Inspection on 08/06/06 for Burncross Road

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Burncross Road 08/06/09

Burncross Road 27/06/08

Burncross Road 01/03/06

Burncross Road 28/07/05

Burncross Road 14/12/04

Burncross Road 27/07/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Burncross Road 209/211 Burncross Road Chapeltown Sheffield South Yorkshire S35 1RZ Lead Inspector Jayne Barnett-Middleton Key Unannounced Inspection 8th June 2006 09:00 Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 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 Burncross Road DS0000002942.V297371.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 Adults 18-65. 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. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burncross Road Address 209/211 Burncross Road Chapeltown Sheffield South Yorkshire S35 1RZ 0114 257 1763 0114 257 1763 NONE www.dimensions-uk.org Dimensions (UK) Ltd 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) Mrs Diane Sutherland Care Home 13 Category(ies) of Learning disability (13), Physical disability (9) registration, with number of places Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2006 Brief Description of the Service: Burncross Road is a care home providing personal care and accommodation for 13 residents. The home is owned by New Era Housing Association Ltd and is situated at Chapeltown areas close to shops and other local amenities and on a main bus route. The home is purpose built and consists of two properties adjacent to each other. One is single story with accommodation for 6 residents and the second is built on two floors and at present accommodates 7 residents. All bedrooms are for single occupancy and one has an en-suite facility. There are pleasant garden areas that are accessible to residents, these areas are private and appropriate garden furniture is provided. The home has a Statement Of Purpose and Service User Guide. The manager confirmed that the current bed fees at the home were between £300 and £1000 per week. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Jayne Barnett-Middleton carried out this unannounced key inspection. Prior to the inspection contacts made to The Commission For Social Care Inspection and the homes service history were examined. A visit to the home was carried out from 9.30 to 15.00. Diane Sutherland, manager was present during the inspection. Opportunity was taken to make a tour of the premises, examine a sample of records including care plans, training records, staff rotas and talk to the staff on duty. It was not possible to formally speak to tenants at the home on the day due to their high support needs. However, the inspector was able to observe the care provided and interactions between the staff and tenants. The inspector wishes to thank the manager and staff for their time and cooperation throughout the inspection process. What the service does well: There is a friendly and relaxed atmosphere within the home. Tenants were encouraged to follow their preferred routines and appeared happy within their environment. Tenants had good opportunities to access appropriate activities. Activities including ice skating, pub lunches and trips out were provided. Holidays for tenants were organised. At the time of the inspection two tenants were taking a holiday abroad, with the support of staff. A holiday to the Lake District was also planned for the near future. The houses were well maintained, odour free, well decorated and homely, promoting a comfortable and safe environment for tenants. There was a pleasant garden area which tenants were making good use of due to the warm weather. All tenants seen appeared very well cared for, they were clean, hair and nails had been attended to and male residents were shaved promoting their dignity and choice. A good induction and training programme was in place. Staff had received all mandatory training including Fire, Moving and Handling and First Aid ensuring that they were able to meet the tenant’s general and specific needs. The manager and staff had a good knowledge of tenants preferred routines, care needs and communication methods and positive relationships were observed. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 6 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. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence during the inspection including a visit to the service. A full needs assessment was carried out by professionals ensuring that tenants individual needs and aspirations were assessed prior to their admission to the home. EVIDENCE: Two care plans were checked and these demonstrated that the tenants care needs were assessed prior to their admission. This confirmed that the service was appropriate for the tenant and provided staff with the information to formulate an individual plan of care. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence during the inspection including a visit to the service. Care plans were detailed and described the action that was required by staff to ensure that all aspects of the tenants personal, social support and healthcare needs were met. Care plans were in the process of being reviewed using a person centred approach. Tenants were supported and encouraged by the staff team to make choices within their capabilities. All tenants had risk assessments, which enabled them to take risks as part of an independent lifestyle. EVIDENCE: Two care plans were checked both of which were detailed and of a good standard. The format in place detailed tenants individual needs including their life history, preferred routines and the ways in how they communicated. The Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 10 care plans checked had not been reviewed on a regular basis. However the manager confirmed that a new care plan format was in the process of being introduced and that all information provided within the care plan did reflect the tenants’ current needs. The manager and staff had a good knowledge of tenants preferred routines, care needs and communication methods and were able to demonstrate how they encouraged tenants to make choices within their capabilities. The tenants were not able to take responsible risks due to their limited awareness and capabilities. Tenants files contained individual risk assessments including meal times, mobility and travel to minimise the risks to tenants both inside and outside the home. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence during the inspection including a visit to the service. Tenant’s had regular opportunities to access appropriate activities enabling them to lead fulfilling lives outside as well as within the home. The daily routines within the home were flexible and promoted independence, individual choice and freedom of movement. Menus had been reviewed providing a healthy diet, promoting the tenants health and wellbeing. EVIDENCE: Tenants had good opportunities to access appropriate activities. During the week several tenants accessed day centres within the community. Regular outings took place. On the day some tenants were out on a trip to Wentworth and others ice-skating. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 12 The home has its own mini bus, which gave staff the flexibility to plan trips on a regular basis. As an example the staff said that recently the weather had been warm and that the tenants had really enjoyed trips to Castleton and Clumber Park. Holidays for tenants were organised. At the time of the inspection two tenants were taking a holiday abroad with the support of staff. A holiday to the Lake District was planned for the near future. Discussions with staff and observations demonstrated that the routines within the home were flexible. The tenants were encouraged to make simple choices about their daily living activities for example when they rose and retired and how they wished to spend their day promoting independence and choice. Tenants who had chosen to spend the day at the home were observed to be relaxing in the lounge areas with staff or spending time in the garden area. Since the last inspection menus had been reviewed to provide a healthier balanced diet. Meal times were flexible to the needs of the tenants. The staff spoken to had a good knowledge of tenants likes, dislikes and dietary requirements. The care plans checked incorporated any risks, i.e. swallowing, that may be presented to tenants during meal times and detailed records of meals taken were maintained. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in the outcome is adequate. This judgement has been made using available evidence during the inspection including a visit to the service. Tenants received personal support, which promoted their privacy, dignity and independence. Tenant’s physical and emotional needs were met. The care plans contained detailed information about how the tenant’s personal support could be met by staff in order to meet their individual needs. A policy and procedure to ensure that staff adhered to the safe administration of medication was in place to protect tenants from risk. However, records of some medication received into the home had not been maintained. EVIDENCE: The tenants care plans detailed how personal support should be offered to each individual. This included the times that they rose and retired and what level of support they required to wash and dress. All tenants seen appeared very well cared for, they were clean, hair and nails had been attended to and male residents were shaved. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 14 There were records to evidence that tenants were receiving regular visits from healthcare professionals dependent on their needs. The two care plans checked detailed the healthcare visits that tenants had received including their dentist, chiropodist and general practitioner. Detailed daily records were maintained of the tenants’ physical and emotional wellbeing and it was evident that in general the healthcare needs of tenants were monitored. One tenant had recently visited a psychologist and records detailed that advice had been given for staff to keep records of the tenants’ behaviour until their next appointment. General records of the tenants’ health had been maintained. However there were no specific records in relation to their behaviour. These need to be maintained to ensure that the needs of the tenant can be monitored and any appropriate action taken. There was a medication policy and procedure to ensure that staff adhered to safe practices. In general there were improvements to the Medication Administration Records (MAR). The MAR records checked detailed the prescribed dosage and medication had been administered and signed for appropriately. However, there were no records to evidence the amount of medication that had been received . The amount of medication received into the home must be recorded to ensure that accurate records can be maintained. Following a recent break-in at the home, the medication cabinet in one house had been moved to a more secure area. However, the cabinet still required fixing to the wall to provide secure storage. Training was provided and close supervision was given to staff prior to them administering medication independently, promoting the safe administration of medication to tenants. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence during the inspection including a visit to the service. The homes complaints procedure ensured that any complaints made by tenants or their relatives would be listened to and action would be taken to deal with complaints promptly. There was an adult protection policy and procedure that promoted the protection of tenants from harm or abuse. EVIDENCE: The complaints procedure ensured that tenants and their relatives were aware of how to make a complaint and who would deal with them. The manager confirmed that no complaints had been received at the home since the last inspection. There was an adult protection policy and procedure that promoted the protection of tenants from harm or abuse. Staff had received Adult Protection and Protection Of Vulnerable Adult (POVA) training enabling them to identify and report any allegations or incidents of abuse to tenants. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence during the inspection including a visit to the service. The houses were well maintained, odour free, well decorated and homely, promoting a comfortable and safe environment for tenants. The home was very clean and the laundry areas were all appropriately equipped to meet the needs of the tenants. EVIDENCE: The environment within the home was clean, well decorated, comfortable and homely. Tenants were observed to move freely around the home and appeared relaxed in their environment. The tenant’s bedrooms were all individually decorated reflecting personal choice. The manager said that tenants were encouraged to choose colour schemes and furnishings within their capabilities. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 17 Previous requirements in relation to the environment had been met. Corridor areas had been redecorated to a good standard promoting a bright and wellmaintained environment. There was a pleasant garden area, which was accessible to tenants. The manager said that two relatives assisted with the maintenance of the garden areas. On the day several tenants were enjoying the warm weather either walking around the home or using the seating areas. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence during the inspection including a visit to the service. The home maintained the required levels of staff maintaining the safety of tenants. A good induction and training programme was in place ensuring that the staff was able to meet the tenant’s general and specific needs. The home operated a recruitment procedure that promoted the protection of tenants. A programme of staff supervision and appraisal had been implemented ensuring that staff were receiving the appropriate support at the required frequency. EVIDENCE: There was an informal and relaxing atmosphere within the home. The manager and staff had a good knowledge of tenants’ individual needs and positive and appropriate relationships were observed. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 19 Four weeks staff rotas were checked and these evidenced that sufficient staff were employed to ensure that the individual needs of tenants’ could be met. There were no staff vacancies promoting a consistency of care to tenants. A good training programme was in place. Discussions with staff and records demonstrated that staff had received all mandatory training including Fire, Moving and Handling and First Aid. One member of staff who was relatively new at the home confirmed that they had received the appropriate level of support and induction, enabling them to safely care for tenants, during their initial weeks of employment. The manager confirmed that ten out of twenty six staff held a National Vocational Qualification Level 2 or 3 in care. Further staff will need to undertake this training to ensure that the home meets the required target of 50 . A recruitment policy and procedure was in place. Three staff files checked contained a range of information including two references, declaration of health and qualifications/training. All staff employed had undertaken a Criminal Records Bureau Check at the enhanced level to promote the protection of tenants. Tenants were involved during the recruitment process. The staff said that tenants were invited to meet prospective staff and felt that this was positive as it gave them the opportunity to assess how they interacted with the tenants. A programme of supervision and appraisal was in place ensuring that staff received the appropriate levels of support and direction to support the tenants appropriately. Staff confirmed that they were receiving regular supervision and said that they felt supported by the management team. Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence during the inspection including a visit to the service. The manager was appropriately qualified and experienced to manage a care home. Quality assurance systems were in need of development to ensure that relatives and other professionals were able to give their views of the service. Policies were in place demonstrating that the health, safety and welfare of tenants was promoted and protected. EVIDENCE: The manager had many years experience within the caring profession. She was in the process of completing the NVQ4 care management award, which will enable her to develop managerial practice and skills. Through discussion and Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 21 observation it was evident that the manager had formed positive relationships with tenants and that she had a good understanding of their individual needs. The majority of previous requirements had been met and it was evident that she was committed in further developing the quality of care that was offered. Staff meetings were conducted on a regular basis promoting good communication and ensuring that staff were able to contribute to the development of the service. Quality assurance at the home required some development to enable relatives, friends and other professionals to comment on the care that was provided and to suggest ideas in how the service could be developed. A questionnaire format was in place and the manager said that she intended to recommence this process within the near future. Regular auditing of the service and providers monthly reports was in place. On the day all areas within the home appeared safe and were well maintained. All staff had received health and safety, moving and handling, food hygiene and fire training. Procedures were in place for the maintenance and servicing of appliances and equipment, promoting and protecting the health safety and welfare of staff and tenants. Burncross Road DS0000002942.V297371.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 Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 3 X Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 15 Requirement All care plans and assessments on care plans must be dated and regularly updated (Timescale of 01/05/06 not met). Healthcare records must be maintained to ensure that the needs of the tenant can be monitored and any appropriate action taken. Timescale for action 01/09/06 2. YA19 17 01/07/06 3. 4. 5. YA20 YA20 YA32 13 13 18 Records of medication received 31/07/06 into the home must be maintained. The medication cabinet must be 30/07/06 secured. 50 of the staff team must have 31/12/06 a National Vocational Qualification level 2 or 3 in care. The manager must obtain a NVQ level 4 qualification in management and care. 31/12/06 6. YA37 9 7. YA39 24 The quality assurance system 31/08/06 must be developed to include the views of carers and relatives on the quality of care provided to tenants (Timescale of 01/06/06 not met). DS0000002942.V297371.R01.S.doc Version 5.2 Page 24 Burncross Road 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 Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Burncross Road DS0000002942.V297371.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!