Inspection on 17/04/07 for Edward House Care Home

This inspection was carried out on 17th April 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

Edward House Care Home 19/04/06

Edward House Care Home 08/09/05

Edward House Care Home 30/11/04

Edward House Care Home 29/06/04

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

CARE HOMES FOR OLDER PEOPLE Edward House Care Home 175 Nottingham Road Eastwood Nottingham NG16 3GS Lead Inspector Karmon Hawley Key Unannounced Inspection 17th April 2007 10:00 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 Edward House Care Home DS0000008667.V336337.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. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edward House Care Home Address 175 Nottingham Road Eastwood Nottingham NG16 3GS 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) 01773 531 591 F/P 01773 531 591 Edward House Care Home Limited Mrs Jillian Sherry Ann Seetul Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only (PC) to service users of the following gender: Both whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - OP The maximum number of service users who can be accommodated is: 32 19th April 2006 2. Date of last inspection Brief Description of the Service: Edward House is a care home providing personal care for up to 32 people of both sexes who are over the age of 65 years. The property is a converted house in a residential location. The accommodation is arranged on two floors. There is lift access to the second floor. There is sufficient communal space to allow for a separate smokers lounge. There are twenty-eight single rooms and two shared rooms one of which has en-suite facilities. There is a small garden, which is accessible to wheelchair users. Edward House is situated within half a mile of Eastwood town centre, with shops, pubs, a library, and leisure and health facilities. The current weekly fees for the home range from £290 - £344 depending upon service users needs. Hairdressing and chiropody costs are not included. Information is made available on the point of initial enquiry. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at information provided by the manager about Edward House and by undertaking a visit to the service with the inspector using a method called “case tracking.” “Case tracking” involves identifying individual service users who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspector also checked that information provided by the manager matched individual experiences of service users living at the home by talking with them and observing the care received. Five service users were spoken with, all of them expressed that care was at a good standard and staff were very kind and attentive. General house records and staff records were also looked at to ensure these were maintained and provided positive outcomes for service users. Two members of staff were spoken with and were able to discuss service users needs and support required. What the service does well: What has improved since the last inspection? Evidence that the majority of service users now have a copy of the service users guide was available to ensure service users are fully informed about the services the home has to offer. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 6 Each service user now has a copy of the terms and conditions of the home, ensuring that they are fully informed of what these are and what services are offered. Monthly visits by the provider take place, they are recorded, and copies are sent to the Commission for Social Care Inspection. Records are maintained to show choices service users have had at each mealtime demonstrating that these have been offered to service users. Individual staff training and development files are now in place, which is kept up to date, to show that staff are working towards completing compulsory training, thus being fully trained and competent to meet service users needs. 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. The summary of this inspection report can be made available in other formats on request. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive the required information needed to make an informed decision to move in to the home. Service users are assured that their needs will be assessed and met. The home does not offer intermediate care. EVIDENCE: Two requirements were set at the previous inspection to ensure service users had copies of the service user guide and terms and conditions of the home. Copies of the terms and conditions were in each service users file examined. There was a main copy of the service user guide in the office and downstairs rooms, however copies of this could not be found in the upstairs service users rooms. The deputy manager said that they were in the process of completing this and the copies were available. The deputy manager said that the manager visits prospective service users in the community prior to admission. Prospective service users and relevant Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 9 others may also visit the service prior to making a decision to move into the home. Whilst examining service users case files there was no evidence of a preadmission assessment taking place, however the deputy manager showed an enquiry book, which held information of prospective service users that had been assessed. This was used along side information received from the referring authority. One service user spoken with explained that they had been given the opportunity to visit the home prior to making a decision to move there. The service does not offer intermediate care. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although service users health, personal and social care needs are met, they are still placed at a degree of risk due to the lack of risk assessments in place. Service users are not protected by the homes medication policies and procedures. EVIDENCE: Each service user undergoes various assessments such as the activities of daily living, nutritional needs, manual handling and pressure area care. Information gained forms the plan of care. Within plans of care there was evidence to show that these had been discussed with service users or relatives and had been signed to show that negotiations had taken place. Plans of care were personalised, relevant to service users needs and contained sufficient information. Where a service user was using bedrails this was mentioned briefly in the plan of care however there was no risk assessment in place for entrapment. On discussing this with the deputy manager she said that she had received the relevant documentation to implement this, this was seen, she stated that she would put this in place immediately. Where risks due to falls Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 11 and diabetes mellitus had been identified within the remaining two plans of care there were no risk management plans in place. Therefore risk assessments were discussed in general, the deputy manager understood the processes required and said she would ensure risk assessments were implemented. Service users spoken with said that staff were kind and caring and that their needs were met. Staff spoken with were able to discuss service users needs and how they assist them in meeting these. Evidence to show that service users have access to the GP, district nurse, optician and other specialist services was seen within service users plans of care. Also during the tour of the home specialist cushions and mattresses were seen. One service user spoken with said that they could see a doctor at any time. Staff spoken with confirmed this. Medication records and procedures were observed. There was an incident where antibiotics had been prescribed, these had been signed for but not given to the service user. This was discussed with the deputy manager and it was established that two doses had not been administered but had been signed for. The drug trolley is locked to the wall in the dining room. The main storage of medication is kept in the staff office in a locked cupboard. Controlled drugs are kept in a locked cash tin in this cupboard. The staff room window is only single glazed and does not have bars across, there has been a break into this room in the past. On checking the controlled drugs register medication had been administered by a member of staff, this had not been checked or signed for by another member of staff, it was stated that this was due to the fact that a relative had witnessed the administration of this however they had not had the opportunity to sign the controlled drugs register. Controlled drugs were not checked on a daily basis to ensure the correct amounts were in stock. Service users spoken with said that staff were respectful at all times and ensured privacy was maintained. Staff were observed to speak with service users in a respectful manner and knock on doors prior to entering a room. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 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. 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. Service users are enabled to find the lifestyle in the home matches their expectations and satisfies their needs. Service users receive a wholesome and appealing diet of their choice and liking. EVIDENCE: An activities coordinator is employed three afternoons a week. Various activities are on offer such as sing alongs, knitting, quizzes, arts and crafts and games. Notices of events to take place were displayed in the main entrance. Service users spoken with said that they enjoyed all the activities on offer and looked forward to these. Recent photographs of service users making Easter bonnets and the Easter bonnet parade were also seen. During the visit several service users were enjoying a singsong. A church service is held on a monthly basis and service users may receive Holy Communion if they wish, one service user spoken with confirmed this takes place however said they do not wish to join in. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 13 There are no restrictions on visiting and service users spoken with said that visitors were made welcome at any time. Visitors may be entertained in private should they wish. Staff spoken with confirmed that this takes place. Within the induction package there is reference to the rights and choices of service users. It also encourages staff to look at ways their work and the way the service is offered may affect service users needs and feelings. Staff spoken with were able to discuss how they ensure that service users are treated as individuals whilst recognising that each have their own needs. They discussed how personalities of service users and their own personal preferences affect the way in which care is delivered. Each service user spoken with said that they felt that staff listened to them and treated them as individuals. Although advocates are not in use at present the deputy manager said that Age Concern have been approached about providing this service for a number of service users. One service user spoken with said that they had been able to bring in their own possessions when entering the home. A wholesome and appealing diet is on offer. Special diets are catered for and the cook was able to discuss these as well as service users personal preferences. All relevant records such as cleaning rotas and temperature controls were completed correctly. Service users spoken with said that food was at a good standard, plentiful and they had choices. Staff spoken with were able to discuss special diets required by service users. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 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. 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. Service users and relevant others are assured that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Relevant policies and procedures for dealing with complaints are in place. No complaints have been received since the last inspection. Staff spoken with were able to discuss how they would deal with a complaint should one be received. Service users spoken with were all satisfied with the staff and care received and expressed no concerns. Relevant policies and procedures for the protection of vulnerable adults were in place. All staff employed have current Criminal Record Bureau checks (a police check to see if an individual has any cautions or convictions) in place. Staff spoken with confirmed this. Staff spoken with were able to discuss the relevant issues with regards to adult protection and how they would respond should they suspect that abuse was occurring. A small number of staff have undertaken training in adult protection, however additional staff are now completing this via the National Vocational Qualification (a nationally recognised work and theory based qualification). Two members of staff spoken with were able to confirm this. All service users Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 15 spoken with said that staff were kind and caring and they felt safe and settled in the home. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a satisfactory maintained environment, which is clean pleasant and hygienic. EVIDENCE: A maintenance book was seen which showed routine maintenance takes place as required. The home was satisfactorily maintained throughout and the deputy manager outlined where further work was to be undertaken in service users rooms. Many of the old characteristics remain in the original part of the home, offering a homely environment. One service user spoken with said that they thought the home was lovely and well looked after. All areas of the home were clean and tidy. Service users rooms were personalised and one service user spoken with said that the home was always clean and their room was kept nice. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 17 The laundry room offers access to the food store cupboard; during the inspection bags of opened potatoes were on the laundry room floor. When discussing this with the deputy manager she stated that all laundry, clean and dirty is moved through this door, therefore passing the potatoes and access to the food store. There was no reference made to this in the last environmental health report and the deputy manager said that no concerns were expressed. Otherwise the laundry room was tidy and the relevant equipment in place. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 18 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. The number and skill mix of staff meet service users needs. Service users are in safe hands at all times. EVIDENCE: The duty rota seen showed that three members of care staff are on duty throughout the day and two members of care staff are on duty throughout the night. Skill mix is taken into consideration when planning the duty rota and senior care assistants are on each shift. In addition to this there are two housekeepers and a cook. Staff spoken with said that sufficient staff were employed to meet service users needs. Service users spoken with said that staff were always available and willing to help them as needed. Three members of staff are working towards completing the National Vocational Qualification (NVQ - a nationally recognised work and theory based qualification) level three, two members of staff are working towards level two, one member of staff is working towards the cleaning NVQ and two members of staff are working towards the cooking NVQ. In addition to this twelve members of staff are waiting for registration to commence training. The induction programme covers the routine of the home and specific training required and also includes written work where staff are encouraged to explore their working performance and ideas of how they feel service users should be treated. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 19 Four staff personnel files were seen, all contained the required documentation. All staff have an individual training plan. On observing these it showed that staff are continuing to work towards completing compulsory training. Staff spoken with said that they felt very supported by the manager in their training, one stated that they would like more training, whereas another felt that there was sufficient. One service user spoken with said that they felt that staff were well trained to do their jobs. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is run and managed by a person who is fit to be in charge. Service users health, safety and welfare are promoted and protected. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She is a registered nurse with sixteen years experience both within a hospital setting and the community. She ensures she remains up to date with training issues and is currently undertaking a management course with Nottingham County Council. All staff said that the manager was very supportive. The deputy manager said that a service user and relatives meeting had been arranged for next month to discuss quality assurance; evidence of this was seen in the diary. She said that questionnaires had not been sent out recently but it was anticipated that these would follow the meeting. Old questionnaires Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 21 were seen in two service users case files, dated 2005. The deputy manager also thought that other systems were in place, however was unable to locate the relevant file to demonstrate this. The provider sends monthly reports to the Commission for Social Care Inspection outlining reviews undertaken. Four service users personal allowance were checked. All corresponded with the accounting sheet. Receipts were available for all transactions. One member of staff signed transactions. No one at the service is responsible for service users money. There was evidence within two service users case files that relatives deal with finances. Relevant maintaince and servicing certificates such as fire system testing, gas, portable appliance testing and lift maintenance were seen. The deputy manager was unable to locate the mains electric certificate and the hoist certificate. The fire logbook showed that emergency lighting and fire systems are tested on a weekly basis. There was no evidence to show that staff had undertaken fire drills, this was discussed with the deputy manager who said that she would arrange this. There are no hot water control values fitted on water outlets and hot water temperatures were not recorded. During the visit on testing outlets three felt extremely hot. This was discussed with the manager who tested outlets several times with results showing satisfactory temperatures. Accident records showed that significant information was recorded, however accident records had been left in the main book once completed and not filed in service users case files to ensure confidentiality. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 22 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 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 2 X 3 X X 2 Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4,c) Requirement To implement risk management plans for all service users identified risks to ensure these are minimised and service users are protected. Medicines must not be signed for unless these have been administered to ensure that accurate records of medicines taken by service users is maintained. A risk assessment and management plan must be implemented to ensure that cross contamination of food does not occur due to current storage arrangements. Further evidence to demonstrate that quality assurance monitoring is taking place is required to show that the home is run in the best interests of service users. Water temperatures are to be recorded on a regular basis to ensure service users are protected from risk of scalds. Evidence of staff attending fire drills is required to demonstrate DS0000008667.V336337.R01.S.doc Timescale for action 20/05/07 2 OP9 13(2) 20/05/07 3 OP26 13(4,c) 20/05/07 4 OP33 24(1) 20/06/07 5 OP38 13(4,c) 20/05/07 6 OP38 13(4,c) 20/05/07 Edward House Care Home Version 5.2 Page 24 that service users are protected from the risk of fire. 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 2 3 4. 5. Refer to Standard OP9 OP9 OP9 OP35 OP38 Good Practice Recommendations Controlled drug administration is signed by two members of staff to ensure that accurate records of administration are maintained. To implement a risk assessment and management plan for the safe storage of medicines to demonstrate that the current storage facilities are safe. To carry out regular drug audits to ensure that medicines are being administered and recorded correctly. Two members of staff sign for all transactions of service users personal allowances. To file service users accident records to ensure confidentiality is maintained. Edward House Care Home DS0000008667.V336337.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Edward House Care Home DS0000008667.V336337.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!