Inspection on 24/07/06 for Clore Manor

This inspection was carried out on 24th July 2006.

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.

Other inspections for this house

Clore Manor 04/06/07

Clore Manor 24/01/06

Clore Manor 14/04/05

Clore Manor 12/10/04

Clore Manor 18/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Clore Manor 160-162 Great North Way Hendon London NW4 1EH Lead Inspector Mr David Hastings Key Unannounced Inspection 10:00 24th July 2006 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 Clore Manor DS0000010423.V292112.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. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Clore Manor Address 160-162 Great North Way Hendon London NW4 1EH 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) 020 8203 1511 020 8202 6426 Jewish Care Care Home 72 Category(ies) of Dementia - over 65 years of age (72), Old age, registration, with number not falling within any other category (72) of places Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Clore Manor is registered to provide care for seventy-two elderly people some of whom have problems associated with dementia. The home is operated by Jewish Care and therefore observes a lifestyle promoting Jewish beliefs and culture. The home is located off the busy Great North Way in Hendon, on the edge of a residential area. It is a short drive to local shops and businesses and Brent Cross shopping centre. The stated purpose of care practice is to provide a homely, relaxed and safe environment for the residents, with an emphasis on individual differences. The aim is to treat residents with dignity and respect, where they can live as individuals leading as full and active lives as their physical and emotional condition will allow. The main building is on three floors. The two extensions that have been added over the years are on two levels at each end of the original building. The home has been effectively divided into three units. One of these, accommodating fourteen service users is designated as a dementia care unit. All service users bedrooms have en suite facilities, with a toilet and bath or shower. Each of the three units has communal sitting and dining space. There is a lift to assist people with mobility problems to gain access to the upper floors. The current scale of charges range from £652 to £694 per week. A copy of this report is available on the CSCI website or/and from the home. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 24th July 2006 and lasted eight and a half hours. Nine staff, twelve residents and one visitor were spoken to. A partial tour of the premises took place and care records were inspected. The inspector spent time in the dementia unit observing staff interactions with residents. The inspector was assisted throughout the inspection by the manager and assistant managers. All management and staff were open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: One requirement relating to the safe use and functioning of window restrictors has been restated. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescales will lead to the Commission for Social Care Inspection considering enforcement action to Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 6 secure compliance. Six new requirements have been issued as a result of this inspection. The dementia unit as well as some bedrooms need redecorating to bring the standard of decoration up to the excellent standards of the rest of the home. Some broken furniture in residents’ rooms need repairing or replacing. As a result of a number of staff leaving the service the organisation must review the needs of staff in respect of NVQ level 2 training. Staff recruitment procedures must be tightened up to ensure the continuing protection and safety of residents. The inspector is confident that the registered provider will comply with these requirements within the timescales given. 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. Clore Manor DS0000010423.V292112.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 Clore Manor DS0000010423.V292112.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 and 4 (6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All prospective service users have a full assessment of their needs carried out before they move into the home. Staff at the home have an excellent understanding of the needs of people living there and how these needs are to be met. EVIDENCE: Two case files of service users who had recently moved into the home were examined. There was evidence that full assessments had been carried out by social workers prior to the service user visiting the home and moving in. The manager and the deputy manager informed the inspector that they would carry out their own assessment of the person’s needs prior to them moving in to the home. These assessments covered all aspects of Standard 3.3 of the National Minimum Standards for Older People. The inspector spoke to a number of service users who confirmed that the staff at the home were able to meet their needs. Staff interviewed had an excellent understanding of individual service users’ needs and how these needs were to be met. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 9 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are aware of and are able to meet the health, personal and social care needs of service users. There is good access to health care professionals. Staff respect service users’ rights and privacy. Service users receive the correct medication at the right times and administered by appropriately trained staff. EVIDENCE: Six service user plans were examined. Jewish Care has recently implemented a new system of care planning. These plans were well designed and clearly set out individual care needs and goals for service users. The inspector was very impressed by the positive use of language used in the plans. There was evidence from service users ‘ plans that service users have good access to doctors and other health care professionals. The dentist was visiting the home on the day of the inspection. Service users confirmed that they had good access to chiropodists, opticians and dentists. Care plans clearly detailed doctors’ visits and the outcomes of these visits. Care plans contained risk assessments covering risks associated with dementia such as wandering out of the home and how these risks were to be minimised. All care plans included a Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 10 section on “life histories” of service users and it was evident that staff were using this information to look at ways of keeping service users with dementia suitably occupied. Medication records were examined. The records in relation to the receipt, administration and disposal of medication that were examined were accurate. Most of the medication in the home is stored in a room where the temperature is controlled. However some medication is being stored in two of the units. The temperature in the areas where medication is stored must be monitored and should not exceed 25 degrees. A requirement has been made in the relevant section of this report regarding this issue. The manager informed the inspector that there had been an issue with medication where staff had not given a service user’s prescribed medication due to confusion over the receipt from the pharmacy. As a result of this the manager had requested her local pharmacist to carry out an inspection. The inspector saw the pharmacist’s report and the manager explained how the home had now met the recommendations of that report. Discussions with staff and service users demonstrated that personal care was undertaken in the privacy of service users own rooms. Service users interviewed spoke highly of the time that staff spent with them on an individual basis, and the way their families are included in the life of the home. The inspector particularly noted the way in which the staff team addressed service users, who were often confused and challenging, promoting their privacy and dignity. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 11 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 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is an excellent range of activities arranged for the home. Visitors are encouraged and made welcome by staff and service users are able to exercise choice and control over their lives at the home. Service users receive a wholesome, appealing and balanced diet. Mealtimes are sociable and stimulating. EVIDENCE: The activities programme for the week was posted at the entrance to the unit as well as in all service users’ rooms, and included varied activities that would appeal to a wide range of interests. Activities available during the week included sessions on arts and crafts, Jewish culture, aromatherapy, bingo, discussion groups, visits from PAT dog owners, manicures, card games and tea parties. Service users were very positive about the activities available to them particularly enjoyed trips out of the home. The social care organiser was very enthusiastic regarding her role and has organised a number of interesting activities since the last inspection. Service users were particularly pleased that a kosher ice cream van had recently called at the home and everyone had an ice cream. On the day of the inspection a PAT dog was visiting with her owner and service users were clearly enjoying the experience. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 12 The inspector was able to speak with a visitor to the home who confirmed that she was always made welcome by staff. The visitors’ book indicated that service users were able to have visitors at any reasonable time. One service user commented that staff were also careful about who they let in the building and always checked with the service user before letting visitors in. Service users confirmed that they were able to exercise choice and control over their lives as far as possible. Staff were able to describe how they enabled service users to exercise choice and service users spoke to the inspector about regular residents’ meetings were they could talk about menus, care provision and other issues. All service users that the inspector spoke with said the food at the home was very good. One service user commented, “the food here is as good as ever, there is a good variety and we are always offered a choice”. The regular chef is currently on sick leave and service users informed the inspector that they wished him well and were hoping he would return soon. Staff were observed sitting with service users during lunch and offering discreet assistance when needed. Lunch was relaxed, sociable and unhurried. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 13 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are able to make complaints and these complaints are taken seriously and dealt with in an open and nondefensive manner by the home. Service users are protected from abuse by clear policies and procedures. EVIDENCE: All service users spoken to said they had no complaints but knew how to complain if they needed to. The records of complaints were examined. Evidence from letters to complainants indicated that the home has dealt with these complaints in a timely and open manner and according to policies and procedures. Records indicated that the staff at the home have undertaken training in adult abuse awareness. A recent adult protection matter brought to light a concern regarding Jewish Care’s human resources unit. An allegation of abuse was made however the staff member was not suspended due to confusion between the management of the home and the human resources unit. An immediate requirement was made at the strategy meeting that the registered provider must ensure all service users are protected by the home’s adult protection procedure and that any other procedures used by Jewish Care do not conflict with the protection of service users. A satisfactory response was received by Jewish Care regarding this matter. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 14 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite its size, Clore Manor has a homely atmosphere and is clean, safe, wellmaintained and generally decorated to a high standard. Window restrictors must be in good working order and functioning properly. EVIDENCE: A tour of the premises indicated that the building is in a satisfactory state of repair and door alarms indicate when confused service users may wander out of the building. This is particularly relevant as the home is situated next to a very busy main road. A requirement was issued at the last inspection that window restrictors are working properly and that windows are not opened beyond safe restriction limits. The inspector found that some window restrictors were still not working properly and that a number of windows had been opened beyond safe limits. The manager informed the inspector that an audit of window restrictors had taken place and that domestic staff had been instructed not to open windows too far. This is particularly worrying as the Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 15 majority of service users are confused and vulnerable. Further work on this issue is needed. The requirement has been restated. At the last inspection a number of bedroom doors in the dementia unit were found to be heavy to open. This issue has been addressed by the manager and most of the doors were easier to open. The manager informed the inspector that service users did not, in practice, go to their rooms on their own and were always accompanied by a member of staff. The ground floor of the home has been refurbished and is decorated to a high standard. The inspector noted that the dementia unit was in need of redecoration as well as some of the service users’ rooms. A number of rooms visited contained broken furniture, which needs either repairing or replacing. Three requirements have been issued relating to the above issues. The inspector acknowledges the work and investment that Jewish Care has made to improve the ground floor of the home. The manager and deputy manager have also worked hard to improve the garden area with garden furniture and extensive planting. Service users told the inspector that the standard of cleanliness at the home was very good. Continence management systems are in place and the home was free from offensive odours. The home has policies on infection control and latex gloves and protective aprons were seen to be available. Laundry and clinical waste were kept separate from the kitchen and food storage areas. The laundry is adequately equipped and staff interviewed were aware of infection control procedures. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 16 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff at the home provide a very good standard of care. The ongoing dementia training has increased staff awareness of the problems faced by people with dementia and their families. Recruitment systems must improve and NVQ training must be seen as a priority. EVIDENCE: Staff were observed interacting and supporting service users in a friendly and professional manner. All the service users spoken to during the inspection were very positive regarding the management and staff at the home. One service user commented that she was very happy at the home and that staff were very good. She added that the night staff were also very helpful. On the day of the unannounced inspection staffing levels matched those recorded on the staffing rota. Four staff files were examined. These files did not all contain the information required to meet this standard. The manager explained that recruitment has now been outsourced and this may explain why not all information including two written references is available. Robust recruitment systems are needed to protect service users. A requirement has been made regarding this issue. There has been a recent increase in staff turnover following an investigation by Jewish Care into staff eligibility to work in the UK. As a result of this a number of staff who had completed NVQ level 2 in care have left. The organisation must continue to provide this training for new and existing staff in order to meet the requirements of standard 28 of the National Minimum Standards for Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 17 Older people. A requirement has been issued that the CSCI receive a training plan regarding how this standard is to me met. Staffing files indicated that staff had completed the required mandatory training and staff interviewed were positive about the training opportunities provided by Jewish Care. There is ongoing dementia training and this has had a direct, positive effect on the well being of service users. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 18 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, 35 and 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 by a very professional and competent manager. Service users and their representatives have a say in how the home is run. Service users’ financial interests are safeguarded by clear policies and procedures. Generally the home has good policies and procedures to monitor health and safety compliance. EVIDENCE: Staff interviewed were positive about the manager and one staff member commented that the manager is “very supportive”. Service users were also positive about the manager and the deputy. One service user commented that the manager was “very good”. The inspector reminded the manager that she must apply to be registered with the CSCI. The inspector was impressed with the commitment and Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 19 professionalism of the manager who is clearly working very hard to improve the lives of the service users living in the home. The home has a number of quality monitoring systems including regular staff, service users and relatives meetings and monthly visits to the home by the provider. The organisation also operates a quality assurance system and produces an annual report which is available to service users and their relatives. The home holds small amounts of money on behalf of service users for minor purchases. These accounts were examined by the inspector and were found to be accurate and clear audit trails were seen which included numbered receipts. Satisfactory documentation was available in connection with gas safety, electrical installation and PAT testing, Legionella checks and fire systems. The fire evacuation plan has been reviewed by Jewish Care’s fire training officer and a copy sent to the local fire brigade. This was a requirement from the last inspection that has now been complied with. Another requirement was made that risk assessments are carried out for all portable oil filled radiators used for service users. The manager informed the inspector that no one currently uses such radiators in the home but a risk assessment would be carried out if required. Records indicated that staff are undertaking appropriate health and safety training. A requirement has been issued under Standard 19 regarding window restrictors, which could impact on the safety of service users at the home. Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 20 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 3 X N/A 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 3 X 3 X 3 X X 2 Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 21 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 OP38OP19 Regulation 13(4) Requirement The registered provider must ensure that all window restrictors are working properly and that windows are not opened beyond the safe restriction limits. (Timescale of 01/03/06 not met) This requirement is restated. The registered provider must ensure that the temperatures of all medication storage areas are recorded. The registered provider must ensure that a programme of redecoration for the dementia unit is sent to the CSCI outlining intended dates for the redecoration of the unit. The registered provider must ensure that an audit of all service user’s rooms are carried out to determine how many rooms require redecorating and this information, along with timescales for action is sent to the CSCI. The registered provider must ensure that an audit is carried DS0000010423.V292112.R01.S.doc Timescale for action 01/09/06 2. OP9 13(2) 01/09/06 3. OP19 23(2) d 01/11/06 4. OP19 23(2) d 01/11/06 5. OP19 16(2) c 01/11/06 Clore Manor Version 5.1 Page 22 6. OP28 18(1) a 7. OP29 17(2) Schedule 4 out of all broken or damaged furniture in service users’ rooms and that this furniture is either repaired or replaced. The registered provider must ensure that a training plan is developed indicating how the home is to ensure that staff receive NVQ level 2 training in order to meet the requirement of this standard. The registered provider must ensure that all staff files contain all information, including two written references, required by The Care Homes regulations 2001. 01/12/06 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Clore Manor DS0000010423.V292112.R01.S.doc Version 5.1 Page 24 - 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!