Inspection on 12/09/06 for Glenavon House

This inspection was carried out on 12th September 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 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

Glenavon House 21/06/07

Glenavon House 18/11/05

Glenavon House 23/05/05

Glenavon House 05/10/04

Glenavon House 29/04/04

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

CARE HOMES FOR OLDER PEOPLE Glenavon House 22 St John`s Road Clifton Bristol BS8 2EZ Lead Inspector Vanessa Carter Key Unannounced Inspection 12th September 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glenavon House DS0000020349.V296599.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. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenavon House Address 22 St John`s Road Clifton Bristol BS8 2EZ 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) 0117 9734232 0117 9734232 rogermcater@compuserve.com GemleighLimited Mrs Denise Worgan Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 29 Persons aged 65 years and over receiving nursing care Of these 29 persons, 5 may be aged between 50 - 65 years with Physical Disabilities Manager must be RN1 or RNA on the NMC Register Staffing notice dated 03/11/1998 applies. Date of last inspection 18th November 2005 Brief Description of the Service: Glenavon is registered as a care home for service users who require nursing and personal care. It is registered to accommodate 34 people, male or female, of which up to five may be between the ages of 50-65years. Since the last inspection some of the double rooms are only being used for single occupancy, therefore the home does not cater for the full 34 service users. The home is situated in the Clifton area of Bristol. It is sited in close proximity to local shops and amenities and also near to Clifton Railway Station. The home is a detached period property, and accommodation is provided over three floors with lift access to all rooms. The communal space includes a lounge, dining room and conservatory. The gardens to the rear are secluded and well tended. The area is accessible to those in a wheelchair. The home is privately owned and operated by Gemleigh Ltd, and Mr and Mrs Cater are the proprietors. The current manager, Mrs Denise Worgan, has been in post for approximately 3½ years - she is assisted to meet the needs of the residents by a team of registered nurses, care assistants and ancillary staff. The cost of placement at the home is between £456.00 to 600.00 and is dependent upon assessed need. Additional costs are made for a range of services and these are listed in the homes brochure. Prospective residents are able to find out about the home by requesting a copy of this from the Home Manager. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over 5.5 hours and was completed in one day. The manager was present for the majority of the inspection and participated in the process, as did the registered nurse who was in charge at the start of the visit. Evidence was gained from a whole range of different sources, including: • Information provided by the manager in the pre-inspection questionnaire • Information taken from resident survey forms • Directly speaking with residents • Case tracking a number of residents • Speaking with care staff • A tour of the home • Examination of some of the homes records • Observation of staff practices and interaction with the residents. The overall analysis is that the home is a good place in which to live and to work. What the service does well: The admission process is well managed, and new residents and their families are given clear information regarding the service. The homes care planning processes and medication procedures mean that residents can be assured their personal and healthcare needs will be appropriately met. Residents are provided with nice meals and have the opportunity to participate in a variety of activities, and to choose how they spend their time. Residents can be assured that any complaints will be listened to and acted upon, and that they will be cared for by staff who will safeguard and protect them. Residents live in a comfortable and homely environment that is well maintained and is equipped to meet their needs. Residents are cared for by staff who are skilled and competent to do their jobs, and can be assured that their needs will be met. Residents live in a home that is well managed and run in their best interests. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Glenavon House DS0000020349.V296599.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 Glenavon House DS0000020349.V296599.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): 1, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process is well-managed and new residents and their families are given clear information regarding the service. EVIDENCE: The statement of Purpose has been updated to reflect the changes in the number of places available at the home and also of staff changes. All other information remains unchanged and the document meets the national minimum standards. Residents confirmed in the CSCI survey forms that they had received information about the home prior to moving to live in the home. The home has good pre-admission assessment processes and no one is admitted to the home without having first being visited by the Home Manager. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 9 The home uses a comprehensive assessment tool to record the specific needs of any prospective resident, and this will form the basis of ongoing care planning. The assessment of the most recently admitted person was viewed and had been completed prior to the date of admission. In addition the home will expect to be provided with community care assessments and health needs assessments where these have been prepared. The home provides placement for older people with nursing care needs. Of the 29 beds available it is able to accommodate up to five people who are aged between 50 and 65 years of age, and who have physical disabilities. The homes does not offer placement to people with a dementia illness although will continue to look after residents who are already placed at the home, who develop the disease, for as long as they are able to meet their care needs. The majority of residents are admitted to the home following a hospital admission. The most recently admitted person had previously had a respite stay at the home, and therefore when was admitted on a long-term basis was already familiar with the home. Relatives would always be encouraged to view the home, and if possible, the prospective resident themselves. Glenavon House DS0000020349.V296599.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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes care planning processes and medication procedures mean that residents can be assured their personal and healthcare needs will be appropriately met. EVIDENCE: The care planning documentation for three residents were examined, including that of the new resident. The plans each contained a full assessment of the residents needs and instructions for the staff in how these identified needs should be met. The home manager generally completes all the care plans. The plans were supported with risk assessments around manual handling, pressure sore development and nutrition needs. The plans were person centred and evidence that the home views each person as an individual. Some minor additions were necessary with two of the plans and these were actioned during the course of the inspection. The care plans are reviewed on a monthly basis and a daily record is made of significant events. The home record when any other healthcare professionals are involved in the care of a resident. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 11 One family stated in a CSCI comment card that “the transformation in their relatives health since moving to the home was a delight to see”. They added that their relative was happy, cheerful, well cared for and liked by the staff. Observations of interaction between the staff and this resident evidenced that the home thinks highly of them. Another relative said that they were very satisfied with the overall care provided by the home. A record of contact with other healthcare professionals including the GP is maintained. A domiciliary optician is due to visit the home and will be seeing those residents who have requested a visit. The home has well managed systems in place for the ordering, receipt, storage and disposal of medications. Where oxygen cylinders are stored and in use, official signage is in place. Residents spoken with during the inspection confirmed that they were well looked after. Observations of the interaction between staff and residents evidenced that the residents are well thought of and treated well. The manager explained that she has had to use disciplinary procedures to manage times when staff attitudes have affected the resident’s wellbeing. The home will continue to look after residents when they are dying. They have received many compliments from grateful families. Members of staff will attend the funeral to pay their final respects. The home has good links with local hospice and the manager would arrange appropriate “refresher” training with the hospice home care nurses, if there was specific needs that the resident had, for example syringe drivers to administer pain control. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with nice meals and have the opportunity to participate in a variety of activities, and to choose how they spend their time. EVIDENCE: Activities are arranged on two afternoons a week and residents have the opportunity to observe or participate in, bingo, exercise games, arts and crafts sessions and music. Some residents choose to remain in their own rooms. The local authority fund two younger residents to have a 1:1 support worker, and this enables them to pursue activities independently from the home. The manager explained that subject to staff availability, trips will be made out to the shops or the garden centre, in small groups of two or three. During the inspection a carer accompanied one resident out into the garden for a walk and some “fresh air”. One carer said they like to take a resident down the road for a coffee. The home has an open visiting policy but the manager explained that the residents do not receive many visitors. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 13 The midday meal served on the day of inspection was a choice of poached fish with grilled tomatoes and sauté potatoes or a mixed grill, followed by apple pie and custard or stewed apple. The food was well presented and looked appetising. The home has a four-week menu plan and a wide range of meals is provided. One resident said she looked forward to having the occasional curry. The meal for the day is displayed on the chalkboard in the main hallway. Observations were made during the midday meal. A number of residents needed assistance with feeding and this was undertaken in an unhurried and sensitive manner. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that any complaints will be listened to and acted upon, and that they will be cared for by staff who will safeguard and protect them. EVIDENCE: The homes complaints procedure is included in the Statement of Purpose and is displayed in the entrance to the home. Residents commented in the CSCI survey forms that they knew how to raise concerns and who to speak to. One relative commented on a CSCI comment card that they had had reason to complain about something and “the matter was handled professionally”. Observations of interaction between the home manager, staff and the residents evidenced that residents have an easy and friendly manner with each other. The home has already demonstrated they have the resident’s best interests at heart and will take appropriate measures to safeguard the residents from any harm. The home followed agreed protocol (protection of vulnerable adult (POVA) procedures) and informed the local authority, where there were concerns regarding the care of one resident. Staff spoken to during the inspection, were aware of their responsibilities to report bad practice and to safeguard residents. Some of the team have had POVA training this year and a further training session is planned. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and homely environment that is well maintained and is equipped to meet their needs. EVIDENCE: The home is an elegant Victorian property, located in the heart of Clifton, Bristol, close to both shops and local amenities. It is a detached property, and although there are a number of steep steps up to the main front door, there are ramped accesses to both sides of the home. An internal lift ensures that the home is fully accessible to residents with impaired mobility. The living accommodation is arranged over three floors. In addition the basement area accommodates the laundry, kitchens and staff rooms. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 16 Since the last inspection the home has reduced the numbers of beds and now offers placement for 29 persons. The home has reduced the number of shared rooms. There are 22 bedrooms - seven shared rooms and 15 single. The reduction in the numbers of residents gives the home a better feeling of space. Communal space consists of a lounge area, dining room and large conservatory. The dining room has been decorated since the last inspection. A number of the residents choose to remain in their own rooms throughout the day, and have TV’s, telephones and radio’s they are able to use. All of the bedrooms bar one were seen during a tour of the home. They were appropriately furnished, and reflected the residents’ personality, by the possessions they have in their rooms. Some of the rooms looked freshly decorated. One family stated in the CSCI comment card that their relative had a bedroom chair that was unsuitable and difficult to keep clean, and the manager explained this was to be replaced. The home has an ongoing programme of decoration and all areas of the home looked fresh and light. Carpets have been replaced in some rooms. Some of the paintwork needs attention but the work is already scheduled to be done. The home is clean and tidy throughout, and was free from any offensive odours. Residents who completed CSCI survey forms said that the home was always fresh and clean. There are a number of toilets located throughout the home, five bathrooms and a shower room. This is sufficient to meet the needs of the residents. Additional commodes have been purchased and these will be added to until each resident has their own commode. The home has sufficient moving and handling equipment to meet the needs of the resident. This will ensure that staff are able to move the residents safely. The home has four hoists, one stand-aid, and range of different types of slings and sliding sheets. The homes programme of installing radiators with low temperature surfaces has been completed. All fire doors are fitted with magnetic devices that will release the doors in the event of the fire alarm system being activated. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by staff who are skilled and competent to do their jobs, and can be assured that their needs will be met. EVIDENCE: The staffing rota’s evidence that each morning there are five care staff plus one registered nurse and in the afternoon/evening, four care staff and one registered nurse. Overnight there is one nurse and two care staff. This is appropriate to the numbers and dependency levels of the residents. The home also employs domestic, catering and laundry staff, and an activities organiser. The home currently has a number of staff vacancies and the owner is looking in to the process of recruiting European care workers through an agency. Ten of the 18 care staff have already achieved an NVQ Level 2 qualification in care (55 ), with two of the staff also having a level 3. This means that residents will be cared for by staff who are competent and able to meet their needs. One new member of staff stated that they would be doing NVQ 2 in the future. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 18 The home has robust recruitment procedures in place to ensure that the right people are employed at the home. New staff will have had to complete an application form and attend for an interview with the home manager. Two satisfactory written references, POVAfirst clearance and CRB disclosures will be obtained for all new recruits. Examination of the personnel files of four staff members, and discussion with a newly appointed care assistant confirmed these procedures. New staff will complete an induction training programme when their employment starts and this will ensure that they are familiar with the homes policies and procedures and are competent in meeting the resident’s needs. One staff member spoken to during the inspection visit was currently working through the programme and said they felt supported by the staff team in settling in at the home. The home has an annual training plan that for this year has include all mandatory training courses and a range of relevant topics. Examples include protection of vulnerable people from abuse, infection control, feeding and swallowing difficulties, and fire prevention. A record of all training attended is kept for each staff member. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well managed and run in their best interests. EVIDENCE: The home has a competent manager who has been at Glenavon for several years, having previously been a home manager in other local nursing homes. The manager is a trained nurse and has also completed relevant management training. The home has made significant improvements in meeting the requirements of the Care Standards Act and the national minimum standards. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 20 Most noticeably has been the overall appearance of the home, the amount of moving and handling equipment, and the training opportunities for the staff. Residents will therefore live in a home that is comfortable and safe and, competent staff will care for them. The manager has a very “hands-on” management style and at all times, ensures that the residents remain at the heart of any decision-making. Staff said that the manager was very approachable, and that they felt able to make suggestions and discuss issues with her. Staff meetings and residents meetings are held every other month, and notes are made of the meetings. Notes of the residents meetings are displayed in the hallway. Any relatives are welcome to attend the residents meeting, but do not tend to. The manager will ensure she has a conversation with any relatives when they visit. The manager completes a number of audits on a monthly basis to monitor standards of service delivery in the home. The home manager completed a full quality assurance audit in January 2006, measuring the service against the national minimum standards. From this the proprietors and home manager developed an improvement plan and have completed the majority of their monthly targets. A “Directors” meeting is held on a monthly basis to look at overall performance of the home. The plan is based upon feedback from residents, CSCI inspections and City Council “contract compliance visits”. This ensures that the service remains appropriate to the residents needs. The home looks after personal monies for most of the residents, and maintains hand written records of all transactions in and out of the accounts. Those checked were correct. The homes records that were examined were all well maintained and kept secure. The home is well maintained throughout and no health & safety issues were identified during the course of the inspection. The fire log evidenced that all necessary weekly, monthly and quarterly checks are undertaken. The hot and cold water temperatures are monitored. All fire doors are kept open with magnetic door devices which are disarmed should the fire alarm system be activated. This evidences that the home takes their responsibility for the health and safety of the residents seriously. Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Refer to Standard Good Practice Recommendations Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Glenavon House DS0000020349.V296599.R01.S.doc Version 5.2 Page 24 - 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!