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Inspection on 25/04/06 for Castletroy Residential Home

Also see our care home review for Castletroy Residential Home for more information

This inspection was carried out on 25th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All of the service users spoken to were positive about their lifestyles in the home. Whilst some acknowledged that they missed their previous lifestyles and others were a little confused, there was a consensus of opinion that they wouldn`t want to live anywhere else. Two said they felt safe in the home. Service users passed compliments about the comfort of their accommodation, the provision of meals and in particular the care they had received from the staff at the home. One said that she had been treated with kindness and others passed similar comments; "they are nice to me", " they treat me kindly", "staff are all right". A visitor stated that his mother had been "well treated". The staffing structure in the home showed that the operation of the home was well organised. Sufficient training for personnel and numbers of staff on duty on a daily basis had ensured that service users had been well cared for and that the catering, cleaning and administration duties had also been carried out to a good standard.

What has improved since the last inspection?

Action had been taken on requirements to improve medication procedures, recruitment of staff and staff training. In addition the manager had contacted service users` doctors to remind them of their obligation to visit service users to diagnose illnesses before issuing prescriptions and to carry out at least an annual health check.

What the care home could do better:

The organisation of the documentation that sets how individual service users will be cared for should be gathered together in one file and include the arrangements to meet all assessed needs and preferences. Service users should be given the opportunity to visit the home prior to admission. Written guidance must be introduced to show when and why medications, that have been prescribed to be taken as required, must be administered. Records must be maintained to show how complaints have been investigated. Assessments of need for those who have been undertaking respite care on a regular basis must be reviewed to ensure that any changes in need between stays have been noted. Consideration must be given to the diagnosis of service users who are confused. The home is not registered to accommodate those whose primary assessed need is dementia. It is recommended that the home review its registration in the light of those who develop this condition whilst living in the home, so that the home can continue to care for those whose mental health is diminishing but whose needs can be met within the home. The home must ensure that new admissions of the home do not have dementia. This may require requesting a review of service users` mental health needs before admission.

CARE HOMES FOR OLDER PEOPLE Castletroy Residential Home 130 Cromer Way Luton LU2 7GP Lead Inspector Leonorah Milton Unannounced Inspection 25th April 2006 10.30 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 Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 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. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Castletroy Residential Home Address 130 Cromer Way Luton LU2 7GP 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) 01582 417995 01582 723615 Castletroy Home Mrs Jacqueline England Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70), Physical disability over 65 years of age (8) of places Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service user must not exceed 70. No one falling within the category of OP may be admitted to the home where there are 70 persons of category OP already accommodated within the home. No one falling within the category of PD(E) may be admitted to the home where there are 8 persons of category PD(E) already accommodated within the home. 4th January 2006. Date of last inspection Brief Description of the Service: Castletroy is a purpose built two-storey home situated on the outskirts of Luton in a residential area. The home is registered to care for up to seventy service users over the age of sixty-five years, eight of whom may also have physical disabilities. Mr Sharma has been the registered provider for several years. Mrs Jacqueline England has worked in the home for a number of years as the deputy and became the registered manager during the last two years. Single room accommodation with ensuite toilet and washbasin facilities is provided for each service user. There are communal areas on both floors such as a lounge and dining room. Shared bathing and toilet facilities are located for convenient access throughout the home. A hairdressing salon and activity room are located on the ground floor. A lift ensures all areas of the home are easily accessible to all service users. There are spacious and well-maintained gardens at the front and rear of the home. An insert in the service user guide detailed the charges for accommodation, which are between £395 and £425. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care (CSCI) since the last visit to and public report on, the home’s service provision in September 2005. Reports submitted to the CSCI by the provider each month on the conduct of the home, reports from other statutory agencies and information gathered at the site visit to the home, which was carried out on 25thth April 2006 from 10.30 to 18.30 hours were taken into account. The visit to the home included a review of the case files for three service users, discussions with seven service users, a visitor to the home, two members of staff, the district nurse, and the manager. Time was spent with service users in the wide foyer on the upper floor that was used as a meeting place and in a ground floor lounge, so that the daily business in the home could be observed. What the service does well: What has improved since the last inspection? Action had been taken on requirements to improve medication procedures, recruitment of staff and staff training. In addition the manager had contacted service users’ doctors to remind them of their obligation to visit service users to diagnose illnesses before issuing prescriptions and to carry out at least an annual health check. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 6 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. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Sufficient information in relation to service users’ care needs had been obtained prior to admission to ensure that the home could properly meet assessed needs. EVIDENCE: The pre-admission assessments of need for three service users were reviewed and showed that through assessments of need had been carried out, which had taken account of the details specified in standard 3 of the National Minimum Standards. There was evidence that an assessment carried out under the care management processes had included consultation with the service user and their representatives. One person had been admitted following a series of previous respite stays. Her original assessment of need had not been reviewed to ascertain whether there had been any changes in need over this prolonged period. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 9 One service user expressed concern that they had not had the opportunity to visit the home prior to admission. They felt that they had been misled by the placing authority. The service user also stated several times that they had no wish to leave the home. The manager explained that the service user’s family had visited the home on their behalf. It is recommended therefore that the home seeks the wishes of the service user at the pre-admission assessment and discusses the practicality of pre-admission visits with any potential service user and their representatives. The home did not provide an intermediate and rehabilitation service. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Whilst care-planning arrangements had improved, the documentation was not fully consistent with assessments of need, which could result in some needs being overlooked. Satisfactory arrangements were in place to ensure that service health care needs were met. EVIDENCE: It was difficult to assess the care planning arrangements fully as documents relating to individual care were not kept in one file. The manager agreed to take action on this. Three care files were assessed. The files contained assessments of dependencies and individual risk factors that had been updated regularly. The resulting care plans however, were still lacking in detail about personal Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 11 preferences, routine healthcare needs, recreational needs and evidence of service users’ contributions (or that of their representative) to care planning exercises. (For example the care plan for one service user only covered continence, hygiene, confusion, mobility, anxiety, depression and sleep). Copies of letters indicated that the manager had contacted local doctors surgeries about the requirement from the previous inspection, “The home must maintain records that they have requested that service users’ GPs carry out at least one annual health check where they have not been examined during the preceding year.” The manager reported that there had been improvements in this situation and also in the previous practice of prescribing for recent illnesses without having examined the service user to make a diagnosis. Observation of medications being given at lunchtime, discussions with the senior carer responsible and assessment of records and systems for the storage and administration of medicine showed that satisfactory procedures for the handling of medication were in place. Service users confirmed that they had been treated with respect since admission to the home and reported cordial relationships with the home’s personnel. Members of staff on duty were observed to treat service users with respect and to knock on bedroom doors before entry. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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 the home. Service users had been supported to exercise control of their lives within the limitations of their physical and mental frailties. Satisfactory arrangements were in place to meet service users’ nutritional needs. EVIDENCE: Service users who contributed to this inspection confirmed that they were happy with the recreational opportunities available to them. They stated that the daily routines in the home suited them and that there were no rules for getting up and bedtimes. The home employed an activity organiser who had organised a schedule of regular craft, exercise and stimulating activities. A game of floor bowls was in progress as the inspection commenced. Nineteen service users were seen to be either taking part or to be observing the exercise. The majority appeared to be engaged by the activity. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 13 Service users confirmed that their visitors were able to come into the home at anytime. Bedrooms and records showed that service users had been able to bring personal possessions into the home. Conversations with service users, assessments of nutritional needs, food stocks and corresponding menus and guidance for the catering team in relation to special dietary needs showed that service users’ nutritional needs had been met. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Satisfactory arrangements were in place to enable service users and personnel to raise concerns, and for the protection of service users. EVIDENCE: Previous inspections had noted satisfactory written complaints and protection procedures. Service users who were able to make comment on complaints procedures stated that they felt able to raise concerns with the staff in the home. The central complaints log identified that the home had taken action on complaints, which were of a minor nature. Records showed letters of response to complainants. The manager was advised to maintain records to show how complaints had been investigated. Records indicated that staff had received training in procedures for the protection of vulnerable adults. A senior carer confirmed that she had undertaken this training and was positive about the experience. She stated that the course had heightened her awareness of issues that could lead to abusive practice. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 15 Personnel files for two recent employees were assessed and showed that recruitment procedures had included checks on identity, performance at previous employment and a disclosure from the Criminal Records Bureau. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the home. Service users had been provided with a comfortable, safe and hygienic environment that was suitable to their needs. EVIDENCE: The home had been built to a high specification that had taken account of safety requirements such as controls to hot water supplies, the elimination of risks of accidental burn from unprotected radiators and restriction on window openings to remove the hazard of accidental fall. Bedrooms, communal lounges, dining rooms and toilet and bathing facilities were spacious, well decorated and furnished. Areas of the building seen at this inspection were clean and orderly. Satisfactory written procedures had been noted at previous inspections to prevent the spread of infection. Notices were seen at this inspection in relation Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 17 to hygiene practices, including instructions for safe working with those who have MRSA. Staff had records indicated that staff had undertaken training in health and safety practice. Service users confirmed that they were satisfied with the comfort and cleanliness of their bedrooms. It was noted that many bedrooms contained service users’ private possessions. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the home. Sufficient trained personnel had been rostered to ensure that service users were properly cared for. Recruitment procedures had ensured that persons of the right calibre were employed to care for service users EVIDENCE: Rotas and discussions with staff and service users confirmed that sufficient numbers of staff had been rostered to care for service users and to also carry out the duties of ancillary personnel. Staffing structures were well organised so that senior personnel were rostered on duty at all times to support and direct the team. This structure had been revised since the last inspection. Two care managers had been appointed to oversee care practice and night and during the day. A member of the team felt that this level of support was working well. Training to National Vocational Qualification (NVQ) was in hand but as with other care homes the turn over of staff impacted on the levels of those with such qualifications. At this inspection records indicated that of the of 40 care staff, 11staff held NVQ awards, 14 were working towards the award. It was Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 19 reported that another 4 were scheduled to commence the course in the near future. Training arrangements had improved since the last inspection because the manager had taken steps so that personnel who had previously reluctant to attend for training had complied with the home’s requirement to do so. Training records were well organised. Documents indicated that all personnel had undertaken statutory training and the progress towards other topics relevant to the care of frail older persons. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 The home was well managed to the benefit of service users by a qualified person who had strategies in place to consult with service users and their representatives. EVIDENCE: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The manager was a qualified nurse and held the Registered Manager’s award. She reported that she had been supported to carry out her role by the provider who had visited the home frequently. As had been noted at other inspections she evidently worked closely with her team and had maintained contact with service users. Staff commented Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 21 favourably on her management style. In discussion with the inspector the manager demonstrated that she was aware of service users’ care needs and the interventions required to meet them. As is inevitable with a large staff team there had been issues with staff working practice. Records indicated that the manager had taken appropriate and professional action to deal with personnel problems for the benefit of the performance of the team and ultimately for service users. Minutes of meetings showed that the manager had met regularly with her team at various meetings scheduled for specific areas of work. Records also showed consultation with service users at quarterly meetings. A review of the quality of the service had taken place in consultation with service users and their representatives shortly before the previous inspection. The inspector was shown an analysis of the results of the exercise. There was however no resulting action plans to show how the few issues identified during the exercise were to be dealt with. The manager explained that she had in fact taken steps to deal with issues but agreed to record this so that information could be shared with service users and the commission. The inspector was unable to assess arrangements in relation to monies held on behalf of service users, as these were not accessible during the administrator’s absence. Given that access was therefore restricted for service users, there will need to be a review to enable service users to access monies at their convenience. Systems were in place to maintain the environmental safety systems within the home. Records were maintained of equipment checks and maintenance carried out by qualified contractors. The manager using a detailed checklist carried out six monthly internal audits. The date recorded when this had last happened was 2nd February 2006. It was noted that one service user was wearing slippers that were far too big for her and which represented a trip hazard. The manager reported difficulties in obtaining replacement slippers from her representatives. Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 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 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 3 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 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 2 Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 12(1)(a) 14 Requirement The home must ensure that the home does not accommodate whose primary assessed need is dementia. Assessments of need at admission must be sufficiently detailed to prevent this from happening. The registered persons must ensure that service user care plans clearly identify the needs of service users and goals relevant to those needs. Files must contain a photograph of the service user. (Previous timescale of 03.01.06 and 31.03.06 had not been met in full). The home must ensure that service users are not put at risk of accidental fall that can result from ill-fitting footwear. Service users must have unrestricted access to monies held on their behalf. The registered persons must ensure that a quality assurance exercise is carried out to seek the views of service users, relatives and other stakeholders. DS0000015033.V290739.R01.S.doc Timescale for action 31/08/06 2 OP7 12(1)(a) 15 Schedule 3 31/08/06 3 OP38 12(1)(a) 13(4)(b) (c) 12(1)(a) (2) 12(1)(a) 24 14/06/06 4 4 OP35 OP33 14/06/06 31/10/06 Castletroy Residential Home Version 5.1 Page 24 A report of the findings of this exercise must be available for inspection by the CSCI. (Previous timescales of 03/01/06 and 31/03/06 had not been met in full in that there was no resulting action plan from the exercise) 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 OP3 Good Practice Recommendations It is recommended that where service users have had repeated admissions to the home that their assessment of need is reviewed at each admission to ensure that there have been no changes of need during the intervening period. It is recommended that the home seeks the wishes of potential service users at the pre-admission assessment re pre-admission visits to the home and discusses the practicality of such with service users and their representatives It is recommended that records be maintained to show how complaints had been investigated. 2 OP5 3 OP16 Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Castletroy Residential Home DS0000015033.V290739.R01.S.doc Version 5.1 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!