Inspection on 18/01/06 for Elwis House, 1

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elwis House, 1 21/08/08

Elwis House, 1 08/06/07

Elwis House, 1 18/12/06

Elwis House, 1 22/09/05

Elwis House, 1 01/11/04

Elwis House, 1 23/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Elwis House, 1 2-8 Bell Green Lane Sydenham London SE26 5TB Lead Inspector Lisa Wilde Unannounced Inspection 18th January 2006 10:00 Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 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 Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 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 Adults 18-65. 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. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elwis House, 1 Address 2-8 Bell Green Lane Sydenham London SE26 5TB 0208 7789485 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) Providence Project Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 4 people with learning disabilities of whom up to 3 may be over 65 years and up to 3 may also have a physical disability 22nd September 2005 Date of last inspection Brief Description of the Service: Elwis House provides a residential service to a maximum of four women and men with learning disabilities with high support needs, including people with signs of dementia or who are frail or older. The overall aim is that of promoting independence, equality of opportunities and social integration. The home aims to achieve this by listening and responding to what each service user wants, valuing diversity and developing a skilled staff team. The organisation the home is run by ‘The Providence Project’, which was a registered charity and a company limited by guarantee, has recently merged with another charity LINC to form the new agency of PLUS. Accommodation is provided in a purpose built ground floor flat, designed to meet the needs of people using wheelchairs. All residents have their own bedroom. The area is served by public transport and has a selection of shops and a supermarket. At the time of this inspection there were no vacancies. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in January 2006. The inspector met all service users and spoke with staff and the manager. Most of the service users at this home have limited communication abilities so the inspector contacted some relatives by phone following the inspection for further views on the service. The organisation has plans to change the way support and care is offered to service users at this home. The suggested plan is that care is offered to service users from the organisation’s Domiciliary Care Agency and that the home stops being a registered care home for adults. On the day of the inspection staff had no awareness of what may be happening and the manager said that he had not been involved in any discussions as yet. The day after the inspection letters were received by the relatives of service users, informing them of the proposed changes and starting the consultation process. These changes are potentially complicated and anyone wishing to have further information should contact the Commission for a more detailed discussion. Relatives who spoke with the inspector had significant concerns about the proposed changes and the inspector confirmed with them the importance voicing these concerns to the organisation when they meet with them. The Commission is meeting separately with senior members of the organisation in the upcoming weeks to discuss the proposed changes. Although they were very worried about any potential changes some relatives were quite satisfied with the service their relatives are offered at the home with one being ‘more than happy’. Specific issues raised are discussed more fully later in the report. What the service does well: The standards assessed at this inspection showed that the home ensures that: • a new service users’ needs would be fully assessed before they were offered a place at the home. • there are full and detailed guidelines in place telling staff how to support service users with their personal care on a day-to-day basis. • reviews take place to establish short and long term goals with the service users and their families. • the home talks with service users and their families about what they want to happen should a service user become seriously ill or die. • the home is comfortable and clean throughout. • service users have individualised their rooms to suit their own tastes. • generally the staff team is effective and there are enough staff on duty. • the manager has an understanding of the needs of the service user group and how staff should meet those needs. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 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. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home was committed to a full assessment of residents’ needs before they were offered a place at the home so that they could be sure the home could meet their needs before they moved there permanently. EVIDENCE: The evidence at this inspection was the same as at the last inspection. No new resident had come to live at the home in recent years. It was understood that the policy of the organisation in relation to any future admissions was that prospective residents would receive a full assessment, by the appropriate professionals. All admissions would be planned, so that the person’s needs could be appropriately identified. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 There are full and detailed guidelines in place telling staff how to support service users with their personal care on a day-to-day basis. Reviews take place to establish short and long term goals with the service users and their families. There is no tool in place that states what action should be taken to make sure these goals are met and which is reviewed regularly by staff in between the annual reviews to make sure that the plans in place are effective. This means that staff are not working towards service users’ established goals in a planned way and have no means of deciding on a daily basis if any plan is working. EVIDENCE: There was a previous requirement that the registered provider must ensure that reviews of care plans give clear evidence of monitoring, evaluation, review and update of objectives. - To this end recording must include what is learnt from supporting the resident. - The individual responsibilities of key-workers / support staff must be clearly identified Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 10 - When there are communication issues, information must be kept around what the person does, what the staff think it means and when it happens. (This would be to help establish how the resident can best be supported). Evidence from the files showed that some effort had been made to record some action that was taken following goals being set but there was still no tool in place that identified what action staff and others would take to meet goals, that was regularly reviewed and changed in response to service users’ changing needs. The requirement is repeated. (See Requirement 1) Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X Most of these standards were not assessed as all had been assessed as met at the last inspection. The home is not fully recording all activities that service users do, so cannot completely assess if they are doing enough to support service users in this area. EVIDENCE: It was not possible to fully assess whether the home is doing enough to engage service users with activities as the Keeping Track forms which show what activities service users do, are not being completed consistently which also means that the home cannot assess whether they are doing enough in this area. (See Requirement 2) There was a previous recommendation that the home contributes towards the cost of meals taken out, when these are an essential activity contributing to the fulfilment of the care plans. The manager confirmed that this money now comes out of petty cash. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 12 There was a previous recommendation that the provider initiates discussion with the placing authorities to establish, as part of the basic contract price, the option of a minimum seven-day annual holiday outside the home for each resident. This had not yet happened but the manager said that he would bring this up in the forthcoming service user reviews. (See Recommendation 1) There was a previous recommendation that management explores additional ways to elicit a response from residents regarding the food or meals they want. This should include using representations of items of food, dishes or other appropriate methods. Staff said that they offer choices at mealtimes to service users by showing them food alternatives. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 & 21 The home is not operating fully effective medication administration procedures which means that service users may be put at some risk of medication not being given at the right times. The home talks with service users and their families about what they want to happen should a service user become seriously ill or die. Any wishes are recorded in their files so that everyone is clear about what needs to happen. EVIDENCE: The inspector examined the medication records and found some gaps on the medication administration sheets. One service user was on a drug for agitation ‘when needed’ but there were no specific written guidelines as to when this should be administered (See Requirements 3 & 4) There was a previous requirement that the registered provider must ensure that residents’ wishes concerning terminal care and death are discussed with the users or their families and a record is kept. One file showed that this had been done. The manager said that he was planning to discuss this issue in the forthcoming service users reviews. There was enough evidence to show that this work had been undertaken and was being done with sensitivity. The final recording of wishes in this area would occur following the reviews. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Neither of these standards was assessed at this inspection as both had been assessed as met at the last inspection. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 & 30 Communal areas of the home are large enough and have been decorated in a homely manner. The home is clean and hygienic throughout. Service users have individualised their rooms to suit their own tastes. EVIDENCE: All service users have large single rooms and one is en-suite. Service users have personalised their rooms to their own tastes. There is a kitchen and large lounge that is big enough for all service users to use it together. On the day of this inspection all areas of the home were clean and hygienic and there are policies and procedures in place around health and safety issues. Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 Generally the staff team is effective and there are enough staff on duty to make sure that service users have all their needs met. Staff showed their understanding of the needs of the service users and how they should go about meeting those needs. (There were some concerns raised about the communication abilities of some agency staff however it was not possible for the inspector to fully assess this as they did not meet all the staff during this inspection.) EVIDENCE: Generally there are three staff on duty at all times during the day with a sleepin and waking night person at night. Staff said that they feel this is enough and don’t have to rush with any tasks even at busy times such as in the mornings. Relatives said that whenever they visit they always believe that there are enough staff on duty. Staf talked through the particular needs of service users and how they meet those needs. Both long term and new staff showed awareness of the service users and how they should work at the home. There was a previous recommendation that agency staff who have been working at the home regularly over a period of time are included in staff meetings. The manager said that this does not happen yet but agreed that it Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 17 could be done with the agency staff who work a lot of hours each week. (See Recommendation 2) Relatives told the inspector that they had concerns about the communciation abilities of some staff, saying that English was not the first language of some of the agency staff used at the home and they found it difficult to understand them. They were concerned that this would be a gerater problem for their relatives living at the home who already had limited ability to understand language. This was difficult for the inspector to fully assess as they did not met all staff on the day of the isnepction but a requireement is made for the manager to verify that all staff he uses have the necessary ability to communicate effectively with all the service users. (See Requirement 5) Two out of six staff are undertaking the NVQ Level 2 with the two new staff undertaking their induction programme with the Learning Disabilities Award Framework. The manager is currently undertaking the Registered Managers Award Level 4. There was a previous requirement that the registered provider must ensure that all statutory checks, to ensure suitability of staff, are conducted and inform the decision to appoint. In particular the registered provider must ensure that: - All previous work and education history is obtained and any gaps explored. - Appropriate references are consistently sought and received before applicants start work. - Existing files are reviewed. - Appropriate steps are taken to ensure that the checks are consistent with the requirements of the national minimum standards and regulations and the home’s own policy. This requirement could not be assessed as the organsiation does not keep its personnel records in the homes. Another inspector is due to assess the records at head office for the entire organisation and their findings will then be included in the next inspections’ report. (See Requirement 6) Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 39 During this inspection the manager appeared competent and showed his understanding of the needs of the service user group and how staff should meet those needs. The manager has not put in an application to be Registered with the Commission which means that the Commission has not had the opportunity to fully assess a manager at this home for over three years. The home does not formally gather the views of service users, their relatives and other stakeholders, in order to assess what they think of all aspects of the service they are offered. There is no individual annual development plan in place that shows how this home will improve over the forthcoming year. EVIDENCE: There was a previous requirement that the registered provider must ensure that an application is submitted to CSCI for registration of the home’s manager. This has not yet happened as the organisation is holding back the application pending the possible deregistration of this home as a care home. This means that there has not been a Registered Manager at this service for several years. The current manager has been at the home for around eighteen Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 19 months and showed his ability to manage the home during the inspection but he has not been through an interview with the Commission for them to fully assess his competence. (See Requirement 7) The organisation has a service user involvement group and representative from his group visit services to meet and talk about issues. The manager said that he talks informally with relatives of service users (and other stakeholders) and within reviews but there is no formal gathering of their views that then forms the basis of an annual development plan for the home. There is a business plan in place for the group of homes, which this service falls into but no individual plan for improvement. When the inspector spoke with relatives none of them had heard of the Commission or knew that the home had reports written about it twice a year. (See Requirements 8, 9 & 10 and Recommendation 3) Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 2 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 X 2 3 2 X 2 X X X X Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1) & (2) Requirement Timescale for action 30/04/06 2. YA14 15,16(2) (m) & (n) 3. YA20 13 (2) The registered provider must ensure that reviews of care plans give clear evidence of monitoring, evaluation, review and update of objectives. - To this end recording must include what is learnt from supporting the resident. - The individual responsibilities of key-workers / support staff must be clearly identified - When there are communication issues, information must be kept around what the person does, what the staff think it means and when it happens. (This would be to help establish how the resident can best be supported). Previous requirement: Unmet timescales 01/05/05 The Registered Manager must 30/04/06 ensure that the ‘Keeping Track’ forms are completed consistantly so that the home (and the Commission) can fully assess if service users are doing enough during their week The Registered Manager must 14/02/06 ensure that all medication is signed for at the time it is given. DS0000025617.V279586.R01.S.doc Version 5.1 Elwis House, 1 Page 22 4. YA20 13 (2) 5. YA33 18 (1) (a) 6. YA34 19 7. YA37 8 (1) (2) 8. YA39 24(1)(2) & (3) The Registered Manager must ensure that there are specific written guidlines in place for staff, describing when all prn medication should be given The Registered Manager must ensure that all staff used at the home have the necessary language abilities to fully communicate with all service users. The registered provider must ensure that all statutory checks, to ensure suitability of staff, are conducted and inform the decision to appoint. In particular the registered provider must ensure that: - All previous work and education history is obtained and any gaps explored. - Appropriate references are consistently sought and received before applicants start work. - Existing files are reviewed. - Appropriate steps are taken to ensure that the checks are consistent with the requirements of the national minimum standards and regulations and the home’s own policy. This requirement was not assessed as records are held at the organisation’s head office – due to be assessed by another inspector later in the year. The Registered Provider must ensure that an application is submitted to CSCI for registration of the home’s manager. Previous requirement: Unmet timescale 30/11/05 The Registered Individuals must ensure that full consultation takes place with service users, their families and other stakeholders asking them how they feel about all aspects of the DS0000025617.V279586.R01.S.doc 14/02/06 14/02/06 31/03/06 31/03/06 31/03/06 Elwis House, 1 Version 5.1 Page 23 9. YA39 24(1)(2) & (3) 10. YA39 24(1)(2) & (3) service they are offered. This consultation must occur at least annually and must be recorded. The Registered Individuals must 31/03/06 ensure that there is an individual annual development plan in place for the home that is based on the views of service users, relatives and other stakeholders and shows how the home aims to improve in the forthcoming year. The Registered Manager must 31/03/06 ensure that service users and their relatives are made aware of the Commission’s reports and offered opportunities to read them if they choose. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA14 Good Practice Recommendations The Responsible Individual should initiate discussion with the placing authorities to establish, as part of the basic contract price, the option of a minimum seven-day annual holiday outside the home for each resident. The Registered Manager should ensure that agency staff who have been working at the home regularly over a period of time are included in staff meetings. The Registered Individual should consider using a professionally recognised quality assurance tool to fully assess the service and develop improvement plans. 2. 3. YA33 YA39 Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Elwis House, 1 DS0000025617.V279586.R01.S.doc Version 5.1 Page 25 - 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!