Inspection on 16/08/06 for Elmsfield House Limited

This inspection was carried out on 16th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Elmsfield House Limited 09/10/09

Elmsfield House Limited 23/10/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elmsfield House Limited Elmsfield House Limited Elmsfield House Holme Via Carnforth Lancs LA6 1RJ Lead Inspector Mrs Margaret Drury Unannounced Inspection 16th August 2006 09:10 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 Elmsfield House Limited DS0000065671.V300714.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. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmsfield House Limited Address Elmsfield House Limited Elmsfield House Holme Via Carnforth Lancs LA6 1RJ 01539 563896 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) Elmsfield House Limited Mr Christopher Wilson Care Home 20 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (20) of places Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 20 service users to include: up to 20 service users in the category of OP (old age, not falling within any other category) up to 5 service users in the category of DE(E) (Dementia over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 15 December 2005 2. Date of last inspection Brief Description of the Service: Elmsfield House is registered to provide care and accommodation for up to 20 older people, five of whom may have varying forms of dementia. Mr Christopher Wilson is the registered manager and the head of care is Mrs Ann Thompson. Elmsfield House is set in a rural location close to the village of Holme and three miles from Milnthorpe. There are extensive views over the open countryside of the South Lake District. The home is a Georgian property that has been extended and adapted for its present use as a care home. There are gardens on all sides of the property, part of which have been landscaped and provide a pleasant area for the residents to sit in during the summer months. Accommodation for residents is over two floors, the upper being served by a stair lift. There are eighteen single rooms and one double although currently all rooms are used for single occupancy. Nine of them have en-suite facilities. There are two lounges and a separate dining room, which gives ample communal space for the residents to meet with visitors, enjoy activities or watch television. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit, which forms part of the key inspection, took place over one day in August. As the manager was on annual leave, the inspector was assisted by the head of care who was able to provide all the documentation required. Time was spent speaking with the residents, family members who were visiting the home, a social worker who was visiting to take part in a review and members of the staff team. Care plans and documentation concerning the care of the residents and running of the home were examined. This documentation was found to be up to date and gave the care staff the necessary information to provide a high level of care. Medication records were examined and found to be neatly and correctly completed. Some parts of the building were looked at and plans for the proposed extension were examined. The fees in this service range from £363.00 - £422.00 per week as at the time of the visit. There are extra charges for Chiropody, hairdressing and newspapers/magazines. This home does not provide intermediate care. What the service does well: The home has a comprehensive admission procedure that includes a full assessment of needs and capabilities. Residents who spoke with the inspector said they liked the staff and they received a high level of care. They were also very appreciative of the manager’s help and support and said “you can go to any of the staff at any time” and “they very approachable”. Care plans are comprehensive and were up to date, with monthly reviews being completed. The home ensures the safe handling of medication and the staff who are responsible for giving out the medication have completed the required training. Currently, there are no residents who are responsible for their own medicines. The home provides warm, comfortable and safe surroundings for the residents with plenty of communal space to enjoy. Visitors are always made very welcome, this being confirmed by comments made to the inspector during the visit. Healthcare needs are met with the help of the local doctors’ surgeries and district nurses. Assistance is also available from the local Authority intermediate support team. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 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. Elmsfield House Limited DS0000065671.V300714.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 Elmsfield House Limited DS0000065671.V300714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5 The quality in this outcome area is good. Admissions to the home only take place if the manager is confident staff have the skills, ability and qualifications to meet the assessed needs. Each resident is provided with a contract and terms/ conditions of residency that sets out in detail the facilities the home provides. This judgement was made using the available evidence including a visit to the service. EVIDENCE: Admissions to the home do not take place until a full assessment of needs has been completed. This assessment is carried out in addition to social services management plans received by the home. The dependency levels of those already living in the home are also taken into consideration when assessing prospective residents. Family members are invited to be present during the initial assessment, wherever this takes place and this ensures everyone knows that the home is able to meet the individual needs. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 9 All prospective residents and their families are invited and encouraged to visit the home prior to admission. This gives opportunity for them to meet the staff and talk to other people living in the home. Many residents were familiar with the home prior to moving in and were aware of the facilities on offer. All residents are given a contract and terms and conditions of residency and there is also a copy held on file at the home. Elmsfield House Limited DS0000065671.V300714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome area is good. Elmsfield House provides a high standard of care, which meets the needs of the residents living there. Health care needs, including medication, are carefully monitored and residents and relatives are confident that the home can meet their needs. Care plans are of a good standard and ensure that each person receives the care they need to be healthy and safe, whilst promoting privacy and dignity. This judgement was made using available evidence including a visit to the service. EVIDENCE: Elmsfield House uses the standex system of care planning, which ensures all the aspects of the care provided is shown on individual sheets. Care plans and daily records were checked to ensure the care plan reviews agreed with the daily care records. In all cases they did, showing that the information contained in the daily records was reflected in the care plan monthly reviews. The care plans are based on the information contained in the initial assessment Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 11 of needs and started the day the resident moves into the home. The monthly reviews are completed by the head of care or one of the senior carers. The daily record evidenced that healthcare needs were met by imput from local healthcare professionals. This was confirmed by discussions with the residents who all agreed that their doctors visited on request and the services of the district nurses were available when required. Currently the district nurses are visiting the home 2-3 times each week. Medication is received monthly in a monitored dosage system and is given out by a member of the senior team. The arrangements for storing medication in the home were well organised, and the senior carer on duty discussed with the inspector the records, receipt and disposal of the medication. The records were checked and found to be correctly and neatly completed. Discussions with the residents and visitors evidenced that they felt all care needs were met in such a way that privacy and dignity were respected at all times. They all spoke highly of the staff and told the inspector that they were a good lot of girls who could not do enough for you. Residents told the inspector that any personal care was given in a caring manner and always in private. Elmsfield House Limited DS0000065671.V300714.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome area is good. The routines of the home are planned around the residents’ needs and wishes and are flexible enough to meet the changing needs of the individual. Family and friends feel welcome and know they can visit the home at anytime. Maintaining independence and enabling the residents to make their own decisions about how they wish to live is a key objective for the home. An experienced cook is responsible for providing quality, nutritious meals that meet the cultural and dietary needs of the residents. This judgement was made using available evidence including a visit to the service. EVIDENCE: All residents are allocated a key worker and the inspector was able to speak with two of those on duty during the visit. Interviews with residents indicated that residents were happy with their daily routines and the choices given about how they wished to spend their day. Routines are flexible and fit in with the needs of the residents. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 13 The visit took place during the morning and early afternoon and residents were observed spending time in all the different communal areas as well as their own rooms. Some residents only leave their rooms for their meals and but others choose to eat their meals in their rooms also. Local ministers visit the home and Holy Communion is provided monthly for those who wish to take it. Activities are organised by the staff for those who wish to join. In. These include, boad games, dominoes, knitting, quizzes, music and visiting entertainers. The home also has a library for the residents to use. Two of the residents have become good friends and spend much of their spare time chatting in one of their rooms. There is open visiting in the home and visitors are always made welcome and offered refreshments. The inspector was able to speak with a gentleman who was visiting his mother-in-law who had lived in the home for a couple of years. He said that the care staff “are wonderful and extremely patient”. He also said he liked “to have a laugh and joke with the staff “ when he visited the home and “always had a joke for them”. He could not “ speak too highly of their care”. He also added that he was always offered tea and biscuits when he was visiting. The home works to a set two week menu with alternatives at each meal. Seasonal changes are accounted for and choices are given at each meal time. The inspector was able to observe the lunch being served, which was carried out in a relaxed manner. All the residents who spoke with the inspector said how much they enjoyed their food especially the home made pies and cakes. The inspector spent time with the cook discussing residents’ likes and dislikes and the store cupboards were inspected during this time. There was a plentiful supply of dried goods and fresh meat, fruit and vegetables. Elmsfield House Limited DS0000065671.V300714.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome area is good. The home has a complaints procedure that is up to date, clearly written and easy to understand. Residents feel confident that any issue they raise will be dealt with promptly. Training of staff in the area of protection is arranged and staff have a good knowledge of adult protection, which protects and safeguard the residents. This judgement was made using available evidence including a visit to the service EVIDENCE: The home has a complaints procedure that forms part of the terms and conditions of residency given to all residents and/or their families. There is a copy on display in the porch with a copy of the previous inspection report. There is a complaints register in place but there has only been one to report and this is currently being investigated. The commission is aware of the investigation and awaits the outcome. The residents who spoke with the inspector were confident that any issue they had to raise would be dealt with immediately and in the proper manner. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 & 26 The quality in this area is good. This judgement was made using the available evidence including a visit to the service. The home provides a well maintained, clean, comfortable and attractive home in which to live and which meets all the assessed needs of the residents. Most of the rooms are well planned with some having en-suite toilet and/or shower facilities. There is a selection of communal areas giving the residents the choice of where to sit and/or meet with their visitors. EVIDENCE: Elmsfield House is a detached Georgian property set in large gardens overlooking open countryside in South Lakeland. The property has been extended and adapted over the years to ensure its suitability as a care home. There are 18 single rooms and 1 double that is normally used for single occupation. The home is well maintained and the registered owner/manager is aware of the need for a planned programme of repairs and maintenance. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 16 There are 2 spacious lounges both having views overlooking the garden and a separate dining room situated on the side of the building. One of the lounges has a large television and the other is used for activities, listening to music or just sitting quietly with friends. There is also a small sitting area on the first floor that can be used for private visits if a resident does not want to meet with visitors in their own room. All the communal areas are well appointed with good quality furniture and fittings. New carpeting has been fitted throughout the ground floor within the last 12 months. Since the last inspection a number of the bedrooms have been redecorated and the en-suite shower in the double bedroom has been replaced and the room re-tiled. There is a range of equipment available in the home to assist people in their day-to-day life. This includes a stair lift, hand and grab rails, assisted baths and toilets and hoists. There are also handrails on the corridors to assist residents with movement around the home. There are sufficient bathrooms and toilets for the residents, all of which are suitable for people with a disability. The bedrooms that were inspected during the visit were all personal to the individual, with ornaments, pictures and photographs from the residents’ own homes. All the residents who spoke with the inspector were happy with their own rooms, all of which were suitable to meet the assessed needs. One resident had recently moved to a temporary room as her own room was having a new carpet laid after water damage. Although she quite liked the room she was in she said she “was looking forward to returning to her own room”. There are large gardens surrounding the home with those at the front of the building having recently been landscaped. New electronically controlled gates have recently been installed to ensure further security for the residents. The home employs domestic staff to ensure residents live in clean, pleasant surroundings and the care staff are provided with gloves and protective clothing to reduce the risk of cross infection. There are plans in place for alterations to the property to provide 8 extra ensuite bedrooms and a passenger lift and the manager has already discussed the proposals with the inspector. A copy of the plans had been made available for inspection should the visit take place whilst he was away from the home. He is aware that there is now a central registration team in place and will make the necessary application should the company decide to move forward with the plans to extend. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome area is good. Residents have confidence in the staff team that cares for them. Staff rotas take into consideration the needs of the residents and busy times of the day are recognised. Management encourage staff to undertake training and recognise the benefits of a skilled and experienced workforce. The home has a robust recruitment and selection policy in place. This judgement was made using available evidence including a visit to the service. EVIDENCE: The owner/manager had provided details of the staffing arrangements in the home prior to the inspection, the details of which were checked during the visit. During the morning, from 8am to 2.30pm there are 3 care staff plus the owner/manager and from 2.30pm until 9pm there are currently 2 care staff plus the owner/manager. The home works to a full recruitment and selection policy and the staff files checked during the visit contained all the required documentation. Two new members of staff have recently been appointed and as soon as the legal checks are complete and documentation received they will be able to start work. This will ensure that there are always 3 members of care staff on duty throughout the day. This will be beneficial to the residents and staff. The home employs 2 waking night staff with the owner living on the premises providing Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 18 on-call cover should this be required. There are also cooks and domestic staff employed. The staff team is both experienced and qualified with a number having worked at the home for over 5 years. The majority of the care staff are qualified to NVQ level 2 or above and there are some currently working towards the award. The owner ensures there is a good training programme with courses recently completed in, moving and handling, safe handling of medication, policies and procedures of care and fire safety training that is ongoing throughout the year. The owner has applied for staff to be trained in Protection of Vulnerable Adults and is awaiting confirmation of the available dates. The residents and visitors spoke highly of the staff and praised their dedication. Comments like “they are lovely girls”, “they are so helpful” and “they are always so polite” were made to the inspector during the visit. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 & 38 The quality in this area is good. The manager has the required qualifications and experience and is competent to run the home. He works continuously to ensure a good quality of life for the residents. He is resident focused and supports a strong staff team. The home has sound policies and procedures that are reviewed and updated on a regular basis. This judgement was made using available evidence including a visit to the service EVIDENCE: The owner/manager was away on the day of the site visit and the head of care was available to assist the inspector. The registered manager has worked at Elmsfield House for a number of years and is qualified to NVQ level 4 and has completed the Registered Manager Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 20 Award. He has overall responsibility for the running of the home and works closely with the head of care to ensure the home is run in the best interests of the residents. There is a warm and relaxed atmosphere and residents were quick to assure the inspector they treated Elmsfield House as their own home. The financial viability of the home is the responsibility of the manager and the other director of the limited company. Annual accounts are prepared and audited by the company accountants. There are no residents’ personal monies kept in the home and expenditure for additional charges such as newspapers and hairdressing is recovered via monthly accounts. Staff supervision is completed every two months and is the responsibility of the head of care and supervisors. Records are held on the staff personal development files and were made available for the inspector to examine. The manager is a registered fire fighter and health and safety officer and as such makes certain that all the required fire safety training is kept up to date. Health and safety audits are completed annually and all the necessary risk assessments are in place. All equipment is serviced regularly under maintenance contracts that were also available for inspection. Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 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 3 3 3 3 3 X 3 Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Elmsfield House Limited DS0000065671.V300714.R01.S.doc Version 5.2 Page 24 - 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!