CARE HOMES FOR OLDER PEOPLE
Glenesk Care Home The Cresent, Queen Street Retford Nottingham DN22 7BX Lead Inspector
Lee West Unannounced Inspection 9th January 2006 10:30 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 Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Glenesk Care Home Address The Cresent, Queen Street Retford Nottingham DN22 7BX 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) 01777 702 339 01777 702 339 Mr Mohammed Akbar Mrs Barbara Khan Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: Glenesk care home provides personal care and accommodation for 22 older people. Privately run and managed by two registered managers, the home does not provide nursing care. The home is an extended, adapted house with 18 single and two double bedrooms. There is a well laid out private garden which is accessible for all service users. Glenesk is situated near the centre of Retford, off the main road in a quiet residential area. There is car parking space at the front of the home. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection commenced at 11.45am and was over 4.5hours. Kaneez Akbar, registered manager was on duty and gave valuable assistance during the inspection process. The manager and staff were welcoming and helpful throughout the whole inspection. At the time of inspection there were 20 service users and there had been one death since the last inspection. The method used for inspection was Case Tracking where Service users were spoken with about their experiences and expectations of living at the home, with analysis of the records and talking with members of staff to ensure that those living at the home have their needs met and their health and welfare maintained appropriately, together with a tour of the home and speaking to visitors present. What the service does well: What has improved since the last inspection?
Footrests were being used on wheelchairs, but when not, a risk assessment was in place within the care plans. All the records inspected were up to date, and there was evidence that appropriate risk assessments had been carried out. The staff rota includes the roles of all staff.
Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 6 The home now have resident meetings and a questionnaire was sent out in May and the results were all used to monitor practice. This led a change in the snacks timing for service users. The storage of medication has been risk assessed and the trolley is secured to the wall in the dining room. A copy of the Administration of Medication in Care Homes has been purchased. What they could do better:
During times when the Managers are not present the staffing levels must be reviewed to ensure they meet the needs of the service users, a number of whom require two carers to assist. The Statement of Purpose and Service User Guide are available as a large file. These should be available as leaflet, booklet style for individual service users and potential service users. A pre-admission assessment must be completed prior to any new service user being admitted to the home to ensure that the home are able to meet the needs of the prospective service user, to be followed by a care plan completed immediately on admission and reviewed regularly to monitor any changes in care needs. All care plans to be developed and reviewed with the involvement of the service user and/or relatives, which should be signed by the service user to evidence this has been done. All staff and service user files require photographs. The staff files only contain photocopies of passport or driver’s licence photos at present. Evidence of structured interview questions, answers and scoring are required in staff files. Supervision for all staff, at least six times a year must be organised, together with an induction programme which meets the National training Organisation specification and a written staff training programme be developed, as, apart from the National Vocational Training, evidence of current training was not seen. The First Aid training records seen were out of date and no training was recorded since 2003. A formal quality assurance system must be put into place to undertake an annual audit, following the informal questionnaires distributed in May 05.
Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 7 Medication Administration Records were kept on top of the medicines trolley on arrival, but during the inspection, following discussions, these were re-sited within the trolley and to avoid breaches of confidentiality must be kept within the trolley, or locked away elsewhere when not in use. There were a number of areas requiring maintenance, redecoration or refurbishment seen during the inspection and although it was noted that the person responsible for this was away on holiday, the home would benefit from a structured programme of maintenance and redecoration. The bathroom on the first floor is not in use at present and improvements and adaptations to bring it into use again should be part of this programme. 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. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 8 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 Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 9 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): 1,2,3,4,5,6, Prospective service users and representatives are encouraged to visit the home and statement of purpose and service user guide master copies are within the home. Evidence of pre-admission assessment by the home, signed contracts or discussions with the prospective service user about levels of care was not seen within the records. EVIDENCE: Glenesk does have a statement of purpose and service user guide, but this is not available as individual leaflets for prospective service users. They also have Terms and conditions, but none of the files case tracked had a signed copy of this within the records. Service users spoken with said they did not know there was a contract, or that there should have been an assessment before coming into the home. The home relies on the social services for their information and there was no evidence of any assessment carried out by the home to ensure that the service user’s needs could be met by the home. One service user stated that there was an opportunity to visit the home before being admitted. The care plans seen, although not negotiated, were appropriate and appeared to meet the needs of the service users.
Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 10 One service user who is in the home on an intermediate basis was very satisfied with the level of care and felt there was enough information. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 11 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): 7,8,9,10,11 Most of the service users had individual care plans which meet their needs. All were treated with dignity and respect during the inspection. The medication was administered in accordance with the regulations, however the Medication Administration Records were kept on top of the locked trolley in the dining room. Information regarding death was in the files case tracked, but it was difficult to find, being at the back of the file. EVIDENCE: Not all the records case tracked had an individual care plan and there was no evidence within them that the service user had been involved in negotiating the plans seen. Those, which did have care plans, were seen to be addressing the needs of the service users. Service users spoken with said they were satisfied with the level of care being given and that they were always treated with respect and dignity. They said the staff, although not enough around sometimes, always tried their best to meet their needs. This was also observed during the inspection, especially during the two meals, which were eaten during that time. The medicines are kept in a locked trolley within the dining room, this is secured to the wall and the controlled drugs are appropriately stored.
Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 12 The medication was administered during the inspection and this was seen to meet the regulations. However it was noted that the individual Medicines Administration Records and the controlled drugs administration records were kept on top of the cabinet, contrary to data protection and confidentiality requirements. During the inspection this was dealt with by finding a suitable area for these documents to be permanently kept. The case notes tracked within the inspection did contain information about religion and death, but this was at the back of the files and difficult to find. This would be much easier to find if it was addressed within the admission assessment, which should be carried out before the service user is admitted to the home, to form the basis of the care plans. Service users spoken with said they had not been involved with an assessment. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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, The home provides an appealing diet with home cooked cakes and buns as well. The dining room is pleasantly decorated and meals are at times which suit the service users. The service users do exercise choice and are encouraged to maintain family and community links. There has been a lack of activities within the home to meet recreational needs, but this was seen to be changing during the inspection. EVIDENCE: Service users said that there was a lack of activities within the home. Some said that they used to get newspapers but these have stopped. However, a daily paper was seen by the inspector, in one service user’s room. The service user confirmed that one is provided every day. Kaneez, Manager, has access to a people carrier vehicle and does sometimes take service users, who wish to, out into the community. The service users confirmed this did happen and that they had some entertainment around Christmas which “cheered things up a bit.” All service users spoken with confirmed that their visitors were always made welcome and felt comfortable when visiting the home. Everyone spoken with said they were happy with the control they had and could “come and go as I please.” This was observed during the inspection as service users were seen to be encouraged to make decisions and choices.
Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 14 The food prepared for the two meals – lunch and tea – was appetising, of substantial portions and all were given choices. The staff also gave service users who wanted it, a glass of sherry as an aperitif. The afternoon tea was an assortment of dishes, from fried sausages and egg, to sandwiches. The service users all praised the food within the home. The home also provide a variety of home baked cakes, buns and pies and during the tea a large sponge cake was enjoyed by the service users. They also said that the staff make them birthday cakes and other treats. The times of the snacks had been changed to conform with the wishes of the service users, who had asked that morning snacks be changed and snacks later during the day increased. The staff had listened to the service users and carried this out. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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 Complaints procedure is in place in the home and staff are aware of the Protection of Vulnerable Adults. EVIDENCE: Service users and staff spoken with all said they were aware of the complaints procedure, of who would be the best person to take a complaint to. The procedure was seen displayed in the entrance to the home. No complaints were seen during this inspection. The staff said that they had not done formal Protection of Vulnerable Adults training, but that they had covered abuse within their National Vocational Qualification training, which they had just completed. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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): 19,20,21,22,23,24,25,26 The home was clean, pleasant and hygienic and there is access to all areas for the service users. There is specialist equipment available and used and service users own rooms are individualised, comfortable and have their own possessions around them. One bathroom on the first floor is not suitable for use of many of the service users, but bathing and showering facilities are available on the ground floor. The home has a number of maintenance issues to address and areas requiring some redecoration and repair. EVIDENCE: The maintenance requirements within the home require addressing, however, the maintenance man is at present on holiday. There is tiling to be replaced behind a new toilet cistern, areas around the home requiring routine maintenance, cupboards in the kitchen requiring attention. During the inspection the heating systems were being thoroughly overhauled by an approved gasfitter. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 17 The home does have a “cosy” feeling according to the service users and all spoken with were really happy with their rooms. Those inspected were clean, warm, well furnished and had their personal possessions around them. The home does have a bathroom on the first floor which has a bath fixed to a wall on one side. This makes it difficult to use any lifting aids within the room and the room itself is quite small. This bathroom is therefore not used and staff and service users prefer to use the bigger bathroom and shower on the ground floor. To ensure enough facilities for the number of service users this bathroom requires some improvements. Lack of storage space continues to be a problem within the home, but wheelchairs during this inspection, were appropriately stored. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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 recruitment practices protect the service users and staff are competent, but more training is required to maintain competence. The staffing numbers are adequate when a manager is on duty, but fall below levels appropriate to meet the needs of service users at other times. EVIDENCE: Staff files inspected showed evidence of two references and Criminal Records Bureau checks being obtained. They contained application forms, but no written interview questions and outcomes were seen. The staff training records were not up to date and the staff said they had just completed the National Vocational Qualification at Level 2. The first aid certificates seen in the files were out of date and the most recent training recorded was in 2003. There was evidence of an induction process, signed by the carer, however, this does not comply with the National Training Organisation specifications. The duty rota seen identifies the role of each staff member, especially during the time that a carer is working in the kitchen, when the kitchen staff have gone home. During the time the kitchen staff, and manager, are not on duty, this leaves the service users vulnerable. When one carer is working in the kitchen preparing the meals, this leaves insufficient carers with all the service users. At the time of inspection there were five service users who required assistance from two care staff. The staffing levels must meet the needs of the service users and additional staff to be on duty during peak times of activity
Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 19 during the day in accordance with the guidance recommended by the Department of Health. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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): 31,32,33,36,37,38 Both the managers, who job-share, are registered with the Commission try to run the home in the best interests of the service users, to protect their rights and safeguard their welfare. There are, however, areas that require changes to support this ethos and the management systems require development to meet the National Minimum standards and legislation. EVIDENCE: Only one of the managers has experience of care and the other “deals mainly with the paperwork” as a “qualified accountant”. There was no evidence seen during the inspection of either Manager receiving any training in Management, NVQ4 or equivalent or of updating of skills and competence. Staff and service users all confirmed that the Managers ensure that their approach creates an open and positive atmosphere and hold service user
Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 21 meetings which help affect the way in which the service is delivered. A questionnaire had been distributed and answered by service users, but a more structured continuous, self-monitoring method of quality assurance involving service users, together with an internal annual audit, would improve the home’s effectiveness of being run in the best interests of the service users. Staff records did not show any evidence of regular staff supervision and formal supervision must be implemented and take place at least six times during the year, which would then influence the annual appraisals which are being carried out. All the records seen during the inspection were accurate and up to date and kept locked in the filing cabinet in the dining room, or in the upper office. None of the staff files case tracked had a photograph, only having photocopies of passport photographs. Service user files case tracked also had files with no photographs, although some were seen in other files. The home has policies and procedures in place to ensure the health, safety and welfare of the service users, and carries out all the mandatory safety checks. Service users confirmed that regular fire alarm testing takes place. However, the staff files case tracked contained out of date first aid certificates. As the number of care staff on duty during each shift is only two, there is no cover for staff to take any official breaks and they confirmed that they only have “quick breaks” during the shifts when the managers are not there to cover and don’t have official breaks at weekends when only two staff are on duty. This practice has a detrimental effect on staff and service users, which could leave service users at risk. Service users said that “sometimes it takes a long time for someone to come”, but “usually they come when you ask” they also said they felt the staff are “overstretched sometimes”, due to there now being five of the service users, at present, who require a higher amount of care from either one or two carers. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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 2 2 2 2 2 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 2 2 Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 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. 1 Standard OP1 Regulation 4(2) Requirement Timescale for action 28/02/06 2 OP1 5(2) 3 OP7 15(1) 4 OP12 16(2)n The registered person shall supply a copy of the statement of purpose to the Commission and shall make a copy of it available on request for inspection by every service user and any representative of a service user The registered person shall 28/02/06 supply a copy of the service user’s guide to the Commission and each service user. The registered person shall, after 28/02/06 consultation with the service user, or a representative, prepare a written plan as to how the service user’s needs in respect of health and welfare are to be met, make the plan available to the service user and after consultation with the service user revise the service user’s plan and notify the service user of any such revision Consult service users about the 28/02/06 programme of activities arranged by or on behalf of the care home and provide facilities for recreation including, having
DS0000008681.V276993.R01.S.doc Version 5.1 Glenesk Care Home Page 24 5 OP18 13(6) 6 OP21 23(2) 7 OP27 18(1) 8 9 OP30 OP31 18(1)C(i) 10(3) regard to the needs of service users, activities in relation to recreation, fitness and training. Make arrangements, by training staff in the Nottinghamshire Protection of Vulnerable Adults procedures. to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse, Ensure appropriate numbers of baths and showers to meet the needs of the service users. There is a ratio of 1 assisted bath to 8 service users. Ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users Ensure staff receive training appropriate to the work they are to perform The Registered Managers shall undertake from time to time such training as is appropriate to ensure they have the experience and skills necessary for managing the care home 28/02/06 31/03/06 23/01/06 28/02/06 28/02/06 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 OP2 OP3 Good Practice Recommendations Each service user to have contract between the home and service user completed and signed and kept in their records The registered person shall not provide accommodation to a service user at the care home unless the needs of the
DS0000008681.V276993.R01.S.doc Version 5.1 Page 25 Glenesk Care Home 3 OP19 4 OP30 5 OP36 service user have been assessed and a written plan prepared as to how the service user’s needs in respect of his health and welfare are to be met and that at all times suitably competent persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Ensure the home is in a good state of repair. Tiling behind the newly installed toilet cistern to be replaced, cupboards in the kitchen require attention to chipped edges. Routine maintenance to be programmed and carried out. Develop and implement a structured programme of training for staff, to include updating of First Aid and Moving and Handling and protection of vulnerable adults with other training appropriate to the work being performed Ensure that care staff receive formal supervision at least 6 times a year and that this supervision covers all aspects of practice, philosophy of care in the home and career development needs. Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Glenesk Care Home DS0000008681.V276993.R01.S.doc Version 5.1 Page 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!
