CARE HOME ADULTS 18-65
Ferncliffe Cousin Lane Ovenden Halifax West Yorkshire HX2 8AD Lead Inspector
Liz Cuddington Unannounced Inspection 2nd April 2007 12:40 Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 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 Ferncliffe DS0000000999.V329083.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 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. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ferncliffe Address Cousin Lane Ovenden Halifax West Yorkshire HX2 8AD 01422 345904 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) Mayfield Trust Mr Stephen Cannon Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Ferncliffe is a residential home providing care and accommodation for up to eight men and women. The home is owned and managed by The Mayfield Trust. There is good access to all local amenities and the home is on a bus route. The people who live at Ferncliffe are encouraged and supported to take part in work, social, educational and recreational activities according to their own wishes. The atmosphere is relaxed and comfortable and the people who live and work at Ferncliffe have created a positive, family feel to the home. The weekly fees range from £373.64 to £681.40. The fee level is made up of the basic fee, plus additional payments for higher levels of need, night staff, extra care and outreach services. Personal items and expenses are not included in the fees. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group, for example ‘Choice of Home’, and ‘Personal and Healthcare Support’. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers these outcomes to the people who use the service. The judgement categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded in the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk The purpose of the inspection was to assess the quality of the care and support received by the people who live at Ferncliffe. The methods I used to gather information included conversations with the people who live at the home and the staff, case tracking, examining records and touring the home. I sent out questionnaires to the people who live at Ferncliffe, their relatives and others involved in the home. I received twelve completed questionnaires back. I also received the home’s pre-inspection questionnaire. These questionnaires provide a lot of valuable information to help me form a judgement about the quality of service offered at Ferncliffe. Although there are still a few areas for development, the home continues to make significant improvements. I would like to thank the people who live at Ferncliffe, and the staff, for their welcome and hospitality and for taking the time to talk to me during my visit. What the service does well:
The people who live at Ferncliffe said they can choose what they want to do each day and the staff support them to make their own decisions. The care plans reflect the individual’s choices and the progress that has been made in achieving their goals. The plans also show how each person’s care, health and support needs are to be met and demonstrate that they have been developed in consultation with the resident. One person commented about the staff, saying ‘They always listen and act on what I say’. One person said about her relative’s care, that she felt the staff at Ferncliffe ‘understand her needs well’. Another relative said they are ‘…very pleased with the care…’ and another commented that the staff are ‘Experienced and capable’. One relative said that the ‘…staff team are sufficiently stable to help her (the resident) feel safe and secure…’.
Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 6 One person who lives at Ferncliffe said, ‘I am very happy’. All the questionnaires from the people who live at the home said that the staff treat them well. Special occasions are marked and, for especially significant events, families and friends are also involved in planning the celebrations. Everyone said they know what to do if they are not happy or need to raise a concern. People’s safety is protected by good adult protection policies and procedures, and by thorough recruitment and staff training. Ten of the thirteen support workers have a relevant National Vocational Qualification (NVQ) and the three newest staff members are due to start the NVQ course when their foundation training programme is completed. The people who live at Ferncliffe all said the home is clean and hygienic and my visit to the home confirmed this. The medication is administered accurately and stored safely. The meals are of a good standard and people are able to choose the menus they prefer. Mealtimes are pleasant, social occasions. All these factors contribute to people’s health and wellbeing. 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. The summary of this inspection report can be made available in other formats on request. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 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 Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive pre-admission assessment and introduction is carried out before offering someone a place at the home, to make sure that the home can meet their needs. EVIDENCE: Although the last new admission to the home was some years ago the care plans showed that all the necessary pre-admission procedures had been followed. This includes a planned introduction period, taken at the prospective residents own pace. On the completed questionnaires, everyone said that they had sufficient information, to allow them to make a decision before moving to Ferncliffe. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To maintain their autonomy and independence, people exercise personal choice in all aspects of their daily lives. Staff support them in this, and respect their decisions. The care plans and risk assessments are developed and reviewed in consultation with the individual or their representative, to make sure the person’s wishes are central to the planning process. EVIDENCE: From my own observation, and comments made by the people who live at Ferncliffe and their relatives, people exercise personal choice in all aspects of their daily lives, and staff respect their decisions. The plans, as well as my own observations during my visit, confirmed that staff actively support each individual to make their own decisions. One relative commented that the staff support people ‘with due consideration to their … interests’ and quoted
Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 10 examples of how this has been put into practice in the person’s social activities and choice of holiday. I looked at a number of care plans. They all include the individual’s plans and goals for the year and show the progress that has been made towards achieving those goals. One person wanted their bedroom to be re-decorated. This goal has been achieved with the full involvement of the individual. The plans show in detail how each person’s care and support needs are to be met and reflect the preferences of the individual. Each person’s preferred routine is known by all the staff. The plans are regularly reviewed and updated and the person is fully involved at every stage. The plans reflect the changing needs of the people who live at Ferncliffe. This is especially important as the people are becoming older and their support needs are changing. Risk assessments are in place where needed. They show how any potential risks have been evaluated and balanced against the wellbeing and preferences of the person. Risk assessments are completed in consultation with the individual, staff and, where needed, an advocate or other relevant person. A new format for the care plans is to be introduced during the coming year. People know what is in the care plans that are currently in use, but the examples I have seen of the new plans confirms that this will make them clearer and more accessible. The people who live at Ferncliffe manage their own finances, with support from staff when needed. All confidential information is stored securely and people know they can access their own files whenever they wish. The staff have a ‘daily routine’ folder which details what the morning, afternoon and ‘sleep-in’ staff need to do during each shift on weekdays. This reminds staff of people’s preferred routines and is helpful, particularly when people are going out to different places in the morning. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Ferncliffe choose how they spend their time and are supported to access a range of educational and leisure activities and maintain contact with family and friends. This makes sure each person’s needs and aspirations are met. The meals are of a high standard and mealtimes are relaxed, providing both the nutrition essential for health and a pleasant social occasion. EVIDENCE: In addition to detailing the person’s individual goals, the care plans show how people have achieved their goals and the level of support needed. One plan shows how someone’s wish to exercise a greater level of independence has been achieved. This has enabled the person to maintain a friendship in the way the individual prefers.
Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 12 The plans show that decisions about holidays, major purchases, special celebrations and other important events have been reached through discussion and that they reflect the individual’s wishes. One relative commented that she was pleased at the greater effort now being made by the staff at Ferncliffe to support the person to keep in more regular contact with family members. Important events, such as milestone birthdays, are planned well in advance and involve all the people who are important to the resident. One relative commented that she was pleased to be contacted by the home to discuss the family’s plans for celebrating an important event in the person’s life. Overall, the comments I received tell me that contacts between the people who live at Ferncliffe and their families and friends have improved. Staff respect the right of each individual to make their own choices. One of the plans showed how one person’s goal of attending educational courses had been achieved. People are supported, where needed, to be involved in the life of the local community. Some people attend church and others take part in regular social activities. The mealtimes are relaxed and sociable occasions. The menus are varied, with a choice of a different main course or dessert to suit individual diets and preferences. Any assistance needed at mealtimes is offered discreetly. The people who live at Ferncliffe are involved in planning the menus and also assist with preparation and clearing up, if they wish. Drinks and snacks are available at any time of the day or night. The people I spoke to said that the food is very good and they enjoy their meals. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans show how each individual’s personal and healthcare needs and preferences are to be met. The plans are developed and reviewed in consultation with the person concerned to make sure their preferences are central to the planning process. For the safety and health of the people who live at Ferncliffe, medications are stored and administered safely and accurately. To maintain their dignity, the staff treat people with respect and consideration at all times. EVIDENCE: Detailed records of everyone’s healthcare needs and progress are kept. In the care plans I saw notes on routine healthcare checks, such as dental treatment and eye tests, as well as information about medical treatment, check-ups and reviews. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 14 People’s specific healthcare needs are handled appropriately. Advice and guidance is sought from specialists where this is needed. People who need to have medical treatment are fully supported by the staff, in order to make the process as comfortable and stress-free as possible. For example, staff will accompany people to hospital and stay with them for as long as they are needed. The medications are securely stored and when a member of staff administers medicines the Medicines Administration Record (MAR) charts are signed at the same time. The charts also show when someone has not taken a dose of their medicine, and the reason. The comments I received from the people who live at Ferncliffe, and their relatives confirmed my observation that everyone is treated with dignity and respect and consideration is given to their individual needs and differences. Each care plan includes details about the person’s final wishes and how they would prefer to spend the last part of their life. The wishes reflect the personality and individuality of the person. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Ferncliffe and their relatives are aware of how to make a complaint if they are dissatisfied with the service. Staff have received suitable training and understand the adult protection policies and procedures, which makes sure that people living at the home are safe. EVIDENCE: The returned questionnaires confirmed that people know how to make a complaint or raise a concern if they need to. The people I spoke to at the home said they would know how to raise any concerns, if they needed to. The relatives who completed questionnaires also said they would know how to make a complaint or express a concern. The home has up to date adult protection and ‘whistle-blowing’ policies and procedures in place that cover the way any concerns or allegations of abuse or poor practice would be handled. The home’s policies and procedures are up to date. All staff have taken Protection of Vulnerable Adults training. The home has an open culture where all suggestions and concerns are listened to and people feel free to express their views and know they will be heard and understood. People are able to contact an advocate if they wish. People who use the organisation’s services are involved in running the services and influencing its ethos.
Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some more refurbishment work is needed, the house and grounds are generally well maintained, attractive and accessible. The bedrooms are well furnished and the doors can be locked. The whole house is clean and hygienically maintained. These factors combine to provide a safe, comfortable and homely environment. EVIDENCE: There is a renewals and maintenance programme in place. Some work has recently been completed. For example all the windows in the house have recently been replaced. The hallway and dining room are the next rooms to be re-decorated. The conservatory was re-painted some time ago and new sofas were purchased. The room still needs more investment to make it as attractive and welcoming as it could be.
Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 17 Some bedrooms have been completely refurbished recently. One person took me to see the changes that had been made to her room. The room reflected her taste and she and the staff had worked hard to choose the right décor and furnishings. The finished result was lovely and the lady said she was very pleased with her room. I observed that the home is clean and fresh throughout, and this view was confirmed by comments from the people who live at Ferncliffe and their relatives. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet the needs of people living at the home. The people who live at the home are protected by thorough recruitment procedures. Suitable staff training is provided; to make sure staff have the skills and knowledge they need to meet people’s needs. EVIDENCE: There are enough staff on duty at all times to meet the needs of the people who live at Ferncliffe, and the home. The home does not use agency staff. Any additional shift cover is provided from within the organisation. I looked at a selection of staff files. They all included completed application forms and two written references. The files showed that satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks have been obtained. I was assured that no new staff start work until a POVA register check had been completed. Then, if the CRB check had not been
Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 19 received, they would work only under the supervision of an experienced staff member. The manager works hard to make sure that staff have all the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. The staff are waiting to update their mandatory training, including basic food hygiene, fire safety and health and safety. Moving and handling and care planning training have been arranged for the near future. Ten of the thirteen support staff have a relevant National Vocational Qualification (NVQ). The three new staff have completed their induction training and are currently taking the Learning Disabilities Award Framework (LDAF) training. They will start their NVQ course when the LDAF course is completed. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the people who live at Ferncliffe, and the staff are all involved in the decision-making processes. The home’s quality assurance systems may benefit from further development, to provide additional information to help improve the service. The home’s policies and procedures are up to date and are available to guide staff in all aspects of their work. EVIDENCE: The manager has the qualifications and experience necessary to manage the home effectively. The management of the home is open and inclusive. The people who live at the home and the staff are all involved in the decisionFerncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 21 making processes. It is very clear that the home is run solely for the benefit of the people who live there. Their views and preferences are at the centre of all the decisions made at Ferncliffe. There is a range of quality assurance measures in place, including questionnaires, which are sent to people in the home, relatives and visiting professionals. During the inspection visit the manager and I discussed widening the scope of the quality assurance systems to gain the views of other people who are connected with the home. The manager acts on information he receives to improve service quality for the people who live at Ferncliffe. A senior manager in the organisation makes regular visits to the home and internal quality audits are also carried out. The kitchen is clean and well organised. People use the kitchen to make drinks and carry out some of the household tasks. All the essential safety checks are carried out in a timely manner. I saw evidence that new staff receive a high standard of induction and foundation training. This gives them a good basis for their NVQ training and helps them understand their role and responsibilities, especially when they are new to care work. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 3 4 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 4 4 X 3 X X 3 X Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 23 NO 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. 1. Refer to Standard YA24 Good Practice Recommendations The programme of re-decoration and refurbishment in the home should be completed with minimal delay, to improve the environment for the residents. Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ferncliffe DS0000000999.V329083.R01.S.doc Version 5.2 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!