Inspection on 30/11/07 for Daisy Nook House

This inspection was carried out on 30th 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

Daisy Nook House 26/09/06

Daisy Nook House 07/12/05

Daisy Nook House 10/05/05

Daisy Nook House 24/01/05

Daisy Nook House 03/09/04

Daisy Nook House 20/03/04

Similar services:

Chirnside House

Sunny Bank (P.R.S.) Ltd

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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

CARE HOMES FOR OLDER PEOPLE Daisy Nook House Bamburgh Drive Ashton-under-Lyne Tameside OL7 9SX Lead Inspector Ann Connolly Unannounced Inspection 09:15 30 November 2007 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 Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Daisy Nook House Address Bamburgh Drive Ashton-under-Lyne Tameside OL7 9SX 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) 0161 343 1033 0161 343 8233 Meridian Healthcare Ltd Mr Ronald Henry Duke Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (39), Physical disability over 65 years of age (39) Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 40 DE (E) up to 10 MD (E) up to 39 OP and up to 39 PD (E) 26th September 2006 Date of last inspection Brief Description of the Service: Daisy Nook House is a purpose built residential home offering accommodation to up to 40 older people in single rooms with en-suite facilities. The home is a detached property, all on one level. Day care is provided as part of Daisy Nook Houses service, but this report only focuses on the residential care facilities. Daisy Nook House is based around three discreet lounges. There is additional communal space in the form of one quiet room and several pleasantly furnished areas around the building. Daisy Nook House includes some gardens and an appropriately sized car park. It is located in a quiet residential area of Ashton under Lyne. The home is run by Meridian Healthcare Ltd, which operates several other care homes. At the time of this site visit, Daisy Nook House charged £353.66 per week. Extras such as outings, etc were not included. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 30 November 2007 at 9:15 a.m. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives who were visiting. Prior to the inspection, questionnaires were sent out to the people who live in the home, asking them to comment on how the home is run and managed, and for their views about how the staff supported them. Some of these were returned and the comments have been included in this report. Several residents living in the home were spoken to during the visit, and discussions took place with them to find out what they thought about the home and what they felt about how the staff supported them. Before the inspection, we also asked the manager of the service to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This is one of the ways that we get information from the manager of the service, about how they are meeting outcomes for people using their service. Information that was provided in the (AQAA) for this service, was detailed and comprehensive, and provided evidence of a service that was committed to focusing on positive outcomes for the people who use the service. Since the last inspection visit, which took place on 26 September, 2006, the Commission for Social Care Inspection has received one concern about this service. There was evidence during this visit that the manager was managing complaints well, and that procedures were followed appropriately Over the last twelve months the home’s manager has received nine complaints, and information in the AQAA states that these were investigated within 28 days. A number of these complaints were upheld. Fees for this home range from £361.75 to £424.34. What the service does well: The physical environment has been refurbished in the last 18 months, and the layout of the home provides useful space for residents to meet with their families and friends. There are pleasant outdoor spaces, which provide a relaxed and safe environment for residents to enjoy in the warm weather. The home provides existing and prospective residents with a care information pack which includes a service user guide, and useful information about the facilities and services provided by the home. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 6 A representative from the home carries out assessments, so that staff are confident that the skill mix of the staff team and the resources available are sufficient to meet the needs of individual residents. The home had taken positive steps to address requirements and recommendations made at the last key inspections, and shown as commitment to developing the service so that residents have better outcomes and quality of life . The programmes of maintenance and refurbishment are well established. The staff recruitment programme is robust and ensures that the well being of residents is protected. During the visit, there was a calm and relaxing atmosphere, and residents were seen moving around the home in a purposeful way, and were encouraged by staff to use the facilities, e.g. the small seating areas. Overall, the comments from residents and relatives were very positive, and most residents who were spoken to were happy about the way in which staff provided care and support. Residents’ comments included, “ Staff are very nice, always helpful”. One relative said, “ I continue to be impressed. Staff seem to be so very kind. I visit regularly, and they keep me informed. All the staff seem to be handpicked and very nice. I have seen all residents to be treated kindly”. What has improved since the last inspection? What they could do better: Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 7 The organisation should continue to develop services and fulfil the plans for improvement as identified in the self assessment information, contained in the AQAA. 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. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given sufficient information about the home to help them in making a decision about their care arrangement. Residents’ needs are assessed prior to admission to the home so they are confident their needs will be met, and the home is sure it can meet their personal needs. EVIDENCE: All existing and prospective residents have access to a range of information about the home. This includes the statement of purpose, and other useful information contained in a care pack. This information is useful in helping prospective residents to make an informed choice about their care arrangements, and to establish if the home is a suitable place in terms of meeting their individual needs. The information in the Annual Quality Assurance Assessment (AQAA), which is a self assessment completed by the manager of the home prior to the inspection, provides evidence that the manager and staff spend time carrying Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 10 out the assessment process. Staff spoken to said that it was important that residents, who were thinking about moving into the home, had the right information and were also provided with the opportunity to visit the home prior to making a decision to move there. Four residents’ files were looked at, and all of them contained an assessment of need. Assessments were carried out by care managers from the funding authority, and supplemented by an assessment carried out by a representative from the home. Information in the assessments was used to generate a working care plan. On completion of the assessment, the manager provided all prospective residents with a letter confirming that they were able to offer a place and that they were confident that they could meet individual needs. Daisy Nook House does not offer intermediate care. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are in place, and these provide staff with the information they need to support residents appropriately. Policies and procedures are in place, which provide staff with specific guidance to ensure that residents receive their medication safely. EVIDENCE: Four care plan files were examined during this visit. These were well organised, and written in a clear way, so that staff had the information that was needed to help them to provide care and support to residents. Since the last inspection visit, staff had received further training to support and guide them in developing care plans. The training focused on a person centred approach, and there was evidence that a number of plans had been re-written. The manager and staff team had been pro-active in involving residents and their family or representatives in developing an individual care plan. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 12 There was evidence that the cultural needs of residents had been considered when developing care plans, and they included information on meeting specific dietary needs as well as social and religious needs. The communication needs of residents were considered when recruiting staff, and there were staff on the team with languages appropriate to residents’ needs. Where appropriate, advocacy services were used to support residents who could not communicate in English. There was evidence that the care plans are reviewed at regular intervals. Some reviews were in more detail than others, and on some care plans it was not made clear if the resident had been involved in the review. The manager said that this was currently being addressed in the care plan training and that there was an emphasis on involving and seeking the views of residents about their care needs, and how they wanted to be supported. Care plans include risk assessments to ensure that any hazards are identified, and strategies and interventions are put into place to minimise any risks. Moving and handling assessments, pressure sore prevention and nutritional risk assessments are included in all the care plans and assessments. There was documentary evidence that residents had appropriate access to the full range of medical services available in the community. Residents spoken to said that they only had to ask for a doctor if it was felt one was needed, and one of the staff would arrange this. The home uses a pre-dispensed monitored dosage system. Medication administration records (MAR) presented as predominately appropriately maintained. In order to improve the auditing of medication, the manager had added the requirement to check stock levels of all medication on to the monthly audit. This will ensure that when the monthly audit takes place, the manager and senior staff will be able to track medication and provide a full audit trail for all medication received into the home. This will minimise any risks, and ensure that medication is handled safely. Controlled drugs were stored appropriately, and the records balanced with stock levels. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14,and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Meals served to residents were of a high quality, providing a well presented and nutritionally balanced meal. Residents are supported to engage in the social activities and daily life in the home, and the home supports and encourages residents to maintain links with their family and friends. This allows residents to exercise as much choice and control over their lives as they can. EVIDENCE: Residents who were spoken to during this visit gave mixed views about the activities offered in the home. Some residents were positive about the activities offered and said that they were sufficient. One resident said that they could always go to the day care unit it they wanted to join in with the activities going on there. Other residents said that they would like to go out on trips more, although there was a general acknowledgement that this was not always possible because of limitations in funding and staffing levels. There was evidence during this visit to show that some trips had been organised. Information provided by the manager in the AQAA stated that there had been Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 14 a number of outings, which included a Christmas outing to a local pub, and a festive trip to Blackpool lights. There are plans to develop the residents committee to increase consultation about planning appropriate activities. There was a written policy in place informing residents and their families and friends that visitors were welcome at any reasonable time. Meals served in the home were nutritious and were pleasantly presented. All residents spoken to were complimentary about the meals served in the home. One resident said, “ The food here is very good”. All residents said that there was always a choice of meals available, and that staff would endeavour to find an alternative meal if the meal on the menu was not to their liking. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place so that residents and relative can raise concerns, and so that the health, safety and well being of residents is protected. EVIDENCE: There is a clear and comprehensive complaints procedure in place. This is made visible and accessible to residents and any visitors to the home. All residents who were spoken to expressed confidence in raising any issue of concern with a member of staff or the manager. The Commission received one complaint about the home, and examination of records showed that the home had responded to this appropriately. Several complaints had been raised directly with the home. The complaints logbook was examined, and all complaints and concerns were appropriately recorded. The records detailed the nature of the complaint, the investigation process, and the outcome. In the AQAA, the manager indicated that there were plans to improve the complaints process, so that staff develop skills in handling complaints more effectively. Training programmes demonstrated that priority was given to providing all staff with training in safeguarding adults. The staff induction programme Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 16 included an introduction into the safeguarding policies and procedures ensuring that all staff are confident and have the appropriate up to date knowledge so that they knew what to do in the event of an allegation of abuse. All staff who were spoken to during this visit had a sound knowledge of the procedures, and were clear that all allegations of abuse must be reported to the social services who take the lead in any investigation. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is appropriately maintained, decorated and cleaned to ensure that residents are provided with a safe, pleasant and hygienic environment. EVIDENCE: This was an unannounced visit to the home. As part of the visit, a tour of the building took place. Communal areas and bedrooms were found to be tidy and were cleaned to a high standard. Information provided by the manager in the AQAA stated that all staff have been made aware of infection control, and there was evidence during the visit that protective clothing was provided and used by staff. The manager provided documentation confirming that all health and safety checks had been carried out in the environment and on equipment as required. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 18 The home was completely refurbished eighteen months ago, and there was evidence of an ongoing rolling programme of decoration and refurbishment. Overall, a pleasant environment was provided for residents and visitors. The external garden and patio areas had thoughtfully been designed to provide an extremely pleasant and safe external area for residents to enjoy all year round, making good use of the external space. Good use was made of internal space, and a number of quiet areas were provided for residents to meet with their families and friends. There was evidence that bedrooms had been personalised with personal effects and furnishings. All residents spoken to and visitors at the time of the visit were highly complimentary of the standards in the home. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a well-trained staff team, and are protected by robust recruitment procedures. EVIDENCE: At the time of this visit, there appeared to be sufficient numbers of staff on duty to meet the needs of residents in the home. The manager stated that the home aims to maintain staffing levels at a minimum of five care staff and a senior member of staff to cover the morning shift. The atmosphere in the home was relaxed, and staff were seen engaging in meaningful conversation and interactions with residents. All comments made by residents about staff were extremely positive. Comments included: “ The staff are so kind, they speak to you so nicely”. “Staff are very good, they will do anything for you”. “I can’t say a wrong word about the staff, they are so nice”. “Staff here are so helpful, they are generally pleasant and they are informative if you ask them anything”. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 20 Three staff files were examined, this included the file of a recently recruited member of staff. All files examined contained appropriate paperwork and Criminal Record Bureau checks and two written references. An employment history was also included on the files. Staff files included details of training. Staff who were spoken to confirmed that there were plenty of opportunities for training. Records confirmed that training was prioritised by the company, and there were a wide range of courses available to the staff team. Staff confirmed that they received a period of induction prior to commencing work. Information in the AQAA provided details about the training programme delivered by the company. National Vocational Qualifications were encouraged, and the information in the AQAA stated that the training programme for staff was in the process of being developed in order to widen the opportunities for ongoing training and development. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 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 in the best interests of the residents, and clear policies and procedures help to ensure that the rights and best interests of residents are promoted. EVIDENCE: The manager holds appropriate qualifications and has the management experience to ensure that the health, safety and well being of residents is promoted. From discussion with residents and staff, it was evident that the manager operated an open door policy, and welcomed discussion about ways in which the service can be developed to improve outcomes for residents living there. During the visit, residents and families were seen going into the office to discuss issues. One relative said he felt comfortable in approaching the manager with concerns and that any issues of concern were responded to positively. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 22 Meridian Healthcare Ltd had established appropriate and clear lines of accountability between the home and the rest of the organisation. The home has structured Quality Audit and Quality Monitoring systems, in addition to the less formal means of establishing the views of residents living in the home. The Quality Assurance Monitoring report was viewed during this visit. It looked at key aspects of the service delivery, and highlighted areas that were good and positive, and also areas that required improvement and development. Staff who were spoken to confirmed that they were in receipt of ongoing supervision, and supervision records supported this, Information provided by the manager in the AQAA provided evidence that policies, procedures and systems were in place to ensure that the safety and welfare of residents was promoted. Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 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 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 24 N0 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. 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. Refer to Standard Good Practice Recommendations Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Daisy Nook House DS0000005566.V349575.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!