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Inspection on 31/05/05 for Cherington Nursing Home

Also see our care home review for Cherington Nursing Home for more information

This inspection was carried out on 31st May 2005.

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 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

A major investment of funds since the new owners have taken over the home has been made and has already made a great difference to the standards and facilities within the home. The residents and staff are supported positively under the leadership of Mrs Boote-Cook the Registered Manager and her deputy. A designated carer is allocated to the main lounge from 8am till 8 pm daily to ensure residents are continually supervised. Care staff are offered training to ensure that they can assist residents to meet their optimum potential for their personal, nursing and mental health care needs. Overseas cares are offered tuition in the English language and some procedures for ancillary staff have been translated into the staff`s own language to ensure safety. Managers and staff treat residents as individuals, respect their privacy and speak to residents in a friendly and respectful manner. Residents are encouraged by staff to make choices about their lives where possible. The atmosphere in the home is friendly with a good team spirit and the new areas of the home are decorated and furnished to a good standard. The theme of the seashore throughout the home is fresh and adds to the homely atmosphere. A good supply of quality specialist equipment is provided by the home for the safety and comfort of residents and the safety of the staff.

What has improved since the last inspection?

The refurbishment of the home continues to be carried out to a good standard. Mrs Boote-Cook is working well with her deputy and other senior nurses to implement new practices and training plans for the benefit of the residents and staff. More specialised input and training into mental health issues has been provided and more is planned. Mrs Boote-Cook promotes teamwork throughout the home which is working well. The deputy manager for the home has implemented a training plan working alongside the induction to ensure staff are taught the basic standards required for hygiene and nursing care throughout the home. More automatic closures have been provided for resident`s rooms since the last inspection and the laundry area has been provided with an alarm system to enable staff to call for help. Staff records are now complete and kept on the premises.

What the care home could do better:

Staff facilities have not yet been provided as required by legislation and is causing concern to staff. Staff references for new staff should have been scrutinised more carefully to ensure they met with requirements. A newly adapted bedroom should have sufficient natural ventilation before a resident is accommodated in it. The menus and meals should be further adapted to ensure the nutritional needs of residents with dementia are individually met.

CARE HOMES FOR OLDER PEOPLE Cherington Nursing Home 15 Stocker Road Bognor Regis West Sussex PO21 2QL Lead Inspector Mrs A Peace Announced Thursday, 1 September 2005, 08:00 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 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. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cherington Nursing Home Address 15 Stocker Road, Bognor Regis, West Sussex, PO21 2QL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 865936 Homebeech Ltd Mrs Sarah Boote-Cook CRH(N)-Care home with nursing 25 Category(ies) of DE(E)-Dementia over 65 - 25 Places registration, with number of places Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31 May 2005 Brief Description of the Service: Cherington is registered to provide personal and nursing care for 25 residents in the category of older peole suffering from Dementia. Homebeech Ltd owns the service and the Responsible Individual on behalf of the company is Mrs Sandra Ellis. Mrs Boote Cook is the Registered Manager. The premises consist of terraced houses that have been extended and adapted for use as a care home. Extensive building work is presently being undertaken at the home to improve the premises and facilities. Cherington is situated in a residential area of Bognor Regis close to the promenade and the sea front. The town centre is approximately ten minutes walk away. Unrestricted parking is available in the road outside the home. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Ann Peace Regulatory Inspector carried out this announced inspection on 1st September 2005. Prior to the inspection all records held on file since the last inspection were reviewed. A pre inspection questionnaire and other various information was submitted by Mrs Boote-Cook to the Commission before the inspection. During the inspection the building was toured and the majority of the bedrooms visited. Records relating to the care of residents and the administration of the home including staff records were examined. A case tracking exercise for new residents was undertaken to enable evidence to be gained about the continuity of care for the residents. Only a small number of residents were able to express an opinion about the home and their comments were positive. Two visitors were spoken to during the inspection and said they were always welcomed into the home, the staff were kind to residents and they were generally happy with the standards in the home. A number of satisfaction surveys were received by the Commission and in the main were positive. Where possible, new staff were asked what it was like to work at the home and they all said that they enjoyed their work and felt well supported by senior staff. Extensive building work has been and is still being undertaken, although almost finished so there is some disruption in the home. However residents are being looked after as safely as possible and risk assessments were in place. From information gathered and by observation and speaking to people, it was concluded that the atmosphere is friendly and homely and a good standard of care is given to residents who live at Cherington. Where information has not changed since the last inspection the report will remain the same. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? The refurbishment of the home continues to be carried out to a good standard. Mrs Boote-Cook is working well with her deputy and other senior nurses to implement new practices and training plans for the benefit of the residents and staff. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 7 More specialised input and training into mental health issues has been provided and more is planned. Mrs Boote-Cook promotes teamwork throughout the home which is working well. The deputy manager for the home has implemented a training plan working alongside the induction to ensure staff are taught the basic standards required for hygiene and nursing care throughout the home. More automatic closures have been provided for resident’s rooms since the last inspection and the laundry area has been provided with an alarm system to enable staff to call for help. Staff records are now complete and kept on the premises. 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. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 The home has a good pre assessment and assessment process, relatives and their representatives are able to visit to ensure the home will meet their needs. Residents are given a written contract with the terms and conditions of the home. A Statement of Purpose is available for interested parties and residents do have the opportunity to visit the home to ensure it will meet their needs. EVIDENCE: The resident’s records comply with legislation requirements and are clear and comprehensive. Care needs documented can be tracked from the assessment process to the care plans. The Statement of Purpose, Service User Guide is available and notices of this inspection were posted around the home. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 10 Mrs Boote Cook was reminded to ensure that the Statement of Purpose is revised as necessary on completion of the building work. Mrs Ellis is reminded to ensure that the Statement of Purpose and resident’s contracts reflect any rooms with restricted views or low lighting to ensure residents or their representatives are aware and are able to make a choice. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11. The care planning system is clear and provides care staff with the information they need to meet resident’s needs. Staff practices meet the specialised needs of residents and respect the privacy and dignity of residents. EVIDENCE: Clear and comprehensive care plans for all residents are compiled from the assessment process, they show that residents and relatives are involved and plans reviewed regularly. Individual mental assessments are carried out every 6 months or more frequently if needed. Supplementary care plans specifically for the dementia needs are presently being formulated by a registered mental health nurse who has recently been employed at the home. Mrs Boote-Cook said that this would ensure all staff are aware of the differing specialised needs of the residents and the action staff will need to take to meet those needs. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 12 Life books and displays are also compiled from information and photos given by relatives to give a picture of the resident’s life and family. Mrs Boote-Cook said that this helps with reminiscence for residents but also ensures staff are aware of the personal needs, previous lifestyle and wishes of the residents. A key nurse system is in operation which provides continuity for the residents. Staff were observed directly and indirectly and were noted to care for and speak to residents in a caring and respectful manner. When asked about daily routines Mrs Boote-Cook informed the inspector number of residents do get up early washed and dressed but only if this is their regular pattern. Other residents are helped up into the chair for breakfast but a number stay in bed until they wish to get up. Nutritional needs are now being given a high priority at the home and work is presently being undertaken to ensure all residents have their appropriate nutritional intake. Records indicated that other specialised professionals are involved in the care of residents when necessary and that mental health training is accessed from outside sources. Policies and procedures for the safe administration of medicines were available and staff when observed were noted to follow correct and safe procedures. Relatives said that “staff were always very kind and helpful” and a comment on one of the surveys said that they were very pleased with the home. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. The home promotes a lifestyle that respects privacy, dignity and choice where possible. Activities are provided to meet the needs of residents and residents maintain contact with family and friends. Good home cooked meals are available but more specialised input is needed into the menus, food preparation and presentation to meet the specialised needs of dementia sufferers. EVIDENCE: The newly refurbished lounge and dining room were being used for the first time during this inspection and residents were well supervised by staff. Meals had been prepared at the adjoining home which also belongs to the company and transferred to Cherington in a heated trolley. This is a temporary situation while the kitchen is being refurbished. The meals were well prepared and looked appetising, but on looking at the menus seemed to be more suited to older people in general. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 14 Once the home’s kitchen is up and running, Mrs Boote-Cook who has researched the subject, plans to tailor the menus specifically for residents with dementia. There is a new chef for the home who is also experienced in this field. Mrs Boote-Cook and the head chef also plan to attend a training course in October related to meeting nutritional needs for dementia sufferers. Craftwork that had been done by residents was on display and staff were noted to try to accommodate individual wishes. Staff carry out activities in the main but outside entertainers do visit the home and flyers advertising this were on display. A cooking club, a men’s club and ladies salon session is also organised for residents. Due to the close proximity to the promenade residents regularly go out escorted by staff. A sensory room and the provision of a fish tank for the lounge are planned for the near future. Due to the building work the rear garden which has been laid with decking is not yet available for the use of residents, however Mrs Boote Cook told the inspector that there are plans to erect an aviary in the garden which it is hoped residents will become involved in. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 The complaint procedure is clear and enables residents, relatives and representatives to be sure that their complaint would be taken seriously and acted on within an appropriate time scale. Not all staff were aware of the adult protection procedure. EVIDENCE: There is a clear complaint procedure which is followed by the home. Two minor complaints were recorded and had been addressed by the home. A relatives meeting had been held previous to the inspection and issues raised were being acted on. Minutes of this meeting were available. Mrs Boote-Cook was reminded to ensure all new staff are told the basics about adult protection during their initial induction until further training can be given. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,23,24,25,26 Residents live in premises that are homely, well maintained, comfortable and clean. Specialised equipment is available to meet needs, and safety checks on equipment and training for staff ensure residents are safe at all times. Safe outdoor space is not yet available. EVIDENCE: Due to the present building work, some areas are temporarily inaccessible to residents, however the building work is almost complete and all areas are expected to be open and available by the end of September. Environmental and individual risk assessments were available and had been updated. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 17 All areas visited were clean and tidy and residents are able to furnish their rooms with their own possessions to make them more homely. Residents are now able to use the dining and lounge if they wish. The lift was in working order and the call bell system was noted to be in working, residents who could speak to the inspector said that staff respond promptly to the calls. The home has been planned in seashore/nautical theme with paintings and ornaments to reflect this. A local painter was commissioned to paint appropriate pictures, these add to the homely and pleasant atmosphere in the home. All areas are being decorated and furnished to a good standard and specialised equipment such as nursing beds, specialist mattresses and overhead hoists have been made available according to identified clinical need. Locks are not routinely provided on doors but all residents have a lockable cupboard in their rooms. Mrs Boote Cook was advised that residents who are able to decide should be given the choice of whether to have a suitable lock that can be opened from the outside in the event of an emergency on their doors. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30. The majority of the procedures for the recruitment and training of staff in the home are robust and do offer protection to residents living in the home. Staff are employed in adequate numbers for the needs of the residents. EVIDENCE: Staff training has been undertaken and records showed that staff are offered training appropriate to their work and the resident’s conditions and illnesses. There are plans to extend dementia training further. Overseas staff are offered tuition in English to enable better communication within the homes owned by the company. Duty rotas were available and showed sufficient staff with the appropriate qualifications are employed over the 24-hour period. A Registered Mental Health nurse has recently joined the home and when spoken with was knowledgeable about the needs of the residents. The recruitment procedure and induction process in operation has improved, with all required safety checks being made for new staff when they are employed. Induction training is carried out and staff are encouraged to undertake a National Vocational Qualification while employed at the home. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 19 Staff when spoken with were positive about the home and the ongoing support they get for their work and for training. The Inspector did identify one area of concern related to the references, where inappropriate references have been accepted by the company for a number of staff. This was discussed with Mrs Boote-Cook at the conclusion of the inspection and will be monitored by CSCI. There are still no appropriate staff facilities at the home which had been identified during the previous inspection and is causing concern among staff. Mrs Ellis told the Inspector that this would be addressed in the near future. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33,34,35,3,6,37,38. Cherington provides an open environment for residents to live in and staff are trained to undertake safe working practices to ensure the safety and welfare of residents. In the majority of cases the record keeping system safeguards resident’s best interests. EVIDENCE: Mrs Sarah Boote-Cook is the Registered Manager and under her leadership the home runs well and the staff are supported to carry out their work. The last few months have been difficult for staff due to the ongoing building works but it is apparent that the home is run in the best interests of residents. The staff at Cherington said they feel well supported by the providers who are always available and approachable. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 21 Monthly Regulation 26 reports on the conduct of the care home have been received by the Commission. Staff training in health and safety issues is provided and clear records are available. Staff recorded accidents and any follow up action recorded. Updated environmental and individual risk assessments were available and records on safety checks available. Daily environmental checks are carried out and recorded. Improvements have been made to protect residents in the event of a fire and fire safety checks on equipment and training for staff has been provided. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 2 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 3 3 2 3 2 2 Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation 23.3(a) Requirement The registered person shall provide suitable facilities and accommodation other than sleeping accommodation for staff. CSCI to be informed of action by The registered person shall ensure that references of new staff comply with legislative requirements and safeguard residents. CSCI to be informed of action taken by Timescale for action 30/9/05 2. 29 19 30/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 15 24 Good Practice Recommendations Residents should be given meals that are suited to individual assessments and recorded requirements. Residents should be offered the choice for a lock to be fitted to their rooms, suited to residents capabilities and accessible to staff in emergencies. Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 2Nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY 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 Cherington Nursing Home H60-H11 S60641 Cherington Nursing Home V239029 010905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!