Inspection on 03/03/09 for Edgelea Care Home Ltd

This inspection was carried out on 3rd March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Edgelea Care Home Ltd 16/11/09

Edgelea Care Home Ltd 14/10/09

Edgelea Care Home Ltd 06/08/09

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Edgelea Care Home Ltd 14-16 Half Edge Lane Eccles Manchester M30 9GJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline Caulfield     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Edgelea Care Home Ltd 14-16 Half Edge Lane Eccles Manchester M30 9GJ 01617890430 01617896000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Edgelea Care Home Ltd care home 37 Number of places (if applicable): Under 65 Over 65 37 0 old age, not falling within any other category physical disability Additional conditions: 0 37 The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of people who can be accommodated is: 37 Date of last inspection Brief description of the care home Edgelea Nursing Home provides nursing and residential care for 37 older people or service users with physical diabilities. Accommodation within the home is situated on the ground, first and second floors in single and double rooms. There is car parking space available at the front and the side of the home but this space is unsuitable for residents to sit out in. Roof space has been converted to a roof garden. There is a Statement of Purpose/Service User Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are, and what the resident can expect if he or she decides to live at the home. Information provided during this visit showed that the fees for the home are three Care Homes for Older People Page 4 of 28 Brief description of the care home hundred and seventy three pounds and eighty pence to four hundred and seventy six pounds and eighty pence per week with added expenses for hairdressing, chiropody, toiletries, newspapers and outings. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Edgelea nursing home changed owners in July 2008, so is rated as a new service. This is the first inspection since the change of owner. Information provided during this visit showed that the fees for the home are three hundred and seventy three pounds and eighty pence to four hundred and seventy six pounds and eighty pence per week with added expenses for hairdressing, chiropody, toiletries, newspapers and outings. This was an unannounced visit undertaken as part of the inspection process, which commenced at 10:30 AM for eight and a half hours. Care Homes for Older People Page 6 of 28 Prior to the visit the home completed an annual quality assurance assessment (AQAA). This is a document that provides CSCI with written information and an assessment about the quality of the services the home provides. The registered person is asked to provide us with this information each year. The inspection involved case tracking three residents as a means of assessing some of the National Minimum Standards. Case tracking a resident includes looking at their care records along with the rooms they occupy in the home, talking to the residents and the staff supporting them and observing staff interactions with them. This is not to the exclusion of other residents who were also spoken to. This process allows the inspector to focus on a small group of people living in the home. All records relating to these people are inspected. They are invited to discuss their experience of the home with the inspector, however this is not to the exclusion of other people in the home. A tour of the home was carried out and a selection of staff, residents and administrative records were examined. Comment cards were received from eight members of staff. From the observations made, comments received and written documentation seen, the information has been put together to form this report. What the care home does well: What has improved since the last inspection? The manager is starting to develop care plans to provide more detailed and person friendly information about residents. The new owner has arranged the major refurbishment to the home. This will make the home look smart and well maintained and make the home a pleasant environment to live in. Care Homes for Older People Page 8 of 28 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed before moving into the home to ensure that the home can meet their needs. Evidence: We case tracked three residents. They all had care needs assessments in place. This helps staff to find out important information about each residents specific care needs and know how they can meet these. The statement of purpose and service user guide need updating following the change of ownership, so that residents and those who want to move to the home have up to date information on the home. They will then be given to all current residents. They will also be given to prospective residents before admission so that they have enough information to decide whether they want to live in the home. Care Homes for Older People Page 11 of 28 Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care records are in place and improving but still need attention to ensure residents health and personal care needs are met effectively Evidence: We case tracked three residents. Care plans were in place for all residents but some areas were not up to date and were difficult to follow. Some of the information was also inaccurate or confusing. One resident prefers to be called by a different name to the one on her care plan. This information was not recorded One resident was recorded in one part of the care plan as having no next of kin when this was not the case. Another resident had specific care needs at night time, some staff gave detailed night time reports about how and where the resident slept. Other staff gave very limited information. This information is important and should be clearly recorded. Another resident case tracked was younger than many of those in the home. The residents nursing needs were being met but there were only limited opportunities to see people of a similar age and this needs looking at. Care Homes for Older People Page 13 of 28 Evidence: One residents moving and handling assessment had not been updated for several years. Another residents mental health issues had not been reviewed and updated to reflect current health and staff actions. There were issues about one residents behaviour but there were only very limited details on this. The home needs a detailed strategy for managing any residents challenging behaviour stating clearly the form the challenges take and how to manage them effectively. Even though the care plan had been reviewed quite recently, the issues around behaviour had not been improved or updated. There were concerns about some residents having their rights restricted as the care records showed restrictions on smoking with no evidence that these had been discussed and agreed with the resident and in one case showed that the resident was unhappy with the restrictions. There were no risk assessments in place for these issues and no clear records and discussion looking at the issues and acknowledging that this was depriving residents of choices. Any possible deprivation of liberty should not be considered without taking into account the mental capacity act and following a best interests pathway and the reasons and rationale clearly recorded along with the decisions made. The manager who had only been in post for a few weeks said he was already aware of the deficiencies of the care plans and pointed out some areas of concern and changes he planned to make. He had new care plans that he was introducing quickly to rectify the problems. These will include likes, dislikes and a life history for each resident. The manager explained that the care plans currently in place were those that had been in use for a long time before the home changed owners and before the manager started working at Edgelea and showed where staff were already making changes. Daily records were detailed and informative. Residents were weighed regularly where needed and clinical nursing tasks carried out effectively. There were daily individual records and professional visit records in place and residents have access to appropriate health services. Accident forms had been completed where appropriate. None of the residents case tracked had been involved in any accident or fall but the manager was aware of the need to audit and discussed individual falls or accidents at the regular staff meetings to see if any lessons could be learnt or accidents reduced. Residents spoken to said staff were very kind and helpful. Other said they were always respectful. We spoke to several residents and also observed residents in both lounges. Staff were seen to be kind and interacted frequently with all residents and were involved often chatting and laughing with people. One resident said, The staff are Care Homes for Older People Page 14 of 28 Evidence: always helpful, it doesnt matter what time you call them or how busy they are they always come to you. Another resident said, Where would we be without them? They always have a kind word. Medication was appropriately administered, signed and stored but the home returns all their medication to the local pharmacy. As a nursing home the home should have a specialist disposal service to dispose of their returned medication. There are regular in house medication audits to ensure that few errors are made and if any are made these are quickly rectified. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines are flexible and visitors are welcomed into the home, enabling residents to continue to have choice and control over their lives. Evidence: Routines in the home are flexible and residents spoken to said that they can choose when they get up and go to bed and whether they want to join in activities. Some residents said there are some activities offered but not as many as they would like. Many residents are quite frail and in their eighties and older but there are several residents who are much younger and sometimes feel isolated living with mainly older people. The manager agreed that senior staff would look at how to increase appropriate leisure activities, particularly for the younger residents and look at ways of making sure they had more contact with people of a similar age. The manager said he would like to have an activities co ordinator so that they focused on developing a variety of different and stimulating activities. He is also looking at buying some sensory equipment for providing residents with stimulation or relaxation. Friends and relatives of residents can visit at any time so that relationships are maintained and developed. Care Homes for Older People Page 16 of 28 Evidence: Meals are of good quality and residents said they are good. One resident said, I cant eat a lot of foods and the chef always checks what I would like. Another resident said The food is lovely here. You want to try it. A member of staff said, We give a well balanced diet to service users. All current residents are White British or Irish and are nominally Christian or have no religious persuasion. The manager said the home would endevour to meet the needs of people from any other religion. Residents who want to can see the ministers of their choice. The manager said they could support residents of other religions if requested. Senior staff spoken too said they wanted to develop a communal area in the home that could also be used for religious services. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns are handled well and residents feel their concerns will be listened to and acted upon. Evidence: Residents spoken to said they knew who to complain to if they had any concerns but they were happy in Edgelea. A resident spoken to said she would tell the manager if she had any concerns but she hadnt needed to so far. Another resident mentioned a minor concern which the manager said he would deal with immediately. There have been no complaints since the last inspection but the manager and senior staff chat to residents every day, checking if things are alright, so that minor niggles are dealt with early and dont become bigger issues. One resident said I could tell any of the staff if I had a problem. The manager said staff have received some safeguarding adults training and have an understanding of the action to be taken if they are alerted to a safeguarding issue. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Renovations to the home have started. Once finished this will make the home safer, more comfortable and nicer to live in. Evidence: We toured the home and found the environment clean and tidy despite being in the middle of major renovations. The home has changed ownership in the last few months and the manager and staff spoken to said that the current refurbishment and repairs were definitely needed. It was clear that some of the carpets needed deep cleaning or replacing as an unpleasant smell permeated some areas of the home. The manager said that these were all being replaced. The new owner has brought in a building company to renovate the home. The refurbishment will include; replacing wiring throughout the home, replacing the hot water supply, repairing or replacing all fire doors, updating the resident call system, updating the fire alarm system and updating the telephone and computer systems. The builders were replastering the stair walls during the inspection. Once the major jobs are completed, the redecorating will start. This will include new carpets in most areas. This will much improve the home. A resident said the jobs were being carried out well. Another resident said how nice it would look when it was finished. One resident said how much she liked the fish tanks in the lounges adding that they were Care Homes for Older People Page 19 of 28 Evidence: so relaxing. She was reassured that the fish would be staying in the home. The new owner also plans to improve the roof garden to make a safe pleasant space where residents can sit with staff supervision. The fire service has made requirements for some fire doors to be replaced or repaired during the renovation and these will be done as part of the work in progress. Residents are encouraged to personalise their bedrooms so that they have familiar things around them. Aids and adaptations are in place to help residents get about more easily and to be as safe and as independent as they can be. Specialist aids for pressure care and mobility aids seen as touring the building. We had concerns about the Domiciliary care service staff sometimes using one of the downstairs corridors as a thoroughfare to the domiciliary care office, passing lounges and residents bedrooms on their way. This is reducing residents privacy. There is a separate entrance to the domiciliary care office and this should be used. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and selection is well managed and there are sufficient numbers of well trained staff in the home. Evidence: Residents spoken to as we toured the building were complimentary about the staff and the new owner of the home. A lot of the staff have worked in the home for several years and there is only a small staff turnover. This ensures that staff are familiar with residents and their care needs and residents know the people caring for them. Staff rotas showed sufficient staff on duty doing the inspection. Residents, and staff felt that there were sufficient numbers of staff on duty to provide good care. The records of three members of staff were checked. There was a robust recruitment and selection process in place. All applicants had an application form with a complete working history from first to present job exploring any gaps. All had interview assessments which showed gaps in employment had been looked at and had written references in place. There was also health information in place and all staff had PoVA checks and had or were awaiting CRB checks. The new manager has started more detailed staff inductions so that staff are clear Care Homes for Older People Page 21 of 28 Evidence: about the tasks they need to carry out and the values of the home. Sixty percent of staff have completed National vocational qualifications (NVQ). All care staff who have not completed NVQ training, have recently enrolled on NVQ courses and are working towards National vocational qualifications (NVQ). These are national awards in care that enable staff to gain up to date skills and knowledge about current care practice. Staff had details of the training they had completed in place. Staff said they are now encouraged to attend more courses. The cook, kitchen, domestic and laundry staff are now involved in some of the courses. One member of staff said she was pleased to be included in courses and had never had the opportunity before. Another member of staff said, I have learnt a lot more through courses I have been on. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and owners provide clear guidance and enthusiasm to staff. They manage the home effectively which support and protect residents, staff and visitors. Evidence: The manager has been in post for several weeks. He has started the process to apply to CSCI to become the registered manager. He is a registered nurse and has completed the registered managers award. He ensures that he updates his skills and knowledge so that he is familiar with any new developments in nursing and care practice. Staff spoken to said they felt well supported by the manager. One member of staff said, The manager is very supportive and helpful. The new owner has started to refurbish and to improve the home, making it a more pleasant environment for residents and staff. He has frequent communication with the manager and visits regularly but regulation 26 visits were not available during the inspection and must be. This is where the owner makes an unannounced visit at least Care Homes for Older People Page 23 of 28 Evidence: monthly and talks to residents and staff, checks paperwork and tours the home. The owner must then provide a report about the visit and send a copy to the home and make available a copy to CSCI if requested. The manager sent copies of the reports to us after the inspection. The new manager has started carrying out formal supervision regularly. Staff supervision allows the member of staff and manager or other nominated person to meet regularly and look at the member of staffs care practice and the care practice in the home, and any improvements that can be made. They also look at future plans in the home, training and the individuals career development. A member of staff said they had frequent supervision. There are staff meetings in place now. However one member of staff would like more frequent meetings with night staff. The manager plans to develop residents meetings soon so that residents have more say in the running of the home. The manager also plans to update all policies and procedures as soon as possible but felt that staff training and the refurbishment of the home were the priority. He said that developing care plans and records was the next thing to be tackled. Staff training ensuring the home remains safe is in place with staff having food hygiene, fire safety and moving and handling training and appropriate health and safety checks in place. The fire risk assessment is up to date and regular fire checks and training are provided by an external company. One member of staff said, We are constantly updating training in all aspects of our work such as first aid, health and safety and medication. There are regular fire alarm and emergency light checks and records kept. The manager said that fire alarms, fire doors and emergency lighting is being brought up to the required standard. The manager also told us that he would take this opportunity to make sure all residents have locks available on their bedroom doors. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care records need to have detailed, up to date information about residents health and personal care needs in place and any restriction of rights agreed and recorded. So that staff know how to meet residents needs effectively 18/04/2009 2 19 23 The fire safety work required 30/05/2009 by the fire service must be completed during the renovation of the home. To reduce the risks of fire in the home. 3 37 26 The monthly unannounced visits carried out by the owner, where he talks to residents and staff and inspects the home and prepare a written report on the conduct of the home must be available for inspection 31/03/2009 Care Homes for Older People Page 26 of 28 This is so all involved know how the care home is being managed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The statement of purpose and service user guide should be updated to reflect the changes in the owner, the manager and the home. Social and leisure activities should be developed, so that residents have a interesting and stimulating things to do in the home and in the local community. Staff from the Domiciliary care service should not use the home as a thoroughfare to the Domiciliary care office as this reduces the privacy of residents living in the home. Some carpets in the home should be cleaned or replaced to reduce the unpleasant odour in some areas of the home. 2 12 3 19 4 26 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!