Inspection on 16/06/08 for Castle Grange

This inspection was carried out on 16th June 2008.

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

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

Other inspections for this house

Castle Grange 01/05/07

Castle Grange 06/06/06

Castle Grange 26/01/06

Castle Grange 01/09/05

Castle Grange 05/01/05

Castle Grange 02/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Castle Grange 9 Haymans Green West Derby Village Liverpool Merseyside L12 7JG Lead Inspector Mrs Lynn Paterson Unannounced Inspection 16th June 2008 09:30 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 Castle Grange DS0000025093.V363528.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. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Grange Address 9 Haymans Green West Derby Village Liverpool Merseyside L12 7JG 0151 226 5676 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) castlegrange@schealthcare.co.uk Southern Cross Operations Limited Manager post vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 41 Nursing and 8 Personal Care in an overall total of 41 One named person under 65 years of age may be accommodated. Date of last inspection 1st May 2007 Brief Description of the Service: Castle Grange is a large modern purpose built care home providing 40 beds to support older people with nursing and social care needs. The home is located near to West Derby village close to shops, churches and other amenities with public transport links to the city centre 5 minutes walk from the home. The care home became part of the Southern Cross Healthcare organisation in July 2005. Accommodation is provided on three floors with lift access to each floor. There is a pleasant garden to the rear of the premises and shrubbery to the front. Car parking facilities are located to the front of the building. All rooms are single Six rooms have en-suite facilities and 38 rooms are at least 12 sq metres in size. There are two lounges, one used as a quiet lounge and the other being a large area with good views over the rear gardens. There is a large L shaped dining room, which affords more than adequate space for all the people living in the home to dine in comfort. Fees are between £322.00 - £650.00-per week Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means that people who use the service receive good quality outcomes. An unannounced visit was carried out over a six-hour period and the methods used to assess the service-included discussion with the people living in the home, their representatives and the manager and staff. To ensure that the home is managed in the residents best interests records on staffing and health and safety were looked at. A sample of four care files were assessed in detail to ensure that staff had all the information and guidance they needed to support each individual. A tour of the premises was undertaken. The manager completed The Annual Quality Assurance Assessment (AQAA) and returned it to us prior to the visit being carried out. This is a selfassessment document, which gives information about how the home has improved in the last twelve months, plans for ongoing development of the service and any barriers to improvement. What the service does well: Residents said they were happy in the home where they enjoyed flexible daily routines and staff treated them with consideration and respect. Comments included: “The staff are kind and caring and look after us well” “We can do what we like here, well almost, staff arrange all sorts of things for us to do-today we are having a party”. “Staff really care about us and try very hard to make us happy”. Care plans show that resident’s health, safety and welfare are promoted in the home. Staff revealed that they were very happy that the home had employed a manager who was good at what she did and was very supportive to her staff. They said that although she had only been in place for about four months they had seen many positive changes to both the care of the residents and the support of the staff in that short time. Comments included: Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 6 “The manager is fair but firm and she has gained the support of all of us in a very short time” “The manager has implemented and updated staff training and supervision and has motivated staff “ “The manager has already started to develop person centred care for the residents and is arranging for an activities organiser to be employed to make life even better for the people who live here”. What has improved since the last inspection? What they could do better: Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 7 Records show that the manager has identified shortfalls in the home and devised systems to ensure that these shortfalls were dealt with as a matter of urgency. These included staff training, supervision, sickness levels and the use of agency staff. Because of the manager’s early inputs to resolving these problems, no shortfalls were identified at this visit. 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. Castle Grange DS0000025093.V363528.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 Castle Grange DS0000025093.V363528.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): 3.6. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are only provided with a service after their needs have been assessed and they have been assured these needs will be met. EVIDENCE: The AQAA document provided by the home states that all prospective residents are encouraged to spend time at the home prior to them making a decision about their future. Residents spoken with said they had visited the home before being admitted and had also had a visit at their homes/hospitals to see what their needs where and if the home could meet theses needs. Four care plans viewed show that an assessment of residents care needs is carried out to ensure staff have all the information they need on how to look after them in accordance with individual needs. The manager said that all Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 10 assessments incorporate equality and diversity issues to include age, disability, gender, heritage, religion and sexuality. Records show that when the assessment is carried out any people who may be involved in the care of the individual is invited to attend. The assessment is then undertaken by ward staff, district nurses, community physiotherapist, relatives, social workers etc. to ensure that all risks are identified and minimised. This results in a pre admission draft care plan being drawn up highlighting and risks or immediate requirements. Staff said the plan is then discussed with the residents and their families and an offer of placement made. Intermediate care is not provided at Castle Grange. Castle Grange DS0000025093.V363528.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): 7.8.9.10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents holistic needs are monitored and met and staff treat the people living in the home with respect. EVIDENCE: Four care plans examined show that residents have a comprehensive care plan based upon activities of daily living and included risk assessment for pressure areas, dependency, moving and handling, nutrition, continence, slips trips and falls, wandering and any other pre identified risk. The manager advised that the full range of issues relating to equality and diversity is in place and all individual needs, wishes, preferences are identified, discussed and acted upon to ensure that residents holistic needs are met. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 12 Care files held signatures of all who had been involved in their formulation to show that the plans had been drawn up and agreed in partnership. Resident’s health care needs are monitored with records of their daily welfare being kept. Reviews of care are carried out on a regular basis. The reviews are generally carried out every six months however if a residents uses bed rails or has any pressure areas they are three monthly or more frequent as required. Records show that regular health checks take place and referrals made to paramedical agencies such as dieticians, speech and language specialists, physiotherapist and occupation therapists. Staff revealed that on admission all residents are allocated a key worker and a named nurse. Residents said they liked this system, as they were able to establish good relationships and have consistency of care. One resident said that she was able to discuss anything with her key worker who she felt was kind and caring and understood her needs. The manager advised that all staff have received training in care/health care practices and in the recording of information. Staff observed carrying out their practices appeared to treat residents with respect and have excellent interactions. Residents spoken with confirmed the staff treat them with respect and uphold their privacy and dignity. Comments included: “Staff are kind and helpful” “Staff do their very best to make life good for us”. Records show the manager holds residents meetings in which some agenda items refer to finding out the views of the residents as to the standard of care they receive. Systems are in place to ensure residents receive their medication as prescribed by their GP and only qualified nursing staff are allowed to handle residents medication. Residents spoken with confirmed they received their medication on time and observations of the nurse in charge administering medications identified that she was carrying out her practices as per the home policies. The manager advised that she carries out a regular medication audit to ensure that the medication systems are well managed. Castle Grange DS0000025093.V363528.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): 12.13.14.15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home suits all residents and all individual needs are met. EVIDENCE: A range of social activities are carried out in the home to include video sessions, sing a longs, bingo, armchair exercises, shopping trips and pampering session. Currently care staff takes turns in arranging and organising activities. However the manager is currently recruiting an activities coordinator to further develop the activities programme in the home. At the time of the visit a birthday party was taking place, which included an entertainer performing for the residents. Comments form residents about the daily life in the home included: “We have a good time here everyone is my friend” “We play bingo and sing songs and talk and watch films, it’s good here we can do what we want. MY friends comes to see me and we talk to everyone” “I go out with my family and they come to see me. Staff take me out as well”. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 14 Resident’s families confirmed that the daily life was flexible and activities were arranged to suit the choices and capacity of the people living in the home. A varied menu is in place and residents spoken with said they enjoyed their meals and there was always plenty to eat and drink. Systems are in place to keep the kitchen clean and tidy and resident’s visitors said they had never seen such a clean and tidy kitchen. The manager revealed that the kitchen was very well managed and she had received very positive feedback about the high quality of the food. Observations of residents during lunchtime revealed that they thoroughly enjoyed their meals and discussion afterwards confirmed that they felt the food was wonderful. Comments included: “We have never had a bad meal yet” “The food is always nice” The food is tasty, well cooked and presented very nicely” “I can say that the food here is wonderful” “Varied menu, plenty of food on my plate, tasty and very good” “I get asked what I want, but I always forget so it is nice to get a surprise each day and I know it will always be good “. The dining area has been resituated since the last inspection and presents an L shaped room in which all residents have plenty of space to enjoy their meals. A number of residents need assistance with eating and staff were seen to be helping them in polite and discreet manner. The manager is aware that mealtimes can be an important part of the day and has changed the dining areas to ensure that all residents are able to mix with other residents to add stimulation and interest to their day. Castle Grange DS0000025093.V363528.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): 16.18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place for the protection of residents form harm and abuse are robust. EVIDENCE: The home complaints policy is widely available. It is distributed to all new residents on admission and is also displayed on notice boards in the reception are of the premises. Complaints policy and procedures are provided to all staff and staff confirmed they knew the complaints process as used by the home. The pre inspection questionnaire indicated the home has received 6 complaints over the past twelve months all of which were upheld. The manager revealed that the complaints process involves complaints being passed to the manager who deal with them as a matter of urgency. Records show that complaints and outcomes are recorded chronologically and are audited by the operations manager. Residents said they were aware of the complaints process and knew what to do if they were unhappy about anything. Comments from residents included: “I complained once but now that we have a new manager I think everything will be alright” Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 16 “I know how to complain but have not done so, as everything is fine” “There was a time when staff were off all the time and there was no manager and the staff we had could not care for us very well but everything is fine now that Ann is here. She has done a lot I the short time she has been here.” All staff are trained in the protection of vulnerable adults from abuse. Records show the range of training input varies from basic to intensive and the manager has noted the variations. As a result she has drawn up a staff training programme to make sure that all staff have full awareness of all adult protection procedures. Staff spoken with were able to demonstrate their knowledge and understanding of the differing types of abuse that can occur and actions that should be taken should the need arise. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 17 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): 19.26. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a maintenance programme, which ensures residents live in a safe well-maintained environment. EVIDENCE: The home is purpose built, well maintained and decorated to a high standard. All bedrooms are single occupancy and six of the rooms have en-suite facility. The overall standards of the building are good with much work being carried out to maintain its homely appearance. The building has a large lounge, which has a safe and easy access to the rear garden. The rear garden area provides seating and tables for residents and their visitors to enjoy the views. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 18 There is a smaller quite lounge and a well -appointed dining area. . All bedrooms presented as comfortably furbished and personalised. There are sufficient bathing facilities for the number of people living in the home. The bathrooms presented as clean, hygienic and equipped to meet the assessed needs of all individuals in the home. Residents said they liked their rooms and felt at home and safe. On the day of the visit the home was clean, tidy and free from unpleasant smells. The manager advised that a floor covering in one resident’s room was now unsuitable due to the medical needs of the resident. It had been agreed that this floor covering would be changed to one that was more appropriate to the cleaning programme required. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 19 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): 27.28.29.30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staff recruitment and training programme ensure suitably qualified staff are employed in adequate numbers and skill mix to meet the needs of the residents. EVIDENCE: The home has a clear recruitment and selection policy and the four staff files examined show that the policy is utilised for all staff appointments. Two references are acquired along with Criminal Records Bureaux (CRB) checks and also a Protection of Vulnerable Adults (POVA) check. On commencement of employment staff are taken thorough a comprehensive indication programme and care staff are assigned a mentor. All staff have individual training file for both mandatory and specialised training needs. Staff do generally receive supervision and appraisals. However it was noted that because of the absence of a manager, some supervision sessions had not taken place. The new manager had noted this shortfall and had arranged a full staff supervision programme of which she has already commenced. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 20 Staff rotas show that staff, are supplied in adequate numbers and skill mix to meet assessed needs of the current residents of the home. Staff said that they pull together and work well as a team. However they revealed that prior to the new manager starting some staff felt unsettled and de motivated by the lack of leadership. Staff sickness figures escalated and agency staff, were needed to assist with the residents care. Staffs said that when the new manager started she put policies in place to deal with staff absences to include back to work interviews and support meetings. Staff, says that due to the way the new manager has valued and supported staff they now feel empowered to move on and develop their knowledge and skills. Comments included: “She is just what this place needs” “She is firm but fair”. Residents said they liked the staff and appreciated the way they provided care and support. Comments included: “They always ask me what I want although it never changes “ “The staff are kind and know how to look after us” “They are like our family” “The staff were a little unsettled when the home kept changing managers, they did not know if they were coming or going. Staff, were off ill, strangers were coming in to look after us, they worked for an agency but we did not know them. Anyway its fine now, we have a new manager, the staff are all here and we are well cared for. Lets hope the manager stays, she has done so much to improve the place in such a little time”. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 21 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): 31.33.35.38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the leadership of the home which ensures residents comfort and welfare and improves overall service provision. EVIDENCE: The home has appointed a new manager who has fourteen years experience in the delivery of care to older people. She has ten years experience of care home management and is currently undertaking her Registered Managers Award, and ha submitted her application to The Commission for Social care (CSCI) to become registered manager of Castle Grange. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 22 There are clear lines of accountability within the home with all staff knowing the line management structure. The pore inspection questionnaire indicated that a range of policies and procedures relating to the care of the residents and the running of the home are in place and have been reviewed and updated as necessary. Systems are in place to ensure the ongoing monitoring of the service. Staff are supervised and monitored in their role and administrative systems reviewed. The company operational manager visits the home on a regular basis and carries out quality assurance assessments. The manager organises residents meetings and completes surveys to make sure the views of the people living in the home as addressed. The administrator takes responsibility for the management of resident’s daily money. A selection of financial records were inspected and noted to be in good order. The manager advised that Southern Cross who own the home are in the process of amending the systems involved with the management of residents finances with a view to identifying accrued interest that are added to individual accounts. Resident’s health, safety ad welfare is promoted in the home. The AQAA document indicated that equipment in the home such as fire systems, hoists, electrical wiring etc. is checked and serviced regularly and that associated records and certificates are in place to validate this. Staff said they are up to date with health and safety training and the manager has provided a training programme to ensure that all training is updated as needed. Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 23 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Castle Grange DS0000025093.V363528.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Castle Grange DS0000025093.V363528.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!