CARE HOMES FOR OLDER PEOPLE
Burnham Lodge Nursing Home Parliament Lane Burnham Bucks SL1 8NU Lead Inspector
Christine Sidwell Unannounced Inspection 10:30 14 August 2007
th 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 Burnham Lodge Nursing Home DS0000019186.V338519.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. Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Burnham Lodge Nursing Home Address Parliament Lane Burnham Bucks SL1 8NU 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) 01628 667345 01628 602761 brian.bronock@zen.co.uk Burnham Lodge Ltd Catherine Mary Bronock Mrs Jo Davidson Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. General Nursing Care maximum 46 Personal Care maximum 6 One service user under the age of sixty-five as identified in the Application for Variation Form, Section 4.2, signed and dated 5th May 2004. 30th May 2006 Date of last inspection Brief Description of the Service: Burnham Lodge is a care home providing nursing and personal care for residents who are elderly and physically frail. There are qualified nurses, supported by a team of carers, on duty at all times. The home has 32 single rooms and 7 shared rooms, on three floors. There are pleasant communal areas. Access to all floors is by a passenger and stair lift. The home is a large country house set in tranquil surroundings, backing on to woodlands at the edge of Burnham Beeches. There are extensive gardens, which are well maintained. A new patio area is under construction. Public transport and other amenities are not easily accessible. The current scale of charges, at the time of writing this report, ranges from £490.00 to £775.00 per week. Additional costs may be incurred for hairdressing, chiropody and personal items. Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was conducted over the course of three days and included a one day unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit the manager completed an annual quality assurance self-assessment. Information from this was taken into account in the planning of the inspection. Questionnaires were sent to residents, their families and healthcare professionals. Nine residents, six family members and three social or healthcare professionals returned the questionnaires. Residents and families were also spoken to on the day of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. What the service does well:
The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Residents and their families have the opportunity to visit to the home and the manager or deputy visits them in their current residence, be that at home, in another care home or in hospital, before the move. Residents’ personal, healthcare and medication needs are met in a manner, which protects their autonomy and dignity. The care plans have been kept up to date and reflect residents’ current needs. The residents and families spoken to said that they were very satisfied with the level of care that they or their families were given. There is a programme of activities arranged for residents to join in if they wish. The standard of food served at the home is good and residents said that they enjoyed it and always had a choice. Families said that they were always made welcome. Diets to meet resident’s cultural or religious needs are available. The home is responsive to resident’s wishes and responds promptly to any concerns. Staff have had training in safeguarding older people. Residents live in an attractive, safe and well-maintained environment. Individual rooms are personalised and there is a programme of ongoing maintenance. The gardens are attractive and well maintained and residents appeared to enjoy them. Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 6 There are good staffing levels. The recruitment procedures are thorough and checks as to the suitability of care staff to care for elderly people are undertaken before the staff member commences work. Staff have been supported to undertake National Vocational Qualifications in Care at level 2 and have had training in basis safe working practices. All staff including the housekeeping, laundry and catering staff are committed to the care of the residents. The home is safe and well managed by a stable, experienced management team. The proprietors visit the home on a daily basis. The manager and deputy manager are both qualified nurses and hold a management qualification. There are quality assurance systems in place, which are responsive to resident’s wishes. What has improved since the last inspection? What they could do better:
The use of pharmacy printed medication administration charts should be considered to reduce the risk of transcription errors and ensure that residents’ medication is accurately described. The proprietors and manager should obtain a copy of Buckinghamshire County Council’s safeguarding policies and procedures and undertake training in this important area to ensure residents are fully protected. The home should obtain a copy of the latest infection control guidance for care homes, published by the Department of Health in June 2006 and available on their website www.dh.org. Residents should not share hoist slings to minimise the risk of cross infection. A training matrix should be developed to show when each member of staff last undertook mandatory training or annual updates to ensure that everyone remains up to date with their training requirements.
Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 7 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. Burnham Lodge Nursing Home DS0000019186.V338519.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 Burnham Lodge Nursing Home DS0000019186.V338519.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. 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. This judgement has been made using available evidence, including a visit to this service. The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. EVIDENCE: The files of four residents were examined. All had evidence that the manager or senior nurse had visited them prior to their move to the home and their needs had been assessed. The residents spoken to said that they had received enough information about the home before they moved and had had the opportunity to visit or stay for a short period prior to moving. Most said that friends or their doctor had recommended the home. They were happy with the information that they had been given and said that the staff had worked hard to make the move as easy and comfortable as possible. The documentation used to guide the assessment of potential residents has been improved and more detail is sought to help residents and the home assess whether the staff and facilities in the home can meet residents’ needs. There is reference to Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 10 potential residents’ religious and cultural needs in the assessment. The home does not offer intermediate care Burnham Lodge Nursing Home DS0000019186.V338519.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. 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. This judgement has been made using available evidence, including a visit to this service. Residents’ personal, healthcare and medication needs are met in a manner which protects their autonomy and dignity. EVIDENCE: The care of three residents was followed through in detail. Their files contained comprehensive care plans and the staff spoken to were knowledgeable about their care. The care plans had been reviewed regularly and updated when appropriate. The residents who returned the questionnaires and those spoken to on the day of the unannounced visit said that they were involved in planning their care and that the staff were responsive to their wishes. The risk of residents acquiring pressure damage due to immobility is assessed and the appropriate equipment is made available. Nutritional risk assessments had been undertaken. The staff and chef were aware of residents dietary needs and could provide special diets when necessary. Continence assessments are undertaken and appropriate aids are provided by the Primary Care Trust, (PCT). No residents have developed pressure damage since moving to the home. Residents register with the local general practitioner who
Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 12 visits the home weekly. He returned the questionnaire and said that the home communicated clearly with him and that any specialist advice was incorporated into the resident’s care plan. There was evidence that falls assessments are undertaken. All the residents who returned the questionnaires said that they always or usually received the care that they need and that the staff listened and acted upon what they say. Two care managers had undertaken reviews of clients in the home and both said that their client and their families were happy with the level of care offered. There are medication policies in place. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. The home still handwrites prescribed medication onto medication administration sheets, which are signed at a later date by the general practitioner. This is not best practice as there is a potential for transcription errors. The manager should discuss with the pharmacist having printed medication administration charts issued by the pharmacy. Controlled drugs were stored satisfactorily and all entries to the controlled register were signed. A contract is held for the safe disposal of unused medication. The registered nurse spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision, the doctor and family would be informed and a way forward agreed. The staff were observed to be treating the residents with respect and their dignity was protected. All care is given in residents’ rooms. The general practitioner said that he saw residents in their rooms. Residents said that they enjoyed the privacy of the home. Burnham Lodge Nursing Home DS0000019186.V338519.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. 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. This judgement has been made using available evidence, including a visit to this service. There is a range of activities available to residents who are encouraged and supported to follow their own interests and to remain in contact with their families and friends. EVIDENCE: There is a programme of activities available to residents if they wish to join in. Most residents had personalised their rooms and had their own televisions and music players where they wished. A number of residents said how much they were looking forward to sitting on the new patio. One resident said he particularly enjoyed going out into the garden, which was well maintained. Church services are held regularly for those who wish. The activities programme was displayed well in advance. The residents who returned the questionnaires said that they were able to choose how they spent their day and most confirmed that activities were usually arranged. The relatives who returned the questionnaires said that they were made to feel welcome at any time and often made a cup of tea. They are able to see their relative in communal areas of the home or in resident’s rooms. Residents have telephones in their room and are able to make outgoing calls free of charge. Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 14 The proprietors indicated in their quality assurance self-assessment that their plans for the next twelve months include considering appointing an activities coordinator at the weekends, creating a gardening area for residents who would like to continue gardening, forging closer links with the local community and making residents aware of the internet access that is available in the home and ensuring staff are available to help. The standard of food is very good. All the residents spoken to said that meals were the highlight of the day. One said ‘there is a good choice, the food is well cooked and appetising. Occasionally there may be something that is not to my liking but there is always a choice’. The menu is varied and residents have a choice of main meal. The chef was very aware individual resident’s likes and dislikes. The chef is also able to offer special diets when necessary and meals to meet resident’s cultural and religious preferences. Snacks and drinks are available during the day if residents are hungry and in the evening to ensure that residents do not have a long period without food. Pureed foods are presented attractively. Burnham Lodge Nursing Home DS0000019186.V338519.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. 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. This judgement has been made using available evidence, including a visit to this service. The complaints policies and procedures work well and residents and heir families feel that any concerns that they have are addressed promptly. Safeguarding procedures would be strengthened by the proprietors and manager undertaking updating training in the local multi agency approach to protecting vulnerable people. EVIDENCE: There are complaints policies and procedures in place. All the residents and families who returned the questionnaires said that they were aware of them. One family member said that she had not had occasion to make a formal complaint but that if ever she had any concerns, she spoke to the manager or proprietors who dealt with it immediately. The home has information about the Department of Health’s Protection of Vulnerable Adult policies and procedures. Most staff have had training in this important area. The proprietors should obtain a copy of Buckinghamshire County Council’s local multi-agency policies and procedures and update their training to ensure that they are fully aware of the steps that they should take if they became aware of any allegations relating to residents wellbeing. The Commission for Social Care Inspection has not received any complaints about the service nor been notified of any safeguarding allegations made to the local authority which is the lead agency in these matters. Burnham Lodge Nursing Home DS0000019186.V338519.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. 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. This judgement has been made using available evidence, including a visit to this service. Residents live in an attractive, safe and well-maintained environment. In general infection control standards are high but should be reviewed in the line with the latest Department of Health guidance to ensure that residents are protected from acquired infection. EVIDENCE: The home is well maintained and there is an ongoing programme of refurbishment. Equipment and services are maintained regularly and records were seen to verify this. There are upstairs window restrictors and radiators are covered to protect residents from accident. Bath temperatures are recorded regularly. Residents are encouraged to personalise their rooms and many had chosen to do so. The gardens are extensive and well maintained. A new patio is being built. The home was clean and tidy on the day of the unannounced visit. There were no offensive odours. The standards in the laundry are high. Residents have their own clothing, which is labelled. It is
Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 17 washed and ironed and the laundry staff take pride in the standard of clothing that resident’s wear. There is a ‘red bag’ system for soiled laundry. There are infection control policies and procedures in place. The home did not have a copy of the latest guidance published by the Department of Health in June 2006 and available on their website www.dh.org which should be obtained. Residents also share hoist slings, which is not recommended. One of the bedpan disinfectors is currently under repair. Appropriate gloves and protective aprons, alcohol hand gel and sanitising gel is available in the home to minimise the risk of cross infection to residents. Burnham Lodge Nursing Home DS0000019186.V338519.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. 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. This judgement has been made using available evidence, including a visit to this service. Staffing levels are good and staff are encouraged to gain qualifications in care. Recruitment procedures are thorough and protect residents from unsuitable carers. EVIDENCE: There is a stable staff team. The staff spoken to enjoyed working at the home and felt valued for the efforts that they put in. The residents spoken to said that the care staff were very kind and those who returned the questionnaires said that they always listened to what they say and tried to help them in the way in which they wished. The staffing levels are good with a ratio of one member of nursing or care staff to four residents. The care team are also supported by full time housekeeping laundry and catering teams. Eight of the fourteen care staff hold the National Vocational Qualifications in Care at level 2 and a two are starting the course at level 3. The home meets the standard that fifty percent of care staff hold this qualification. The recruitment files of three recently recruited staff members were examined. All had the required documents and had evidence that appropriate checks had been undertaken before the staff member commenced work. There was evidence that the person’s identity had been checked, two references had been obtained and criminal bureau disclosures sought. The training records showed that they had undertaken an induction programme. Individual staff training
Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 19 records were held in staff personnel files. The records seen showed that staff had had training in safe working practices and had had safeguarding training. The staff spoken to confirmed that they had found the training offered to them beneficial when caring for residents. It is recommended that the manager develop a training matrix, which gives the dates when each member of staff last undertook mandatory training, with annual updates, to ensure that ongoing training needs are identified and met in a timely way. Burnham Lodge Nursing Home DS0000019186.V338519.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home is safe and well managed by a stable experienced management team. There is a quality assurance programme in place and the management team are responsive to the wishes of residents. EVIDENCE: There is a stable management team. The proprietors visit the home on a daily basis. The manager and deputy manager are both qualified nurses and hold the National Vocational Qualifications in Management at level 4. The lines of accountability are clear. The staff, residents and families spoken to said that there was an open atmosphere and that the management team were very approachable. Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 21 There is a quality assurance programme in place. Regular residents’ questionnaires are undertaken and the results collated and action taken in response to the findings. The proprietors undertake regular quality reviews with residents and reports of these visits are kept in the home and made available at inspection. The requirements and recommendations of the last report have been addressed. The home does not manage resident’ money on their behalf. A small amount of personal allowance may be kept at the home for residents. This is banked separately and statements are available for residents at whatever frequency they wish. There are health and safety policies and procedures in place. Staff have had training in safe working practices. Fire safety equipment is checked regularly and the staff spoken to were aware of the action to be taken in the event of a fire. Electrical equipment had been tested. Water temperatures are checked regularly. Some staff have had first aid training. Burnham Lodge Nursing Home DS0000019186.V338519.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 X X X X X X 2 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 Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 1 2 Refer to Standard OP9 OP18 Good Practice Recommendations The use of pharmacy printed medication administration charts should be considered to reduce the risk of transcription errors. The proprietors and manager should obtain a copy of Buckinghamshire County Councils safeguarding policies and procedures and undertake training in this important area to ensure residents are fully protected. The home should obtain a copy of the latest infection control guidance for care homes, published by the Department of Health in June 2006 and available on their website www.dh.org. Residents should not share hoist slings. A training matrix should be developed to record the dates when staff undertake mandatory training and annual updates, to ensure that all staff undergo this training in a timely way. 3 OP26 4 5 OP26 OP30 Burnham Lodge Nursing Home DS0000019186.V338519.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Burnham Lodge Nursing Home DS0000019186.V338519.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!
