Inspection on 24/11/08 for The Firs

This inspection was carried out on 24th November 2008.

CSCI found this care home to be providing an Adequate service.

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

The Firs 08/03/10

The Firs 24/11/09

The Firs 12/08/07

The Firs 10/10/06

The Firs 01/12/05

The Firs 22/07/05

The Firs 01/03/05

The Firs 18/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Firs and 16 Margaret Road, The 141 Malvern Road Worcester Worcestershire WR2 4LN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Martin George     Date: 2 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Firs and 16 Margaret Road, The 141 Malvern Road Worcester Worcestershire WR2 4LN 01905426194 F/P01905426194 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Eldahurst Limited Name of registered manager (if applicable) Mrs Sandra Lynne Ghalamkari Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 22 The Firs accommodates 15 service users Fern House accommodates 7 service users The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category OP 15, at The Firs Physical Disability over 65 years of age (PD)(E), at The Firs Dementia over 55 years of age (DE) 4, at The Firs Dementia over 55 years of age (DE) 7, at Fern House Date of last inspection Brief description of the care home The Firs provides care for fifteen people over the age of sixty-five years with physical disabilities. 14 and 16 Margaret Road are separate semi-detached houses that are Care Homes for Older People Page 4 of 27 care home 22 Over 65 0 15 15 11 0 0 Brief description of the care home divided from The Firs by their joint back gardens. The two properties are registered as one care home. The home is located in the St Johns area of Worcester. The two buildings are adapted and extended to provide a comfortable domestic environment for older people. The registered proprietor is the company Eldahurst Limited. The responsible individual and the registered provider is Mrs Sandra Lynne Ghalamkari. The fee ranges from three hundred and ninety seven pounds to a maximum of four hundred and fifty pounds per week. The standard fee does not include hairdressing, chiropody, newspapers or having own telephone in bedroom. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out by a single inspector between 09:45 and 17:00. As part of the inspection all National Minimum Standards defined as key by the Commission for Social Care Inspection were considered. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we were provided with written information and data about the home through their annual quality assurance assessment (AQAA). Information from the last key inspection report was analysed prior to inspection to help us formulate a plan for the visit and to help us in determining a judgement about the quality of care provided by the home. Care Homes for Older People Page 6 of 27 On the day of the inspection we spoke to the manager, deputy manager/administrator, accounts clerk, staff, people living at the home and their relatives. We also undertook a tour of the premises and observed practice, which provided evidence in support of the records we also checked on the day. This approach allowed us to assess how well outcomes were being met for those receiving a service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with useful information to help them decide if the home is right for them. Evidence: The home has a statement of purpose and a welcome guide to ensure people who use the service and their relatives are provided with information that describes what the home offers. It would however be helpful for those who might be interested in using the service to have information about the fees and what is included within the standard fee, to help them decide if the home is the right place for them. Two relatives we spoke to said they had received very good pre admission information and were given the opportunity to clarify things if they needed to with the manager, who they found very approachable. The home ensures that it receives pre-admission multi-agency assessments prior to Care Homes for Older People Page 10 of 27 Evidence: admission for people who are funded by the local authority. For people who are self funding there are assessments done by the home, usually by the deputy/administrator, who takes a lead on this aspect of the service. The ones that are completed by the deputy/administrator are of good quality but we saw one that was not completed by her that we considered too basic to inform a care plan that could satisfactorily identify outcomes. Terms and conditions were in place detailing what the people living at the home can expect. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are having their needs carefully assessed and planned for. Medication practice safeguards people from the risk of harm resulting from medication errors. Evidence: Care planning processes and recording have improved significantly and now cover all areas of personal and healthcare needs and show how outcomes for people living at the home will be met. Most of the pre-admission assessments are completed by the deputy/administrator and are very comprehensive. These form the basis of individual care plans. However on the day of inspection we were shown a recent pre-admission assessment that had been done by someone else and we found this to be too basic and would not have been much use in the development of a care plan. There have been evident improvements in the development of care plans, which now Care Homes for Older People Page 12 of 27 Evidence: cover several areas necessary to help meet outcomes for those living at the home. Areas covered in the care plans include medical history, dexterity, medication needs, religious and cultural needs, personal and physical well-being, diet/allergies, falls, personal safety, mobility, continence, oral care, foot care, communication, cognition, personal care, sight and hearing needs, family involvement, interests and daily routines. All care plans are reviewed monthly and clearly show any changes that are needed. The home also completes a section in the care plan to cover the death of people living at the home. An indicator of dependency assessment is undertaken on each person, which helps staff understand how capable each individual is with regard to doing things on their own. Through discussion with both the manager and deputy we were made aware of a recent admission to hospital, who after admission had been found to have a pressure ulcer to the sacrum. At our request the deputy looked in the persons file and could find no written chronological record of why the person had been admitted, progress whilst in hospital or why it had been decided not to return the person to The Firs. The manager, who had attended a meeting about the person the week before the inspection, claimed she had not had the opportunity to write up the outcome of the meeting yet. We would expect records to be kept up to date to show what the home is doing to safeguard those being provided with a service. Throughout the day we observed several staff and the manager interacting with people living at the home and we are satisfied that these relationships are mutually respectful. Privacy is recognised as important for people and the practice we observed reflected this. The medication receipt, storage, administration, recording and disposal procedures and practice are robust and protect people from potential harm due to medication errors. Records were checked and found to be well maintained and observation of practice showed that the necessary vigilence is given to administration. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home expressed high levels of satisfaction with how they are looked after and kept occupied and stimulated. Evidence: We spoke to several people living at the home during the day and they all said that there were plenty of opportunities to get involved in things if they wished to. Three people said that they were quite happy not doing anything and did not feel pressure to get involved. Outings are regularly arranged by the home and the day after the inspection there was to be a shopping trip, which many of those we spoke to said they were looking forward to. We observed staff checking with the individuals to see whether they wanted to be involved in the trip or not. During our visit a couple of men arrived at the home to check out arrangements for a Christmas show being put on for the people that live there. Relatives of those living at the home are always made welcome and we spoke to two during our visit. Both said they are very satisfied with the way staff look after their Care Homes for Older People Page 14 of 27 Evidence: parents and said they are always kept informed of any changes or concerns. One of the relatives said she regarded the home as faultless. People living at the home said the meals are good and a brief examination of menus showed a nutritional balance and interesting range of meal options. The dining areas in both The Firs and Margaret Road are welcoming environments and create the right ambience for relaxed mealtimes. We found no evidence of people living at the home being involved in preparation of food. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals living at the home and their relatives express satisfaction with the quality of care and staff are aware of how to safeguard vulnerable people. Evidence: The home has not recorded any complaints at all, although there is a complaints book and a policy, which is known about by those who use the service and their families. During the day of the inspection we asked several people, including people living there and a couple of their relatives, if they knew about the complaints procedure and all confirmed they did. We were also satisfied that they would feel confident to use it if they were disatisfied with anything. The managers said they occassionally have minor concerns raised with them and it is a shame that these minor concerns are not recorded, with action taken to allay the concerns. This would provide evidence of how the home responds to concerns by taking action to improve outcomes for those living at the home. We found awareness of safeguarding matters to be satisfactory. Access to the home is restricted as the front door, when opened from the inside, can only be done by use of a numerical code, which is only known by staff. An example of good safeguarding practice was evidenced during a discussion with the Care Homes for Older People Page 16 of 27 Evidence: manager. One person living at the home needed to be moved to a ground floor room because she has a tendency to lean over the bannister on the first floor when she wants or needs the attention of staff. The potential risk was recognised and it was felt the best solution was to discuss and agree a move to the ground floor with the individuals family. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are provided with an environment that is well suited to their needs, is hygienic and well maintained. Evidence: We saw evidence that equipment checks have all been completed and are up to date, helping to protect people living at the home from harm as a result of poorly maintained aids. The home has two rooms which are shared and people using the service said they are involved in discussion about sharing a room before it is agreed that it will happen. We are satisfied that families are involved too. There is screening available to ensure dignity and privacy are protected. The toileting and bathroom arrangements are sufficient to meet the needs of those living there. The downstairs bathroom in The Firs is being considered for refurbishment as it is rarely used by people living there. The manager explained she wants to change it into a wet room, similar to the other wet room at the home, which is the preferred choice of most people. If this refurbishment happens there will still be a bath available for people who prefer that to a shower. During the tour of the homes we noted that the red alarm cords were not hanging free to the floor but were hitched up at a height that cannot be reached from the floor. The Care Homes for Older People Page 18 of 27 Evidence: manager explained that the home has installed a new alarm system and no longer needs the cords. We feel therefore that the cords should be removed to avoid any confusion about how to call for help. There are a number of alcohol swab dispensers around the premises but they are not being used consistently. A discussion with managers identified that currently the expectation is that staff use these following using the toilet and undertaking direct work with people living there. Consideration needs to be given to making this hygiene safeguard more robust, including expecting visitors to use them to ensure people, especially those who are particularly vulnerable, are fully protected from the risk of infection. The environment overall is well maintained and pleasing on the eye. Laundry facilities are suitable for the number and needs of people living there. We did not inspect the kitchens fully on this visit but brief inspection indicated this area meets necessary standards of hygiene. The garden area between The Firs and Margaret Road provides a safe outside area where even those with limited mobility can move around safely. There are plans to build a summer house. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are cared for by a committed team of staff but recruitment procedures need to be more robust to ensure this important safeguarding outcome is met. Evidence: We feel there has been some improvement in the recruitment procedures but there are still some shortfalls that need to be addressed to ensure people living at the home are cared for by staff that have been thoroughly vetted. In a number of staff files there was an absence of information about employment gaps, which is known to be a major safeguarding issue that must be addressed as part of the recruitment process. Several files also had a personal information sheet included but none of the ones we saw had been completed. One file we looked at (the gardener) contained no references. A discussion with the manager and the accounts clerk (who maintains the staff files) identified that most staff employed are friends of friends, but this must not detract from ensuring that robust recruitment procedures are adhered to for every appointment, no matter what the job role being applied for or prior knowledge of the applicant. Making assumptions about the integrity of people applying for work at the home could potentially leave the people living there at risk. As a counter to the shortfalls identified in the recruitment procedure two relatives we Care Homes for Older People Page 20 of 27 Evidence: spoke to said their experience to date had been that all the staff were very friendly and approachable and were always very helpful. They were also very complimentary about the standard of care provided. Training records are being well maintained and show a commitment to training in a range of areas relevant to helping staff meet outcomes for those living at the home. Although the home has an induction programme for new staff it is the old induction model, which is now out of date and has been replaced by the Skills for Care common induction standards some years ago. The home needs to acquire the new induction standards to ensure new staff reach the initial level of competency within their probationary period deemed necessary to provide safe care to vulnerable people. The consistency of care provided to people living at the home is good because many of the staff have worked at the home for several years. Based on information received on the day of inspection we are satisfied that staffing levels throughout the day and night are sufficient to meet the needs of those living there. The Annual Quality Assurance Assessment, submitted by the home prior to the inspection, states that only one carer is male and all but two of the staff are white British. Most staff now hold the recognised qualification for the role they perform. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to develop several of the administration tasks to show how outcomes for people living at the home are being met, so that the good quality care we observed on the day can be evidenced if required. Evidence: The manager has now completed her Registered Manager Award but completion of this award does not seem to have inspired her to increase priority for the administration aspects of the manager role. Instead administration tasks are shared between the deputy/administrator, who works three days per week, and the accounts clerk. Both of these do a good job but we would like to see the manager giving increased priority to this required element of care provision, particularly with regard to how she monitors the quality of recording, to enable the home to provide effective evidence of how outcomes are met in situations where the quality of care may be brought into question. We saw some entries on individuals daily sheets that were written in very judgemental language. Other entries were far more professional and there seems to Care Homes for Older People Page 22 of 27 Evidence: be a difference in the standard of recording between The Firs and Margaret Road. The deputy/administrator said that although she is trying hard to change the culture in the home with regard to recording she does not have the necessary authority to make resistant staff change their established habits. Change is needed and must be led by the manager. There is still some work to be done to ensure policies and procedures cover all aspects of the service and are specific to the home. Policies and procedures help to guide staff in how to meet outcomes for those they are responsible for. In the Annual Quality Assurance Assessment, submitted prior to the inspection, we noted that there are no policies on food safety and nutrition, gifts to staff, common induction standards, physical intervention, sexuality and relationships, working with volunteers or contact with family. These policy shortfalls need to be addressed so staff are given the necessary direction they need to successfully meet outcomes for people living at the home. Risk assessments on safe working practices are now in place but the quality of these needs some further work to show how the people living at the home are actually protected from preventable harm by the working practices of the staff. One safe working practice that has not yet been met is the introduction of a Care Of Substances Hazardous to Health (COSHH) file, which should contain data sheets giving emergency advice on how to deal with ingestion or splashing of certain chemical products. Although the home is careful about which products it buys our discussion with the managers did identify some products that could cause harm if accidentally or deliberately misused. The deputy/administrator assurred us she would introduce this following our visit. There is a need to introduce robust health and safety records and monitoring to ensure the well being of people living at the home is maintained. All finance matters are dealt with by the accounts clerk and records we looked at showed an effective system, with clear entries. She said only two people handled their own money, and records showed how this was managed. Quality assurance is an area that needs further development to show clearly how the home identifies areas for improvement, what is done to effect change and how these changes subsequently benefit those living at the home. It should also show the process used by the manager to monitor practice and care standards. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 Records must be kept up to date to show what the home is doing to manage healthcare issues to ensure outcomes for individuals are being met fully When recruiting staff the home must ensure that application forms contain information about any employment gaps as this is a recognised safeguarding issue for those providing care to vulnerable people. References must always be acquired. The home needs to acquire the nationally recognised Skills for Care common induction standards to ensure new staff gain the initial level of competence required to provide safe care. Policies and procedures need to cover all aspects of service delivery to guide staff in how to meet outcomes across the full range of care provision. Records kept about the people that live at the home need to be written in language that is not judgemental and accurately describes what has occurred so that progress toward meeting outcomes can be properly monitored. Care Of Substances Hazardous to Health (COSHH) records need to be kept so that any accidental or deliberate misuse Page 25 of 27 2 29 3 30 4 33 5 37 6 38 Care Homes for Older People of chemical products can be managed properly to safeguard people from unnecessary harm. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!