CARE HOME ADULTS 18-65
Carrick 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU Lead Inspector
Mike Dennis Unannounced Inspection 31st July 2007 09:30 Carrick DS0000009100.V342840.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 Carrick DS0000009100.V342840.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. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Carrick Address 11 Carlyon Road Playing Place Truro Cornwall TR3 6EU 01872 864657 01326 371099 mail@dcact.org 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) Spectrum Christopher John Halford Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Carrick is a care home providing personal care and accommodation for up to 5 adults with a learning disability. The registered provider is Spectrum, an organisation that provides specialist care for people with autistic spectrum disorders. Spectrum employs a manager, who is registered with the Commission and a team of staff to provide care to the service users living in the home. The aim is to provide them with specialist support in a homely environment. The home is located in the village of Playing Place, which is within easy reach of the city of Truro. It has vehicles for providing transport to service users and there are accessible local bus routes. The home is a single storey building, set in its own grounds, slightly off the main road. All the service users have their own bedrooms. The home has ample communal space, including a lounge/dining room, further lounge and conservatory. There is a spacious kitchen, a separate laundry room and an adequate number of bathrooms. Staff have a small office and separate sleeping in accommodation. The home has a large garden with space for parking. The home has level access and could be adapted to provide for service users with physical disabilities if necessary. Current service users do not require specialist equipment or adaptations and are able to readily access all parts of the premises. Fees range from £813.00- £7084.00 per week, according to information provided by the Registered Manager to the Commission, which was received on 15 May 2006. There are additional charges made to service users for personal items such as toiletries, newspapers and magazines. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection, which was unannounced. It took place on the 31st. July 2007 and lasted for approximately seven hours. The purpose of the inspection was to ensure that residents needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that resident placements in the home result in good outcomes for them. During the course of the day we observed the residents being attended to by staff in a courteous and professional manner. They informed the inspector that their expectations of being in a care home were being fully met. Various records, policies and procedures were inspected and found to be satisfactory. Service users expressed satisfaction with all aspects of the home and were keen to show us evidence of some of their achievements. What the service does well:
All of the residents have lived in the home for several years and are very familiar with the services provided to them. They are a settled group, who know each other well and there are no plans to change this. They all have written statements of the terms and conditions of their placement in the home. They have detailed written care plans so that they know what the aims of their placements in the home are. These are shared with their representatives, where necessary and regularly reviewed. Their care plans take into account their individual and diverse needs, including their age, religion, physical and sensory abilities, cultural background, sex and sexual orientation. Residents are helped to make decisions about things that are important to them such as the activities they take part in and staff were observed helping them to make choices during mealtimes and when assisting them with their personal care so that they can develop their skills and independence. Residents spoken with at the time of the inspection were able and very confident about expressing their views. Residents are encouraged to take risks in a safe way, so that they develop their skills and independence.
Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 6 Residents have active lives in and out of the home and are encouraged to maintain contact with their families and friends. Residents are informed of their rights and responsibilities, for example about what is expected of them in relation to household tasks in the home, so that they are clear about them and they are fair. Mealtimes appear to be relaxed and enjoyable for residents and they confirmed that they liked the food served in the home. They are able to make snacks and drinks for themselves or with staff to help them if they need it. Staff work with residents to prepare healthy, home cooked meals that they all like. Residents are helped and encouraged to dress smartly and appropriately and to keep themselves clean and tidy. Where possible staff encourage them to be independent, whilst assisting them with specific tasks if they need help. Residents are encouraged to maintain good physical and mental health and are helped to access external NHS healthcare providers such as doctors, dentists and opticians when they need to. Their medicines are mainly managed safely for them. They have good information on how to make complaints about the service and are actively encouraged to make comments about it, so that improvements and developments will be based on their needs and views. Residents said that they feel safe in the home and there are systems in place to protect them from harm and abuse. The home’s situation, as an ordinary domestic dwelling in a small, rural community, is conducive to enabling the people who use the service to develop their skills and independence in a safe and comfortable way. At the time of the inspection, which was unannounced, it was clean and tidy throughout. Staff are recruited fairly, in accordance with good employment practices and on the basis that they are suitable to work with vulnerable adults in a care setting. They are provided with good initial and ongoing training to ensure that they develop and maintain the skills they need to work effectively with service users. What has improved since the last inspection? Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 7 The previous inspection report highlighted a number of shortfalls resulting in statutory requirements being made. It is pleasing to note that all of these requirements have been met and complied with. Copies of initial care assessments are now to be found in the home allowing comparisons of progress of individual residents to be made. Progress has been made by way of compiling ‘person centred’ care plans and a wider use of pictorial formats allows residents to understand and more readily access information held about them. Record keeping in general has improved as has the storage of records to maintain confidentiality. There is evidence to indicate that improvements have been made to the decoration and fabric of the building. 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. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 8 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 Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have been given the information they need to make an informed choice about where to live. Admission to the home for residents is based on assessment so that they can be confident it will be suitable for them. Residents have individual statements of the terms and conditions of their placements in the home, so that they are aware of their rights and obligations. EVIDENCE: There have not been any recent admissions to the home and all of the current residents have lived there for several years. Those that are living there are very familiar with the services that the home provides. Initial assessment information is now held at the home, so that people working with them can review current care plans against their needs when they were initially admitted. All of the residents have written statements of the terms and conditions of their placements in the home. Copies of these are held on their individual files,
Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 10 with evidence that they have also been sent to their representatives and relatives. Some of the residents are able to access the information contained in the documents, through verbal explanations by staff and they have been provided with versions translated into pictorial formats so that they can access the information directly, which they have signed, as evidence that they have seen them. Information in service users’ guides includes the amount residents are expected to contribute towards the cost of their placements and the amount of personal allowances they are entitled to. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans exist, are reviewed regularly and contain personal goals and assessed needs incorporating a risk management framework. Residents are consulted and participate in all aspects of their life at the home. Confidentiality is maintained EVIDENCE: From discussion with residents, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of residents files, and in discussions it is evident that Carrick encourages residents and their representatives to express their views in the formation of their care plans. The care plan specifies what actions staff should take to
Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 12 ensure that the care need is approached in a consistent manner. The care plans are reviewed monthly and include appropriate risk assessments Staff facilitate regular one to one opportunities for service users to express their opinions. The care plans include information on health care, personal care, social interests, daily living skills, behaviour patterns and likes and dislikes. Service users’ care plans consider their abilities to make choices for themselves. Their daily care records demonstrate the choices they have made, for example between different activities offered to them. Residents have clear, written risk assessments, which are shared with their representatives. These address specific activities, in such a way as to enable service users to take risks to enhance their skills, abilities and the quality of their lives. Any restrictions necessary to protect residents and/ or others are clearly documented and shared with their representatives. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents take part in a range of activities in and out of the home and maintain contact with their families and friends. They are informed of their rights and responsibilities so that they are clear about what is expected of them. They are involved with the planning of menus and assist with the preparation of meals from time to time. EVIDENCE: Daily care records demonstrate that residents access activities in and out of the home that are planned around their individual needs, goals and preferences. Residents confirmed that they enjoy the activities provided for them and they were observed taking part in a range of different activities at the time of the inspection. Their ages and cultural backgrounds are considered as part of the care planning process so that activities are suitable for them.
Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 14 Residents daily care records show that staff help them to access a variety of resources in the local community. They often go out for walks, locally or further away from the home. They attend local colleges, make use of shops and go to cafes and the theatre, so that they are not isolated. Residents were observed going out in the home’s transport during the inspection and confirmed that they go out of the home regularly. Daily care records show that residents maintain contact with their families, friends or advocate. They have opportunities to socialise with service users at other Spectrum homes. The registered manager confirmed that senior Spectrum staff provide advice and assistance in relation to residents wishing to form and develop relationships, where necessary. Residents individual care plans and service users’ guides provide them with information on their rights and responsibilities so that they are clear about what is expected of them in the home. Their service users’ guides have been provided to them in translated formats so that they can access the information directly. They have been provided with information on independent advocacy and records show that one has an advocate who regularly visits them. Dietary needs and preferences are considered as part of the care planning process and they are encouraged to eat healthily. Meals tend to be prepared and eaten as a household and residents are involved in menu planning, shopping and preparing meals so that they develop their skills and independence. Records of food provided are kept. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19,20. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support that preserves their privacy and dignity. Medication is administered according to the homes policies and procedures EVIDENCE: Staff were observed assisting residents with their personal care according to their needs and abilities. There are detailed records and instructions to staff on how to care for them so that they are able to maintain and develop their skills and independence. Residents said that staff look after them well. Residents individual care plans, backed up by daily and healthcare records provide evidence that they are assisted to access a range of healthcare services in the local community. They are registered with local NHS providers and assisted to access specialist healthcare services where necessary, so that they maintain good physical and mental health.
Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 16 Residents risk assessments indicate that they need assistance with their medication. The home has written policies and procedures to ensure their medicines are safely stored and managed. There are suitably secure storage facilities and accurate records are maintained of medicines provided to service users. Staff have received appropriate training in the handling and administration of medication. On the odd occasion when hand written entries are made to the MAR sheets, these entries should be signed by two members of staff. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are listened to and the home is pro-active in obtaining their views. Any form of abuse is not tolerated EVIDENCE: Residents are provided with the home’s complaints procedure in a translated format as part of their service users’ guide. A quality assurance system, which involves consulting service users and their representatives about the service is regularly undertaken. A complaints log is kept. Residents said that they feel safe in the home. Staff appeared to be confident about the steps they should take to protect service users from harm and abuse. The home has copies of the local multiagency procedures for the local and service users’ placing authorities and the manager has undertaken multi-agency training so that he is informed on how different agencies work together locally to protect vulnerable adults from abuse. Records show that the home’s recruitment practices include checks to ensure that staff are suitable and safe to work with vulnerable adults in a care setting. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is evidence of ongoing improvements to the home to make it comfortable, safe and homely for residents. EVIDENCE: The home is an ordinary domestic dwelling, which has been suitably adapted to meet the needs of the people placed there, so that they benefit from an environment that has been designed to promote their integration with the local community and independence. There has been investment in the fixtures and furnishings and improvements to the home’s security so that service users are safer and more comfortable. Some of the carpets have been replaced thus improving the appearance of the home. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 19 During the course of the inspection the company’s maintenance team arrived to effect minor repairs and clear a blocked drain. Electricians were also busy doing Potable Appliance Testing. The home appeared clean and tidy at the time of the inspection. Staff have some equipment to maintain hygiene in the home and the registered manager has undertake training in infection control. Staff are guided by written procedures so that they have information on how to prevent the spread of infection. A previous damp problem appears to have been overcome in bedrooms although in one room there is still a suspicion that damp may be present. Laundry facilities have been improved by the installation of new machinery. The kitchen, being domestic in style is deemed satisfactory bearing in mind the people who use the service. We were shown some bedrooms by the residents who were pleased to show us around. The rooms were clean and appointed according to the individuals taste. Overall the premises were deemed to be satisfactory and safe for use. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New staff are recruited on the basis of fair, safe and effective recruitment policies and practices. They have access to induction and ongoing training so that they have the knowledge and skills to provide good care to service users. EVIDENCE: The home’s records show that over 50 of them are qualified to NVQ level 2 or above. Staff on duty and the home’s manager said that there has been quite a low turn-over of staff recently, so there are sufficient numbers of qualified and experienced staff on duty to ensure that service users receive continuity of care and duty rosters verified this. The home’s records indicate that staff are recruited fairly and safely, in accordance with good employment practice, and on the basis of their suitability to work in a care setting. They confirmed this during interviews as part of the inspection.
Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 21 The home’s records provide evidence that staff receive induction and ongoing training linked to meeting residents needs. Staff interviewed at the time of the inspection confirmed this. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41,42. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is competently managed for the benefit of residents. There are systems in place to ensure that residents views are included in the ongoing planning and development of the home. EVIDENCE: The home’s manager has been registered with the Commission for approximately two years. There is evidence that he has undertaken training to update his knowledge and skills and he has made improvements to the home Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 23 for the benefit of residents. He is qualified to level 4, NVQ., holds the Registered Managers Award and is an NVQ Assessor. Improvements continue to be made to the ways in which residents and their representatives are consulted about their satisfaction with the care and services provided to them in the home. The home’s annual development plan includes consideration of their needs, views and preferences so that ongoing development of the service is clearly linked to improving outcomes for residents. Residents confirmed that they are satisfied with the care and services provided to them and a representative of two of them confirmed that there are good arrangements in place to ensure regular consultation so that their needs are met. Record keeping in the home has improved and better storage facilities help maintain confidentiality. There are written risk assessments relating to individual residents and the registered manager has completed, signed and dated the home’s environmental risk assessment. Staff receive essential training to ensure their own health and safety and that of the residents as part of their induction and ongoing training. The registered manager has completed the home’s fire safety risk assessment. A recent inspection by the fire authority proved successful. Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 X 4 X 5 3 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 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 3 3 X 3 X 3 X 3 3 X Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 25 None 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 Refer to Standard YA20 Good Practice Recommendations When hand written entries are made to the MAR records, these should be accompanied by the signature of the author and a signature of a witness One remaining bedroom still slightly smells of damp. Further investigations as to the cause are recommended 2. YA30 Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Carrick DS0000009100.V342840.R01.S.doc Version 5.2 Page 27 - 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!
