Inspection on 08/11/07 for Burley Willows Home For Older People

This inspection was carried out on 8th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Burley Willows Home For Older... 09/01/07

Burley Willows Home For Older... 17/11/05

Burley Willows Home For Older... 02/11/04

Burley Willows Home For Older... 13/05/04

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

CARE HOMES FOR OLDER PEOPLE Burley Willows Home For Older People Willow Garth Leeds LS4 2HL Lead Inspector Catherine Paling Key Unannounced Inspection 8th November 2007 09:45 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 Burley Willows Home For Older People DS0000033139.V352568.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. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burley Willows Home For Older People Address Willow Garth Leeds LS4 2HL 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) 0113 2456579 0113 2456579 Leeds City Council Department of Social Services Mrs Kathryn Louise Yeoman Mrs Collette Noelle Shekarchi-Khanghahi Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Burley Willows is a local authority home providing personal care primarily for older people of both sexes. There are 30 permanent places including two places for respite care and five places for intermediate care. The home is single storey and there is level access throughout the building. Accommodation is in single rooms, all of which have their own washbasin. None of the rooms have en-suite facilities but the three bathrooms and two shower rooms are of a high standard and allow for full assistance. There are plenty of toilets situated throughout the building. There are six lounges, one of which is a designated smoking area, and all lounges have television and hi-fi units. There is level access to the enclosed gardens. The home is situated about two miles from Leeds City Centre and is close to many local amenities including shops, library, doctors and dentist. Information about the service is available in a Statement of Purpose and Service User Guide. These documents are reviewed regularly to make sure that the information is up to date. They are accessible throughout the building together with copies of the most recent inspection report. The fees range from £98.60 to £473.60 per week. There are additional charges for hairdressing and newspapers. This information was provided by the service at the November 2007 visit and is displayed in the home. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit by one inspector who was at the home from 09.45 until 15.50 on 8th November 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. A number of documents were looked at during the visit and all areas of the home used by the people who lived there were visited. A good proportion of time was spent talking with the people at the home as well as with the manager and the staff. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. Survey forms were sent out to the home before the inspection providing the opportunity for people at the home; visitors and healthcare professionals who visit to comment, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A small number of surveys were returned and comments are included in the body of the report. What the service does well: Information provided in the AQAA stated: ‘We provide a warm, safe friendly environment where residents are treated as individuals and encouraged to speak their mind about the service we provide. We have an open door policy and good relationships with other professionals such as district nurses, chiropodist, ICT staff, doctors, social workers and joint care managers. We have very few complaints and several compliments from service users. All staff are well trained.’ This is a busy home but is always welcoming and provides a high level of care to people living at the home and their relatives. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 6 Comments received before the inspection were complimentary and included ‘the staff manage the residents efficiently and show great respect and love for them. People said that they were well cared for and that staff knew how to look after them. Relatives spoke highly of how staff worked to help people settle down at the home when they had just moved in. The home operates at a good level with highly committed staff led by competent and capable managers. 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. The summary of this inspection report can be made available in other formats on request. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience good quality outcomes in this area. People are provided with enough information to enable them to make an informed choice about the home. The admission process is good and includes introductory visits. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA gave detailed and accurate information about the care taken before someone is admitted to the home to make sure that needs can be met. Everyone is offered an introductory visit as part of the admission assesment and one person was visiting the home on the day of the visit. This person spent time with staff being shown around the home and with the people living at the home joining them for the lunchtime meal. People are also welcome to stay overnight before coming to live at the home, if they wish. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 9 Families, carers or friends are also made welcome and can come at any time to see the home and get the information they need to help make a decision about the home. The family of a recently admitted person spoke highly of how the staff had worked with the person and the family to help her settle at the home. Other information is gathered about people before they move in in the form of the local authority Easycare document and from other healthcare professionals who may be involved. The managers are clear that admission only takes place if they feel that the staff team have the skills, ability and qualifications to meet the assessed needs of the individual. Information is freely available throughout the home and displayed on the large noticeboard in the entrance area. Information in the AQAA makes it clear that individual rights and choices are respected and promoted. ‘The staff have great understanding of the life changing decisions that the service user and their families have to make and work hard to make them feel comfortable. They ensure that the service user knows they still have choices about their future after admission if they feel it is not the right place for them’. Some people are admitted for short term respite care and there are good facilities for those admitted for intermediate care. Care staff are supported by the intermediate care team (ICT) in the interests of the rehabiliatation and promotion of independence of those people admitted for intermediate care. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. Health care needs are met and care plans provide detail about care needs so that staff know how to look after people properly. People at the home are protected by safe medication practices. The staff respect the privacy and dignity of people living at the home. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states: ‘Each sevice user has a designated keyworker who works closely with them on completing, developing and reviewing their individual care plan. All health needs are identified and met using outside professionals where necessary including district nurses, dentists, opticians, OTs, physios, CPNs, orthotics etc Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 11 Sensitive and needs led arrangements are made in the care of the seriously ill or dying service user. We liaise with the service user, family, GP and other health care professionals to ensure that this is the best possible care for the service user and that between us we can meet their needs. Several staff have attended courses on Death and Dying. The home operates a safe and efficient medication system. Care staff administering medication have the required accredited training. We have lockable bedside cabinets if service users wish to self medicate.’ The managers and their staff have continued to work hard at making sure that care records reflect the good standard of care provided at the home. In the sample of records looked at there was good detail of care including the input required from other healthcare professionals. Each permanent resident at the home has a lifestyle plan containing information about likes and dislikes and the support needed from staff. There was evidence of review and update, which was dated and signed. The level of detail was good and gave clear guidance on peoples’ preferences, for example, ‘sometimes likes to have breakfast in her dressing gown’ and ‘needs help removing facial hair which she doesn’t like’. There was evidence that individuals had been involved in the development of the lifestyle plans and that regular in-house reviews had been held. Changes in people’s condition were monitored and other healthcare professionals involved where necessary. The home has a very good reputation with visiting nurses and the General Practitioner (GP). Comments received from healthcare professionals were very supportive of the service and the staff: • Staff know the individuals very well • Excellent relationships with their GP/District Nurses and myself (community matron) • They readily problem solve and reflect on events to continually improve practice • We are establishing a system of regular reviews in an attempt to be, medically more proactive (GP) Although care records have improved the managers themselves continue to strive to maintain and build on the work already done on improving the quality of the information in the records. Observation and discussion with people living at the home provide evidence that the staff respect privacy and dignity. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. The social, religious and cultural needs of people living at the home are met. People are able to maintain contact with family and friends and they are encouraged to be part of the decision making at the home. A good, varied and nutritious diet that takes into account individual choice is served at the home. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated that: ‘We provide a range of varied activities that are based on service user requests through resident meetings, care plans and activity feedback. We have motivation and exercise once a week, coffee morning with bingo once a week, craft sessions once a week, prize bingo, hairdresser, students from the university once a week and trips out. 4 residents go out to day centres. Service users are encouraged to keep in contact with family and friends. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 13 Visitors are always made welcome and facilities are available for them to make drinks. They can also have a meal with their relative if they wish. We have a payphone for the use of service users and some service users have had telephones installed in their bedrooms. Residents can choose where to entertain their visitors, either in the lounge areas, their own rooms or the garden area. The chef is qualified and experienced in cooking for older people. He knows the service users, their likes and dislikes and their dietary needs. The menu is nutritious, well balanced and varied. We have a summer and winter menu. We discuss food and preferences at service user meetings. Staff give assistance where needed to service users who need help or encouragement to eat. Drinks and snacks are available 24hrs a day and all staff have access to food should the service users request something during the evening or night. Service users can choose to eat in their own rooms if they wish.’ This is a busy and active home and on the day of the visit there was a Pie and Pea Supper and Talent show planned for the evening. People living at the home, their relatives and the staff were all involved. On the day of the visit there were several visitors who said that they were always made welcome by the staff. “Staff are always happy to see relatives and we are always greeted well even when staff are busy.” The kitchen has recently been awarded 5*(excellent) by Leeds City Council Food and Health Service. The lunchtime meal was observed and people were seen to enjoy their meal. Help and support was given where it was needed. Portions were generous and second helpings were offered. Juice was served with the meal and those people who wanted a hot drink after their meal were given one. Staff were observed supporting and encouraging people to make their own choices about how they wished to spend their time. One person staying at the home for convalescence said that she was able to spend her time how she wanted to. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. A robust adult protection and complaints policy and procedure makes sure that people who live at the home are listened to and are protected from abuse. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There is a comprehensive complaints procedure, which is displayed throughout the home, and the homes own quality assurance questionnaires results indicated that 90 of people living at the home felt that they knew who to talk to if they had a concern or complaint. The staff survey indicated that the vast majority of staff felt confident that they could explain the complaints procedure to people. A log is kept of any complaints and of compliments received. There is a low level of complaints received. No complaints have been received at the home or by us in the last twelve months. The number of compliments received is high. All the senior staff at the home have received training in safeguarding and the training is ongoing for all staff. The AQAA also states that training is to be given regarding the Mental Capacity Act 2005. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. People live in a very well maintained and safe environment. Good levels of specialist equipment ensure that peoples’ independence is maintained. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The AQAA stated that the environment is maintained to a high standard. This is the case with all areas visited clean and fresh smelling. Since the last visit flooring in the main corridors and the dining areas has been replaced and several bedrooms have been redecorated. Application was made to the local authority for a dignity grant which will be used to upgrade the bedrooms, installing new vanity units, wardrobes and Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 16 chests of drawers. This work is to start early in 2008. Although there are no ensuite facilities the communal sanitary facilities are spacious and allow for full assistance if needed. There is a designated lounge for the use of smokers who live at the home. Fire safety systems are in place and the home has a sprinkler system. Staff have regular fire training including taking part in fire drills. The majority of staff have had training in infection control and good practices were observed. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. The numbers and skill mix of staff were sufficient to meet peoples’ care needs. The staff are trained and competent to do their jobs. People are protected by robust recruitment procedures. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states: ‘There is a high emphasis on training and staff are very keen to go on courses’. National Vocational Qualifications (NVQ) for care staff are well established and the number having achieved level 2 in care exceeds the standard of 50 . The commitment to NVQ training includes the cleaning and support services staff. Duty rotas indicated that there were enough staff to meet the needs of people living at the home. The carers have the support of a team of ancillary staff carrying out domestic, laundry and catering duties. There is a low staff turnover and the stability of the staff team means there is continuity and familiarity for people at the home. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 18 Information provided in the AQAA states – ‘We have a well organised supervision and appraisial scheme’. Records of staff appraisal and supervsion were seen on staff files. There were clear target dates for completion of planned training and these were being achieved. Records of training are currently kept on individual files. The managers recognise the need to develop a system of providing an overview of planned and completed training for inspection purposes. Staff recruitment is carried out centrally and all the required checks are carried out before staff start work at the home. Copies of documents detailing recruitment are kept at the home on individual files. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience excellent quality outcomes in this area. The home is well managed and the managers are well able to discharge their responsibilities. They provide excellent leadership to the staff and ensure that people living at the home are protected and cared for appropriately. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There are two experienced and capable managers who ‘job share’ the position of registered manager. This is an effective arrangement and they provide clear leadership and stability at the home. Both managers are well qualified and Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 20 have completed the Management Charter Initiative and also hold an NVQ in care at level 4. One of the managers was at the home briefly on the day of the visit and commented that completing the AQAA had provided an opportunity to review the service objectively. This had already triggered a review of some policies and procedures. This reflects the continued proactive style of management demonstrated previously by both managers and a commitment to the continued development and improvement of the service provided to people at the home. The people living at the home, their relatives, the staff and visiting healthcare professionals are surveyed annually. The collated results are freely available in the entrance area and provide an overall positive view of the home. Where shortfalls have been identified there was evidence that the managers had developed a plan to address them. Feedback from surveys completed by people living at the home highlighted clearly that they did not feel involved in decision making at the home. In an attempt to address this, a ‘suggestion box’ has recently been introduced and there is a commitment to have more frequent residents’ meetings. The most recent meetings was in early October when people were informed about the planned refurbishment to bedrooms, lifestyle plans were discussed as well as menus and outings Managers are accessible to people living at the home and their relatives through their ‘open door’ policy. Regular in house care reviews are also held giving people and their relatives the opportunity to discuss care and any concerns they might have about the service provided. Staff meetings are held three monthly with the most recent held in October. Topics discussed included plans for Christmas, mealtimes and fluid provision and lifestyle plans. There is a commitment to health and safety with all the senior staff having attended a course in managing safety run by the Institution of Occupational Safety and Health. Regular checks of the building are made to make sure that there is a safe environment for staff and the people living there. A programme of mandatory training is in place for the staff including manual handling and moving and fire safety. The home do not act as appointees for people living at the home and do not handle anyone’s money, other than a small amount of personal allowance for incidentals. These procedures are subject to regular in-house checks and external audit. Records are kept of accidents involving people at the home and accident reports are held on the individual files. Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 21 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 22 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 Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Burley Willows Home For Older People DS0000033139.V352568.R01.S.doc Version 5.2 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!