Inspection on 20/11/07 for College House

This inspection was carried out on 20th November 2007.

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

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

Other inspections for this house

College House 25/10/06

College House 17/01/06

College House 10/08/05

College House 03/11/04

College House 25/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 College House 26 Keyberry Road Newton Abbot Devon TQ12 1BX Lead Inspector Graham Thomas Unannounced Inspection 20th November 2007 09:30 College House DS0000003674.V352706.R01.S.doc Version 5.2 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 College House DS0000003674.V352706.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 Adults 18-65. 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. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service College House Address 26 Keyberry Road Newton Abbot Devon TQ12 1BX 01626 351427 01626 351437 collegehouse@parkviewsociety.fsnet.co.uk 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) The Parkview Society Mr Wayne Steven Osbond Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2006 Brief Description of the Service: College House cares for adults aged over 18 with a learning disability. Most of the people currently living in the home are over 65 years old. The Registered Providers of the service are the “Parkview Society”. This is a registered charity that runs several care homes in the South Devon area. College House is a large detached bungalow in a residential area of Newton Abbot. It is close to local amenities and within a short walk of the bus route. The premises has a lounge with sitting area overlooking the well-maintained gardens which are accessible to people living in the home. There is also a kitchen and dining room and most of the bedrooms are on the ground floor. There are two bathrooms one which is adapted, and additional toilets. The first floor is reached by stairs and has further bedrooms and the office and sleep-in rooms for staff. The current weekly fee at College House is £320.77 per week College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before our visit to the home, the manager completed an Annual Quality Assurance Assessment (AQAA). This is a self-assessment sent by the Commission that Providers are required to complete. We also sent surveys to people living in the home, staff and their relatives or advocates. Eight people living at College House returned these as did two relatives and four staff. We spent a day visiting the College House. During our visit we looked around the home, spoke with six people who live there and joined staff and residents for lunch. We spoke with three staff individually and discussed various issues with the deputy manager. What the service does well: What has improved since the last inspection? What they could do better: Information needs to be made easier to understand for people who do not read • Staff should have more training about looking after older people • The manager should make sure that CSCI has the information it needs to assess the home • College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 6 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. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive adequate information about the home before they move in. Individual needs are appropriately assessed before admission to ensure the home can provide appropriate care. EVIDENCE: At the time of this inspection, there had been no recent admissions to the home. Six of the people living at College House who returned surveys felt that they had received enough information before moving into the home. A Service Users’ Guide has been produced by to provide information to people thinking of moving to the home. Although there are some pictures in this guide it is not in an easily accessible format for those who might have difficulty in reading. Although there had been no recent admissions to the home, many residents had been involved in reviews with care managers. All the care plans examined were based on information received from care managers before admission. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people living at College House are well understood by staff who provide generally good support for people to make choices about their daily lives. EVIDENCE: Three care plans were reviewed during this inspection. Each was divided into two files. One part contained assessments, goals, reviews and risk assessments. The other part of each plan contained health and financial information. The plans examined had been reviewed every six months. “Person Centred” plans seen in the files had been produced in a format using symbols. However, it was not clear from our discussions with people that they understood their plans or could understand the symbolised format. The plans did not provide detailed information about individual communication needs and preferred form of communication. However, our observations during College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 10 the visit indicated that staff were able to communicate will with people living in the home. Specialist individual needs were clearly described in the plans. One person, for example, had received a hip replacement. This person’s file contained a moving and handling plan and clear instructions for staff in the use of a hoist and sling. There was also information on a physiotherapy regime. Another person’s behaviour had presented challenges to the service. A local specialist support team had been consulted and a risk assessment produced with specific guidance for staff. During the visit, individuals were following their own preferred routines in the company of others or on their own in their rooms. We observed staff offering people choices about day to day matters such as what they would like to eat and where they wished to spend time. In surveys returned to us by people living at College House, they were asked whether they could make decisions about what they do each day. Of the eight people who returned them, three said they always made these decisions one said “usually” and three stated “sometimes”. However, all said that they could do what they wanted during the days, evenings and at weekends. People said they felt able to speak up at the regular meetings held in the home and felt that they would be listened to. The registered manager is Department of Work & Pensions appointee for many residents. Records concerning these matters were seen during the visit. These were up to date and in good order. Risk assessments had been produced with regard to individuals who were unable to mange their own finances or medication. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at College House are well supported to maintain their own interests and join the life of the wider community. EVIDENCE: People living at the home do not have to contribute to the costs of transport in the home’s minibus. During our visit some people spoke enthusiastically about a recent group trip to a donkey sanctuary. There were many photographs around the home of similar trips and outings. Other activities discussed included discos, shopping trips and attending the local Gateway club. Individual interests were being supported and encouraged by the home. For instance, one person was very keen to show us rugs made he was making. Others showed us collections of things such as those related to dolphins. In addition some people attend an arts and crafts group. A masseur also visits the home. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 12 One person was able to travel independently by bus to a gardening job in a town eight miles away. People were able to participate in the daily chores and routines of the home. Some described cleaning their own rooms. One person told us about laying the tables for lunch and another was seen helping with the washing up afterwards. The lunchtime meal when we visited was a freshly prepared pasta bake with garlic bread, which we sampled. This was attractively presented and eaten with relish by people living at the home who all commented that they enjoyed the food. People with whom we spoke were aware of the meal being prepared. Discussion with staff and people living in the home demonstrated that individual likes and dislikes were catered for and that alternatives were available if an individual did not want the meal on offer. The meal time was a relaxed and convivial occasion in which staff and people living in the home ate together engaged in conversation. One person told us how she had lost two stones by attending weight watchers and with the support and encouragement of staff. The two relatives who returned surveys to us said that they always or usually were helped to keep in touch and were kept in touch with important issues. One commented, “I am a pensioner with special needs so I do not have as much time as I would like to visit my cousin, about once a month. But when we call we are always made welcome”. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are generally well supported to maintain and improve their health. Staff support people sensitively and administer medicines safely. EVIDENCE: People living at College House have varied health and personal care needs. Some require considerable support while others are more able to look after themselves with prompting and encouragement. During our visit we observed staff offering sensitive support to people. People with whom we spoke were happy with the way staff supported them. Records showed that staff had received moving and handling training, and training on using equipment and hoists. Detailed guidance was also seen in one care plan file. Healthcare needs are well monitored and supported with records of doctor, eye, hearing, chiropody and dental checks being carried out when needed. Specialist input from the learning disabilities team was also evident in individual records. The challenges posed by one person’s behaviour College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 14 had been risk assessed in consultation with the specialist support team and guidance produced for staff. Individual health needs are monitored and people are encouraged to maintain their health. One person, for example, had developed a deep vein thrombosis. The symptoms had been noted and acted upon promptly by staff. One person had been supported to lose two stones as part of developing a healthier lifestyle. None of the people living at the home was administering their own medicines. Risk assessments had been produced to indicate why people could not selfmedicate. A “monitored dosage system” was being used to administer medicines. In this system medication is supplied in pre-packaged dosages by the pharmacy. All the records examined were up to date and in good order. No controlled drugs were in use at the time of our visit. Some homely remedies were in use. There was no list of homely remedies approved by an appropriately qualified person. This means that staff had no information concerning the safe use of such remedies College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at College House can feel confident that their concerns will be listened to and taken seriously. There are sufficiently robust systems in place to protect people from abuse. EVIDENCE: The home’s records showed that the last recorded complaint was in March 2006. No complaints about the home have been received by the Commission since the last key inspection. A complaints procedure was available in the home. However, this remains in a written format and therefore inaccessible to most people living in the home. However, people living at the home who returned surveys all stated that they knew who to speak with if they were not happy. All but one stated that they knew how to make a complaint. In conversation during our visit people said that they would speak with Wayne (the Registered Manager) or their key worker. Both relatives who returned surveys stated that they could not remember how to make a complaint though one commented that the need had never arisen. All staff had received training in safeguarding vulnerable adults from abuse. The staff with whom we spoke were all clear as to how they would respond to suspected or actual incidents of abuse. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 16 College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at College House benefit from a homely clean, safe and comfortable environment EVIDENCE: College house is a two storey building with accessible gardens at the front and rear. Individual accommodation is situated on both floors. Each person living at the home has their own room. There is additional communal space consisting of a large lounge and dining room. A tour of all the communal rooms and bedrooms was made during our visit. All the rooms were comfortably furnished in a domestic style, well decorated and full of personal possessions. Artwork by people living in the home decorated the communal areas. People who returned comment cards said the environment was always fresh and clean and this was the case on the day of inspection. The cleaner was seen during the visit with whom we discussed the College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 18 cleaning regime. All residents spoken with were happy with their bedrooms and proud allow us to see them. The home is suitably adapted for the needs of those residents with mobility needs. The ground floor is accessible to wheelchair users, and there is a hoist and adapted bath. Other aids and adaptations were seen such as bed rails with protective cushions and grab rails. A monthly health and safety checklist was seen which covered matters of urgent maintenance. Records were also seen or regular equipment checks and maintenance. Personal electrical appliance test labels seen during the visit showed expiry in August 2007 suggesting that these tests were now due for renewal. The home’s laundry had cleanable walls and washable floors. Washing and drying machines were in place. The washing machine had a sluicing facility. In discussion, the cleaner was aware of infection control procedures and was seen wearing a disposable apron during cleaning tasks. Since our last visit recommendations of a previous Environmental Health Department inspection had been implemented. The home’s flat roof had also been repaired. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at College House are supported by a well-motivated and supportive staff team. EVIDENCE: Four staff questionnaires were returned to the Commission and three staff were interviewed during the inspection. Four staff files were also examined These included the files of people most recently recruited. The home has a low staff turnover and the most recently recruited staff member had previously worked there. Our observations during the visit continued to show that staff were approachable, enthusiastic and interested in the people living in the home. The interactions we observed were positive, helpful and supportive. Although the techniques of total communication were not being used, staff did appear to understand and communicate well with all people living there. Relatives who responded to our questionnaire felt that staff usually had the skills to meet the needs of people living in the home. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 20 Examination of staff files and discussion with staff demonstrated that there was a sound recruitment procedure in place. This included pre-employment criminal records checks, references and a formal application process. The staff files examined showed that staff received a structured induction. Following a recommendation made at the last key inspection, materials had been obtained to improve this induction to meet national training standards. This new induction format had yet to be fully implemented. Evidence of training was seen in health and safety topics such as moving and handling and first aid. Training in communication techniques had not recently been undertaken by staff. There was some evidence during our visit that further development was needed in this area such as producing more userfriendly documents for people who could not read. The home provides a service for a predominantly older group of people. There was little evidence in the staff training plan of training related to the specific needs of older people in general or those with a learning disability in particular. Action was being taken to increase the proportion of staff who hold a nationally recognised qualification in care. Of four staff who returned our questionnaires, two stated that they met with the manager regularly, one stated that this happened often and one other stated that this was sometimes the case. The staff interviewed all confirmed that they had regular opportunities for supervision. Of the files examined, all showed evidence of regular staff supervision and appraisal. The appraisal system included the staff member’s own review of their performance. Action plans had been set following these reviews and there was evidence that the needs identified had been followed up. College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. College House is generally well managed for the benefit of people who live there. EVIDENCE: The registered manager was not present during our visit. The deputy manager was in charge and was able to locate the documents and paperwork necessary for the inspection. Evidence from previous sections of this report shows that work has been undertaken in a number of areas to meet requirements and recommendations made at the previous key inspection. Following recommendations from the last key inspection, work had been undertaken to develop the homes system of quality assurance. The views of College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 22 people living in the home had been surveyed as well as other people concerned with the home. The results of these surveys had been summarised and an action plan formulated. In addition, there had been monthly meetings for people living in the home in which their views had been sought. Minutes of these meetings were seen during our visit. Examination of the home’s health and safety records provided evidence of regular checks of equipment and facilities. These included, for example, a check of gas safety in June 2007 and servicing of the home’s “Arjo” assisted bath. Monthly health and safety checks were recorded in checklists seen during our visit. The deputy manager stated that fire risk assessment and evacuation plans were in place. Staff training, evidence of which was seen in their files, included health and safety topics such as food hygiene, first aid and moving and handling. Before our visit, we sent an Annual Quality Assurance Assessment document to the home for completion. The completion and return of this document is a legal requirement. Part 2 of the document was returned to us before the visit. The remainder, which had been partially completed, was collected during the visit. Other documents seen during the visit such as accident records, policy files, care plans and staff records were in sufficiently good order and up to date. Evidence in previous sections of this report has highlighted the need to improve the accessibility of some of the home’s documents for people living in the home. College House DS0000003674.V352706.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 Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Care plans and information throughout the home should be in accessible to residents who do not read the written word. Care plans should also include information about residents communication needs, especially those with communication difficulties. A list should be held of any homely remedies in use. The list should be approved by a relevant professional. The home’s complaints procedure should be produced in a format or formats which are accessible to people who do not read the written word Staff should receive training specific to the needs of older people with a learning disability. The whole of any Annual Quality Assurance Assessment document should be completed and returned to the Commission within the set timescale 2. 3. 4. 5. YA20 YA22 YA35 YA41 College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 25 College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 College House DS0000003674.V352706.R01.S.doc Version 5.2 Page 27 - 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!