Inspection on 16/08/06 for Fourseasons

This inspection was carried out on 16th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fourseasons 14/01/09

Fourseasons 19/10/05

Fourseasons 09/06/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Fourseasons 33 Church Walk South Rodbourne Cheney Swindon Wiltshire SN2 2JE Lead Inspector Bernard McDonald Key Unannounced Inspection 16 January 2007 08:30 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 Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fourseasons Address 33 Church Walk South Rodbourne Cheney Swindon Wiltshire SN2 2JE 01793 527103 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) Coate Water Care Company Limited Mr Christopher Leonard Smith Care Home 15 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (1) Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2005 Brief Description of the Service: Four Seasons is a family owned, privately run care home. One of the homeowners assumes day-to-day management of the home. The home provides a good overall standard of accommodation on two floors. Each floor is linked by a vertical passenger lift. The home is ideally located in a quiet cul de sac with easy access to Swindon town centre. The home seeks to specialise in the care of older people who experience dementia but who do not need nursing care. Typically there are 2 staff on duty throughout the period 8-00 a.m. to 930 p.m. plus staff who clean and cook. At night time there is one person who works an awake duty and one staff member who undertakes a sleep-in duty. This person can be called upon to assist in an emergency or meet night time needs. The range of fees for the service have not been made available. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit of this unannounced key inspection was completed in eight hours during which time there was opportunity to meet with all service users. As part of our inspection methodology, comment cards were sent to a random sample of service users, their representative’s health care professional and placing authorities. No adverse comments were received. Four care plans were examined in detail. In addition medication records, staff recruitment files, training records, health and safety documents and a sample of risk assessments were also examined. A tour of the building was made and the majority of service users bedrooms were viewed. Three members of staff were interviewed in private. The relatives of three service users who were visiting the home at the time of our site visit shared their views on the care provided to their family member. Comments received were positive and complimentary. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The quality of recording in service users care plans has improved since our last site visit. Records demonstrate service users care plans are being reviewed each month to ensure care plans reflect their current needs. More attention is Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 6 being given to ensure risk assessments are updated following any fall to a service user to reduce the risk of it happening again. Quality assurance is progressing well and the development of the newsletter ensures service users and their family are made aware of new developments at the home. The extra hour of staff cover in the morning means the morning routine appears less chaotic and ensures service users have support from at least one member of staff during the breakfast period. 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. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6. The home is ensuring service users care needs are assessed prior to admission to ensure their needs can be safely met. The Quality rating in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Information relating to the admission of three service users was examined in detail. The records demonstrated each service user had an assessment of their needs undertaken prior to moving into the home. In addition the home had completed a ‘daily living needs assessment’ on each service user as part of their admission procedure. One service user had been receiving day care services at the home prior to becoming resident. Issues relating to the service users ethnicity where known prior to admission. Following admission a care programme approach (CPA) meeting was held. Records demonstrated that the service user briefly attended the meeting and family members have provided the staff with appropriate Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 9 Punjabi words to assist with communicating core tasks. Discussion with staff members confirmed they are aware of the words and their meaning. One service user was asked about their experience of moving into the home. The service user stated they “ I don’t remember coming to the home but I like living here”. The deputy manager confirmed the home does not provide intermediate care. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. The home is striving to ensure service users are treated with respect and their care plans reflect their changing personal and health care needs. Staff handle medicines appropriately, however entries on the reverse of medication administration records could lead to errors. The Quality rating in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The care plans of four service users were examined in detail. Records demonstrated service users care needs are being reviewed each month. The records of one service user had amendments made to their care plan due to a change in their care needs. The personal care plan had been signed by the service user or their representative to demonstrate they understand and have been made aware of the contents of their review. Currently all service users care plans and risk assessments are being reviewed by the deputy manager. Nutritional risk assessments are also being updated, as part of the review and food supplements are being provided where a risk has been identified. In Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 11 addition to ensure service users remain as independent as possible an occupational therapist assessment has been completed for one service user who required assistance with feeding. A plate guard has been provided and the service user is now able to manage their meal independently. On the day of our site visit one service user was being assessed by the speech and language therapist. The service user had been having difficulty with swallowing and was at risk of aspirating. The assessment identified the service users drinks needed to be thickened and this was recorded in their short-term care plan. Observations made during the site visit found staff speaking to service users in a respectful manner and taking time to explain what actions they were undertaking. Service users preferred form of address is clearly recorded in their care plan and staff were observed using their preferred name. One service user was asked about their experience of living at the home said, “I like living here”. When asked why they said, “the people are just nice”. There was opportunity to meet with the relatives of three service users. They confirmed they were more than satisfied with the care being provided and that they were kept informed of any significant changes. These views were also reflected in the comments cards we received from relatives as part of our pre inspection methodology. The majority of service users are registered with the local health care practice. A small number of service users have elected to remain with the GP they were registered with prior to moving in. A domiciliary optician service visits the home on an annual basis. When required service users can access a chiropody service. Discussion with the deputy manager confirmed the relatives of service users are encouraged to assist with outside health care appointments. Where this is not possible then staff at the home would provide this support. A sample of medication records were examined. Each service user has a medication profile, which highlights any allergies and provides details of the service users GP and contact number. Records demonstrated staff are recording medication when it is administered to service users. However when service users either receive their medication late or receive “as required” medication this is recorded at the back of the medication administration record (MAR). This is a confusing system, which can lead to error. For example on the day of the site visit one service user received all their medication late as they had chosen to stay in bed. All of this medication was recorded on the back of the MAR sheet together with records relating to the administration of “as required” medication. It is recommended this practice is reviewed. All medication is held in a secure cupboard. As a matter of good practice eye drops should be dated when they are opened. This will ensure they are discarded by the date given on the medication. The deputy manager confirmed all staff responsible for the administration of medication have completed training in the safe handling of medication. Training records provided evidence of successful completion of the course. As a matter of good practice the local Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 12 pharmacist visits the home every three months to review the medication procedures. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15. More structure needs to be given to meeting service users recreational needs. Contact with relatives is promoted and visitors are welcome at the home. Routines offer flexibility. Mealtimes are relaxed and unhurried. The Quality rating in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Observations made during the inspection found staff trying to engage service users in a game of quoits. Service users appeared to enjoy participating but the member of staff had to leave the room on two occasions to deal with other care related activities. As a result the service users interest in the game was lost. In contrast in the afternoon when more staff were on duty service users were enjoying dancing and listening to music with the support of two care staff. When one member of staff had to leave the room this did not interrupt the activity. Service users would benefit from a designated activities coordinator who could provide a planned programme of activities without interruptions. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 14 Service users religious preferences are recorded in their care records. Two service users have regular visits from a deacon who provides them with communion. Routines in the home appear to be flexible in relation to getting up and going to bed, where to eat and what to wear. On the day of our site visit service users preference on whether they wish to stay in bed were respected. There was opportunity to meet with the relatives of three service users. They confirmed they can visit the home at anytime and are always made to feel welcome. There is a pay phone in the hallway for service users to make personal calls if they wish. Information on local advocacy services is available at the home. The home encourages service user to handle their financial affairs. Where support is required this is provided by the service users family member or their legal adviser. The home provides a set menu for meals. Discussion with the cook confirmed that should a service user refuse a meal than an alternative would be provided. A requirement was made at the last inspection that alternative meals provided at the home must be recorded. This has not been met. The cook has recently been appointed to the position and was not aware of the need to keep this record. This requirement will be carried forward to the next inspection. Part of the breakfast and lunchtime meal was observed. Where service users required assistance with their meal this was provided by staff in a discreet manner. One service user commented that they enjoyed their lunch and said it was “good”. Special dietary requirements to meet service users religious and cultural needs were known to the staff. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The home is making every effort to ensure service users views are listened to and that they are protected and safe. The Quality rating in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Discussion with one relative confirmed they were aware of the homes complaints procedure. This was also reflected in the comment cards we received prior to our site visit. Examination of the complaints logbook showed the home had received no complaints since our last inspection. In discussion with service users it was difficult to evidence whether they had been made aware of the how they could make a complaint. However one service stated they would “tell staff” if they were unhappy. Local procedures for reporting any concerns affecting the welfare of service users are displayed on the notice board together with an abridged version of “No Secrets”. Examination of staff training records showed all but one member of staff has completed abuse awareness training. Private discussion with staff demonstrated an awareness of the local safeguarding adults procedure and what action they would take if they had any concerns regarding the safety of service users. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 26. Improvements made to the overall standard of accommodation ensure service users continue to live in a clean, comfortable and well-maintained environment. The Quality rating in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A tour of the building was made and all service users sleeping accommodation was viewed. The home was clean and tidy and well maintained. There are three separate communal areas, which provides service users with a choice of whether to listen to the television or sit quietly on their own. The accommodation is split over two levels with the majority of service users bedrooms on the first floor. New dining room and bedroom furniture has been purchased since our last site visit improving the standard of accommodation for service users. The majority of service users bedrooms have been personalised to reflect their individual taste. Where space allows and with Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 17 agreement of the home, service users have been able to bring small items of furniture for their rooms. Since the last inspection the home has taken action to reduce the risk to service users with regard to the fire escape staircase on the first floor. This area can now only be accessed by a keypad, which is now linked into the fire alarm system. The laundry area is situated on the ground floor and care staff have responsibility for service users laundry. Infection control guidelines are in place and “red alginate” bags are used to reduce the risk of infection from soiled linen. The home has a commercial washer and dryer, which are sufficient for their needs. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. The home is ensuring staff receive training appropriate for their role but are unable to fully demonstrate service users are protected by their recruitment practices. The Quality rating in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Examination of the rota shows there is two staff on duty at all times throughout the day. There is one waking night staff and one member of staff provides sleep in cover. There has been some improvement to the staffing levels in the morning. The extra hour enables care staff to spend more time supporting service users with their breakfast. One extra member of staff also provides additional support at lunchtime. The home is providing opportunities for staff to complete the National Vocational Qualification (NVQ) in care. Discussion with staff and examination of training records confirmed four members of the care team have completed NVQ level 2. Two members of staff have gone on to complete NVQ Level 3 one of which is currently working towards the registered managers award. The home has also successfully achieved the “Investors in People” award, which demonstrates the company’s commitment to having a trained workforce. Discussion with staff and examination of training records confirmed staff are satisfied with the availability of training being offered. Records examined showed staff have received training in dementia care and the needs of older Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 19 people in addition to the necessary health and safety training. The trainee manager confirmed the “Skills for Care” induction standards had been obtained for new staff commencing work. The recruitment records of three members of staff were examined. The trainee manager stated the majority of staff recruitment records are now held at the company’s main office. However records to demonstrate staff have received a satisfactory Criminal Records Bureau, (CRB) clearance and Protection of Vulnerable Adults (POVA) check were held at the home. While these checks do demonstrate the home is making important recruitment checks it does not fully demonstrate safe recruitment practices are being followed. The trainee manager was advised of the need to ensure recruitment documents are available for inspection. A requirement made at the last inspection relating to safe recruitment practices will be carried forward to our next inspection. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 20 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, 38. Every effort is being made to ensure the home is run in the best interest of service users, though more attention needs to be given to extending the scope of the quality assurance audit. Safe working practices are being followed. The Quality rating in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Mr C Smith is currently the registered manager of the home and was on leave during our site visit. Mr J Smith (trainee manager) is currently completing his Registered Managers Award (RMA). Mr J Smith was available for part of our site visit and stated it is his intention to make an application to become the registered manager of the service. Since our last inspection the company has developed a newsletter, which is a result of the outcomes of the last quality satisfaction survey. The newsletter, Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 21 which was on display in the home, forms part of the action plan from comments received from service users and their relatives. Mr J Smith confirmed that questionnaires are sent out every six months. It is recommended that in addition to seeking the views of service users and their families’ questionnaires should also be sent to relevant stakeholders and to the staff working at the home. The home was holding money on behalf of service users. A random sample of the records relating to the money being held for service users was seen. The records demonstrated service users money was being safely managed. As part of our inspection methodology a pre inspection questionnaire was sent to the home. Evidence provided in this document demonstrated policies relating to safe working practices are available and had been reviewed in the past year. Records demonstrated staff have received training in safe working practices such as infection control first aid and manual handling. Risk assessments have been completed in relation to the service users environment including the absence of radiator covers in some service users bedrooms. It is recommended that where radiator covers are not fitted they are put in place to fully protect service users from the risk associated with hot surfaces. Fourseasons DS0000057308.V304775.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 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 01/02/07 1. OP29 19(1) The registered person must explore any gaps in applicants’ employment history. This was a requirement at the last inspection. The timescale given was 20/10/05. 2. OP29 19(1) The registered person must ensure records relating to safe recruitment practices are available for inspection. 01/02/07 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. Refer to Standard OP9 OP9 Good Practice Recommendations The registered person should review how “as required” medication is recorded. The registered person should ensure eye drops are dated when they are opened. DS0000057308.V304775.R01.S.doc Version 5.2 Page 24 Fourseasons 3. 4. 5. 6. OP12 OP33 OP38 OP15 The registered person should consider employing a designated activities coordinator. The registered person should consider sending out quality satisfaction surveys to relevant stakeholders and staff working at the home. The registered person should consider fitting covers to all radiators. The Registered person should ensure all meals served in the home are recorded. Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Fourseasons DS0000057308.V304775.R01.S.doc Version 5.2 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!