Inspection on 29/06/05 for Eastham

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Eastham 08/08/07

Eastham 13/09/06

Eastham 31/12/05

Eastham 12/01/05

Eastham 19/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Eastham Main Road Woodham Ferrers Chelmsford Essex CM3 8RF Lead Inspector Kay Mehrtens Final Unannounced 29 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Eastham Address Main Road, Woodham Ferrers, Chelmsford, Essex CM3 8RF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01245 320240 01245 427243 Runwood Homes Plc Care Home 25 Category(ies) of Old Age, not falling within any other category registration, with number (25) of places Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 25 persons) Date of last inspection 24/03/05 Brief Description of the Service: Eastham is a detached period property situated in the rural village of Woodham Ferrers, approximately two miles from the town of South Woodham Ferrers with all its main amenities. This home cares for a total of 25 older people with a range of dependency levels from semi-independent to high dependency. The aim of the home is to provide a homely environment where service users are supported and encouraged to exercise their rights by suitably trained staff. The home has been adapted to meet the needs of older people that include the provision of ramps for easy access and a full passenger lift. Bedroom accommodation is on the ground, first and second floors and consists of nineteen single and three shared rooms. The house is set in well-maintained gardens with views over open countryside and has adequate parking facilities at the front. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place on the 29th June 2005, lasting 6.5 hours. The inspection process included: discussions with the acting manager, six staff, fifteen residents, three relatives, two visitors and a representative of the registered provider. There were 24 residents accommodated at the time of the inspection. The fees are £416.08 per week. There are additional charges for hairdressing, newspapers and personal items. Activities and outings are subsidised through fundraising by the “Friends of Eastham”. The premises were inspected, including the grounds. Samples of records and residents care plans were inspected. The inspection covered seventeen standards. The staff were caring and residents were positive in their comments about the staff and the home. The registered manager has now left the home. The acting manager approached the inspection in a positive and cooperative manner that was focused on achieving best practice to meet the needs of the residents. What the service does well: Eastham provides resident with a small, caring environment. The staff group promote a relaxed and friendly place in which residents feel well cared for and listened to. This is a home that does not rely on the television for activities and entertainment. The manager and staff offer residents a good variety of activities provided by the money raised through their fundraising. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 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 standard(s) 2, 3 and 5. Standard 6 is not applicable. Residents are provided with a statement of terms and conditions that do not reflect current charges. The arrangements for pre-admission assessments are good so staff are aware of residents’ needs prior to their placement. Residents are encouraged to visit before admission and consider the suitability of the home. EVIDENCE: Residents are provided with a Statement of terms and conditions. Those sampled, at the inspection, indicated the need for them to be updated to reflect the changes in fees and contributions. The home has a good admission procedure that includes visits to the home by prospective residents and their families. The acting manager undertakes preadmission assessments. Residents are visited and assessed at their own home with their families present. There is a format for assessments that covers the required areas. Those sampled were detailed and contained sufficient Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 9 information to enable staff to work with residents and their families to produce a working care plan. Residents are given the opportunity to visit the home prior to admission. Some residents use the home for respite care prior to considering a permanent placement. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 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 standard(s) 7, 9 and 10 Care plans were of a good standard and provided a clear document that enabled staff to meet the residents’ needs. Medication is well managed. The manager and staff are caring and positive in their contact with residents. EVIDENCE: Two care plans were sampled and were of a very good standard. The care plans addressed all the identified needs as stated in the pre-admission assessment and from discussion with the residents concerned. They were well written and provided detailed information so that new staff would know exactly what to do to meet the needs of the residents. The plans included clear information with regard to the individual health care needs and difficulties as well as residents’ comments and requests with regard to contact with their friends and families. Daily recording reflected the needs and moods of residents in an informative and positive manner. Risk assessments and monitoring of residents’ pressure Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 11 areas and nutritional needs were clear and were regularly reviewed, as were all the care plans for each resident. Records of specialist health appointments and outcomes were well maintained. Senior staff were observed to administer medication respectfully and correctly. They were aware of the medication for recently admitted residents and clear about the procedure to transfer these residents onto the system used by the local surgery and pharmacy. Medication storage and stocks were well managed. The home had policies and procedure in place with regard to the storage and administration of controlled medication. Residents’ wishes to have “time alone” was detailed in their care plans. They are offered of a key to their room to enable more privacy. The manager and staff were very aware of individual residents’ personal space and right to entertain friends and family in private. The staff were observed to respect residents’ privacy and dignity throughout the inspection. This included observed incidents such as, staff knocking on residents’ doors before entering, staff speaking quietly and discreetly to residents when asking them about personal issues and talking with them in a friendly and polite manner. This attitude and approach was much appreciated by the residents. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 and 15 The staff provide opportunities for residents to participate in activities in the home, that reflect residents’ wishes, within the budget available to them through fundraising. Residents are supported in maintaining contact with family and friends who are made welcome when visiting. Catering arrangements are good. Residents enjoy a social and pleasant time during mealtimes. EVIDENCE: Residents were very positive about the variety of activities provided at the home. They enjoyed trips to the local pub and other outings organised by the staff. Several residents had spent time planting flowers in tubs to decorate the patio area and they looked lovely. A member of staff organises the activities in the 15 hours allocated for the “activity worker” part of her job. Due to the recent very hot weather she had worked in the evenings and arranged drinks, nibbles and card games for residents. The residents told the inspector that it was a very enjoyable activity. They also like the “shop trolley” that “visits” every week. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 13 The inspector observed the staff sitting and chatting with residents, at different times, throughout the inspection. There was different music playing in the lounges and a noticeable absence of daytime television playing. Residents were clear that they enjoyed time with the staff and each other, rather than television. Activities in the home are funded through fundraising events organised by the staff and the “Friends of Eastham”. The inspector has the opportunity to meet two of the “friends” as they were preparing for the forthcoming garden fete by cleaning and painting the garden furniture. The inspector was informed that the “Friends” had purchased all the garden and patio furniture for the residents. Whilst their efforts are to be commended, the provision of furniture and facilities that allow residents to access the outdoors must be provided by the registered provider, as stated in National Minimum Standard 19. The entrance hall is furnished and decorated with old style furniture and pictures, set out as a reminiscence area and much enjoyed by residents and their visitors. Relatives told the inspector that they are always made welcome whenever they visit and are regularly invited to attend functions and events in the home. There were photographs of lots of parties and events displayed in the home. The inspector had the privilege of meeting a resident who had recently celebrated their 100th birthday. They were very happy with the party provided and told the inspector that they enjoyed their time at the home. The residents were very positive about the meals offered and the choice provided. The menu is displayed in the dining room and offers a good choice of healthy meals. The kitchen was clean and well organised. The cook came across as someone that knew the residents and took pleasure in meeting their needs and requests. The inspector was invited to join some residents for lunch. The residents were chatting with each other and with staff. The staff served the meal and were very aware of the individual likes and dislikes of residents. There was plenty to eat. Residents felt at ease asking for second helpings which was responded to quickly. Staff were seen to be very gentle and respectful when helping residents that needed assistance. They used this time to chat with the residents and encouraged conversation at the table. The whole mealtime was a very pleasant and sociable occasion. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 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 standard(s) 16 The home has a good complaints system and there was evidence that complainants are listened to. EVIDENCE: The complaints procedure is displayed for residents and visitors to access. Complaints were well recorded with an open and honest approach taken by the acting manager. Residents were very clear that “should they ever have any complaints” then they could talk to the acting manager. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 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 standard(s) 19 and 26 The standard of maintenance and décor in the home is poor and provides residents with areas that are unsafe and not homely. EVIDENCE: The premises have some major shortfalls. Several concerns regarding the premises have been raised at previous inspections. These include the poor standard of décor and the need to repair or replace the driveway gate to ensure the safety of residents, particularly as the home does accommodate some residents that get very confused. The inspector also noted several old sash windows that were broken. Some were being held open by the use of video boxes and talcum powder boxes. This is clearly not safe practice and these windows need to be urgently repaired. These issues were also noted in the providers’ own Quality Audit, in February of this year, as requiring urgent repair and maintenance. The representative of the provider (operations manager), who was visiting the home during the inspection, did inform the inspector of plans to redecorate and refurbish the home hopefully starting the next week. However, this will remain a requirement until the next inspection to ensure that these actions are Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 16 achieved. The commission requested information and an action plan with regard to maintenance and redecoration following the previous inspections and has yet to receive any information. The home does have large grounds but only a small area is maintained at the front of the home. The “Friends of Eastham” provided the furniture for the patio and garden areas. Residents and visitors enjoy using the patio and front lawn area though, as previously stated, the grounds need to be made safe. The standard of cleanliness was generally good and there was no evidence of any bad odours. Residents and relatives were pleased with the cleanliness of the home. The residents commented positively about the standard of the laundry services. They told the inspector that their clothes were always returned clean and fresh. The residents certainly looked well dressed and presented on the day of the inspection. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staffing levels are sufficient to meet the needs of the residents. Staff recruitment practices are not sufficient to ensure residents’ protection. EVIDENCE: Examination of the staff rota and observation during the inspection indicated that the staffing levels are sufficient to meet the needs of the current resident group. There is one senior carer and three care staff on duty throughout the waking day and one senior and two care staff on waking night duty. In addition, the manager is available during the week, domestic and catering staff are employed in sufficient numbers and there are 15 hours of allocated activity time. The home continues to benefit from a stable staff group. Some new staff had joined the team and informed the inspector that they felt well supported and enjoyed the induction days at the home, prior to their full employment. The staff were observed to be polite and pleasant when in the company of the residents. The inspector observed many occasions when the staff sat and chatted with the residents, responding to requests for assistance in a discreet and appropriate manner. Residents and relatives spoke very highly of the acting manager and staff at the home. They said that they were respectful, helpful and kind. The residents Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 18 clearly enjoyed their company. There was lots of pleasant banter between residents and staff. This included comments and laughter from some residents about staffs’ actions such as, “stand still and they bath you!” The home was a cheerful and pleasant place much appreciated by the residents, their visitors and the staff team. The staff recruitment records were well organised. However, one file sampled did not have copies of the qualifications stated as achieved by the member of staff. The application form does not allow for a full employment history, it only asks for information from the past 7 years. The manager was advised to request a full employment history. The manager was aware of the procedure with regard to ensuring evidence of POVA and CRB checks. She had taken appropriate steps to ensure the safety of the residents through supervised practice of staff whose CRB checks were delayed. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 37 The acting manager is well supported by the providers’ representative and staff in providing a well managed home that ensures good care for the residents. Records were generally well maintained though some shortfalls were noted which when addressed will ensure residents’ best interests are safeguarded. EVIDENCE: The home is currently without a registered manager. The acting manager was very helpful and cooperative during the inspection. Staff and residents were very complimentary regarding the acting manager. They stated that they found her to be helpful, supportive and easy to talk to. The inspector observed very good interaction and contact with the residents, by the acting manager, throughout the inspection. The acting manager and the operations manager informed the inspector that the manager is to enrol on an NVQ level 4 course in September. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 20 The residents’ monies were well managed and records were well organised. The inspection did highlight shortfalls with regard to some records. This included the staff rota and the record of furniture brought by residents. The use of tippex on the staff rota is not recommended and each resident must have a record of their belongings and furniture brought by them into and during their stay at the home. Standard 33 regarding quality assurance was not inspected. However, the inspector was provided with a copy of the most recent QA audit undertaken, by the provider, in February of this year. An action and development plan was set with regard to meeting identified shortfalls. The majority of the actions had been met by the set target dates with the exception of the premises issues that have also been highlighted in this report. This standard will be monitored at the next inspection. Standard 38 regarding safe working practices was not inspected. However, the inspector did observe two staff members attempt to move a resident by lifting them under the arms. This is not good practice and the staff were quickly advised by a senior carer to stop and use the handling belts and other equipment readily available for them. This incident was brought to the attention of the manager. She informed the inspector that all the staff had received manual handling training but she will ensure that the poor practice observed is discussed with all staff and monitored. Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 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 1 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x 2 2 Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 22 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 19 Regulation 23 Requirement Timescale for action 05.08.05 2. 19 23 3. 19 23 The registered provider must ensure the home’s grounds are secured to protect service users who may wander out to the busy road. This is a repeat requirement. The timescales of March 2004 and March 2005 had not been met. The timescale from the last inspection had not expired and has been encorporated into this inspection timescale. The registered provider must 05.08.05 ensure that the premises are reasonably decorated. This refers specifically to some bedrooms already identified with the home. This is a repeat requirement. The timescales of June 2004 and March 2005 had not been met. The timescale from the last inspection had not expired and has been encorporated into this inspection timescale. The registered provider must 05.08.05 ensure that the premises are wel maintained and ensure the safety of residents. This refers specifically to the broken sash windows in some bedrooms and other rooms. I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Eastham Page 23 4. 19 23 5. 29 19 schedule 2 6. 34 25 7. 37 17(2) schedule 4 8. 38 18 The registered person must ensure that the garden, particularly the enclosed courtyard, is kept tidy, safe, attractive and accessible to residents for them to enjoy the sunlight. The registered person must ensure that all the required information is sought proir to the employment of staff. This refers specifically to the need to obtain a full employment history. The registered provider must ensure the business plan is available to the home manager and to the Commission for Social Care Inspection. This is a repeat requirement. The timescale of March 2005 had not been met. The registered provider must ensure that records required by Regulation are maintained. This refers specifically to the staff rota and the use of tippex and the need for a record of furniture brought by residents. The registered provider must ensure staff training with regard to manual handling is provided, monitored and refreshed, as appropriate. 05.08.05 05.08.05 05.08.05 05.08.05 05.08.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 19 Good Practice Recommendations It is recommended that the manager produce a maintenance and decorating plan for the home. This is a repeat recommendation. I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 24 Eastham Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex C01 1RJ 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 Eastham I56-I05 Eastham UI S28664 V235782 290605 Stage 4.doc Version 1.40 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!