Inspection on 17/05/06 for Craigielea Lodge

This inspection was carried out on 17th May 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

Craigielea Lodge 24/11/05

Craigielea Lodge 15/04/05

Craigielea Lodge 01/10/04

Craigielea Lodge 23/04/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Craigielea Lodge Lyndhurst Avenue Low Fell Gateshead Tyne & Wear NE9 6AY Lead Inspector Mr Lee Bennett Key Unannounced Inspection 10:00 17 and 18th May 2006 th 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 Craigielea Lodge DS0000007388.V293011.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. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Craigielea Lodge Address Lyndhurst Avenue Low Fell Gateshead Tyne & Wear NE9 6AY 0191 482 5823 0191 487 0639 sj@craiglea.fsbusiness.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) Gateshead Dispensary Housing Association Limited Patricia Anne Hillary Care Home 33 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Old age, of places not falling within any other category (33), Physical disability over 65 years of age (2), Sensory Impairment over 65 years of age (2) Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Categories MD(E), PD(E) and SI(E) relate to current residents only. Date of last inspection 24th November 2005 Brief Description of the Service: Craigielea Lodge is care home, providing personal care for up to 33 older people. Nursing care is not provided, but District Nursing services can be arranged where necessary. It is a purpose built care home with accommodation provided over two floors, with level access throughout. A lift provides access between the two floors of the home. Adapted bathing facilities have been provided, and there are hand rails fitted to the corridors. There are garden areas to the front and around the home. This includes a paved seating area. The home is situated in the Low Fell area of Gateshead, near to local public transport links. It is also situated near to a wide range of local facilities, including a doctors surgery, a library, shops, pubs and places of worship. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days in May 2006 and was a scheduled unannounced inspection. The inspection included a separate look at the pre-inspection questionnaire (completed by the manager), and comment cards received from service users and their relatives before the inspection. The care experienced by a sample of service users was ‘case tracked’ (this is where the inspector focuses on the service provided for individual service users) and time was spent chatting with service users and observing life in the home. A tour of the building took place, and a sample of staffing and service users’ records was inspected. The inspector took a meal with service users on both the ground and first floors. The judgements made are based on the evidence available to the inspector during the inspection, the pre-inspection questionnaire supplied by the registered manager and the comment cards completed by service users and their relatives. The fee level for the home is £359.00 per week. What the service does well: Service users were complimentary about many aspects of the service provided at Craigielea Lodge. Many positive comments were made about different aspect of the home, such as the food provided, staff’s approach and the environment. Comments included; • • • • • • “It’s a very good home, the food’s excellent, we’re all happy here.” “The food is very good, we have a choice, they (the staff) come round in the morning with the book to ask us what we would like.” “I’m very happy here, I wouldn’t want to move out now.” “The staff are all very nice and that makes a difference.” “Staff, food, laundry are excellent. Nothing is a bother, they do all they can to make my stay here very comfortable.” “I visited a friend living here for many months and knew I wanted to be a resident where I would be happy.” An activities worker is employed in the home, and provides both 1 to 1 and group activities. These include trips out to local places of interest, and the home has access to its own adapted minibus. Service users spiritual and cultural needs are recorded, and measures taken to ensure they are met. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? The last inspection highlighted the need for staff to sign medication records after each administration, and for staff to start duty only after the receipt of thorough employment checks, such as two references and a Criminal Records Bureau ‘disclosure’. This is largely completed, but CRB disclosures must be obtained prior to staff commencing duty. Staff now complete medication records appropriately. The dining room areas have been redecorated, and new floors laid. Bedroom areas are refurbished where necessary, including the fitting of new carpets. This was noted by a service user, who commented: • “The dining room looks lovely now it’s been redecorated, our rooms have been done too.” Nearly three quarters of the staff team are now qualified to NVQ level two or higher, and further, relevant training is planned for the forthcoming year. 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. Craigielea Lodge DS0000007388.V293011.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 Craigielea Lodge DS0000007388.V293011.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): Standards 2, 3, 5 and 6. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service Each service user has an adequate written contract / statement of terms and conditions with the home, which provides information on the rights and obligations of both parties. This helps to ensure that service users and their representatives are clear about what they can expect from the home. The admissions process ensures that service users’ needs are, on the whole adequately assessed prior to care being offered. This helps to ensure that service users are offered the right type of care at the home. Service users and their relatives are offered good opportunities to visit the home before they move in. This can help them to judge if it has facilities to meet their needs and preferences. Intermediate care is not provided at Craigielea Lodge. EVIDENCE: Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 9 Each service user is offered a contract (a copy of which is held on file in the home), outlining various terms and conditions regarding their occupancy within the home. Half the service users surveyed stated that they had not received a copy of this. The registered manager must therefore check to ensure that all have indeed received a copy for their own reference. Where a service user has been placed with the assistance of a local authority their residency is also determined by the detail of the contract between the local authority and the home. Should a person move to the home under a ‘private’ arrangement then they would be supplied with a standard form of contract between the home and service user only. Service users deemed as ‘self-funding’ by the local authority can still, if assessed by that authority, be placed under the local authority contract. Prior to the last inspection of the home, the Commission for Social Care Inspection received a complaint relating to the contract. The complaint was not upheld, but a recommendation made to review the content of this. The contract, on previous inspection, was found to provide no specific detail on the arrangements that apply when a service user is admitted to hospital or other care facility, such as the fee rate applicable, the holding open of accommodation, the continued provision of services, and so on. The contract has now been amended in the light of this recommendation. For those service users most recently admitted to the home (whose placement and needs were case tracked – a method by which inspectors are required to look at the service provided at the home, by focusing specifically on individual service users experiences of care), a Care Managers’ assessment was received before care was offered to them. Following this a plan of care was developed, and a review planned to take place after six weeks. This involves the service user, their social worker and other representatives. Care plans are, thereafter reviewed by senior member care staff on a regular basis. Should a reassessment of need be required, this is arranged with the relevant Social Services Department, as was found to be the case for another service user whose needs were specifically looked at. One service user was found to have been admitted following a diagnosis of dementia. This is outside of the homes current registration. The registered manager must therefore apply to the Commission for a variation to the homes registration categories. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8 9 and 10. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service Service users’ care plans are in place, and reflect their observed needs to a good level. Effective care planning can offer guidance to care staff regarding care practice and ensure consistency where necessary. Service users’ health care needs are identified through assessment and observation, and areas such as pressure care and falls prevention are subject to good supervision and care practice. Arrangements for the ordering, receipt, storage and administration of medication are implemented to a good level. This can contribute to the health, safety and wellbeing of service users. Staff undertake appropriate care practices that help to preserve service users’ privacy and dignity to a good degree. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 11 EVIDENCE: Each service user (whose needs and experience of care was ‘case tracked’) has a plan of care in place, and the manager, her deputy and senior carers have undertaken gradual revisions of these documents. Each service user’s care file follows a standardised format. A system whereby assessments are used to guide the development of care plans, which are then monitored, evaluated and reviewed has been developed for service users. Monitoring of specific needs occurs by using monitoring charts (for pressure relief, continence, diabetes and falls) and through daily progress notes. Highlighted risk areas, such as pressure care / skin integrity and mobility are also care planned /risk assessed. Service users’ health care needs are detailed within their care plan files, and any contact with health care professionals is listed within their monitoring records. For those service users whose cases were ‘tracked’, the input of such professionals (such as the District Nurse) was found to have been obtained where necessary, for example to attend to dressings, monitor blood levels and so on. Areas of risk to health (such as a high falls risk), or where care practice can impact on a service user’s health and wellbeing (such as special dietary requirements) are detailed within the service users care plan, to offer guidance to care staff in these areas, and thereby promote service users health and wellbeing. The management and administration of service users’ medication is governed by a set of policies and procedures, available to staff responsible for this task. Medication is, in the vast majority of cases, handled and administered by senior care staff. Medication rounds take place during the morning, at lunch time, at tea time and in the evening. A monitored dosage system (Manrex) is used, whereby the dispensing pharmacist supplies each service users’ medication within a tray. This contains a series of small blisters that are colour coded to correspond to the four medication rounds of the day, for a twenty eight day period. Printed ‘medication administration records’ are also supplied by the pharmacist. An audit of medication used by those service users who were ‘case tracked’ was concluded successfully. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Good arrangements are in place to provide activities and occupation within the home. The development of a planned, structured and well delivered activities programme can contribute to a more interesting and stimulating lifestyle for service users. Service users are able to maintain family and other contacts to a good degree should they wish. This can help ensure they do not become socially isolated. Service users are actively encouraged by staff to a good degree in exercising choice and control over their lives. This can help promote their independence. Service users receive a good, varied and well presented, choice based, menu. This can help promote their general health and wellbeing. EVIDENCE: The home has a worker employed specifically to plan and coordinate activities for service users. Activities are carried out on a regular basis and on the day of the inspection one to one craft therapy activities were being undertaken. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 13 The majority of service users who completed questionnaires stated that there were ‘always’ or ‘usually’ activities that they could participate in made available to them. One person said they never took part in activities. One service user commented: “We have an excellent Activities Organiser who arranges wonderful entertainments and activities for us and great quizzes too.” Visitors regularly call to the home, and all of the questionnaires received from service user’s relatives and representatives indicated that they are welcomed in the home, and that they are able to visit their relative or friend in private. During the inspection several visitors called to the home. The home has a variety of communal lounges available, should service users wish to meet people in private outside of their own room. Relatives are also encouraged to contribute to the care of the service user to whom they are related. Meals are provided within four small lounge areas, two on each floor. Some service users take meals within their own bedrooms. Service users are offered a range of choices for meal times and staff are attentive to service users’ requests, and provide support and prompts where necessary. The lunch-time meal was attractively presented and service users were very complimentary about the food provided. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service A clear complaints procedure is available for service users and their representatives. This can allow service users’, and their relatives, confidence in the process, and provide opportunity for the management team to improve the service provided. Local adult protection procedures are available to help contribute to the protection of service users from abuse. EVIDENCE: Service users and their relatives indicated that they were aware of the home’s complaints process. All of the comment cards received from service users stated that they were aware of who to speak to if they were unhappy with their care. Similarly all of the relatives stated that they were aware of the home’s complaints procedure. Procedures are in place to guide staff on local adult protection procedures. Staff have also received training on this topic. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 15 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): Standards 19, 21, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home is clean, well decorated and maintained. This can help promote a positive image for service users, and ensure they remain comfortable and safe. The service users’ bedrooms inspected are spacious and are furnished to a good standard. This can contribute to their comfort during their stay at the home. EVIDENCE: The service users’ rooms were clean and many contained furniture and possessions personal to the person. They exceed 12 square metres and either have en-suite toilets or toilet facilities near by. A rolling programme of redecoration is in place. Accommodation is provided over two floors, both of which have level access. Adaptations, such as accessible baths and walk in shower facilities have been installed to assist those service users who find it difficult to use standard facilities. Craigielea Lodge DS0000007388.V293011.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): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Staffing levels are adequate to allow service users’ needs to be effectively met. The staff team benefits from a good level with care qualifications, which can help ensure that a competent staff team is available to meet service users’ needs. Service users are generally protected by the home’s recruitment procedures, which are implemented to an adequate standard. This can help ensure that unsuitable candidates do not gain employment in the home. Training is planned to a good standard. A range of appropriate training can contribute to staffs’ understanding of service users’ needs and ensure sufficient competence to undertake their job. EVIDENCE: There are four care staff deployed within the home during the daytime (08:00 to 20:00) one of whom acts in a senior capacity. The manager is not included in these hours. A worker employed specifically to plan and help undertake activities is also employed in the home. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 17 Staff records indicate that the manager receives an ‘enhanced’ Criminal Records Bureau disclosure for each staff member, but this must be received prior to staff commencing duties. POVA first checks are also being received. Two references are always obtained prior to employment being offered. Staff recruitment practices are governed by a policy that aims to ensure equal opportunities practices are adhered to. Care staff have received training in a range of subjects, including fire safety, adult protection, food hygiene, manual handling, infection control, aging and disability, dementia care, first aid and medication during 2005. Several have undertaken a course of study to attain an NVQ award in care. Several care specific courses are planned for 2006, which includes training specific to diverse or minority care needs, and training on equality and diversity is planned for later this year. The manager has indicated that over 50 of the care staff team have attained an NVQ qualification in care, at level 2 or higher. Craigielea Lodge DS0000007388.V293011.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): Standards 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. External management support and oversight arrangements ensure the registered manager is supported to effectively undertake her job. This operates at a good level, and can help ensure that the service is run in the best interests of service users. Internal and external quality assurance systems have been developed to a good level. This can allow the views of service users, relatives and others to be sought and the internal quality management of the service to be progressed. Good arrangements are in place to safeguard service users monies held in the home. Risks to the health and safety of service users, visitors and staff are minimised. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 19 EVIDENCE: The registered manager undertakes quality monitoring of the service, and the views of service users are regularly sought by questionnaire. The home is seeking to attain investors in people status. The Chief Executive provides regular, professionally based support, oversight and supervision of the home. Monthly inspections of the home by this person are also being progressed, which includes a focus on the quality, practices and procedures operated within the home. This can contribute to an effective quality assurance and management system focusing on service processes and outcomes. The home is kept clear of hazards to the health and safety of service users, visitors and staff. Craigielea Lodge DS0000007388.V293011.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 3 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 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 3 Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 21 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 OP2 Regulation 14(1) Requirement The registered manager must not admit to the home anyone whose needs are outside the homes categories of registration. (This is a new requirement). The registered manager must ensure that staff commence work only after the receipt of full and satisfactory pre employment checks, including an enhanced CRB disclosure. The previous action plan date for this requirement was 20/12/05. Timescale for action 17/05/06 2. OP29 19(4) (a to c) 17/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations The registered person should verify that each service user has been provided with a copy of the contract between them and the home. Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Craigielea Lodge DS0000007388.V293011.R01.S.doc Version 5.1 Page 23 - 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!