OP19 OP26 23 (2) 13(6) 9. OP29 19 10. OP30 18(1)(c) 11. OP38 13(6) met. Information as identified in the Care Home Regulations must be kept for each person. This requirement has been outstanding since 10th August 2005 The registered person shall make arrangements for the recording, handling, safe keeping, administration and disposal of medication. The registered person must provide sufficient and suitable kitchen equipment and adequate facilities for the preparation and storage of food. The registered person must ensure that by staff training or other measures, to prevent residents from harm, abuse or being placed at risk or harm or abuse. Facilities at the home must be kept odour free and safe. The registered person must ensure that by staff training or other measures, to prevent residents from harm, abuse or being placed at risk or harm or abuse. The registered person must operate a thorough recruitment procedure at all times. This requirement has been outstanding since 15th Feb 2006 The registered person shall ensure that persons employed at the care home shall receive training appropriate to the work they are to perform. The registered person must ensure that by staff training or other measures, to prevent residents from harm, abuse or being placed at risk or harm or abuse. DS0000009500.V314656.R01.S.doc 02/03/07 02/03/07 30/04/07 02/03/07 02/03/07 02/03/07 30/04/07 30/04/07 Braeside Version 5.2 Page 26 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. 2. Refer to Standard OP12 OP33 Good Practice Recommendations Opportunities should be given for regular planned social and recreational activities. The registered person is recommended to ensure that quality assurance and quality-monitoring systems are dated and made available to residents and visitors to the home. Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Braeside DS0000009500.V314656.R01.S.doc Version 5.2 Page 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!