Inspection on 09/08/06 for Bramblings Residential Home

This inspection was carried out on 9th August 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bramblings Residential Home 09/02/10

Bramblings Residential Home 14/01/09

Bramblings Residential Home 07/09/07

Bramblings Residential Home 11/11/05

Bramblings Residential Home 26/07/05

Bramblings Residential Home 07/09/04

Bramblings Residential Home 26/04/04

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 Bramblings Residential Home Bramblings Residential Home Hartley Road Longfield Kent DA3 7PE Lead Inspector Eamonn Kelly Key Unannounced Inspection 9th August 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 Bramblings Residential Home DS0000023910.V301849.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. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramblings Residential Home Address Bramblings Residential Home Hartley Road Longfield Kent DA3 7PE 01474 702332 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) Bramblings (Kent) Limited Mrs Bernadette Ramsey Care Home 26 Category(ies) of Learning disability over 65 years of age (1), Old registration, with number age, not falling within any other category (25) of places Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care for an older person with learning disabilities is restricted to 1 person whose d.o.b is 20/04/1931. 11th November 2005 Date of last inspection Brief Description of the Service: Bramblings Residential Home provides accommodation and care for up to 22 older people. The registration is currently for up to 26 persons. However, the policy of the home is to provide single bedrooms with the capability of catering for couples requiring a shared bedroom. Consequently, the current position is that 20 single and 1 shared bedroom are in use. The capacity of the home is being increased. This is likely to lead to an increase in capacity to double the present number of service users. The current accommodation and facilities will be altered and upgraded before the new premises come into use. The project is scheduled for completion in 2006 or early 2007. Bedroom accommodation is presently situated on ground and first floors. There are several areas where visitors are able to meet residents in private. Bedrooms (other than one) do not have en-suite facilities. However, there are bathrooms with hoists. The home does not have a passenger lift but the new premises will have this additional facility. The home has a smoking for service users. Provision is being made in the new premises for this facility to be continued. There are car-parking facilities on site. Public transport is nearby. There are gardens surrounding the premises. The home provides 24-hour supervision. Two members of staff are on duty at night. Weekly fees are £303-£382. In some cases, the home levies a “top-up” charge of £20 per week that must be paid by service users. There are additional charges for chiropody (£7), hairdressing (£7-£23), newspapers and magazines ordered by service users, toiletries and personal phone costs. Prospective service users are able to obtain full information about services and facilities by asking for a copy of the home’s Service User’s Guide (currently being revised). New service users are given a copy of a personal contract that outlines the rights and responsibilities of both parties. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 5 Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit between 11am-4pm consisted of meeting with service users, visitors and members of staff on duty. All bedrooms and communal areas were visited and a number of records associated with service user care and safety were assessed. A brief visit was also made to the new day care centre being constructed on the site and to parts of the care home extension. Survey questionaires (“Have Your Say About...”) were sent by the CSCI to the home prior to the inspection visit. Relatives and representatives and care managers returned 10 completed survey questionnaires. Comments made were positive. The inspection visit concentrated on the care and support in place for service users. Meetings with members of staff and service users served to give a broad understanding of how service user’s current and changing needs are addressed. The results indicated that service users are well cared for at the home. Visitors met were satisfied with the support their relatives at the home were receiving. What the service does well: The personal and health care needs of service users are identified and met. Service users receive personal care discreetly and they are treated with respect. They are supported in maintaining choice and autonomy. Visitors are made to feel welcome. Good pre-admission assessments are made. Care is taken to help new service users settle-in and start to enjoy the benefits of their retirement years. Care plan records are begun at this stage. If situations occur when suitable care and support can no longer be guaranteed, there is a commendable commitment to helping them find suitable alternative accommodation. People at a vulnerable stage of their lives are protected from exploitation and abuse. Bedrooms are comfortable and well personalised with personal possessions. The policy of the home is to provide single rooms and shared rooms are available to couples requiring this facility. Members of staff receive training to carry out their work effectively. They are encouraged to attend relevant training courses including NVQ Level 2 and 3 in Care. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 7 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 contacting your local CSCI office. Bramblings Residential Home DS0000023910.V301849.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 Bramblings Residential Home DS0000023910.V301849.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): 1, 2, 3, 4, 5, 6. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users and their representatives have the benefit of knowing, via preadmission assessment and information provided about services and facilities, that the home will be able to meet their needs. EVIDENCE: Prospective service users get good information about services and facilities to enable them to make a decision about taking up residence. This process is being improved by the imminent availability of a Service User’s Guide to each service user. The manager intends to combine the information currently available from 2 sources into an A5 size booklet that will be revised and updated every 6 months. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 10 New service users receive a copy of a personal contract that outlines the rights and responsibilities of both parties. Detailed pre-admission assessments are carried out. These involve the service user, his or her representatives and other parties (GP, care manager). The care plan record is begun at this stage. Examples were discussed where service user’s needs can no longer be met by the home. The manager makes commendable efforts to make sure that service users and their supporters receive as much assistance as needed to find suitable alternative accommodation. The manager is also reviewing how best to assist staff in achieving further skills in being able to identify why service users adopt behaviours that are challenging to staff and how to alleviate the causes of these behaviours. Visitors met (with the information corroborated by completed CSCI survey forms) stated that they were satisfied with the care provided by members of staff. In most cases, prospective service users visit the home before taking up residence and meet other residents and members of staff. They are helped to settle in through a variety of means. The home provides permanent care rather than “intermediate” care (eg. rehabilitation following a hospital stay before returning home). Bramblings Residential Home DS0000023910.V301849.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): 7, 8, 9, 10. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Each service user has a written plan of care that assesses their support needs, reviews changing care needs and identifies if each agreed objective of care is met. EVIDENCE: Care plan records seen clearly showed the support needs of service users and how these were being addressed. Each service user’s file contained relevant information including care needed/being given, Waterlow charts, weight charts, risk assessments, GP/district nurse interventions and daily records of service user’s progress. In the examples discussed, service users received attention as needed from GP’s, nurses, and other support agencies. Service users are able to varying degrees depending on their ability and interest contribute to the upkeep of their care plan record. Several said that they had recently been attended to by a GP/nurse or were waiting for this attention. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 12 Service users may retain responsibility for keeping their own medication subject to recorded risk assessment. Part of a medication round was observed. Carers completed MAR (medication administration record) sheets at the time of administration. Staff receive training and their practice is supervised by the manager and deputy manager. Service users receive personal care discreetly. This aspect of care is emphasised during induction to the home and practice is evaluated through observation and supervision. The manager is an NVQ assessor and this topic forms part of practice supervision. Service users receive assistance if they need help with reading their mail. They have access to a house phone and some have their own phones in their bedrooms. All bedroom doors are lockable but the building project will lead to this facility throughout. Some service users lock their bedroom doors. Bramblings Residential Home DS0000023910.V301849.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): 12, 13, 14, 15. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users will shortly have the benefit of improved support from staff in maintaining their physical and mental awareness and agility. EVIDENCE: The previous inspection report stated that service users did not want a structured programme of activities. The manager outlined activities that are provided. During the inspection visit, many service users were in their bedrooms and somewhat isolated. The manager is planning to increase the level of activities provided. A new day care centre is being constructed in the home’s grounds. There will be a range of support activities provided at the day centre and it was stated that the care home would profit from this service provision. The manager agreed that service users would have the benefit of assistance by an activities organiser for at least 30 hours per week when alteration are completed later in 2006. This person or persons would have membership of the National Association for Providers of Activities for Older People or be encouraged to join the association and follow its guidance. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 14 The home is also making progress with preparing personal profiles of service users and having a system for updating these. These profiles, typed for ease of use by carers, will be available in each care plan record. The previous inspection report stated that residents’ meetings are held but that minutes were not available. The proposed new regime for improving service user’s physical and mental awareness is likely to involve the activities organiser in a variety of measures from using means of obtaining service user’s views to providing initiatives that involve groups of service users to having 1:1 meetings with service users in their bedrooms. Visitors are welcome at all reasonable times. There was positive comment from visitors and via CSCI survey returns. Service users are able to exercise autonomy in many areas. They decide on routines that suit them. They can call for assistance by using call bells at any time. Incidents were discussed where service users left the premises without advising staff. The home has a specific duty of care for all service users and their safety is recognised as being of primary importance. Serving of part of the mid-day meal was observed. Meals are delivered to the dining area via a heated trolley. Service user’s meals are taken individually to their bedrooms. There were some indications that service user’s actual likes and dislikes were not taken into account by staff in that some were repeatedly served foods they disliked. The manager indicated that this aspect of service would be improved. A copy of the Commission’s advice on meals for older people in care homes was sent to the home. A menu is available to service users detailing breakfast, lunch, tea and supper. Bramblings Residential Home DS0000023910.V301849.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): 16, 18. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. The comments and views of service users and their representatives are taken into account and acted upon. Service users are protected from abuse. EVIDENCE: The manager has attended a trainer training course on the causes and prevention of adult abuse. She provides all members of staff with information about the concept of protection of vulnerable adults and about the responsibilities of the Dept of Health POVA manager. The manager and deputy manager are aware of how to use Local Authority procedures on adult protection. Two members of staff demonstrated their awareness of the home’s procedures in this regard. Members of staff are encouraged to report issues that they are concerned about including incidents where medication might have been administered incorrectly so that lessons can be learned and practices improved. Service users and their representatives are given a copy of the home’s complaint’s procedure. Bramblings Residential Home DS0000023910.V301849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users have the benefit of living in safe and comfortable premises with significant improvements underway. EVIDENCE: The home is comfortable and safe. The main part of the premises has become rundown: the extension is set to double the capacity of the home. When this is completed, the older part of the premises will be renovated. While the main part of the new building was being constructed service users were protected well. This, the manager stated, would continue during the period when final work is underway and where individual bedrooms and communal areas are more closely affected. Bedrooms are comfortable and well personalised. Emphasis is placed on steam cleaning carpets and the results of this work are of benefit to service users. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 17 During the inspection visit, the home was clean and tidy. A separate block has been built at the rear of the home to contain the office, staff room, and laundry. There are sufficient WC’s and 4 bathrooms some of which have hoists. All radiators not currently covered or having low surface temperatures will be replaced as part of building improvements. Bramblings Residential Home DS0000023910.V301849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users are in the care of a group of staff that receive the training needed to meet their care and support needs. EVIDENCE: The staffing rota showed that the following members of staff were on duty: AM: Four carers and manager. Two domestic staff. Cook. Laundry assistant. Night (9pm-8am): Two carers. The manager indicated that there was sufficient staff available to meet the assessed and possible changing needs of service users. The smaller number of carers on duty in the evening/afternoon was because many service users went to their bedrooms during this time. The manager indicated that these figures would be reviewed in view of the probable need to provide additional assistance to service users in maintaining their physical and mental abilities. There was some evidence from recent regulatory contact between the home and commission that staffing levels are very tight and that emergency situations are just capable of being met. In addition, the pressure on staff in Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 19 PM: Three carers and manager. attending service users within dispersed premises is considerable. For example, if service users were encouraged to dress and have meals in the dining room they would be hard pressed to do so. Accordingly, the routine has developed of serving meals to many service users in their bedrooms. Service users have also become used to being served by a small number of staff and are unwilling to demand better attention. This position is typified in reduced staffing in the afternoon and evening when service users should receive encouragement to be active which would also help them to sleep better or without drugs. Three staff files indicated that relevant checks are carried out. These include assessing information about applicant’s previous employment, taking up two written references including where one from the previous employer, interview notes, proof of identity (passport, birth cert, driving licence), and CRB and POVA-first checks. The method for recording that CRB’s have been taken up and results verified has been improved recently. The manager is currently visiting staff on duty at night to update their training (in respect of NVQ and mandatory courses). The statement included in the draft Service User’s Guide relating to staff training profiles indicated that most elements of mandatory training are present. The final version to be available shortly will contain an addendum showing the month/year when the training event took place. This is intended to assist with updating the training (eg. 1st aid, moving & handling, food hygiene, adult protection, health & safety). Twelve members of staff are currently undertaking a course over 3 months on dementia in association with Orpington College. In the case of two members of staff met, both had completed NVQ Level 3 in Care through sponsorship by the home and had completed the range of mandatory training. They said that they are encouraged to identify relevant training courses they wish to attend and they receive payment for time spent on these events. The manager is an NVQ assessor for staff within the home and at other residential homes. Bramblings Residential Home DS0000023910.V301849.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users have the benefit of living in a well managed home. EVIDENCE: The manager, Mrs Bernadette Ramsey, is a nurse registered with the NMC. She has a Bsc in Health Studies and has ENB 998 (teaching & assessment) and END 941 (care of the elderly). She has the Registered Manager’s Award, is an NVQ assessor and is a trainer in prevention of adult abuse. Two other members of staff have achieved the Registered Manager’s Award. The deputy manager is a trained trainer in safe movement & handling of frail older people. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 21 Members of staff met had a good knowledge of service user’s backgrounds and support needs. The new day centre close to the care home will have a deputy manager responsible to the manager of the home. The manager is clear that there will be clear separation of duties between staff in both locations. Service users or their representatives are responsible for their legal and financial matters. Where a service user is becoming less proficient in maintaining control over their legal/financial affairs, the home provides assistance for them to obtain independent advice. The pre-inspection questionnaire submitted to the Commission by the manager contained a declaration that all safety checks have been made and are repeated as required (eg portable appliance checks, fire safety tests). The manager is reviewing the training status of all members of staff (including night-time staff) to ensure that mandatory training has been carried out and updating courses attended where this applies. Care plans for each service user contained good information on service user’s support needs. This procedure was improved following the manager’s attendance on a care-planning course. Dangers associated with the individual risks to service users are identified and recorded. The CSCI survey produced positive responses from 10 service users. In some cases a member of staff or relative assisted the service user to make a response. Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 22 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 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 3 x 3 x x 3 Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Bramblings Residential Home DS0000023910.V301849.R01.S.doc Version 5.2 Page 25 - 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!