CARE HOMES FOR OLDER PEOPLE
Caxton Lodge 25 Caxton Avenue Blackpool Lancashire FY2 9AP Lead Inspector
Mrs Ruth Edgington Unannounced Inspection 4th June 2007 09:15 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 Caxton Lodge DS0000009874.V336753.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. Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Caxton Lodge Address 25 Caxton Avenue Blackpool Lancashire FY2 9AP 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) 01253 356100 01253 356100 nichconnor@aol.com Mrs Isobel Conner Mr Nicholas Conner Care Home 7 Category(ies) of Dementia (7) registration, with number of places Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 7 Date of last inspection 7th June 2006 Brief Description of the Service: Caxton Lodge is situated in a residential area between Bispham and Norbreck, within easy access of shops and local amenities. The home can accommodate a maximum of seven persons, who have dementia. There are five single bedrooms and one double bedroom, none of which have en-suite facilities. The home has a separate lounge and dining room and sufficient toilet and bathing facilities to meet the needs of the residents. There is a passenger lift, which enables residents to move between the ground and first floor easily. A copy of the Statement of Purpose/ Service User Guide, which has recently been amended, is available for anyone making enquiries about the home. In addition there is a Brochure, copies of which are kept in the entrance hall of the home. The written information explains the care service that is offered and what the residents can expect if they decide to live at the home. A copy of the latest report is available for relatives to read if they so wish. Information received prior to this visit showed that the fees for care at the home are from £336.49, which includes payment for chiropody and hairdressing. Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced site visit was undertaken as part of the home’s Key Inspection. The site visit commenced at 9.15am and took place over 3 hours. Prior to the visit the manager completed a pre-inspection questionnaire, which provided information about the people living in the home, staff and other information, which assisted in assessing how the home was meeting the National Minimum Standards. Comment cards were sent out prior to the visit to enable people to have their say about the service provided, however only one relative and one visiting professional person returned these. The residents presently accommodated would have difficulty completing such information due to their abilities. Although the residents’ abilities to communicate varied greatly and in the main was very limited, information was gained from their comments and through observations made during the visit. The homeowner, manager and member of staff on duty were spoken to individually. A tour of the home was undertaken and a selection of staff, residents and administrative records were looked at. From observations made, comments received and written documentation seen, the information has been put together to form this report. What the service does well:
The residents in this home are well cared for. The staff team work well together and show an understanding of the needs of the people living at the home. The relatives are encouraged to be involved in the care provided and the information that they can share about the individuals and their life style before coming into the home is essential in making sure that the needs of the residents are met. One relative stated “ I find the residents of Caxton Lodge are happy and stimulated to enjoy their surroundings, they are well fed and warm, a real home from home”. Examination of the care plans and observations made during the visit confirmed that equality and diversity is promoted and residents are treated with respect and dignity. Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 6 The management team work closely with other professionals, such as the doctors and the district nursing service, to meet the individual needs of the residents. The member of staff on duty confirmed that they received positive feedback from the district nurses and comments received from a doctor who visited individual residents, were also very positive. What has improved since the last inspection? What they could do better:
Throughout the inspection evidence was seen of the improvements made in relation to the building and the efforts taken to ensure that new residents had fitted in well in order that their individual needs and those of the existing residents were met. However to some degree the time taken to accomplish the changes had restricted the time that the manager had available to undertake administrative duties, although there was no evidence to indicate that this had affected the care and service provided to the residents. The manager was reminded of his responsibility in this area. It was noted that the systems presently used for the identifying, planning and recording of residents’ needs were found to be complicated and time consuming. The manager confirmed that he would review these systems to ensure that that information was recorded fully and the needs of the residents continue to be identified and met.
Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 7 The receipt and disposal of all medication coming into the home should be clearly recorded to provide a clear audit of medication being taken by the residents to ensure that there is no mishandling and that the residents are protected by the procedures in place. The manager should continue to work towards obtaining the relevant qualification. The manager was reminded of the requirement to inform the Commission for Social care Inspection (CSCI) in writing of any deaths and serious incidents that affect the well being of the residents. 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. Caxton Lodge DS0000009874.V336753.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 Caxton Lodge DS0000009874.V336753.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment and admission procedures were clear to ensure the care needs of the residents are met. EVIDENCE: There have been two admissions to the home since the last inspection and the information recorded on both of these residents was looked at in detail. The records contained assessment information that had been obtained prior to the residents being admitted in order to ensure that the home could meet their needs. A copy of a letter sent to each resident confirming that their assessed needs could be met was seen on each of the files looked at. One of the residents had previously come to the home for day care and therefore the manager was able to assess their needs over a longer period of time. Evidence was gained that the residents and their relatives had been involved in the assessment and admission process.
Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 10 The member of staff on duty was able to demonstrate that they were fully aware of the needs of the individual residents. This home does not provide intermediate care. Caxton Lodge DS0000009874.V336753.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. Promotion of health is taken seriously, however the systems in place for the recording of information is complicated having the potential for important details to be overlooked. EVIDENCE: Examination of the records of two of the residents showed that there was comprehensive information kept. This covered all aspects of the individual resident’s health, personal and social care needs. Risk assessments had also been carried out and these included risk in relation to falls and nutrition. It was recorded that one resident would regularly change their mind about what they did or did not like to eat and this was identified as a possible risk to their health that required staff to monitor closely. On the previous inspection visit the manager had just introduced new care planning documentation to ensure that the care needs of the residents were
Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 12 met. However these were found to be so detailed that could possibly result in the information not being recorded fully and reviewed frequently enough to ensure that the needs of the residents were being met. Evidence was seen that the care plans had recently been reviewed. The manager agreed to review their recorded systems to ensure that the residents’ needs are constantly monitored by an effective system. Comments made by the relative of one resident confirmed that the needs of their relative were being met. They said that they found the care to be the best. The staff are extremely kind and supportive. Comments from a visiting professional indicated that the individual health care needs of the residents are being met , staff seek advice and act upon it. They stated that the carers look after the residents very well. Observations of practice and examination of the care plan records confirmed that staff were meeting the diverse needs of the residents. Through discussions evidence was gained that staff were aware of the needs of the residents and the level of care required. There is a policy and procedure in place for the administration of medication and the staff who administer medication have received appropriate training. Information in relation to individual medication such as adverse affects and when medication should be taken is available for all staff to refer to. The system used in the home is a monitored dosage system that is supplied by the chemist on a weekly basis. The medication records were found to be correct and it was noted that none of the residents were prescribed sedation, with one resident not requiring any medication at all. The medication is kept in a secure cabinet in the office. It was noted that whilst the manager has available a system for recording incoming medication and any medication returned to the chemist, the record had not been kept up to date. This again was in some part due to the complicated way in which the record were being completed. The manager confirmed that he would look at the recording system in order to provide an audit trail for the protection of the residents. Observations were made during the visit of the caring approach of the management team and staff towards the residents and the practices in the home ensured that the residents were treated with respect and their right to privacy was upheld. The residents have regular visitors, some on a daily basis, which ensures that they are kept aware of any changes in the residents’ need and can contribute to the needs of the resident continuing to be met. Caxton Lodge DS0000009874.V336753.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 social, cultural, religious, recreational and nutritional needs of the residents are well managed to meet their individual capabilities and those of the group. EVIDENCE: The residents’ abilities to exercise choice and control over their lives is dependent on their ability to understand and make their wishes known. In the main the information obtained about the needs of the residents is acquired through discussions with their relatives. Since the previous inspection visit the number of residents that the home can now accommodate has reduced from eleven to seven and there has been a change to the individuals in the group. The majority of the residents are not as physically dependent as previously, which enables the staff to spend more quality time with them on an individual basis. This may be sitting talking to them or encouraging group activities.
Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 14 One relative indicated that due to the stimulation provided, the individual resident had improved very much. The staff member spoken to confirmed that one resident in particular enjoyed going out and the manager regularly took them out for lunch. Residents also enjoy sitting in the garden and in the good weather barbeques are held, which the staff member said they enjoyed. The home has acquired some chickens which has created an interest for some of the residents, one of whom checks daily to see if they have laid any eggs, which are then eaten by the residents. It was noted that the residents were dressed in their own clothing, which was individual and appropriate for their age and daily activities. The main meal of the day is at teatime, as this is thought to be better for people suffering from dementia and it has proved beneficial for the residents. As already stated one resident’s dietary requirements were identified as a potential risk factor to their health due to their constant changing of what they liked or disliked. The manager confirmed that this was being monitored closely and a daily record was kept of what the residents had eaten. The staff member on duty was overheard asking residents what they wanted for their lunch and evidence was seen of the choices given. Through observations evidence was gained that those residents who required assistance with their food were being helped and this was done in a very relaxed way ensuring that the process was enjoyable for them. Resident are able to have a meal with the individual resident if they wish and one relative in particular visits each day and has their evening meal. Caxton Lodge DS0000009874.V336753.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 arrangements in place for handling complaints ensure that people feel confident that their complaints will be listened to, taken seriously and they will be protected at all times. EVIDENCE: The home has a detailed complaints procedure in place which is made available to all residents and their relatives in admission and a copy is displayed in the hallway. The relative who competed the questionnaire confirmed that they had been made aware of the procedure. The home keeps a record of any complaints and compliments made, however since the last inspection there had been no complaint made either to the home or to the Commission for Social Care Inspection. There is a procedure in place in the event of any allegation of abuse or neglect. The manager and member of staff spoken to had a good understanding of the procedures to be followed. The majority of staff had received training in relation to these issues and the manager was contacting the local Social Services Department to access the up to date with regard to
Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 16 Safeguarding Adults, in order that staff knowledge is updated and the residents continue to be protected. The daily visits and involvement by relatives provides additional monitoring of practices being carried out in the home. Caxton Lodge DS0000009874.V336753.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 planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure that residents live in a comfortable, homely, clean and safe environment. EVIDENCE: As already stated there has been a planned reduction in the number of places available, which has resulted in changes to the home. A tour of the building showed that improvements had been made throughout. These included the provision of a shower facility on the first floor, which is to be further improved by making this room into a facility that will enable those residents who prefer a shower to be assisted easily.
Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 18 The dining room has been redecorated and refurnished, the newly appointed lounge has also been upgraded. Redecoration as taken place in many areas of the home and the appearance of the whole home has improved. The laundry facilities have temporarily been moved and plans are in the process of being agreed for the provision of a new laundry room, upgrading of the ground floor bathroom, kitchen and office. The manager confirmed that the vehicles that have been parked in the driveway at the home are to be removed, which although not causing any danger to the residents will greatly enhance the outside appearance of the home. The residents’ bedrooms are very personalised, which is helpful in making the residents feel secure with items around them that they are familiar with. Following the last inspection the owner and manager had carried out a critical look at each room and the improvements made confirmed that they had taken their findings on board. The manager produced a maintenance book which clearly showed that any work identified was attended to ensure that the residents continue to live in a safe and homely environment. Hot water temperatures were checked and were found to deliver water at a safe temperature in line with health and safety guidelines. The home was found to be warm, clean and hygienic ensuring a pleasant environment in which to live. Caxton Lodge DS0000009874.V336753.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. Improvements have been made in the recruitment process and residents are being cared for by staff who are trained and competent to do their job. EVIDENCE: There have been no new staff employed since the last inspection, however the report from that visit identified the need for the recruitment procedures to be followed correctly in order to protect the residents. Examination of the records of the staff member on duty confirmed that the manager had taken on board the requirements made in the previous inspection report in respect of recruitment and the staff file contained all the documentation required. Records showed that 50 of the staff had achieved a National Vocational Qualification (NVQ) and the staff member spoken to had completed level 2 and was waiting for verification. Examination of the training records confirmed that staff received appropriate training in order that they had a clear understanding of the specific needs of the residents accommodated in the home.
Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 20 The rotas showed that the number of staff employed in the home was limited, however it was found that the needs of the residents presently accommodated could be met by the number of staff employed. The manager and homeowner are very much hands on and cover any shortages of staff that occur due to sickness and holidays. The staff member spoke to was very clear about their role and said that they were involved in all aspects of the residents’ care and felt well supported by the management team. With the reduction of the number of residents who can be accommodated and an improvement in their dependency levels, the situation in regard to staffing has improved. The manager confirmed that an additional member of staff is to be employed, which should ensure that he has more time available to carry out his designated role Comments received from one relative indicated that they thought that the staff “did a good job, they really care for the elderly”. Caxton Lodge DS0000009874.V336753.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. The home is run in the best interests of the residents. EVIDENCE: The manager holds the diploma in management and has almost completed level 4 NVQ in care. He had previously hoped to complete this by September of last year, however due to circumstances this had not been possible. There has been a lot of work involved in the changes that have taken place in the home in a very short period of time, which has ultimately affected the time available to the manager to complete various records fully, however there was no evidence to indicate that the needs of the residents were not being met. Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 22 The manager confirmed that he was aware of the areas of administration that required attention and would ensure that these were attended to ensure that the needs of the residents continued to be identified and met appropriately. The management team rely on the relatives for information and verbal feedback about the service provided. Questionnaires are available for relatives to complete but it the main the relatives are involved in all aspects of the care provided therefore do not feel the need to complete the forms. The home recently was awarded the Investors in People Award, which is an external quality award that demonstrates the owner’s commitment to staff training and development. The residents’ finances are handled by their relatives or appointed representative and the management do not hold any monies on behalf of the residents. The relatives provide the support that the residents require in this matter. Inspection of the maintenance records confirmed that facilities and equipment were being maintained as required by the health and safety legislation to provide a safe environment for the residents and staff. The manager was reminded of the requirement to inform CSCI in writing of any notifiable incidents in line with Regulation 37. The pre-inspection questionnaire indicated that there had been two deaths since the last inspection and no notification had been received by CSCI. The manager confirmed that he had the appropriate forms and would ensure that these were completed in the future. Caxton Lodge DS0000009874.V336753.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 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 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 2 x 3 x 3 x x 3 Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13(2) Requirement A record must be kept of all medication received and disposed of to ensure that there is no mishandling and residents are protected by the procedures in place. The Commission must be informed in writing of any accidents, injuries, illness, communicable disease or other event that adversely affect the well-being and safety of the residents. (Timescale of 07/06/06 not met) Timescale for action 30/06/07 2. OP38 37 30/06/07 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 OP31 Good Practice Recommendations The registered manager should complete the required level 4 NVQ in care. Caxton Lodge DS0000009874.V336753.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Caxton Lodge DS0000009874.V336753.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!
