Inspection on 07/11/05 for Fern Villa

This inspection was carried out on 7th November 2005.

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

The inspector 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

Fern Villa 21/01/09

Fern Villa 22/01/08

Fern Villa 08/08/07

Fern Villa 19/12/06

Fern Villa 14/06/06

Fern Villa 11/07/05

Fern Villa 20/09/04

Fern Villa 17/05/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Fern Villa The Green Ellerker East Riding Of Yorks HU15 2DP Lead Inspector Pam Dimishky Unannounced Inspection 7th November 2005 09:00 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 Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fern Villa Address The Green Ellerker East Riding Of Yorks HU15 2DP 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) 01430 422262 01482 666013 Mr Jeremy William Southgate Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2005 Brief Description of the Service: Fern Villa is a care home registered for 23 people over 65 years of age, some of whom may have dementia. Application has been made to the Commission for Social Care Inspection to vary the registration to allow one person under 65 years of age to reside there. The home is situated in the quiet village of Ellerker which is close to the M62 motorway. It is a converted house with a modern extension and overlooks fields at the back and the village green at the front. For less ambulant residents, the first floor is served by a stair lift. There is a small sheltered garden with patio furniture and a parking area. The home is privately owned and is generally well maintained inside and out. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7.75 hours (including preparation). The inspector spent some time with the residents and in particular 10 of the 20 were spoken to along with three relatives and three members of staff and the manager. A number of records were inspected and a tour of the premises took place. What the service does well: What has improved since the last inspection? Staff responsible for giving out medications have completed their training making the task more safe for the residents. New valances for the beds have been purchased which is an interim measure until the audit is completed for the beds to be replaced. Ensuring the availability of soap in the laundry and toilet areas has been addressed. There is evidence of ongoing training for staff although there is much still to be done in this respect. Records are now being kept of routine maintenance and renewal of the fabric and decoration of the premises. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 6 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. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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 Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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): 3 and 6 Information is available for prospective residents to make an informed choice about where to live. The admission procedure includes a proper assessment being made of residents moving into the service to ensure the home can meet their needs. However, admissions have been made out of category for which the home is registered and as staff do not have the experience or training it is not certain their particular needs can be met by the home. EVIDENCE: The home has a welcome pack which is given to prospective residents and a copy is displayed on the notice board in the entrance to the home and a copy is also kept in each bedroom; the document is made up of the statement of purpose and service user guide. Prior to entering the home the provider makes an assessment of care needs and confirmation these can be met by the home is, according to the manager, included in the contract. One resident, recently admitted to the home, may have care needs outside the categories for which the home is registered and therefore may be at risk as staff do not have the experience or training. However, support is being provided to the home by Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 9 other NHS professionals. The home is not registered to admit residents requiring intermediate care. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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 and 9 Residents care plans generally have sufficient detail to provide staff with the information they need. However there are shortfalls in some, which may have the potential to place residents at risk. There is evidence of good multidisciplinary working taking place on a regular basis to ensure specific health needs are being met. The systems for the administration of medication are good with arrangements in place to ensure residents medication needs are met. EVIDENCE: All residents appeared relaxed, looked clean and tidy and were complimentary about their care, the staff, the home and particularly the manager. One resident who enters the home regularly for respite care told the inspector how much he looked forward to coming into the home. The manager said all the residents have “at least one hug a day” and from observation, it was clear there is a very good relationship between her and the residents. One resident has recently been admitted to the home and there was no evidence in the care plan of the assessment of care needs made by the provider. The district nurse was seen visiting the home and there are arrangements in place for chiropody, dental and optical services. The manager stated the NHS chiropodist attends Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 11 to the special needs of diabetics but no longer provides a service routinely. However, the chiropodist is giving staff the training to undertake basic footcare. Medications are being stored appropriately and the records checked were seen to be in order. Five staff, responsible for administering medications, had recently completed a course on safe handling of medicines. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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): 12,13,13 and 15 The residents’ lives are enriched by being able to take advantage of activities provided by the home and also being able to participate in community and family life. Meals in the home are good offering choice and variety according to the wishes of the residents. EVIDENCE: Residents spoke highly of their daily life in the home, the staff and the manager. Examples of being able to exercise choices in daily living were given and it is clear residents are supported in the decisions they make. Since the last inspection all but two of the residents, some relatives and staff have been to Goole for a riverboat trip, including a buffet lunch, which once again proved to be very successful. More recently a Halloween party was held which included a visiting entertainer. Plans for Christmas are being made and the manager said a Christmas lunch has been arranged for 15th December at the Triton Inn, an entertainer has been booked for a buffet lunch on Christmas Eve and relatives friends and staff will be present; carol singers from South Cave are visiting on 16th December to provide a carol service and a sherry and mince pie afternoon is being held on 18th December. The manager said links have been made with a group of four from Lifestyle who visit the home and provide entertainment during the school holidays. Staff provide other activities eg dominoes and card bingo. Newspapers are delivered daily, the hairdresser Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 13 attends weekly and the library and church visit monthly. One resident who enjoys water painting was seen to be producing some very attractive pictures and the manager said she had also made posters for the home advertising the Halloween party. The daily menu is displayed in the entrance to the home and on the day of the inspection the roast pork, potatoes, swede, carrot, cabbage and gravy looked very appetising and plentiful; this was being followed by sponge and custard. The cook keeps a record of food provided and knows individual residents likes and dislikes. Residents who do not like pork were being offered beef instead. The cook is currently attending training in healthy eating and expressed the importance of how a meal is presented. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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 and 18 The home has a satisfactory complaints procedure available to resident, their families and friends; compliments the home has received indicate complete satisfaction with the services provided. Not all staff are aware of the policies and procedures for the protection of vulnerable adults, nor had awareness training which together, does not ensure residents are protected from abuse. EVIDENCE: The home has a complaints procedure which is included in the service user guide given to all residents. A compliments/complaints book is available in the reception area for residents and visitors to the home. No complaints have been recorded since the last inspection, but many cards expressing grateful thanks for the care given to loved ones are included. Residents were not sure of the complaints procedure but added they have no complaints about the home or the services provided and if they had would speak to the manager. The home has a copy of the East Riding multi-disciplinary guidelines for the protection of vulnerable adults which the manager stated had been read by all staff. However, it was evident that some staff were not aware of the home’s policies and procedures and have not received awareness training. The manager stated she would ensure all staff read the policy and procedure and arrange for a showing of a video, held by the home’s sister home, on the subject of protecting vulnerable adults from abuse. The manager has attended a manager’s abuse awareness course provided by social services. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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 and 26 The standard of the environment within this home is reasonable and generally provides residents with an attractive, clean and homely place to live. However, requirements made at the last inspection to make the environment safe have not been acted upon. EVIDENCE: Residents said they had a lovely room and that they had been able to bring some of their own furniture into the home; evidence was seen of rooms being made comfortable and homely with personal possessions and memorabilia. One resident was extremely pleased with a gadget which gives him some independence in being able to turn his TV on and off and to insert DVD’s. Records are being kept of routine maintenance and redecoration taking place, and two bedrooms and the lounge have been redecorated since the last inspection; garden maintenance is also recorded. The home has three bathrooms but only one of these on the ground floor is in use as one is used as a store area and for the hairdresser’s use and the Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 16 proprietor has disconnected the hot water from the bath on the first floor. A bathing policy is displayed in the bathroom which is used and a thermometer is available to check the hot water temperature. Doormats at the entrance to the home and in the corridor of the extension have worn and are presenting a trip hazard. Despite being made a requirement at the previous inspection, this work remains outstanding. (The Commission received a telephone call from the proprietor the day following the inspection to say the doormats had been raised). Although the inspector was informed a year ago that the manager had sourced a supplier for radiator guards to be fitted to those radiators which do not have a low temperature surface, this is also a requirement which has remained outstanding for some considerable time. A number of divans are in need of replacement and no progress has yet been made towards a requirement made at the last inspection for a programme to be implemented for replacements; the timescale for completion was agreed for 30/06/06; the manager has obtained a stock of valances to be put on the beds in the interim. One room had an unidentified odour. The manager has exhausted all attempts at finding the source of the odour and the inspector suggested drains should be checked as a toilet is in the room next door to the bedroom. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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 and 30 The staff have a good understanding of the residents support needs. This is evident from the positive relationships which have been formed between the staff and residents. The home cannot be sure residents are in safe hands at all times until training is complete and the home’s recruitment practices improve. EVIDENCE: Twenty residents are currently living in the home and staffing levels have not changed from three care staff on duty for the early shift, two for the late shift and two at night. The manager is routinely working two days (four days when the cook is on holiday) in the kitchen to cover the cook and three days alongside care staff making up the numbers on the rota. This arrangement has previously been accepted due to the low dependency needs of the resident. However, some of the residents have become more frail and their care needs increased therefore the time the manager is involved in caring and providing cover for the cook, does not allow her the time to fulfil the role of manager and the proprietor must ensure she is given the support to do so. The home does not employ a cleaner and the manager and care staff are also employed in cleaning and laundry tasks. Since the last inspection, one new member of staff has been recruited to work two shifts a week. The manager stated she has taken verbal references, although the content has not been documented, a Criminal Records Bureau (CRB) check has been applied for but not yet received, and she has commenced working without any evidence of a POVA check being made. CRB checks for other staff remain outstanding, due to the applications going astray, Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 18 but no progress has been made in these being reapplied for. Apart from the manager, none of the staff have an employment contract and, despite previous requirements being made, there is no evidence progress is being made in this direction. There is evidence of staff training continuing to taking place. However, further improvements must be made in this area to ensure residents are always in safe hands. Five members of the care staff have now completed a course in safe handling of medicines, one member of staff is taking a course in infection control, and the cook is currently undertaking a healthy eating course. Mandatory training is outstanding for all staff including any person working in the kitchen and/or handling food must have food hygiene training; all staff must have fire safety training (twice a year), lifting and handling, infection control and there must be a qualified first aider available at all times. The home will not achieve 50 of care staff trained to NVQ level II (or equivalent) by 31/12/05. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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): 31,33,35,37 and 38 Residents’ lives are enhanced by the manager’s ability to create a homely, caring environment and by having effective communication to residents, relatives and staff. The systems for residents’ consultation is good with evidence that indicates their views are both sought and acted upon. Some legally required notifications to the Commission have not been sent and some safety certificates were not available at the time of this inspection, which may result in residents being put at risk. Some areas of health and safety have the potential to put residents at risk. EVIDENCE: The manager confirmed she has enrolled with Lincoln University and has commenced taking a qualification at NVQ level IV in care and management. Since becoming manager improvements have been made to the environment, staff training and records kept about the residents. However, progress with these improvements must continue and be continually updated. The Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 20 Commission had not received reports of monthly, unannounced, visits to the home, required to be made by the proprietor, since June 2005. However, outstanding reports were handed to the inspector during the course of the inspection. Residents meetings are held quarterly with minutes kept and the proprietor is keeping a record of quarterly audits he undertakes. It is clear the manager listens to the views of the residents and where possible takes appropriate action. The home does not keep any monies on behalf of residents and is not involved in their financial affairs. Accident records are being maintained, but until a new book is obtained, these are not being recorded appropriately. One resident has had a number of falls and is having her medication reviewed by the general practitioner. Five death notifications to the Commission are outstanding, the last being received for a death occurring 27/05/05. A new stair-lift was installed in February this year and a new bath hoist in January. However, there is no evidence they have now had the six monthly thorough examination required by health and safety legislation. Fire extinguishers indicated they had been checked 25/08/05, and records are being made weekly of fire alarm tests and emergency lighting checks. Mandatory health and safety training is outstanding and someone with a first aid qualification is not available at all time. Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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 x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 x x x x x x 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 x 1 1 Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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. 1 Standard OP3 Regulation 14 Requirement Timescale for action 07/11/05 2 OP18 13 3 OP19 13 4 OP25 13,23 The registered person must not offer accommodation to a service user unless the home is suitable for meeting the service users needs The registered person must 31/01/06 ensure staff are trained to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse The doormats at the entrance to 07/11/05 the home and in the extension corridor must be replaced or adjusted to make level with the top of the mat well. (This is an outstanding requirement from the previous inspection. However, the Commission received telephone confirmation the day following the inspection the work had been completed) Pipe-work and radiators must be 31/12/05 guarded or have guaranteed low temperature surfaces. (This requirement is outstanding from previous inspections and the agreed timescale has DS0000019669.V261609.R01.S.doc Version 5.0 Fern Villa Page 23 5 OP24 16 6 OP30OP27 18 7 OP29 19 8 OP29 19 9 OP37 37 10 OP38 13 11 OP38 13 not been increased at this inspection) An audit of all beds must be undertaken and a programme implemented for replacements. (A requirement from the previous inspection and no evidence seen of any progress being made. The timescale has not been extended) The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home, in such numbers as are appropriate for the health and welfare of the service users All staff working in the home must have a CRB check and application must be made for a check for new staff before they commence working in the home. (This requirement is outstanding from previous inspections) Records for staff, which must be kept in the home, must include all the information listed in schedules 2 and 4 of the Care Homes Regulations 2001. (This requirement is outstanding from previous inspections) The registered person must give notice to the Commission without delay of the occurrence of the death of any service user, including the circumstances of his death The registered person must provide the Commission with evidence the stair-lift and bath hoist have had a six monthly thorough examination The registered person must ensure persons employed in the home receive mandatory training DS0000019669.V261609.R01.S.doc 30/06/06 07/11/05 07/11/05 07/11/05 07/11/05 31/12/05 31/01/06 Fern Villa Version 5.0 Page 24 including first aid, and receive training appropriate to the work they are to perform and be given suitable assistance, including time off, for the purpose of obtaining further qualifications. (This requirement is outstanding from previous inspections and the timescale has been extended) 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 Refer to Standard OP7 OP26 OP29 OP31 Good Practice Recommendations The homes own assessment prior to the service user moving into the home should be kept with the care plan The odour in Room 12 should be further investigated, including drain pipes which may run from the toilet next door and under the bedroom floor A minimum ratio of 50 trained members of care staff (NVQ II or equivalent) should be achieved by 31.12.05 The manager should have an NVQ IV in management and care (or equivalent) by 31.12.05 Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Fern Villa DS0000019669.V261609.R01.S.doc Version 5.0 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!